Reduction In Intraoperative Blood Loss Research Articles

Preoperative embolization of primary bone tumors: A case control study.

To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.

Laparoscopy versus laparotomy for the management of early stage cervical cancer

BackgroundThe possible advantages of laparoscopic radical hysterectomy (LRH) versus open radical hysterectomy (RH) have not been well reviewed systematically. The aim of this study was to systematically review the comparative effectiveness between LRH and RH in the treatment of cervical cancer based on the evaluation of the Perioperative outcomes, oncological clearance, complications and long-term outcomes.MethodsThe systematic review was conducted by searching PubMed, MEDLINE, EMBASE, the Cochrane Library and BIOSIS databases. All original studies that compared LRH with RH were included for critical appraisal. Data were pooled and analyzed.ResultsA total of twelve original studies that compared LRH (n = 754) with RH (n = 785) in patients with cervical cancer fulfilled quality criteria were selected for review and meta-analysis. LRH compared with RH was associated with a significant reduction of intraoperative blood loss (weighted mean difference = −268.4 mL (95 % CI −361.6, −175.1; p < 0.01), a reduced risk of postoperative complications (OR = 0.46; 95 % CI 0.34–0.63) and shorter hospital stay (weighted mean difference = −3.22 days; 95 % CI–4.21, −2.23 days; p < 0.01). These benefits were at the cost of longer operative time (weighted mean difference = 26.9 min (95 % CI 8.08–45.82). The rate of intraoperative complications was similar in the two groups. Lymph nodes yield and positive resection margins were similar between the two groups. There were no significant differences in 5-year overall survival (HR 0.91, 95 % CI 0.48–1.71; p = 0.76) and 5-year disease-free survival (hazard ratio [HR] 0.97, 95 % CI 0.56–1.68; p = 0.91).ConclusionsLRH shows better short term outcomes compared with RH in patients with cervical cancer. The oncologic outcome and 5-year survival were similar between the two groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1818-4) contains supplementary material, which is available to authorized users.

Minimally invasive liver surgery: an update.

It is a great pleasure for us to introduce this special issue of Updates in Surgery focused on ‘‘Minimally Invasive Surgery of the Liver’’ (MILS). Indeed, this area has recently developed and grown thanks both to advances in new technologies and to efforts done by a new generation of surgeons: in 2015, minimally invasive liver surgery has proved its safety and efficacy when performed by teams with good experience in both laparoscopic and hepatic surgery, allowing a significant reduction of intraoperative blood loss, need for portal clamping, postoperative morbidity and shortening postoperative hospitalization, as a result of a more rapid functional recovery. Initial skepticisms regarding technical challenges and oncological adequacy have been overcome, and great enthusiasm has been raised in this newborn field. In 2014, the 2nd consensus conference on MILS was held in Morioka, Japan, and recommendations based on the strength of scientific evidences have been provided. Many training opportunities are now available for surgeons who want to get specific experience. Overall, the future of MILS seems to be promising. Despite this, many topics still deserve in-depth study: this monographic volume tries to reply to many open issues and to certify and codify what has already been acknowledged in clinical practice; we are witnesses of a dramatic change in the way of approaching many liver diseases and have the duty of offer the best available treatment to our patients. We have the honor of including an Editorial from Professor Wakabayashi who describes current trends of laparoscopic liver surgery and its evolution from Louisville to Morioka. The volume is then structured into two sessions, thanks to the contribution of Italian and international authors: in the first one, four review articles are provided, focusing on hot topics like HCC surgery, definition of segmentectomies, robotic approach and difficulty scores; in the second part, by means of original articles, contributions are provided to scientific knowledge on issues that are still debated, such as indications and contraindications of major resections, resections of posterosuperior segments, outcomes of metastases resection, MILS in highand low-volume Italian centers, advantages and limitations of robotic approach, learning curve and accuracy of laparoscopic ultrasound. We therefore wish to thank all the authors for their effort in providing a better insight into the present and future time of this revolutionary approach to liver surgery. We do hope that this editorial effort may help Italian and foreign colleagues willing to develop their activity in minimally invasive MILS according to the principles of scientific knowledge and evidence-based medicine. Luca Aldrighetti Fulvio Calise

