Intraoperative Complication Rate Research Articles

Outcomes and complications of cataract surgery using phacoemulsification in eyes with and without pseudo exfoliation syndrome

Cataract remains a significant cause of visual impairment globally, with pseudo exfoliation syndrome (PEX) posing additional challenges for cataract surgery. This study aimed to compare outcomes and complications in patients with and without PEX undergoing phacoemulsification for senile cataract. A total of 70 patients were divided into two groups: PEX (Group 1) and non-PEX (Group 2). Surgical procedures were performed, and outcomes were evaluated. Group 1 exhibited smaller pupil diameter and higher rates of advanced cataracts and intraoperative complications. Despite similar postoperative parameters, Group 1 showed increased inflammatory response and poorer initial visual recovery. Tailored management strategies for PEX patients undergoing cataract surgery are warranted.

Open versus robotic transversus abdominis release for ventral hernia repair: an updated systematic review, meta-analysis, and meta-regression.

Posterior component separation using transversus abdominis release (TAR) is well established as an option for repair of large hernia defects. TAR can be performed robotically (rTAR) or open (oTAR) with limited data to demonstrate benefit and guide decision making. We conducted a systematic review and meta-analysis comparing rTAR and oTAR approaches for ventral hernia repair (VHR). We searched Pubmed, Embase, Cochrane, and Web of Science for studies comparing rTAR and oTAR for VHR. Hybrid rTAR was not included in our analysis. Our primary outcomes were overall postoperative and intraoperative complications, surgical site occurrences (SSO), SSO requiring surgical intervention (SSOPI), surgical site infection (SSI) superficial or deep, and fascial closure. Additional outcomes were operative time (OT), readmission, length of hospital stay (LOS). We performed sensitivity analysis to explore reasons for heterogeneity and outliers, and a proportional meta-analysis of conversion during rTAR. We performed a meta-regression exploring the relationship of BMI, hernia defect and mesh width rTAR/oTAR with the analyzed outcome within each study. 503 studies were screened and seven studies were included in this analysis. Our sample totaled 780 patients, of which 298 (38.2%) underwent rTAR. Defect width ranged between 8.7 to 13.5cm (cm) for rTAR and 10 to 13.5cm for oTAR. Mean mesh area ranged from 66.9 to 980cm2 and from 51.3 to 1344cm2 for rTAR and oTAR respectively. We found lower overall complications (9% versus 24.6%; RR 0.43; 95% CI 0.26 to 0.73; P < 0.01) and intraoperative complication (5.9% versus 9.1%; RR 0.44; 95% CI 0.22 to 0.88; P = 0.02) rates for the rTAR group. There was no difference in fascial closure between the groups (99% versus 94.6%; RR 1.05; 95% CI 0.99 to 1.11; P = 0.11). rTAR presented lower SSI rates (2.5% versus 7.8%; RR 0.33; 95% CI 0.13 to 0.8; P = 0.01). No differences were found in SSO (16.3% versus 13.7%; RR 0.87; 95% CI 0.51 to 1.48; P = 0.6) or SSOPI (5.4% versus 8.9%%; RR 0.5; 95% CI 0.22 to 1.15; P = 0.1) rates. No statistically significant differences were found in superficial SSI (0.76% versus 3%; RR 0.36; 95% CI 0.07 to 1.75; P = 0.21) and deep SSI (0% versus 4.2%; RR 0.23; 95% CI 0.02 to 3.12; P = 0.27). Open surgery presented a lower OT (MD -67.7min; P < 0.001), but robotic surgery showed a reduced LOS (-3.9days; 95% CI -4.8 to -3.1; P < 0.001). No differences were found in readmission and 1year recurrence rates. The proportional meta-analysis showed a conversion to open rate of 6.4 per 100 patients (95% CI 3.3 to 12 patients) during rTAR. Meta-regression presented no statistically significant influences of rTAR/oTAR mesh width and defect width relations and BMI, despite the analysis was limited by the low number of studies. Robotic TAR may be associated with lower intraoperative and postoperative complications, lower SSI, shorter LOS, and longer operative times when compared to oTAR. Given the limitations of the included studies, randomized trials are needed to better evaluate the impact of the robotic-assisted surgery for complex abdominal wall reconstruction. CRD42024540991.

