Surgery Room Research Articles

Development of memorial Sloan Kettering (MSK) surgery stress score for older adults with cancer.

e24014 Background: The stress from oncologic surgeries for older adults may lead to poor surgical outcomes. In this study, we aim to develop a MSK Surgery Stress Score to measure the complexity of surgery for these patients. The score could then be used for future analyses using datasets where patients undergoing a variety of procedures. Methods: This is a retrospective analysis of adults aged 75 and older who underwent elective cancer surgery in our institution with hospital length of stay of at least one day in 2015 to 2020. Based on surgery stress score developed by Haga et al., we explored various models including at least one or some of these variables as linear or non-linear terms: operation time, weight (kg), blood loss (cc), type of surgery, body mass index, and incision score. The primary outcome of interest evaluated was defined as the composite outcome of death within 90-day of surgery, readmission or emergency room visit or major complications (grade 3-5) within 30 days of surgery. We additionally explored models for a secondary outcome, where minor complications (grade 1-2) were included in the definition, and lastly, we looked at major complications alone as a tertiary outcome. For each of the model and outcomes, we used a logistic regression. We then used the logit transformation of the predicted probability to represent the proposed surgery stress score. Using this score, we evaluated the area under the curve (AUC) for each outcome. Results: In total, 1573 patients were included in the study. The median age was 80 (quartiles 77, 83) and just under half (49%) were male. The median (quartile) operation time was 181 minutes (115, 259), weight was 71 kg (62, 84), blood loss was 100 mL (50, 300), and just over (51%) of patient underwent an abdominopelvic procedure. The rate of 90-day mortality was 3.8%, while the rate of 30-day major complication, readmission and emergency room visit was 7.4%, 10% and 13%, respectively Furthermore, 21%, and 35% experienced primary, and secondary outcomes, respectively. Overall, 18 predictive models for each of the outcomes were developed and assessed. AUC for our different models ranged from 0.59 to 0.73 for the different definitions of our outcomes. Among the various models, the one defined using whether patients underwent an abdominopelvic procedure, incision score, operation time, weight, and blood loss (the latter two both included as non-linear terms) appeared to the front runner. Conclusions: We explored potential models to be used as the MSK Surgery Stress Score. Currently the model is being optimized by additional work. Following optimization of the model, future studies should validate this score in other cohorts of older surgical patients with cancer.

P331 IMPLANT OF THE BALLOON EXPANDABLE BIOLOGICAL PROSTHESIS FOR TAVI (EDWARDS SAPIEN 3 ULTRA) PRE–ASSEMBLED ON EXPANSION BALLOON, IN “OPEN” SITUATION WITH PATIENT IN CEC

Abstract The biological valve prostheses malfunctioning often leads to severe forms of heart failure, whose treatment requires surgical or percutaneous re–intervention. We report the case of a 77–year–old man with a biological aortic prosthesis since 2009 (Elan stentless–21), hospitalized for acute cardiac decompensation related to severe aortic prosthetic insufficiency (likely infective endocarditis with periprosthesis abscess involving the perivalvular fibrous lamina) and coexistence of severe mitral insufficiency. After 25 days of therapy, in stable haemodynamic conditions, surgery was scheduled to replace the aortic prosthesis and the mitral valve, in CEC. The exposure of the aortic valve plane highlighted the rupture of the prosthetic coronary cusp in the absence of prosthetic detachment and perivalvular abscess. After removal of the degenerated cusps, the preparation and implantation of the new biological prosthesis (perimount–Magna–19) was hindered by the excessive presence of calcium–fibrosis in the suture site of the valve ring which did not allow adequate sealing, with multiple peri–prosthetics leaks; the possibility of sutureless prostheses implantation was made impossible by lack of adequate anatomical conditions. In these conditions, the possibility of implanting a biological prosthesis for TAVI, pre–mounted on the expansion balloon (Ewards–Sapien3–Ultra–23mm), in an “open” situation and in CEC, was considered. The implantation of the balloon–expandable prosthesis was performed with direct vision of the aortic annulus and coronary ostia; the insertion of the prosthesis was performed on a standard “J” guide wire positioned in the ventricle; the expansion of the prosthesis was performed in two balloon inflation steps. The intraoperative ecotransophageal echo demonstrated the correct positioning of the biological aortic prosthesis with minimal periprosthetic leak. The presence of severe residual mitral insufficiency suggested a replacement of the mitral valve with biological prosthesis. On day 4 the patient was clinically stable; the transesophageal echocardiogram showed normal functioning of the prostheses. The direct implantation of the expandable biological prosthesis in the cardiac surgery room, in “open” and CEC, after excluding active endocarditic processes and infectious complications, allowed the implantation of a larger prosthesis and to avoid significant perivalvular leaks.