Preoperative Embolization in Surgical Treatment of Spinal Metastases: Single-Blind, Randomized Controlled Clinical Trial of Efficacy in Decreasing Intraoperative Blood Loss

PurposeTo assess whether preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the need for transfusion with allogeneic red blood cells (RBCs), and surgery time in the surgical treatment of patients with symptomatic metastatic spinal cord compression. Materials and MethodsThis single-blind, randomized (1:1), controlled, parallel-group, single-center trial was approved by the Danish National Committee on Biomedical Research Ethics and was conducted from May 2011–March 2013. Participants (N = 45) were scheduled for decompression and posterior thoracic/lumbar spinal instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat. ResultsThe intention-to-treat analysis included 45 patients. Mean intraoperative blood loss did not differ significantly (P = .270) between the embolization group (618 mL [SD, 282 mL]) and the control group (735 mL [SD, 415 mL]). There was also no significant difference in allogeneic RBC transfusion (P = .243). Surgery time was significantly shorter in the embolization group (P = .031): median 90 minutes (range, 54–252 min) versus 124 minutes (range, 80–183 min). The subanalysis of hypervascular metastases revealed a significant (P = .041) reduction in blood loss in the embolization group: 645 mL (SD, 289 mL) versus 902 mL (SD, 416 mL). ConclusionsPreoperative embolization in patients with symptomatic spinal metastasis independent of primary tumor diagnosis did not reduce intraoperative blood loss and allogeneic RBC transfusion significantly but did reduce the surgery time. A small reduction of intraoperative blood loss was shown in hypervascular metastases.

Comparison of piezosurgery and traditional saw in bimaxillary orthognathic surgery

PurposeInvestigators have hypothesised that piezoelectric surgical device could permanently replace traditional saws in conventional orthognathic surgery. MethodsTwelve consecutive patients who underwent bimaxillary procedures were involved in the study. In six patients the right maxillary and mandible osteotomies were performed using traditional saw, whilst the left osteotomies by piezoosteotomy; in the remaining six patients, the surgical procedures were reversed. Intraoperative blood loss, procedure duration time, incision precision, postoperative swelling and haematoma, and nerve impairment were evaluated to compare the outcomes and costs of these two procedures. ResultsCompare to traditional mechanical surgery, piezoosteotomy showed a significant intraoperative blood loss reduction of 25% (p = 0.0367), but the mean surgical procedure duration was longer by 35% (p = 0.0018). Moreover, the use of piezoosteotomy for mandible procedure required more time than for the maxillary surgery (p = 0.0003). There was a lower incidence of postoperative haematoma and swelling following piezoosteotomy, and a statistically significant reduction in postoperative nerve impairment (p = 0.003). ConclusionsWe believe that piezoelectric device allows surgeons to achieve better results compared to a traditional surgical saw, especially in terms of intraoperative blood loss, postoperative swelling and nerve impairment. This device represents a less aggressive and safer method to perform invasive surgical procedures such as a Le Fort I osteotomy. However, we recommend the use of traditional saw in mandible surgery because it provides more foreseeable outcomes and well-controlled osteotomy. Further studies are needed to analyse whether piezoosteotomy could prevent relapse and promote bony union in larger advancements.

Is a Vessel-Sealing System Useful for Resection of Anterior Mediastinal Mass?

To valuate if the LigaSure (Valleylab, Boulder, Colorado, United States) vessel-sealing system could reduce operative time, intraoperative blood loss, drainage duration, and hospital stay in patients with anterior mediastinal mass undergoing open resection. Forty consecutive patients having resection of anterior mediastinal mass were randomized into two groups according to whether LigaSure was used (n = 20) or not (n = 20). Tumor size, operative time, intraoperative blood loss, chest tube output and duration, length of hospital stay, morbidity, and mortality were prospectively recorded, then intergroup differences were statistically analyzed. Both groups were well matched for age, tumor size, pathologic diagnosis, and incidence of complications. LigaSure significantly reduced operative duration (p < 0.0001) compared with the traditional technique but without leading to any significant reduction in intraoperative blood loss (p = 0.2), chest tube output (p = 0.2) and duration (p = 0.2), and length of hospital stay (p = 0.5). The reduced operative time using LigaSure translates into less exposure to general anesthesia, which is particularly important for patients with myasthenia and potentially reducing cost.