The Effect of After-Hours Resection on the Outcomes in Patients with High-Grade Gliomas.

The "weekend effect" is the finding that patients presenting for medical care outside of regular working hours tend to have worse outcomes. There is a paucity of literature in the neuro-oncology space exploring this effect. We investigated the extent of resection and complication rates in patients undergoing after-hours high-grade glioma resection. A retrospective review was conducted on patients with high-grade glioma requiring emergent surgery between January 1, 2021, and March 31, 2023. After hours was defined as surgical resection on the weekend and/or evening (>50% of surgical time between 1630 and 0659). These patients were matched to patients undergoing resection during regular working hours. Groups were compared on the basis of the extent of resection, postoperative complications and 6-month mortality rate. A total of 38 patients were included in this study (19 after hours, 19 regular hours). There was no significant difference in age, sex, tumor grade and tumor size between the two groups (all p > 0.05). There was no significant difference in the extent of resection between the groups (p = 0.7442). There was no significant difference in the rate of intraoperative complications, postoperative complications, reoperation and death at 6 months between the groups (all p > 0.05). Estimated blood loss was significantly higher in the regular hours group (p = 0.0278). There was no significant difference in the total operative time (p = 0.0643) and length of stay (p = 0.0601). After-hours high-grade glioma surgery has similar outcomes to regular-hours surgery for lesions not requiring specialized functional mapping.

Is Endoscopic Surgery a Safe and Effective Treatment for Lumbar Disc Herniation? A Meta-Analysis of Randomized Controlled Trials.

Systematic Review. This meta-analysis systematically evaluates the safety and effectiveness of endoscopic techniques in the treatment of lumbar disc herniation (LDH). A comprehensive computerized search was conducted on PubMed, Embase, Cochrane Library, China National Biomedical Literature Database (CBM), VIP Database, China National Knowledge Infrastructure (CNKI) and Wanfang Database. Randomized controlled trials (RCTs) comparing endoscopic techniques with non-endoscopic techniques for the treatment of LDH were identified. Meta-analysis was performed using RevMan 5.4 software. Seventeen RCTs involving 1748 LDH patients were analyzed. The meta-analysis revealed that, compared to the non-endoscopic discectomy (NED) group, the endoscopic discectomy (ED) group exhibited significantly lower intraoperative blood loss [MD = -74.45mL, 95% CI (-124.88, -24.02), P = .004], shorter hospitalization duration [MD = -4.07days, 95% CI (-6.67, -1.48), P = .002], lower Visual Analogue Scale (VAS) pain scores at the last follow-up [MD = -.35, 95% CI (-.63, -.07), P = .01], and a lower incidence of complications [RR = .35, 95% CI (.25, .48), P < .00001]. Moreover, the ED group exhibited a higher ratio of excellent and good therapeutic effects postoperatively [RR = 1.05, 95% CI (1.01, 1.10), P = .01]. However, there were no statistically significant differences between the 2 groups in terms of the Oswestry Disability Index (ODI) scores at the last follow-up [SMD = -.49, 95% CI (-1.14, .17), P = .14] and operation time [MD = -10.17min, 95% CI (-27.05, 6.71), P = .24]. Endoscopic techniques in the treatment of LDH exhibit significant superiority in intraoperative blood loss, hospitalization duration, postoperative pain, complication rates, and postoperative therapeutic effects. This provides patients with a safer and more effective treatment option.

Dupuytren’s contracture: is a history of percutaneous needle fasciotomy a risk factor for postoperative complications after secondary open fasciectomy? A retrospective study of 62 hands

