Reduction In Intraoperative Blood Loss Research Articles

567 Compression of the lower uterine segment (colus) – new technique for reducing the bleeding during c-section in women with placenta previa

Objectiveto evaluate efficiency of a new approach for bleeding prevention and cessation during C-section in pregnant women with placenta previa. Study design: 61 pregnant women with diagnosed by ultrasound examination placenta previa were recommended planned operative delivery. All of them were randomized and divided into 2 groups. Study group (n=30) had elective C-section at 36-36+6 gestation weeks using our modified method of surgical hemostasis (COLUS): after placenta's we perfomed compressive suture on the lower uterine segment, uterine vessels' ligation and placed catheter inside the uterine cavity. All patients received prevention of neonatal RDS. Pregnant women in control group (n=31) had planned caesarean section at 38-39 weeks. Hemostasis of the area of the placenta location was reached by using electrocoagulation of the lower uterine segment vessels and additional suturing of bleeding areas, wherever necessary. Intraoperative blood loss and neonatal outcomes in both groups were evaluated, analyzed and compared respectively. Newborns’ condition was assessed using Apgar score at the 1st and 5th minute after delivery. Results: Bleeding control was achieved in all patients (100%). Average intraoperative blood loss in control group was 1277 ± 119 mL vs. 698±139 mL - in study group. Apgar score at 1'-5' min ranged between 7 and 9 in both groups. Weight and length of newborns were 2679±33g and 47±1cm for study group vs. 3151±78g and 48±1cm for control group, that matches the normal values for that gestational ages. No major complications occurred in both groups. Conclusions: tactic developed by us allows to prevent massive obstetric hemorrhage in most cases of placenta previa during cesarean section and lead to reduction of intraoperative blood loss by 45%.

The Evaluation of the 1318 nm Diode Laser in Open Liver Surgery.

Simple SummaryThe surgical treatment of liver metastases but also of primary liver tumors is of particular clinical relevance in view of their high incidence. As a therapy option with a prospect of long-term survival in curative intent, liver resection plays a crucial role in modern multimodal treatment concepts. Advances in surgical and perioperative medicine have led to a reduction of procedural mortality to less than 5% and morbidity to around 35–45% and have rendered liver resections from high risk to routine procedures. Several comparisons of common parenchymal dissection techniques showed no specific advantages in favor of one of the methods in terms of morbidity, mortality and intraoperative blood loss. The aim of our retrospective study was to evaluate the 1318 nm diode pumped neodymium-yttrium aluminum garnet laser in open liver surgery. It could be shown that liver resections using the 1318 nm surgical laser can be carried out with an acceptable risk and are equally safe compared to conventional resection methods with comparatively little blood loss and favorable oncological surrogate outcomes.(1) Background: Numerous dissection instruments are available for liver resection. So far, there has been no evidence in favor of a specific dissection device effecting a reduction in postoperative mortality and morbidity or a reduction in intraoperative blood loss. The aim of the study was to evaluate the safety of liver resection with the 1318 nm surgical laser. (2) Methods: 151 consecutive patients who underwent liver resection using the 1318 nm surgical laser (n = 119) or conventional dissection methods (n = 32) were evaluated retrospectively. As primary outcome, postoperative complications were assessed using the Clavien–Dindo classification. Secondary outcomes were postoperative mortality, reoperations and reinterventions, intraoperative blood loss, the need for vascular control using the Pringle maneuver and oncological safety assessed through histopathological evaluation of resection margins. (3) Results: For liver resections using the 1318 nm surgical laser, the postoperative morbidity (41.2% vs. 59.4%, p = 0.066), mortality (1.7% vs. 3.1%, p = 0.513) and the reoperation rate (2.5% vs. 3.1%, p = 1.000) were not significantly different from conventional liver resections. In the laser group, a lower reintervention rate (9.2% vs. 21.9%, p = 0.050) was observed. The oncological safety demonstrated by a tumor-free resection margin was similar after laser and conventional resection (93.2% vs. 89.3%, p = 0.256). The median intraoperative blood loss was significantly lower in the laser group (300 mL vs. 500 mL, p = 0.005) and there was a significantly lower need for a Pringle maneuver (3.4% vs. 15.6%, p = 0.021). (4) Conclusions: Liver resections using the 1318 nm surgical laser can be routinely performed with a favorable risk profile. Compared to alternative resection methods, they are associated with low blood loss, appear adequate from an oncological point of view, and are not associated with increased mortality and morbidity.