Laparoscopy versus Conventional Laparotomy for the Management of Tubal Ectopic Pregnancy— A Randomized Controlled Trial

Objective: To assess the efficacy and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared to that of open laparotomy. Study design: A randomized, prospective clinical trial was conducted at a private clinic setting, over a period between February 2007 and December 2012. Methods: A total of 166 women were admitted for suspected EP. Out of them 149 patients who had confirmed tubal EPs were subjected to different management options (conservative/medical/surgical). The diagnosis was based on the patient’s history, gynecological examination, ultrasound findings (transvaginal and or transabdominal), and serum [beta human chorionic gonadotrophin (β-hCG)] estimation. Based on inclusion criteria (only haemodynamically stable patients), a total of 85 patients were enrolled for the study. All the enrolled patients were managed surgically and randomly allocated to either laparoscopy group (n = 43) or laparotomy group (n = 42) by lottery method. Data regarding patient’s demographics, clinical presentation, diagnostic modalities, and treatment outcomes of two surgical techniques (laparoscopy or laparotomy) were recorded for every patient in a pre-designed data capture form. Statistical analysis was done by using SPSS version-15. Results: No significant differences were found between the two study groups regarding age, parity, gestational age, size & location of the ectopic gestation, the mean pre-operative β-hCG level, history of previous surgeries, pelvic inflammatory disease, or endometriosis. Total operation time (entry to peritoneal cavity up to exit) needed in the laparoscopic group was less compared to that of laparotomy group (73.2 ± 26.8 min vs. 84.5 ± 34.3 min), which was not statistically significant (p > 0.001). The laparoscopic approach was associated with a reduction in intra-operative blood loss (subjective), need for post-operative analgesia (odds ratio 0.08, 95% CI, 0.04–0.43) and other post-operative morbidity (odds ratio 0.29, 95% CI, 0.18–0.55). The length of hospital stay following laparoscopic management was significantly less (p < 0.001) than that of laparotomy group (2.7 ± 0.6 vs. 3.2 ± 1.1 days). Conclusion: Laparoscopic management of EP offers major benefits in terms of less operating time, fewer analgesics, early recovery, and significantly shorter hospital stay within maximum safety and efficacy. DOI: http://dx.doi.org/10.11593/bje.2013.0102.0015 Bangladesh Journal of Endosurgery Vol.1(2) May 2013: 35-38

Impact of Ultrasonically Activated Scalpel on Thyroid Surgery

Objective: This prospective study was designed to evaluate the feasibility and outcome of thyroidectomy using Ultrasonically Activated Scalpel (UAS) in comparison to the conventional thyroidectomy. Patients and Methods: This study comprised 40 patients with mean age 41.4 ± 9 years, divided into two groups: Group A comprised 25 patients underwent thyroidectomy using UAS and 15 patients underwent conventional thyroidectomy (Group B). Both groups were compared as regards operating time, operative blood loss, postoperative seroma formation and surgeons’ satisfaction regarding the ease of dissection, need of blood vessel ligation and dryness of the surgical field. Results: Mean operative time was significantly shorter in group A (77 ± 5.8 minutes) compared to group B, (105.7 ± 6.5 minutes). Intraoperative blood loss showed a significant reduction in group A, (85 ± 5.4 gm) compared to group B (125.3 ± 7.8 gm). There was a positive significant correlation between the reduction of intraoperative blood loss and operating time in both groups despite being more significant in group B. Mean total surgeons’ satisfaction scores showed a significant difference in favor of satisfaction by using UAS. Conclusion: The use of UAS for thyroidectomy is feasible and could minimize intraoperative bleeding with shorter duration of surgery and had achieved significant surgeons’ satisfaction.