IntroductionDupuytren’s disease is a benign disorder leading to flexion contracture of the fingers and functional disability. Many treatments have been described. Open fasciectomy is the gold standard; however percutaneous needle fasciotomy (PNF) is a reliable option for uncomplicated primary contracture but it has a high rate of recurrence. HypothesisA history of PNF treatment before open fasciectomy is a risk factor for postoperative complications. Material and methodsA retrospective single-center study was conducted involving 56 patients (62 hands) who were operated for Dupuytren’s contracture by open fasciectomy between November 2016 and November 2020. We compared the outcomes of patients with history of prior PNF on the same finger (group A) to patients without history of PNF (group B). There was no significant difference between the two groups in the severity, comorbidities or preoperative finger mobility. The primary outcome was the complication rate during surgery or during the follow-up period (mean follow-up of 2 years). ResultsThe intra- and postoperative complication rate was 26% (n = 9) in group A (history of PNF) versus 9% (n = 4) in group B (no PNF) (p = 0.0482), corresponding to a relative risk for complications of 2.8 (95% CI: 1.2-6.4) in case of previous PNF. Tourniquet time per operated ray was higher in group A than in group B (34.1 min versus 24.9 min, p = 0001). DiscussionA history of PNF for Dupuytren’s disease can lead to a higher rate of major intraoperative or postoperative complications when open fasciectomy is performed compared to open fasciectomy as a first-line therapy. Level of evidenceIII; retrospective comparative study.

Surgical and Oncological Outcomes of Level III-IV Versus Level I-II Inferior Vena Cava Thrombectomy: A Decennial Experience of a High-Volume European Referral Center.

In patients with renal cell carcinoma (RCC) the role of the extent of tumor thrombus into the inferior vena cava (IVC) has never been addressed from a surgical and oncologic standpoint. This study aims to evaluate differences between level III-IV versus level I-II patients concerning peri- and postoperative morbidity, additional treatments and long-term oncological outcomes. Overall, 40 patients with RCC underwent radical nephrectomy (RN) with IVC thrombectomy at a single European institution between 2010 and 2023. Complications were reported according to the European Union (EAU) guidelines recommendations. Spider chart served as graphical depiction of surgical and oncologic outcomes. Overall, 22 (55%) and 18 (45%) patients harbored level III-IV and I-II IVC thrombus. Level III-IV patients experienced significantly higher rates of intraoperative transfusions (68 vs 39%), but not significantly higher rates of intraoperative complications (32% vs 28%). Level III-IV patients had significantly higher rates of postoperative transfusions (82% vs 33%) and Clavien Dindo ≥3 complications (41% vs 15%). In level III-IV versus level I-II patients, median follow up was 482 and 1070 days, the rate of distant recurrence was 59% and 50%, the rate of systemic progression was 27% and 13%, and the rate of additional treatment/s was 64% and 61%, respectively (all p values > 0.05). Overall survival was 36% in level III-IV patients and 67% in level I-II (p = 0.001). Our findings suggest that patients with level III-IV RCC who are candidates for IVC thrombectomy should be counselled about the higher likelihood of postoperative severe adverse events and worse overall survival relative to level I-II counterparts.

Virtual reality simulation and real-life training programs for cataract surgery: a scoping review of the literature

BackgroundCataract surgery requires a high level of dexterity and experience to avoid serious intra- and post-operative complications. Proper surgical training and evaluation during the learning phase are crucial to promote safety in the operating room (OR). This scoping review aims to report cataract surgery training efficacy for patient safety and trainee satisfaction in the OR when using virtual reality simulators (EyeSi [Haag-Streit, Heidelberg, Germany] or HelpMeSee [HelpMeSee foundation, Jersey city, New Jersey, United States]) or supervised surgical training on actual patients programs in residents.MethodsAn online article search in the PubMed database was performed to identify studies proposing OR performance assessment after virtual-reality simulation (EyeSi or HelpMeSee) or supervised surgical training on actual patients programs. Outcome assessment was primarily based on patient safety (i.e., intra- and post- operative complications, OR performance, operating time) and secondarily based on trainee satisfaction (i.e., subjective assessment).ResultsWe reviewed 18 articles, involving 1515 participants. There were 13 using the EyeSi simulator, with 10 studies conducted in high-income countries (59%). One study used the HelpMeSee simulator and was conducted in India. The four remaining studies reported supervised surgical training on actual patients, mostly conducted in low- middle- income countries. Training programs greatly differed between studies and the level of certainty was considered low. Only four studies were randomized clinical trials. There were 17 studies (94%) proposing patient safety assessments, mainly through intraoperative complication reports (67%). Significant safety improvements were found in 80% of comparative virtual reality simulation studies. All three supervised surgery studies were observational and reported a high amount of cataract surgeries performed by trainees. However, intraoperative complication rates appeared to be higher than in virtual reality simulation studies. Trainee satisfaction was rarely assessed (17%) and did not correlate with training outcomes.ConclusionsPatient safety assessment in the OR remains a major concern when evaluating the efficacy of a training program. Virtual reality simulation appears to lead to safer outcomes compared to that of supervised surgical training on actual patients alone, which encourages its use prior to performing real cases. However, actual training programs need to be more consistent, while maintaining a balance between financial, cultural, geographical, and accessibility factors.