Intraoperative halo-femoral traction during posterior spinal arthrodesis for adolescent idiopathic scoliosis curves between 70° and 100°: a randomized controlled trial.

Surgical management of scoliosis curves between 70° and 100° remains controversial. The authors designed this randomized controlled trial to validate the efficacy of intraoperative halo-femoral traction (IOHFT) in patients with adolescent idiopathic scoliosis (AIS), Cobb angles between 70° and 100°, and flexibility < 35%. The authors prospectively recruited and randomized 29 patients with severe AIS scheduled for posterior surgery into a traction group or control (nontraction) group. The primary outcome measures were operative time, blood loss, and length of hospital stay. Secondary outcomes included degree of spine deformity correction, traction-related complications, and health-related quality of life. In the traction group, the average preoperative Cobb angle was 83.2°, with an average 20.6% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.3° at the final follow-up. In the control group, the average preoperative major curve was 80.3° with 22.8% flexibility. The average postoperative Cobb angle was 16.1° and the major curve was 18.1° at the final follow-up. The operative duration was 325.7 minutes for the traction group and 385.4 minutes for the control group (p = 0.018). Compared with the control group, the traction group had a 29.5% reduction in intraoperative blood loss and a significantly lower rate of blood transfusion (13.3% vs 50.0%, p = 0.033). There were no neurological complications in either group. One patient in the traction group had a superficial infection at the traction site. Use of IOHFT contributed to significant reductions in operative time and blood transfusion requirements, with no added morbidity. It is an effective and safe method to assist correction of AIS curves between 70° and 100° and flexibility < 35%.

Paper on surgical site infections post cesarean section

Background: Surgical site infections are among the most common hospital acquired infections. They make upto 14-16% of inpatient infections. Objective of present study was to evaluate the risk factors associated with surgical site infections in caesarian cases, the bacteria causing wound infections in obstetric operations, the antibiotic sensitivity and resistance pattern of the pathogens isolated. Methods: 100 women with wound infection during hospital stay or within 30 days following caesarean section were taken for the study. These case records were thoroughly studied and noted. Pus samples were collected from the wound site with help of sterile swabs under aseptic precautions and immediately transported to microbiology laboratory for culture and sensitivity. Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55% of the cases. Majority of the women are from rural areas (71%). 57% of the cases were unbooked. 90% of the SSI were seen in emergency surgeries and 10% in elective surgeries. Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders 25%. The risk of post operative infection has been found to be proportional to volume of blood loss during cesarean section and duration of surgery. Staphylococcus aureus was found to be predominant organism of wound infection of which 21% were MRSA followed by Klebsiella and E.coli.Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the development of strategies for reducing the incidence of SSI and for identifying high risk patients requiring intensive postoperative surveillance. We can conclude that reduction in intraoperative blood loss and duration of surgery can reduce the incidence of Postoperative infections.Also Pre operative antibiotics should not be made mandatory in all lower segment caesarean section as no significant difference has been found in the infection rate inspite of giving preoperative antibiotics.

The efficacy of Tranexamic Acid Administration in Patients Undergoing Tonsillectomy: An Updated Meta-Analysis.

There is controversy regarding the efficacy and safety of tranexamic acid (TXA) in reducing tonsillectomy-related hemorrhage. We conducted a systematic review and meta-analysis to evaluate the prophylactic role of TXA in tonsillectomy. We searched 6 databases to identify studies that directly compare the effect of TXA versus controls in tonsillectomy patients. Standardized mean difference was applied to summate the findings across the studies. Dichotomous data were expressed as relative risk. Ten studies representing a total of 111 898 patients were included. The pooled results showed a significant reduction of intraoperative blood loss by 39.02 ml (SMD = -1.05, 95% CI: -1.91 to -0.20, P = .016) and the rate of post-tonsillectomy hemorrhage (RR = 0.42, 95% CI: 0.28 to 0.65, P < .0001), with no significant difference in reduction of further intervention risk (RR = 0.78, 95% CI: 0.45 to 1.35, P = .373). Overall, this study indicates that TXA may reduce blood loss and frequency of post-operative hemorrhage associated with tonsillectomy. Further large, high-quality clinical trials are still needed to explore TXA's effect on post-tonsillectomy hemorrhage and the safety of its use.