Robotic versus Laparoscopic versus Open Gastrectomy: A Meta-Analysis

PurposeTo define the role of robotic gastrectomy for the treatment of gastric cancer, the present systematic review with meta-analysis was performed.Materials and MethodsA comprehensive search up to July 2012 was conducted on PubMed, EMBASE, and the Cochrane Library. All eligible studies comparing robotic gastrectomy versus laparoscopic gastrectomy or open gastrectomy were included.ResultsIncluded in our meta-analysis were seven studies of 1,967 patients that compared robotic (n=404) with open (n=718) or laparoscopic (n=845) gastrectomy. In the complete analysis, a shorter hospital stay was noted with robotic gastrectomy than with open gastrectomy (weighted mean difference: -2.92, 95% confidence interval: -4.94 to -0.89, P=0.005). Additionally, there was a significant reduction in intraoperative blood loss with robotic gastrectomy compared with laparoscopic gastrectomy (weighted mean difference: -35.53, 95% confidence interval: -66.98 to -4.09, P=0.03). These advantages were at the price of a significantly prolonged operative time for both robotic gastrectomy versus laparoscopic gastrectomy (weighted mean difference: 63.70, 95% confidence interval: 44.22 to 83.17, P<0.00001) and robotic gastrectomy versus open gastrectomy (weighted mean difference: 95.83, 95% confidence interval: 54.48 to 137.18, P<0.00001). Analysis of the number of lymph nodes retrieved and overall complication rates revealed that these outcomes did not differ significantly between the groups.ConclusionsRobotic gastrectomy for gastric cancer reduces intraoperative blood loss and the postoperative hospital length of stay compared with laparoscopic gastrectomy and open gastrectomy at a cost of a longer operating time. Robotic gastrectomy also provides an oncologically adequate lymphadenectomy. Additional high-quality prospective studies are recommended to better evaluate both short and long-term outcomes.

Laparoscopic total gastrectomy versus open total gastrectomy for cancer: a systematic review and meta-analysis

The possible advantages of laparoscopic (assisted) total gastrectomy (LTG) versus open total gastrectomy (OTG) have not been reviewed systematically. The aim of this study was to systematically review the short-term outcomes of LTG versus OTG in the treatment of gastric cancer. A systematic search of PubMed, Cochrane, CINAHL, and Embase was conducted. All original studies comparing LTG with OTG were included for critical appraisal. Data describing short-term outcomes were pooled and analyzed. A total of eight original studies that compared LTG (n = 314) with OTG (n = 384) in patients with gastric cancer fulfilled quality criteria and were selected for review and meta-analysis. LTG compared with OTG was associated with a significant reduction of intraoperative blood loss (weighted mean difference = 227.6 ml; 95 % CI 144.3-310.9; p < 0.001), a reduced risk of postoperative complications (risk ratio = 0.51; 95 % CI 0.33-0.77), and shorter hospital stay (weighted mean difference 4.0 = days; 95 % CI 1.4-6.5; p < 0.001). These benefits were at the cost of longer operative time (weighted mean difference = 55.5 min; 95 % CI 24.8-86.2; p < 0.001). In-hospital mortality rates were comparable for LTG (0.9 %) and OTG (1.8 %) (risk ratio = 0.68; 95 % CI 0.20-2.36). LTG shows better short term outcomes compared with OTG in eligible patients with gastric cancer. Future studies should evaluate 30- and 60-day mortality, radicality of resection, and long-term follow-up in LTG versus OTG, preferably in randomized trials.