P177 A SHOT TO THE HEART

Abstract We report the case of a 50–year–old man who, during a wild bird hunt, was accidentally fired with a shotgun loaded with pellets which hit the chest, the neck and the face of the hunter. The patient was taken to the emergency room, tachypnoic and suffering from chest pain, systolic blood pressure was 150/70 mmHg, SpO2 88%, analgesic therapy, liquids administration and O2 therapy were performed with moderate response. On physical examination there was a reduced vesicular murmur in middle field on the right, no heart murmurs; noticeable edema of face and neck soft tissues and absence of evident jugular turgor. The ECG showed sinus rhythm, HR 100/min, morphology at the limit for ST slightly rigid in the inferior site. He underwent a total body CT in which a shotgun pellet was found located at the heart base near the right atrium, with associated pericardial fluid, with a maximum thickness of about 10 mm, with blood density. A shotgun pellet was also found in the apical segment of the right upper lung lobe with associated parenchymal ground glass (the pellet site of passage) without pneumothorax and pleural effusion. CT also showed multiple hunting pellets in the soft tissues of the face and of the neck without significant lesions. The echocardiogram confirmed the presence of circumferential pericardial effusion of mild degree, but progressively worsening, mainly represented along the cardiac apex and the inferolateral wall, but without signs of cardiac tamponade (right atrium within limits, absence of significant Doppler variation in blood flow across cardiac valves). The hospital where the patient arrived was at a distance of 30 minutes from the cardiac surgery, therefore the patient was urgently transferred to the cardiac surgery room of the hub (distance of 30 minutes). Fortunately, the patient maintained hemodynamic stability and arrived in the operating room with good blood pressure, but with a pre–tamponade effusion. The man quickly underwentcardiac surgery, the pericardial effusion was drained and the responsible breach was found in at the atrio–caval junction and successfully sutured. The patient was discharged in the 6th day and currently is in good clinical condition.

Is There Room for Microsurgery in Robotic Surgery?

Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms ' robotic surgery ' AND microsurgery , with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.

A multi-sensor architecture combining human pose estimation and real-time location systems for workflow monitoring on hybrid operating suites

Despite the advancements to improve patient safety, a significant number of errors still occur in Operating Suites (OS). To improve medical decision-making and the resulting quality of care, it is essential to monitor and understand medical activities’ workflow and interactions. Although some strategies employ different sensor devices, their focus is not on generating complete workflow information. They only combine different data sources to generate their final output, lacking at least one piece of information from a workflow. To tackle this challenge, this paper presents ▪ , a distributed architecture model for sensor data acquisition and processing. ▪ ’s main contribution lies in its multi-sensor data fusion algorithms to extract a computational representation of activities in surgical procedures. In addition, ▪ is flexible to accommodate different deployment configurations,combining depth cameras, Ultra-Wideband positioning systems,and deep learning-based human pose estimation (HPE) mechanisms. The workflow monitoring mechanism was deployed in an actual hybrid OS for an extensive evaluation of the proposal. Our experiments demonstrate that the architecture can capture the information required to monitor the surgical workflow. In particular, the proposed HPE methodology accurately detects the poses of medical staff members, with a maximum error of 5cm.