Efficacy of Preoperative Misoprostal in Reducing Hemorrhage during Abdominal Myomectomy

Objective: The aim of this study is to determine the efficacy of preoperative misoprostal in reducing hemorrhage during abdominal myomectomy. Study Design: Prospective comparative randomized double blinded Place and Duration: Conducted at DHQ Zanana hospital Dera Ismail Khan for one year duration from January 2019 to December 2019. Methods: Total 100 patients underwent abdominal myomectomy were presented in this study. Patients were aged between 18-45 years of age. Patients’ detailed demographics including age, body mass index and parity were recorded after taking informed written consent. Patients were categorized equally into two groups, I and II. Group I had 50 patients and received single dose 400 micrograms of misoprostol transrectally one hour preoperatively and group II had 50 patients and received 2-tablets of placebo preoperatively. Outcomes intraoperative blood loss, blood transfusion, hysterectomy and complications among both groups were assessed. Complete data was analyzed by SPSS 23.0 version. Results: Mean age of the patients was 32.16±9.44 with mean BMI 26.07±10.44 kg/m2. There were no significantly difference among age and body mass among both groups. 60 Patients had 0 parity, 30 patients had parity 1 and the rest were had parity 2. Mean pre-operative hemoglobin in group I was 13.64±8.55 and post-operative was 9.88±8.55 and in group II mean pre-operative hemoglobin was 13.55±8.55 and post-operative was 9.12±5.55. Mean intraoperative blood loss in group I was 388.17±37.18 ml and in group II was 501.16±17.64 ml. Post-operatively blood transfusion in group I was among 2(4%) cases and 3 (6%) in group II. Mean hospital stay in group II was greater as compared to group I. Nausea, vomiting and shivering were the complications found in this study. Conclusion: We concluded in this study that the use ofmisoprostol preoperatively during abdominal myomectomy was effective safe and useful in reduction of intraoperative blood loss and post-operatively blood transfusion among patients. Keywords: Abdominal myomectomy, Misoprostol, Placebo, Intraoperative, Blood loss

The Manchester-Fothergill technique: Browsing in the cutting-edge art gallery.

No consensus regarding the surgical strategy for repairs of pelvic organ prolapse (POP) has existed since the writings of Hippocrates. Archibald Donald of Manchester, in 1888, quite independently began to treat cases of prolapsus uteri with a combined operation of anterior and posterior colporrhaphy and amputation of the cervix. To describe the surgical technique of Manchester-Fothergill and to chart its history. A bibliographic search was performed of the PubMed and National Library of Medicine (NIH) databases. The terms "Manchester-Fothergill" AND "History" AND "Pelvic Organ Prolapse" were searched from the first publication on this topic (1951) to December 2020. Data were extracted from studies independently by two authors. All types of relevant abstracts were selected and analyzed due to the scarcity of studies (books and documents, clinical trials, meta-analysis, randomized controlled trial, review and systematic review). Although this is a well-described procedure in historic texts, the practical application is not often employed, and modern surgical texts rarely describe how to perform this surgery. The advantages of the Manchester-Fothergill technique include maintenance of the pelvic anatomy, integrity, a reduction of intraoperative blood loss, and shortened operation times and hospital stays. Many young gynecologists are not familiar with this operation; therefore, it is important to provide training and exposure to the Manchester-Fothergill technique in the practice of gynecological surgery.

Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals.

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400–4500) mL vs. 1000 (400–5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

Outcomes of Preoperative Embolization of Juvenile Nasopharyngeal Angiofibroma

Background: These are rare fibro-vascular neoplasms, out of all head and neck tumors, JNA contributingfor only less than 0.5%. JNA incidence rate almost 1/150,000 and affects men and adolescents’ malesObjectives: To study outcome and the role of Pre-operative Embolization of surgeries for JuvenileNasopharyngeal Angiofibroma.Methods: A retrospective cross sectional study conducted at Al-Sader Medical City during the period 2010through 2020 included 15 male patients who were managed for JNA, in whom embolization was performedpreoperatively.Results: The study included 15 male patients with an average age of 16.4 ± 3.1 (standard deviation) (range:11-22) years. The duration of the procedure is 126 minutes, on average and ranged 75 to 180 minutes;Average intra-operative blood loss was 300 (range: 150-750) ml. The postoperative hospitalization periodwas 2 days in 14 cases and a recurrence rate of 13.3% was reported.Conclusions: The use of preoperative embolization in JNA patients has been very beneficial in shorteningsurgery time, improve bloodless of the operative site, with a significant reduction in intraoperative bloodloss, reduction in postoperative hospitalization time, and reduction in recurrent rate.