Infiltration of Epinephrine in Reduction Mammaplasty

Evidence of the benefit of dilute epinephrine infiltration before reduction mammaplasty is provided by several controlled trials. Despite variation in operative technique and data collection, a reduction in intraoperative blood loss has been shown. The aim of this review of the literature is to weigh the available evidence with respect to reducing blood loss during surgery and other outcome measures such as postoperative drainage. Two researchers independently selected articles for review, and data were extracted from each primary article and used for statistical and descriptive comparisons. A meta-analysis of operative blood loss showed a highly significant drop in operative blood loss in breasts infiltrated with epinephrine and a reduction in the need for blood transfusion. Operative time, postoperative drainage, and complications were not significantly affected by epinephrine infiltration. The authors' recommendation would be for the use of dilute epinephrine infiltration before reduction mammaplasty.

Reply to the comments of Kathpalia et al. to the article: effect of intraprostatic epinephrine on intraoperative blood loss reduction during transurethral resection of the prostate

We read Kathpalia’s et al. letter [1] regarding our recently published article ‘‘Effect of intraprostatic epinephrine on intraoperative blood loss reduction during transurethral resection of the prostate’’ [2]. Postoperative blood loss was discussed when we made the study design and we realized that, from the operative viewpoint, it would be very difficult to make an objective report, because we would have to collect all the irrigation during the first 12 or 24 h and take the sample from there in order to determine the postoperative blood loss. Therefore, we decided to design the study for evaluating intraoperative blood loss only. On the other hand, we reviewed the article by Schelin et al. and it does not mention the fact that epinephrine causes temporary vasoconstriction resulting in reactionary hemorrhage. The postoperative and intraoperative observations in that article cannot be transposed because the treatment method is based on local temperature and is different from the treatment mechanism in transurethral resection of the prostate. What was useful for us from that reference was the following: At the prostatic level, epinephrine with mepivacaine reduces intraprostatic flow. This has been demonstrated by means of flow measurements made with positron emission tomography. Therefore, the comment itself is one that is based on supposition. The patients were randomly assigned to each of the two groups, and there was no particular reason for the difference in resected tissue grams. There was no statistically significant difference in regard to mean resected tissue in either group (p = 0.097). However, there was a wide dispersion due to the outlier value in the control group with 85 grams of resected tissue. In addition, sample size probably had an influence. This reply refers to the comment available at doi:10.1007/s11255-012-0228-7.

Comment to Lira-Dale et al.: Effect of intraprostatic epinephrine on intraoperative blood loss reduction during transurethral resection of the prostate

We appreciate the authors for conducting this study on the effect of intraprostatic epinephrine on intraoperative blood loss reduction during transurethral resection of the prostate, but few points need clarification [1]. The authors have shown the benefits on intraoperative blood loss but do not mention whether intraprostatic epinephrine had any benefit in postoperative period. We assume that the vasoconstrictive effect of epinephrine can conceal the bleeding vessels intraoperatively that could have been coagulated and postoperatively as the effect weans off, these patients may have reactionary hemorrhage [2]. Is there any reason why the resected prostatic tissue was less in epinephrine group than the placebo group, despite larger gland volume in the former? This can bias the results as the intraoperative blood loss is proportional to the resected tissue [3]. Finally, the amount of epinephrine injected into the prostate was fixed, that is, 20 ml. Probably, the effect may vary based on prostate volume, where smaller glands may require lesser dose in comparison with larger ones. We would like to have author’s opinion in this context.

Laparoscopic vs open resection for rectal cancer: a meta‐analysis of randomized clinical trials

Laparoscopic and open rectal resection for cancer were compared by analysing a total of 26 end points which included intraoperative and postoperative recovery, short-term morbidity and mortality, late morbidity and long-term oncological outcomes. We searched for published randomized clinical trials, presenting a comparison between laparoscopic and open rectal resection for cancer using the following electronic databases: PubMed, OVID, Medline, Cochrane Database of Systematic Reviews, EBM Reviews, CINAHL and EMBASE. Nine randomized clinical trials (RCTs) were included in the meta-analysis incorporating a total of 1544 patients, having laparoscopic (N = 841) and open rectal resection (N = 703) for cancer. Laparoscopic surgery for rectal cancer was associated with a statistically significant reduction in intraoperative blood loss and in the number of blood transfusions, earlier resuming solid diet, return of bowel function and a shorter duration of hospital stay. We also found a significant advantage for laparoscopy in the reduction of post-operative abdominal bleeding, late intestinal adhesion obstruction and late morbidity. No differences were found in terms of intra-operative and late oncological outcomes. The meta-analysis indicates that laparoscopy benefits patients with shorter hospital stay, earlier return of bowel function, reduced blood loss and number of blood transfusions and lower rates of abdominal postoperative bleeding, late intestinal adhesion obstruction and other late morbidities.