Topical treatment of pyogenic granulomas in a pediatric population: A single-institution retrospective review

To the Editor: Pyogenic granulomas (PG) are common benign vascular proliferations of the skin and mucous membranes. Because of their propensity to grow and bleed, surgical management is favored, but it can be costly, traumatic, result in scarring, or require an in-office or operative suite setting. Noninvasive treatment modalities include topical beta-blockers,1 imiquimod,2 and corticosteroids.3 By promoting vasoconstriction and downregulating proangiogenic factors such as vascular endothelial growth factor A, matrix metalloproteinase 1, and interleukin 6, topical corticosteroids potentially target several key pathways implicated in the PG pathogenesis.

The Hybrid Operative Suite with Intraoperative Biplane Rotational Angiography in Pediatric Cerebrovascular Neurosurgery: Utility and Lessons Learned

Introduction: The benefits of performing open and endovascular procedures in a hybrid neuroangiography surgical suite include confirmation of treatment results and reduction in number of procedures, leading to improved efficiency of care. Combined procedural suites are infrequently used in pediatric facilities due to technical and logistical limitations. We report the safety, utility, and lessons learned from a single-institution experience using a hybrid suite equipped with biplane rotational digital subtraction angiography and pan-surgical capabilities. Methods: We conducted a retrospective review of consecutive cases performed at our institution that utilized the hybrid neuroangiography surgical suite from February 2020 to August 2021. Demographics, surgical metrics, and imaging results were collected from the electronic medical record. Outcomes, interventions, and nuances for optimizing preoperative/intraoperative setup and postoperative care were presented. Results: Eighteen procedures were performed in 17 patients (mean age 13.4 years, range 6–19). Cases included 14 arteriovenous malformations (AVM; 85.7% ruptured), one dural arteriovenous fistula, one mycotic aneurysm, and one hemangioblastoma. The average operative time was 416 min (range 321–745). There were no intraoperative or postoperative complications. All patients were alive at follow-up (range 0.1–14.7 months). Five patients had anticipated postoperative deficits arising from their hemorrhage, and 12 returned to baseline neurological status. Four illustrative cases demonstrating specific, unique applications of the hybrid angiography suite are presented. Conclusion: The hybrid neuroangiography surgical suite is a safe option for pediatric cerebrovascular pathologies requiring combined surgical and endovascular intervention. Hybrid cases can be completed within the same anesthesia session and reduce the need for return to the operating room for resection or surveillance angiography. High-quality intraoperative angiography enables diagnostic confirmation under a single procedure, mitigating risk of morbidity and accelerating recovery. Effective multidisciplinary planning enables preoperative angiograms to be completed to inform the operative plan immediately prior to definitive resection.

Assessment of Mastectomy Skin Flaps for Immediate Reconstruction with Implants via Thermal Imaging-A Suitable, Personalized Approach?

Background: Impaired perfusion of the remaining skin flap after subcutaneous mastectomy can cause wound-healing disorders and consecutive necrosis. Personalized intraoperative imaging, possibly performed via the FLIR ONE thermal-imaging device, may assist in flap assessment and detect areas at risk for postoperative complications. Methods: Fifteen female patients undergoing elective subcutaneous mastectomy and immediate breast reconstruction with implants were enrolled. Pre-, intra- and postoperative thermal imaging was performed via FLIR ONE. Potential patient-, surgery- and environment-related risk factors were acquired and correlated with the occurrence of postoperative complications. Results: Wound-healing disorders and mastectomy-skin-flap necrosis occurred in 26.7%, whereby areas expressing intraoperative temperatures less than 26 °C were mainly affected. These complications were associated with a statistically significantly higher BMI, longer surgery duration, lower body and room temperature and a trend towards larger implant sizes. Conclusion: Impaired skin-flap perfusion may be multifactorially conditioned. Preoperative screening for risk factors and intraoperative skin-perfusion assessment via FLIR ONE thermal-imaging device is recommendable to reduce postoperative complications. Intraoperative detectable areas with a temperature of lower than 26 °C are highly likely to develop mastectomy-skin-flap necrosis and early detection allows individual treatment concept adaption, ultimately improving the patient’s outcome.