Tranexamic Acid in Craniomaxillofacial Surgery: A Meta-Analysis and Systematic Review.

Objective: To compare the effectiveness of tranexamic acid (TXA) in reducing blood loss and decreasing surgery duration in craniomaxillofacial surgery. Methods: The literature was searched systematically for all comparative studies of the effect of TXA on craniomaxillofacial surgery with placebo to evaluate the efficacy of TXA in craniomaxillofacial surgery. The primary outcome was intraoperative blood loss, and secondary outcomes were postoperative hematocrit, postoperative hemoglobin, and operation duration. Results: This systematic review included 16 studies consisting of 958 patients. Meta-analysis revealed that compared with the placebo group, the TXA group showed a significant reduction in intraoperative blood loss of 139.81 mL (95% confidence interval, CI: -179.66 to -99.96 mL; p < 0.01), a shortening of the maxillary surgery duration of 15.48 min (95% CI: -21.03 to -9.92 min; p < 0.01), an elevation of the postoperative hemoglobin level of 0.74 mg/dL (95% CI: 0.42 to 1.07 mg/dL; p < 0.01), and a limited effect on increasing the postoperative hematocrit level of 1.77% (95% CI: 0.17 to 3.36; p = 0.03). Conclusion: The use of TXA in craniomaxillofacial surgery can effectively reduce intraoperative blood loss, maintain elevate postoperative hemoglobin and hematocrit levels, and reduce the operation duration.

Intravenous Tranexamic Acid Prior to Hysterectomy for Reduction of Intraoperative Blood Loss: A Randomized Placebo-Controlled Trial

Study Objective Only two prospective studies exist that investigated the use of TXA during benign hysterectomy. Our study objective was to evaluate the efficacy of a single, preoperative, intravenous (IV) dose of TXA in reducing intraoperative blood loss at the time of benign hysterectomy. We hypothesized that IV TXA would be more effective in reducing blood loss when compared to placebo. Design Randomized, double-blind, placebo-controlled trial. Setting Academic, tertiary care medical center. Patients or Participants Patients undergoing hysterectomy by any route, for benign indications from November 2017 through August 2019. Interventions Patients were consented at the preoperative visit. Consented participants were randomized to either the placebo-control group (100 mL of 0.9% sodium chloride solution) or the treatment group (1 g of IV TXA in 100 mL of 0.9% sodium chloride solution). Patient characteristics and perioperative data were recorded, including estimated blood loss (EBL) and preoperative and postoperative hemoglobin. Measurements and Main Results Interim analysis was conducted due to low study participant retention and recruitment rates. A total of 35 participants completed the study, 13 in the control group and 22 in the TXA group. Nonparametric tests were performed for statistical analysis. Median EBL was no different between groups, 200 g/dL for controls and 150 g/dL for TXA (p=0.58). The median drop in hemoglobin was 1.7 g/dL in the control group versus 1.9 g/dL in the TXA group (p=0.47). Median specimen weights were higher for the TXA group (323 g) than the control group (163 g, p = 0.031). Operative time was not different between groups (p = 0.53). Conclusion There was no significant benefit of using TXA for reduction of EBL or drop in hemoglobin. More robust study with a larger sample size is needed to validate the clinical efficacy of TXA for reducing blood loss in hysterectomy for benign indications.