A Meta-Analysis of the Short- And Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Open Colectomy for Colon Cancer

Purpose: We conducted a meta-analysis to evaluate and compare the short- and long-term results of laparoscopy-assisted colectomy (LAC) and open colectomy (OC) for colon cancer.Methods: We searched MEDLINE, EMBASE, Science Citation Index, and Cochrane Controlled Trial Register for relevant papers published between January 1990 and October 2011 by using the search terms “laparoscopy,” “laparoscopy-assisted,” “surgery,” “colectomy,” “colon cancer,” and “randomized clinical trials (RCTs)”. We analyzed the outcomes of each type of surgery over short- and long-term periods.Results: We selected 12 papers reporting RCTs that compared LAC with OC for colon cancer. Our meta-analysis included 4614 patients with colon cancer; of these, 2444 had undergone LAC and 2170 had undergone OC. In the short-term period, we found that the rates of overall postoperative complications and ileus in LAC were lower than in OC groups. LAC was associated with a reduction in intraoperative blood loss, a shorter duration of time to resumption and hospital stay, and lower rates of overall complication and ileus over the short-term, but with similar long-term oncologic outcomes such as overall and cancer-related mortality, overall recurrence, local recurrence, distant metastasis, and wound-site recurrence, compared to OC.Conclusions: It is suggested that LAC may be preferred to OC for colon cancer.

Effect of intraprostatic epinephrine on intraoperative blood loss reduction during transurethral resection of the prostate

To determine whether the use of intraprostatic epinephrine during transurethral resection of the prostate reduces intraoperative blood loss. A random, double-blind, prospective study was carried out on twenty-three patients that underwent transurethral resection of the prostate. Patients were divided into two groups: (1) group receiving intraoperative intraprostatic injection of epinephrine (thirteen patients) and (2) group receiving intraoperative intraprostatic injection of saline solution as placebo (ten patients). Blood loss was quantified with the following formula: irrigation solution hemoglobin × 1000/intraoperative presurgical serum hemoglobin. The variables analyzed were blood loss, resection time, presurgical prostate volume, and grams of resected tissue. Student´s t test and Pearson correlation were used for their analysis. There were thirteen patients in the epinephrine group and ten patients in the placebo group. Mean blood loss in the epinephrine group was significantly lower than in the placebo group (127.48 mL ± 77.0 mL vs. 336.63 ± 185.6 mL, 95% CI, 45-234, P < 0.001). There were no statistically significant differences in mean resected grams or mean resection time between the two groups. One patient in the epinephrine group presented with intraoperative hypertensive crisis (7.7%). Intraprostatic epinephrine injection can be used to reduce blood loss during transurethral resection of the prostate in selected patients. Cardiovascular monitoring should be carried out during its application. Resection time and grams of resected tissue continue to be the most influential factors in relation to blood loss in patients undergoing this treatment modality.

Bone radiofrequency ablation combined with prophylactic internal fixation for metastatic bone tumor of the femur from hepatocellular carcinoma

A 64-year-old man with 6-year history of hepatocellular carcinoma (HCC) was referred to us regarding bone metastasis to the right proximal femur. Although he underwent radiotherapy for pain palliation and local tumor control, the pain persisted and the tumor relapsed 3 months after the radiotherapy and he was thought to be at high risk of pathologic fracture. Given hypervascularity and large tumor size, a prophylactic internal fixation combined with adjuvant radiofrequency ablation (RFA) was proposed to reduce blood loss and prevent viable tumor cells being disseminated. His postoperative course was uneventful without requiring blood transfusion and preoperative symptoms immediately disappeared after surgery. He became capable of weight-bearing walk with a single cane and was almost asymptomatic without local progression on the plain radiographs when he died 14 months after surgery. Combination therapy of RFA and internal fixation using intramedullary nailing for metastases of the long bones from HCC seems to be a very promising technique both for sufficient pain relief and for local control of the tumor. Adjuvant RFA may become a potential option for patients with metastases of the long bones for the purpose of prevention of tumor dissemination and reduction of intraoperative blood loss.