PD29-10 RETROSPECTIVE ANALYSIS OF PHALLOPLASTY BY A SPECIALIZED TRANSGENDER SURGERY CENTER

You have accessJournal of UrologyCME1 May 2022PD29-10 RETROSPECTIVE ANALYSIS OF PHALLOPLASTY BY A SPECIALIZED TRANSGENDER SURGERY CENTER Brenna Briles, Jessica Gondran, Emma R. Linder, Michael Safir, Curtis Crane, and Richard Santucci Brenna BrilesBrenna Briles More articles by this author , Jessica GondranJessica Gondran More articles by this author , Emma R. LinderEmma R. Linder More articles by this author , Michael SafirMichael Safir More articles by this author , Curtis CraneCurtis Crane More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Phalloplasty is a masculinizing genital gender affirmation surgery, requested by 91% of patients seeking surgical transition. Due to the complexity of reconstruction involved, phalloplasty has been associated with high complications, with all cause urinary complications being reported as high as 70%1. The objective of our study is to observe the specific urinary, emergent, donor site, and aesthetic complications associated with this complex procedure. METHODS: Data was gathered via retrospective chart review of 280 transmasculine patients undergoing phalloplasty at our center between 7/17 and 10/20 (38 months). RESULTS: Patients had an average follow up period of 17 months. Average age at phalloplasty was 34 years (range 18-64). 66% (185/280) received a radial forearm flap, 34% (94/280) received anterolateral thigh flap, and 0.4% (1/280) received a musculocutaneous latissimus dorsi flap. The average phallus length was 5.7 inches (range 4.5-8.5). Patients with prior masculinizing genital gender affirming surgery included: 23 metoidioplasty, 3 phalloplasty, and 28 vaginectomy. Thirty patients (11%) experienced a complication requiring urgent surgery or emergency room admission, and 19 patients (7%) experienced complications of the donor site requiring surgery. Many patients experienced urinary tract complications (Table 1) while 21 patients (7.5%) did not have urethral lengthening. No patients experienced rectal injury. Total phallus loss occurred in two cases (0.7%), due to vascular insufficiency and subsequent necrosis. Eighteen patients experienced infection of the phallus, which were resolved with antibiotics or minor incision/drainage. Seven patients (2.5%) had no phallic sensation. There were a variety of procedures done for aesthetic and hygienic purposes post-phalloplasty (Table 1). Overall, patients experienced an average of 3.6 complications requiring surgery (range 0-18) and had an average of 2.8, usually planned, visits to the operating room after phalloplasty (range 0-12). CONCLUSIONS: This is the first report of phalloplasty results from a US, high-volume (∼90 cases year), dedicated phalloplasty unit. This detailed analysis of complications of this hypercomplex surgery should prove useful to practitioners, patients and payors alike. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e508 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brenna Briles More articles by this author Jessica Gondran More articles by this author Emma R. Linder More articles by this author Michael Safir More articles by this author Curtis Crane More articles by this author Richard Santucci More articles by this author Expand All Advertisement PDF DownloadLoading ...

Detection of SARS-CoV-2 Contamination in the Operating Room and Birthing Room Setting: Risks to Attending Health Care Workers

The exposure risks to front-line health care workers (HCWs) who are in close proximity for prolonged periods of time, caring for COVID-19 patients undergoing surgery or obstetrical delivery, is unclear. Understanding of sample types that may harbour virus is important for evaluating risk. The objectives are as follows: to determine if SARS-CoV-2 viral RNA from patients with COVID-19 undergoing surgery or obstetrical delivery is present in: 1) the peritoneal cavity of males and females 2) the female reproductive tract, 3) the environment of the surgery or delivery suite (surgical instruments, equipment used, air or floors) and 4) inside the masks of the attending health care workers. In this cross-sectional study, conducted at 2 Toronto hospitals, 32 patients with COVID-19 underwent urgent surgery or obstetrical delivery and the presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real time reverse transcriptase polymerase chain reaction. Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of HCW masks positive for SARS-CoV-2 RNA. SARS-CoV-2 RNA was detected in 20/332 (6%) patient and environmental samples collected: 4/24 (16.7%) patient, 5/60 (8.3%) floor, 1/5 (1.9%) air, 10/23 (43.5%) surgical instruments/equipment, 0/24 cautery filters and 0/143 (95% CI 0–0.026) inner surface of mask samples. While there is evidence of SARS-CoV-2 RNA in the surgical and obstetrical operative environment, the finding of no detectable virus inside the masks worn by the medical teams would suggest a low risk of infection for our health care workers using appropriate personal protective equipment.