Iris Fixation for Intraocular Lens Dislocation: Relocation with Iris Suture Versus Exchange to Sutureless Iris Claw IOL.

Background/Objectives: To compare the clinical outcome of suture and sutureless iris fixation techniques for dislocated intraocular lenses (IOLs). Methods: Retrospective cohort study including patients who underwent surgery for late IOL dislocation over a 10-year period. IOL repositioning was achieved either by suturing the original IOL to the iris using the Siepser slipknot technique or by replacing it with a retropupillary sutureless iris claw IOL. Data collected during surgery included the type of dislocation, the need for anterior or posterior vitrectomy, duration of surgery, and intraoperative complications. Six months after surgery we assessed the eye and iris anatomy; refraction, astigmatism, and visual acuity; endothelial cell damage; and rate of postoperative complications. Results: Included in the study were 60 patients: 32 underwent IOL relocation and 28 underwent IOL exchange. Pseudoexfoliation (43.7% and 39.3%) and retinal surgery (34.4% and 28.6%) were identified as the main possible causes for IOL dislocation. The mean duration of the surgery was 62.9 ± 14.9 min for the Relocation group, and was 42.7 ± 11.4 min for the Exchange group (p < 0.001), with similar low intraoperative complication rates (6.25% and 7.14%, respectively). The studied parameters showed no differences between the two groups postoperatively, except for corneal astigmatism which was 1.31 ± 0.45 D in the Relocation group and was 1.89 ± 0.86 D in the Exchange group (p < 0.001). Conclusions: Both suture and sutureless iris fixation techniques for dislocated IOLs yielded similarly favorable outcomes in this study. IOL relocation resulted in less postoperative astigmatism, while IOL exchange offered the advantage of shorter surgical time.

Robotic Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy (SADI-S) for Morbid Obesity: A Systematic Review.

The global obesity epidemic has seen a dramatic increase in prevalence since 1975, posing significant health and economic challenges worldwide. Robotic-assisted single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has emerged as a promising surgical intervention for morbid obesity, offering potential advantages over traditional laparoscopic approaches in terms of precision, safety, and recovery outcomes. This study aimed to evaluate the efficacy and safety of robotic-assisted SADI-S, focusing on perioperative and postoperative outcomes including intraoperative complications, operative time, conversion rates, mortality, length of hospital stay, weight loss, and postoperative complications. A comprehensive literature search was conducted on PubMed, Scopus, and Cochrane Library, adhering to inclusion and exclusion criteria focused on obese adult humans undergoing robotic SADI-S. Seven studies, published between 2015 and 2024, involving 204 patients, were ultimately included for analysis. The analysis revealed a low rate of intraoperative complications (0.49%), no mortality, and varied operative times (138 to 205.7 min). The median hospital stay ranged from 2 to 6.7 days, with minimal readmission rates. Postoperative complications occurred in 6.37% of patients, but no late complications (>30 days) were reported. Notably, significant weight loss outcomes were documented, with mean excess weight loss (EWL) up to 113.74% at 24 months follow-up. Robotic-assisted SADI-S demonstrates a favourable safety profile with promising weight loss outcomes, highlighting its potential as a primary or revisional treatment for morbid obesity. Further research, including randomized controlled trials, is needed to establish its long-term efficacy and cost-effectiveness compared to traditional laparoscopic methods.

Incidental findings of borderline ovarian tumor or ovarian cancer - real-world data on surgical and oncological outcomes.