Use of Ultrasonic Shears in the Harvest of the Free Osteocutaneous Fibula Flap

Traditionally, the fibula free flap has been raised by electrocautery and sharp dissection with clipping and tying of vessels. Use of the ultrasonic scalpel has been proposed to be a faster, more hemostatic, and less traumatic method of harvest. We performed a retrospective chart review of 58 patients who underwent fibula free flap reconstruction between 2007 and 2010. The main outcome measures were blood loss, operative time, and flap harvest time. Use of the ultrasonic shears was not associated with a statistically significant reduction in intraoperative blood loss, operative time, or flap harvest time. However, the flap harvest time did trend toward statistical significance (p = 0.073). Use of distribution-based effect sizes demonstrated a moderate clinically important difference in favor of the ultrasonic shears for both operative time and flap harvest time. The use of ultrasonic shears is comparable to traditional methods of fibula free flap harvest and can be considered an alternative method of harvest.

Ewolucja chirurgicznych metod leczenia włókniaka młodzieńczego

Juvenile Angiofibroma has been challenged generations of surgeons. The problem is, not only in specific clinical features of the tumour, but also in difficult surgical approach to anatomical area in which it is located. was to analyze development of surgical techniques in treatment of juvenile angiofibroma and potential conditions which influence on therapy results. The retrospective study that analyzes 47 juvenile angiofibroma cases, which were treated in the Otorhinolaryngology Department of Warsaw Medical University in years 1980–2010. The five surgical approaches were used in the group of patients, filled in this study. The use of midfacial degloving has become increasingly popular, replacing lateral rhinotomy and transpalatal approach, which were commonly used in early nineties of the last century. The infratemporal approach was used in one case of disease with parapharyngeal and infratemporal extension. One of the recent patients was treated, first time in history of the Department, using endoscopic approach. The routine protocol of treatment includes preoperative CT and MRI and angiography with embolization of the main tumour vessels. The gradual, but consequent improvement in therapy results is revealed as reduction of recurrence from 35% to 20%. In therapy of juvenile angiofibroma become popular surgical techniques, which are not connected with visible scars and which reduce tissue trauma in operated area. Besides mastering surgical skills, the independent condition, which improves therapy results, is using modern diagnostic and therapeutic procedures. They contribute to better assessment of tumour location and extension, and reduction of intraoperative blood loss.

A Meta-analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Rectal Cancer

PurposeWe conducted a meta-analysis to evaluate and compare the short- and long-term results of laparoscopy-assisted and open rectal surgery for the treatment of patients with rectal cancer. MethodsWe searched MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant papers published between January 1990 and April 2011 by using the search terms “laparoscopy,” “laparoscopy assisted,” “surgery,” “rectal cancer,” and “randomized controlled trials.” We analyzed outcomes over short- and long-term periods. ResultsWe identified 12 papers reporting results from randomized controlled trials that compared laparoscopic surgery with open surgery for rectal cancer. Our meta-analysis included 2,095 patients with rectal cancer; 1,096 had undergone laparoscopic surgery, and 999 had undergone open surgery. In the short-term period, 13 outcome variables were examined. In the long-term period, eight oncologic variables, as well as late morbidity, urinary function, and sexual function were analyzed. Laparoscopic surgery for rectal cancer was associated with a reduction in intraoperative blood loss and the number of transfused patients, earlier resumption of oral intake, and a shorter duration of hospital stay over the short-term, but with similar short-term and long-term oncologic outcomes compared to conventional open surgery. ConclusionsLaparoscopic surgery may be an acceptable alternative treatment option to conventional open surgery for rectal cancer.