The Relationship Between Therapeutic Communication With The Patient's Level of Anxiety Performed Thoracentesis invasive Actions in the Room Lung Actions RSU Karsa Husada Batu

Anxiety is often experienced by patients who undergo an invasive procedure in health services. One such invasive procedure is thoracentesis. Efforts by officers to reduce patient anxiety by conducting therapeutic communication. The purpose of the study was to determine the relationship between therapeutic communication and the patient's level of anxiety on invasive thoracentesis in the pulmonary surgery room at Karsa Husada Batu General Hospital. The research design uses Correlative Study. The data collection method used observational research with a cross sectional approach. Respondents in this study were divided into 2, namely patient respondents as many as 41 people and officer respondents as many as 6 people. The independent variable was assessed using an observation sheet while the dependent variable was measured using the HARS instrument. The results showed that the value of good communication (53.7%) had an effect on the value of the level of mild anxiety (53.7%), sufficient communication (41.5%) had an effect on the value of the moderate level of anxiety (39%) and poor communication (4.9). %) affects the level of severe anxiety (7.3%). This shows the relationship between therapeutic communication with the patient's level of anxiety. Pearson's statistical test showed a significance value of 0.000 or (p <0.05), meaning that there was a relationship between therapeutic communication and anxiety levels of patients undergoing invasive thoracentesis. The value of r = +0.6, this indicates that the better the therapeutic communication, the lower the anxiety. It is recommended for officers to apply therapeutic communication so that the anxiety of patients facing thoracentesis can be controlled.

Successful management report of COVID-19 with unusual symptoms after heart surgery

COVID-19 is a pandemic and general health urgency with global concern which is rapidly spreading with the new sign. A 72-years-old man with diagnosis of myocardial infarction is transferred to the operating room for the coronary artery bypass surgery. The coronavirus-2019 test and the other diagnostic methods related to it were done and the result was negative. He returned to the hospital with hypotension two months after surgery. At first, the surgeon thought that these symptoms were related to the side effects of the cardiac medicines, so stopped taking and decreased the dose of those medicines. However, the hypotension persisted while the patient complained of anorexia, dizziness, and nausea. Considering the fact that the patient’s daughter was a health care worker who suffered from COVID-19, chest High-Resolution CT (HRCT) was conducted showing multi-focal peripheral consolidations in both lungs purposing viral pneumonia. Consequently, the patient was isolated. COVID-19 Polymerase Chain Reaction (PCR) was cheeked, which turned out to be positive and confirmed the diagnosis. Patients received intensive care in the hospital for six days and were discharged in good general condition to pass the rest of the isolation period at home. It is recommended according to the common symptoms of the coronavirus-2019 disease and the side effects of the cardiac patients’ medicines, such as vertigo, nausea, and vomiting, that these symptoms, in the case of these symptoms’ occurrence for the patients of coronary artery bypass surgery, can be resulted from the coronavirus-2019 disease, not from the medicine effects.

Detection of SARS-CoV-2 contamination in the operating room and birthing room setting: a cross-sectional study.