Intraoperative balloon occlusion of the aorta for blood management in sacral and pelvic tumor resection: A systematic review and meta-analysis

BackgroundNeoplasms of the sacrum and pelvis are challenging to manage due to their complex vascularity and size and are at high risk of bleeding during resection. Intra-aortic balloon occlusion (IABO) has been used in trauma to control massive blood loss, but its efficacy and safety in oncologic sacral and pelvic surgery are unknown. The primary objective of this systematic review and meta-analysis was to assess the effectiveness of IABO in providing hemorrhage control during resection of sacral and pelvic tumors. MethodsThis PROSPERO pre-registered study meta-analyzed all studies reporting on the use of IABO in the setting of pelvic and sacral tumour resection, in accordance with the PRISMA guidelines. The primary outcome of the meta-analysis was intraoperative blood loss, with secondary outcomes consisting of transfusion volume, post-operative blood loss, operative time, complication rate, and mortality. ResultsAcross studies, IABO was associated with a large, significant reduction in intraoperative blood loss (SMD -0.81, 95% CI -1.01 to −0.60, P < 0.0001) and transfused red blood cell volume (SMD 0.92, 95% CI -1.30 to −0.53, P < 0.0001). Two studies reported that complication rates were comparable between patients receiving IABO and patient receiving conventional surgery (Odds ratio = 1.29, 95% CI: 0.59 to 2.83, P = 0.52). All studies descriptively reported improved visualization of the operative field with IABO. ConclusionsOur findings demonstrated that IABO is an effective technique to decrease blood loss and transfusion requirements during sacral and pelvic tumor surgery. Future clinical trials should be conducted to establish the safety of this method and explore potential contraindications.

A Randomized Control Trial to Assess Intraoperative and Postoperative Outcomes of Colorado Microdissection Needle Versus Conventional Surgical Knife in Neck Dissection.

We designed a prospective randomized study to assess the outcome of Colorado microdissection needle in comparison with conventional surgical blade for performing neck dissections. Sixty patients who underwent neck dissection for oral cancers were randomly allocated into two groups. The outcome measurements were in terms of cosmetic outcome of neck scar, intraoperative blood loss, over all operative time, and postoperative neck drain assessment. The use of microdissection needle in performing skin incision and neck dissection eliminates the need for local anesthetic with vasoconstrictor along with significant reduction in intraoperative blood loss, postoperative drainage and with acceptable cosmetic outcome. No significant difference was seen in perioperative and postoperative complications between both groups.

Comparison Between Unilateral and Bilateral Sacrospinous Ligament Fixation for Management of Vault Prolapse

Background: Hysteropexy is an effective procedure for vault prolapse as abdominal sacrocolpopexy but easier and simple. Right sacrospinous fixation has the same results of bilateral fixation. Aim of the work: To evaluate the value and safety of unilateral or bilateral sacrospinous fixation [SSF]. Patients and methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Al-Azhar University, Damietta over a period of two years [July 2017 to June 2019]. A total of 32 patients posted for 16 cases unilateral sacrospinous ligament fixation to vault and 16 cases for bilateral fixation were enrolled after informed consent. Results were recorded under headings of procedure time [min], blood loss [ml], major intro-operative complications and post-operative complications, postoperative pain and duration of hospital stay. Results: The result of unilateral transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal [Pelvic Organ Prolapse stage III and stage IV and vault prolapse] was evaluated as better than bilateral approach with the same efficacy, less time consuming, less blood loss and low post-operative pain. Conclusion: Unilateral transvaginal sacrospinous ligament fixation revealed a significant reduction in intraoperative blood loss, procedure time, immediate post-operative pain, and mean length of hospital stay.

Миомэктомия: рациональное ведение периоперационного периода и отдаленные результаты лечения