Centralization of ovarian cancer treatment is associated with higher rates of optimal surgery and longer survival. However, preoperative diagnosis of ovarian cancer is challenging and some diagnoses are made incidentally after surgery. This study investigated the surgical and oncological outcomes of patients with incidental findings of borderline ovarian tumors or ovarian cancer who were centralized postoperatively and treated with a two-stage surgical procedure, and compared these with those of patients with adnexal masses of suspected malignancy who were offered a single-stage surgical procedure with intraoperative frozen section in a tertiary hospital. A database of 390 patients with adnexal masses and surgical treatment at the Bern University Hospital, Switzerland was retrospectively reviewed to identify patients with borderline ovarian tumors or ovarian cancer between 2010 and 2020. Among 390 patients with adnexal masses, 223 were diagnosed with a borderline ovarian tumor or ovarian cancer. Compared with patients with suspected malignancy and a centralized single-stage surgical procedure, patients with an incidental postoperative malignancy diagnosis and a two-stage surgical procedure underwent more surgical interventions (1.3 vs. 2.1 p<.001) and had a longer time interval from diagnosis to initiation of chemotherapy (33.3 vs. 45.1 p=.005) and to completion of surgical cytoreduction (31.9 vs. 73.7 days, p<.001). However, there were no differences in the rates of complete cytoreduction (90.0% vs. 93.2%, p=.719), intraoperative (11.3% vs. 13.7%, p=.664) or postoperative (38.7% vs. 37.0%, p=.884) complication rates, and number of hospitalization days (11.1 vs. 12.0 days, p=.369). An incidental diagnosis of malignancy with postoperative referral was neither associated with an increased risk of recurrence (hazard ratio (HR) 0.8, 95% confidence interval (CI) 0.6-1.8, p=.839) nor death (HR 0.7, 95% CI 0.4-1.1, p=.113), and there was no difference in mean recurrence-free survival between the study subgroups. Although patients with incidental findings of borderline ovarian tumors or ovarian cancer treated with a two-stage surgical procedure had a longer time to completion of surgical staging and initiation of chemotherapy, our results showed no negative impact on oncological outcomes.

Long-term results of artificial urinary sphincter in women: A retrospective monocentric study

BackgroundStress urinary incontinence (SUI) is a public health issue, with major impact on quality of life. An efficient treatment for intrinsic sphincter deficiency (ISD) is the artificial urinary sphincter (AUS). ObjectivesAnalyzing patient survival in terms of revision-free survival, removal-free survival and global survival without reintervention long-term results concerning continence status and complications. DesignWomen with severe ISD and negative Bonney test who were treated with AUS first implantation between 1987 and 2022 were included. ResultsIn our study, 478 patients were treated by AUS first implantation with a mean age of 59.7. The median follow-up time was 13.2years. The median revision-free survival was 19.5years with survival rates at 10, 20 and 30years were 86%, 47% and 32% respectively. Removal-free survival rates at 10, 20 and 30years were 84%, 80% and 60% respectively. Median reintervention-free survival was 17.5years. Survival was negatively affected by neurological etiology of the ISD, history of previous incontinence treatment and intraoperative complications with more early removals in the latter group. The absence of previous incontinence surgery was a protecting factor. Continence status was assessed at 10, 20 and 30years follow-up with a fully continence rate of respectively 83%, 68% and 61%. Intraoperative complication rate was 17.7%, explantation rate was 14% and the revision rate was 23%. ConclusionWomen treated with AUS have an excellent revision-free, removal-free and global survival rate. AUS is a very efficient treatment for women with ISD in terms of continence results with an acceptable intraoperative and long-term complication rate of which patients should be well informed before choosing this treatment for their SUI.

Perioperative Complications and In-Hospital Mortality in Paraplegic Radical Cystectomy Patients.