Background:The exposure risks to front-line health care workers caring for patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery are unclear, and an understanding of sample types that may harbour virus is important for evaluating risk. We sought to determine whether SARS-CoV-2 viral RNA from patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery was present in the peritoneal cavity of male and female patients, in the female reproductive tract, in the environment of the surgery or delivery suite (surgical instruments or equipment used, air or floors), and inside the masks of the attending health care workers.Methods:We conducted a cross-sectional study from November 2020 to May 2021 at 2 tertiary academic Toronto hospitals, during urgent surgeries or obstetric deliveries for patients with SARS-CoV-2 infection. The presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real-time reverse transcription polymerase chain reaction (RT-PCR). Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of health care workers’ masks positive for SARS-CoV-2 RNA. We included adult patients with positive RT-PCR nasal swab undergoing obstetric delivery or urgent surgery (from across all surgical specialties).Results:A total of 32 patients (age 20–88 yr) were included. Nine patients had obstetric deliveries (6 cesarean deliveries), and 23 patients (14 male) required urgent surgery from the orthopedic or trauma, general surgery, burn, plastic surgery, cardiac surgery, neurosurgery, vascular surgery, gastroenterology and gynecologic oncology divisions. SARS-CoV-2 RNA was detected in 20 of 332 (6%) patient and environmental samples collected: 4 of 24 (17%) patient samples, 5 of 60 (8%) floor samples, 1 of 54 (2%) air samples, 10 of 23 (43%) surgical instrument or equipment samples, 0 of 24 cautery filter samples and 0 of 143 (95% confidence interval 0–0.026) inner surface of mask samples.Interpretation:During the study period of November 2020 to May 2021, we found evidence of SARS-CoV-2 RNA in a small but important number of samples obtained in the surgical and obstetric operative environment. The finding of no detectable virus inside the masks worn by the health care teams would suggest a low risk of infection for health care workers using appropriate personal protective equipment.

PENGARUH PENDIDIKAN KESEHATAN METODE DEMONSTRASI TERHADAP HAND HYGIENE 6 LANGKAH 5 MOMEN KELUARGA PASIEN

Hospital arrangement is a place that has a high risk of Healthcare Associated Infection (HAIs). Family behavior and patients undergoing treatment at the hospital greatly influence the emergence of HAIs, one of which is applying handwashing. Health education is one way to improve the accuracy of hand washing 6 steps the first moment. The purpose of this study was to determine the difference in the accuracy of the implementation of hand washing in the patient's family with and without the provision of health education using the hand hygiene demonstration method in Irna 2 Surgery Room, RSUD Dr. Saiful Anwar Malang. Method: The design of this study was a quasi-experimental study with a non-equivalent control group design. The treatment group was given an intervention in the form of demonstration method handwashing education, while the control group was not given an intervention. 26 respondents as the control group and 26 respondents as the treatment group. Result and analysis: The results obtained 14 respondents (53.85%) in the control group did not wash their hands properly. 17 respondents (65.38%) in the intervention group washed their hands properly. There is a difference in the accuracy of hand washing in the patient's family in IRNA 2 Surgical Class 3 of RSUD Dr. Saiful Anwar Malang between control and intervention groups (p<0.05). Health education demonstration method increases the accuracy of handwashing in the patient's family. It is hoped that education about 6 steps of hand washing will continue.

ASSOCIATION DEXMEDETOMIDINE AND DEXAMETHASONE AS AN ADJUVANT TO LEVOBUPIVACAINE FOR SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK IN PATIENTS UNDERGOING UPPER LIMB SURGERIES.