Objective – to study the influence of various surgical approaches on the outcomes of myomectomy and to determine the optimal strategy of postoperative management of patients of childbearing age with uterine fibroids. Patients and methods. A retrospective study included 145 patients who had uterine fibroids with a total increase of 480–560 cm3, with the intramural component not less than 55% of the total volume. Patients of group 1 (n = 62) underwent classical laparoscopic myomectomy. Patients of group 2 (n = 48) had surgery supplemented by temporary reduction of arterial perfusion by temporary clipping of the uterine or internal iliac arteries. Robot-assisted myomectomy was performed in 34 patients of group 3. The comparison group comprised 54 women with uterine fibroids of the same sizes who did not undergo operative treatment, and the control group consisted of 36 healthy women. Results. After myomectomy, the progesterone/oestradiol receptor ratio in the endometrium increased from 1.8 to 4.6 and from 1.6 to 2.7 in patients who suffered from primary or secondary infertility before surgery. After surgery, the expression of НОХА-10 became higher in the epithelium and pinopodes of patients of both groups. But the positive response of the stromal cells was obtained only in women who had pregnancies before surgery. The expression of the proto-oncogene bcl-2 after myomectomy decreased in patients of all groups in both the stroma and epithelium, but it was more pronounced in women with primary infertility. Changes in the endometrium occur irrespective of the type of operative intervention. Taking into account the fact that temporary cessation of arterial perfusion in the uterus does not worsen endometrial receptivity but allows a 5-fold reduction of intraoperative blood loss, this technique might be regarded as one of the most effective for prevention of intra- and postoperative complications. The incidence of pregnancy following myomectomy was 84.7% among women who planned conception, whereas among women with myoma it was only 18.9%. The number of pregnancies after assisted reproductive technologies amounted to 19.4% of the total number of patients. Conclusion. Surgical treatment of uterine fibroids makes it possible to improve a reproductive prognosis and achieve a pregnancy in 85% of cases, which, among other factors, is due to improvement of endometrial receptivity. Key words: pregnancy, contraception, uterine fibroid, myomectomy, reproductive outcomes, endometrial receptivity

2676 Laparoscopic Myomectomy: A New Suturing Technique

Study Objective The aim of the present study was to find a surgical technique that allows to perform laparoscopic myomectomy even of large fibroids located in difficultly accessible locations, such as the posterior uterine wall, by reducing both the operative time and the risk of bleeding related to the suture of the uterine wound. Design Prospective case control study, lasting 8 months. Setting Department of Gynecology in Nuona Villa Claudia Clinic, Rome (Italy). Patients or Participants Forty women of reproductive age with an intramural-underserous posterior uterine wall myoma, measuring 6-8 cm, undergoing laparoscopy to remove it. Interventions The 40 women enrolled underwent laparoscopic myomectomy according to the classical technique: transversal incision in the most distended part of the myometrium down to the pseudocapsule, identification of the cleavage plane and enucleation of the myoma. All of the study women had the myometrial wound repaired using an absorbable 2/0 barbed polygliconate wound closure device, but while in 20 of them a single layer continuous suture was performed, starting from the left end of the wound up to the right, in the remaining 20 women a single stitch was initially placed in the central part of the wound and transversal to it. That thread was cut sufficiently long to be grasped with a joanne and lifted upwards, while a single layer semicontinuous suture was performed. Measurements and Main Results The evaluation showed, in group 1 and 2 respectively, an average surgery duration of 55 and 42 minutes and a mean intraoperative blood loss of 1.5 and 0.8 g/dl of hemoglobin. Conclusion The suturing technique proposed in group 2 significantly facilitates the operator work, allowing both a shorter duration of the surgical procedure and a reduction in intraoperative blood loss. It could be, then, a valid alternative to the classic suturing technique, especially in cases of myomectomy of large fibroids of the posterior uterine wall.

Is Ultrasonic Bone Scalpel Useful in Le Fort I Osteotomy?

Safety and precision are 2 main goals in research to improve bone cutting in maxillofacial surgery. The aim of this prospective clinical study was to analyze the outcomes using an ultrasonic bone scalpel versus a piezoelectric surgical device and the conventional technique in a Le Fort I osteotomy. We designed a prospective, randomized, single-blind cohort study. The predictor variables were the devices used to perform the Le Fort I osteotomy, divided into 3 groups: 1) ultrasonic bone scalpel (BoneScalpel; Misonix, Farmingdale, NY), 2) piezoelectric surgical device, and 3) conventional technique (Lindeman burr and reciprocal saw). The primary outcome of the study was cutting time, whereas secondary outcomes were length of the procedure, total blood loss, intraoperative complications, and postoperative edema. Other variables of interest were age and gender. Data were analyzed using 1-way analysis of variance and the Kruskal-Wallis test. The study sample was composed of 34 patients with a mean age of 21.5years, and 63.3% of patients were women. The mean cutting time (P<.001) and length of the procedure (P=.012) were significantly shorter with the bone scalpel than with the other types of surgery. The ultrasonic bone scalpel showed a significant reduction in intraoperative blood loss of up to 45% compared with the piezoelectric surgical device and the conventional technique (P=.038). The results of this study suggest that the ultrasonic bone scalpel is an effective ultrasonic bone-cutting instrument in a Le Fort I osteotomy as evidenced by the significant decrease in the cutting time, intraoperative blood loss, and postoperative edema compared with the other techniques.