The aim of this study was to test for the association between paraplegia and perioperative complications as well as in-hospital mortality after radical cystectomy (RC) for non-metastatic bladder cancer. Perioperative complications and in-hospital mortality were tabulated in RC patients with or without paraplegia in the National Inpatient Sample (2000-2019). Of 25,527 RC patients, 185 (0.7%) were paraplegic. Paraplegic RC patients were younger (≤70years of age; 75 vs. 53%), more frequently female (28 vs. 19%), and more frequently harbored Charlson Comorbidity Index ≥3 (56 vs. 18%). Of paraplegic vs. non-paraplegic RC patients, 141 versus 15,112 (76 vs. 60%) experienced overall complications, 38 versus 2794 (21 vs. 11%) pulmonary complications, 36 versus 3525 (19 vs. 14%) genitourinary complications, 33 versus 3087 (18 vs. 12%) intraoperative complications, 21 versus 1035 (11 vs. 4%) infections, and 17 versus 1343 (9 vs. 5%) wound complications, while 62 versus 6267 (34 vs. 25%) received blood transfusions, 47 versus 3044 (25 vs. 12%) received critical care therapy (CCT), and intrahospital mortality was recorded in 13 versus 456 (7.0 vs. 1.8%) patients. In multivariable logistic regression models, paraplegic status independently predicted higher overall CCT use (odds ratio [OR] 2.1, p<0.001) as well as fourfold higher in-hospital mortality (p<0.001), higher infection rate (OR 2.5, p<0.001), higher blood transfusion rate (OR 1.45, p=0.009), and higher intraoperative (OR 1.56, p=0.02), wound (OR 1.89, p=0.01), and pulmonary (OR 1.72, p=0.004) complication rates. Paraplegic patients contemplating RC should be counseled about fourfold higher risk of in-hospital mortality and higher rates of other untoward effects.

Durability of Laser Endoureterotomy for the Treatment of Benign Ureteral Strictures: A Systematic Review and Meta-Analysis

Purpose: Laser endoureterotomy is a common minimally invasive treatment of ureteral strictures. However, data evaluating the durability of this technique are limited. This systematic review and meta-analysis assessed treatment success rates after laser endoureterotomy for managing benign ureteral strictures. Materials and Methods: A systematic literature search identified studies published from January 2000 to December 2023 reporting outcomes of laser endoureterotomy for benign ureteral strictures. Random-effects meta-analysis models calculated treatment success rates at 3 months, 6 months, and annually thereafter until estimates became unreliable (standard error &gt; 10%). Results: Nine studies comprising 308 patients (310 strictures) met eligibility criteria. The methodological quality of the studies was rated as good in 8 studies and fair in 1 study. Strictures were most commonly attributable to stone disease or previous surgery, predominantly located in the proximal (38%) or distal (35%) ureter, with a median length of 10 mm. Holmium laser was used in 98% of cases. Intraoperative complication rates were low (0.9%). The treatment success rate was 84% at 3 months, 74% at 1 year, 70% at 2 years, and 68% at 3 years. Sensitivity analysis indicated that the results were not overly influenced by any single study, and modest heterogeneity was observed among studies. Conclusions: Minimally invasive laser endoureterotomy is an effective and durable treatment for short benign ureteral strictures, making it a viable alternative to reconstructive surgery.

Thoracic surgery in children and adolescents: Experience from the thoracic surgery unit of a single referral center

Background: The study aimed to highlight and evaluate thoracic surgical procedures performed in children and adolescents and demonstrate the extent to which thoracic surgeons can benefit this population. Methods: This retrospective study included 200 pediatric patients (100 males, 100 females; mean age: 14.7±6.7 years; range, 1 month to 21 years) who underwent thoracic surgery between January 2018 and January 2023. Patients’ indications for surgery, surgical approach, complications, length of hospital stay, need for intensive care admission, and mortality were evaluated. Results: The most commonly performed surgery was sympathectomy (30.5%), followed by decortication (16%) and traumatic exploration (14%). Approximately 50% of surgeries were minimally invasive. The average length of hospital stay was 2.8 days, and the rate of intensive care admission was 20%. The intraoperative and postoperative complication rate was 10%. Conclusion: The concept of treating pediatric patients as small-size adults is irrational. Pediatric patients need special care and tailored guidelines due to their peculiar physical, psychological, and anatomical characteristics. We believe that having a dedicated team of thoracic surgeons trained and subspecialized for pediatric thoracic pathologies will improve outcomes. Furthermore, more research must be directed to this age group to establish evidence-based consensus and guidelines.