320.4: Use of Arterial Embolisation to Facilitate Exenteration during Multi-visceral and Intestinal Transplantation

Introduction: Exenteration during multi-visceral and intestinal transplantation is associated with significant blood loss that increases patient instability intra-operatively and may affect the subsequent post-operative course. This is particularly the case for multi-visceral transplantation (MVT) for porto-mesenteric thrombosis (PMVT). Methods: Embolisation was undertaken in theatre following anaesthesia and placement of lines. Amplatzer arterial plugs (St Jude), either type I (8mm in length) or type II (16–24 mm) were utilised. In the case of full MVT, the plugs occluded both coeliac axis (CA) and superior mesenteric arteries (SMA). In circumstances where the stomach was retained the SMA, hepatic and splenic arteries were occluded and the left gastric artery preserved. Results: Pre-operative embolisation was performed in 13 patients who have had either MVT, liver/small bowel transplant (LSB), or small bowel/ pancreas/colon transplant (SBP). Nine of the 13 cases were embolised for severe portal hypertension (PHT). We have compared blood loss and use of blood products in this group to a historical cohort of intestine containing transplants in patients with severe PHT (table 1). By performing embolisation in the operating theatre there was minimal delay in the explant procedure and no increase in the cold ischaemic time. There was a reduction in intra-operative blood loss, blood products and metabolic instability. One patient undergoing a full MVT for PMVT required no blood products intra-operatively. There were no complications associated with the embolisation procedure. Conclusion: We believe that arterial embolisation is a very useful technique to minimize the blood loss associated with severe PHT during intestine containing transplantation. It reduces blood loss, blood products and metabolic instability. The use of arterial plugs substantially reduces the time required for embolisation and the selective occlusion of visceral arterial branches allows for the preservation of the stomach.

Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty: A Systematic Review and Meta-analysis.

Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss. To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty. A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications. The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included. The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size. The primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 (7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of -41.6 mL (95% CI, -69.8 to -13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high. Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty. 4.

Advanced hemostasis in axillary lymph node dissection for locally advanced breast cancer: new technology devices compared in the prevention of seroma formation

BackgroundBreast cancer is the most frequent neoplasm in women. Axillary lymph nodes dissection represents the treatment of choice in locally advanced breast cancer for prognostic and curative purposes. Seroma formation, an abnormal collection of fluid in the dead space of the axilla, is described in Literature with a wide range of incidence (3–85%). It is a source of significant morbidity and discomfort. The aim of the study is to compare the different haemostasis devices used in breast surgery, investigating the eventual superiority of an instrument among the others in terms of intraoperative and postoperative outcome, especially of seroma formation.MethodsClinical cases of female patients undergone axillary lymph nodes dissection for local advanced breast cancer between January 2013 and July 2017 at the Surgery Unit of University of Campania “Luigi Vanvitelli” were retrospectively reviewed. Patients were divided into four groups, according to device utilized during surgery: Electrocautery, Harmonic Scalpel, LigaSure and Thunderbeat. All patients underwent II level axillary lymph nodes dissection associated to radical mastectomy or quadrantectomy.ResultsOne hundred consecutives patients were enrolled in the study. Intra-operative blood loss resulted statistically significant different (P < 0,01) between the Electrocautery group (94,7 ml) and the Thunderbeat group (57,2 ml), while the Harmonic Scalpel group and the Ligasure group, despite presented a lower amount of blood loss, did not differ significantly. Drainage volume resulted significantly lower (P = 0,002) in the comparison between the Electrocautery group and the Thunderbeat group; the Ligasure group and Harmonic Scapel group showed no difference between them and Electrocautery group. About the seroma formation, the Electrocautery group resulted affected by the highest seroma formation rate (64%). Seroma incidence in Harmonic Scalpel group was 24%, in Ligasure group was 44%, while Thunderbeat group showed the lowest presentation of seroma with 16%.ConclusionsIn patients affected by breast cancer requiring axillary lymphnodes dissection, the use of advanced hemostasis devices is highly desirable. Among the non-traditional tools, Thunderbeat resulted to be superior in terms of reduction of intra-operative blood loss and post-operative drainage output, moreover associated to a substantial reduction of postoperative seroma incidence.