A prospective study comparing intra-operative and postoperative complications in totally extra peritoneal repair vs extended totally extra peritoneal for inguinal hernia

Introduction: Inguinal hernia repair is one of the most common surgical procedures worldwide. Total extra peritoneal repair (TEP) and Extended-TEP (eTEP) are widely used minimally invasive methods. TEP involves creating a space in the preperitoneal plane without entering the abdominal cavity, whereas eTEP extends this approach, allowing for a broader operative field.This study compares the intra-operative and postoperative complications of TEP and eTEP, contributing to the optimisation of inguinal hernia management. Methods: It is a prospective study. A total of 60 patients who underwent TEP and e-TEP for inguinal hernia, who fulfilled the inclusion criteria. Patients were randomised by simple random sampling technique and were divided into two groups of 30 each (group A-TEP and group B-eTEP). Data of both groups were compared and analysed for statistical significance using Chi square test and Student ‘t’ test. Result: The comparative analysis between TEP and eTEP procedures shows no significant differences in demographic parameters. However, eTEP demonstrates significantly shorter operative time and hospital stay, quicker return to work. Both procedures have similar rates of low intra-operative and postoperative complications, indicating comparable safety profiles. Conclusion: Our study suggest that both techniques are associated with low complication rates and good patient outcomes, with eTEP showing potential advantages in terms of pain, recovery and wider access. These findings help to take better surgical decision, to make and helped optimize patient care in inguinal hernia management.

Lung ultrasound diagnosis of pulmonary edema resulting from excessive fluid absorption during hysteroscopic myomectomy: a case report

BackgroundHysteroscopic surgery is a safe procedure used for diagnosing and treating intrauterine lesions, with a low rate of intraoperative complications. However, it is important to be cautious as fluid overload can still occur when performing any hysteroscopic surgical technique.Case PresentationIn this case report, we present a unique instance where lung ultrasound was utilized to diagnose pulmonary edema in a patient following a hysteroscopic myomectomy procedure. The development of pulmonary edema was attributed to the excessive absorption of fluid during the surgical intervention. By employing lung ultrasound as a diagnostic tool, we were able to promptly identify and address the pulmonary edema. As a result, the patient received timely treatment with no complications. This case highlights the importance of utilizing advanced imaging techniques, such as lung ultrasound, in the perioperative management of patients undergoing hysteroscopic procedures.ConclusionsThis case report underscores the significance of early detection and intervention in preventing complications associated with fluid overload during hysteroscopic myomectomy procedures.

Determining the learning curve of minimally invasive antireflux surgery: systematic review, meta-analysis, and meta-regression.

The rapid uptake of minimally invasive antireflux surgery has led to interest in learning curves for this procedure. This study ascertains the learning curve in laparoscopic and robotic-assisted antireflux surgery. A systematic review of the literature pertaining to learning curves in minimally invasive fundoplication with or without hiatal hernia repair was performed using PubMed, Medline, Embase, Web of Science, and Cochrane Library databases. A meta-regression analysis was undertaken to identify the number of cases to achieve surgical proficiency, and a meta-analysis was performed to compare outcomes between cases that were undertaken during a surgeon's learning phase and experienced phase. Twenty-five studies met the eligibility criteria. A meta-regression analysis was performed to quantitatively investigate the trend of number of cases required to achieve surgical proficiency from 1996 to present day. Using a mixed-effects negative binomial regression model, the predicted learning curve for laparoscopic and robotic-assisted antireflux surgery was found to be 24.7 and 31.1 cases, respectively. The meta-analysis determined that surgeons in their learning phase may experience a moderately increased rate of conversion to open procedure (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.28, 4.64), as well as a slightly increased rate of intraoperative complications (OR 1.60; 95% CI 1.08, 2.38), postoperative complications (OR 1.98; 95% CI 1.36, 2.87), and needing reintervention (OR 1.64; 95% CI 1.16, 2.34). This study provides an insight into the expected caseload to be competent in performing antireflux surgery. The discrepancy between outcomes during and after the learning curve for antireflux surgery suggests a need for close proctorship for learning surgeons.

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study

Study ObjectiveTo compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GO), or general obstetrician/gynecologists (OB/GYN). DesignRetrospective cohort study. SettingQuaternary care academic hospital. Patients or participantsPatients undergoing MIH for benign indications from 3/2015 to 3/2020 were included. InterventionsMIH. Measurements and Main ResultsThe primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons’ group.A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs.Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (OR 2.25, 95%CI 1.36-3.71) and 25.9% of the OB/GYN group (OR 2.65, 95%CI 1.70-4.12). Major intra- or postoperative complications were associated with surgeons’ groups (OR 7.02 95%CI 2.67-18.47, and 6.84 95%CI 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%, OR 7.21 95%CI 2.52-20.60) and OB/GYNs (9.7%, OR 7.82 95%CI 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs compared with MIGS (18.5% vs. 10.9%, OR 1.86 95%CI 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared to GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs compared with MIGS surgeons (OR 2.12 95%CI 1.07-4.22; OR 2.48 95%CI 1.49-4.12, respectively). ConclusionFellowship trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.

Bilateral cataract surgery in children: immediate sequential versus delayed sequential surgery

PurposeTo compare ocular and anesthesia-related complications in a cohort of patients having undergone either delayed sequential bilateral cataract surgery (DSBCS) or immediate sequential bilateral cataract surgery (ISBCS). MethodsThe medical records of children who underwent bilateral cataract surgery at our institution between 2012 and 2021were reviewed retrospectively. Included patients were 0-24 months of age, aphakic, and followed for at least 1 year after surgery. ResultsA total of 56 children were included: 23 underwent ISBCS; 33, DSBCS. Mean age at surgery was 2.6 ± 2.5 months for ISBCS patients and 2.8 ± 3.0 months for DSBCS patients (P = 0.752). Association with systemic diseases was more common in the ISBCS group. The mean anesthesia time per child was shorter in the ISBCS group (P < 0.001), although the mean total procedure time was similar in both groups. The rate of intraoperative anesthesia-related complications and intraocular complications was similar in both groups. There were no cases of endophthalmitis. The mean number of additional surgical interventions per child and the mean number of follow-up visits within 1 year were similar between groups. Children in the ISBCS group required fewer nights of hospital admission (P < 0.001). ConclusionsISBCS in children in this series did not lead to an increased incidence of ocular or anesthesia-related complications compared with DSBCS. ISBCS avoids repeated anesthesia and shortens the total time that the child is under anesthesia.

Intra-operative and post-operative complications of endometriosis excision using the SOSURE approach - A single- surgeon retrospective series of 1116 procedures over 8 years.

Endometriosis surgery outcomes have been widely studied, yet heterogeneity in terminology and techniques persist. This study focuses on the perioperative outcomes of a single surgeon using the same structured approach (SOSURE: Survey & Sigmoid mobilisation, Ovarian mobilisation, Suspension of uterus and ovaries, Ureterolysis, Rectovaginal and pararectal space development, Excision of all visible disease) and adheres to the recent standardised terminology proposed by international gynaecological and endometriosis societies. A quality improvement study was conducted retrospectively from January 2015 to January 2023. Data collection involved two databases: the National British Society for Gynaecological Endoscopy (BSGE) database and a more comprehensive locally kept database. The methodology also integrated four endometriosis staging systems. Intra-operative and post-operative complication rates. Between 2015 and 2023, 1047 women underwent 1116 endometriosis procedures in various UK hospitals with S.K. as primary surgeon. Exclusions totalled 20 due to missing records and specific surgical criteria. The rate of major post-operative complications (Clavien-Dindo grade 3a and 3b) was 1.5% and minor post-operative complications (Clavien-Dindo grade 1 and 2) were seen in 13.8%. No Clavien-Dindo grade 4 or 5 complications were noted. Our study has shown a low complication rate in endometriosis surgery, despite increasing complexity of surgical cases. This is likely attributed to the surgeon's learning curve, high surgical volume and adherence to a structured approach. Our study demonstrates the learning curve of a surgeon over the course of 8 years. This series involved more than 1000 patients and to our knowledge, is the first to report the complexity of the casemix using four different endometriosis staging systems.