Introduction: Brachial plexus block has evolved into an excellent substitute to general anaesthesia for upper limb surgeries. By curtailing the 1 stress response and using minimal anaesthetic drugs it provides intraoperative analgesia along with prolonged postoperative pain-relief. Varied avenues of brachial plexus blockade exist namely interscalene, supraclavicular, infraclavicular and axillary approach. With swift onset of dense anaesthesia of upper limb, supraclavicular brachial plexus block (SCBP) block is considered as the 'spinal of the arm. Objective: To conduct a comparative evaluation between Dexmedetomidine and Dexamethasone as an adjuvant to Levobupivacaine for supraclavicular brachial plexus block inpatients undergoing upper limb surgeries. Material and Methods: This is a prospective randomized controlled intervention study was Patients undergoing elective upper limb surgeries under supraclavicular brachial plexus block at orthopaedic surgery rooms of MGM Medical College From March 2019 to August 2020 Patients aged between 20-60 years of either sexes. Patients belonging to ASA Grade I and ASA Grade II and Patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block in included in this study. Result: The mean Onset of sensory block (mean± s.d.) of patients was higher in Group-C [13.2333± 1.6333 Mins] compared to Group-S patients [11.2000± 1.1265(Min)] which was statistically signicant (p<0.0001). the mean Duration of Sensory Block (mean± s.d.) of patients was higher in Group-S [753.5667± 5.2172 (Min)] compared to Group-C patients [718.2333± 25.7504 (Min)] which was statistically signicant (p<0.0001). the mean Duration of Motor Block (mean± s.d.) of patients was higher in Group-S [708.5667± 4.2644 (Min)] compared to Group-C patients [682.3667± 20.0095 (Min)] which was statistically signicant (p<0.0001). Conclusion: The difference of mean Fingers 0 (p=0.6311), Fingers 5 (p=0.8860), Fingers 10 (p=1.0000), Fingers 15 (p=1.0000), Fingers 20 (p=1.0000), Fingers 25 (p=0.5936) and Fingers 30 (p=0.8469) with both Groups were not statistically signicant. Bromage Score 0 (p=0.8469), Bromage Score 5 (p=0.8355), Bromage Score 10 (p=0.5693), Bromage Score 15 (p=0.5671), Bromage Score 20 (p=0.5671), Bromage Score 25 (p=0.6973) and Bromage Score 30 (p=0.7176) with both Groups were not statistically signicant.

226 Management of Closed Fractures of the Hand; Single Centre Audit

Abstract Aim To compare current practice at the local Plastic Surgery Department to national Standard British Society for Surgery of the Hand BSSH guidelines recommend for closed hand fractures. Method Retrospective data collection All procedures done within one month June 2021, compare it to previous audit done in Feb 2021 and close the audit loop Electronic data records Results June 2021 (90.5 %) meet the standard of time to presentation compared to 76% in Feb 2021 June 2021 62% meeting the standard for time to surgery compared to 46% in Feb 2021 Main reasons for delay unavailable dedicated Plastic Surgery theatre lists, busy emergency theatre lists. Conclusions Documentation of delays in presentation/Management has improved. More theatre capacity is required to avoid cancelation and delayed management.

Multimodal Intraoperative Image-Driven Surgery for Skull Base Chordomas and Chondrosarcomas.

Simple SummaryAchieving gross total resection during the first surgical intervention is particularly important for chondrosarcomas and chordomas, as recurrences are frequently impossible to resect due to post-surgical and post-radiation scarring and vascular fragility. Despite overall survival and progression-free survival being strongly dictated by gross total resection, it is reportedly achieved in less than 70% of patients. While the individual utility of several imaging modalities such as intraoperative CT, MRI, ultrasound, endoscopy, fluoroscopy and neuronavigation has already been demonstrated in previous literature; our case series highlights the importance and methodology of their simultaneous, real-time integration in the Advanced Multimodality Image-Guided Operating (AMIGO) suite at our institution to maximize of resection and mitigate complications.Given the difficulty and importance of achieving maximal resection in chordomas and chondrosarcomas, all available tools offered by modern neurosurgery are to be deployed for planning and resection of these complex lesions. As demonstrated by the review of our series of skull base chordoma and chondrosarcoma resections in the Advanced Multimodality Image-Guided Operating (AMIGO) suite, as well as by the recently published literature, we describe the use of advanced multimodality intraoperative imaging and neuronavigation as pivotal to successful radical resection of these skull base lesions while preventing and managing eventual complications.

Application of Simultaneous Localization of Multiple Pulmonary Nodules in a Hybrid Operating Room for Uniportal Video-Assisted Thoracic Surgery.

ObjectiveThis study explores the value of the application of simultaneous localization of multiple pulmonary nodules in a hybrid operating room for uniportal video-assisted thoracic surgery (VATS).MethodsThis study performed a retrospective analysis of 60 patients with multiple pulmonary nodules (the number of nodules in every patient was ≥2, 131 in total) admitted to our hospital from September 2020 to September 2021. After computerized tomography (CT) scanning in a hybrid operating room, a multi-hook locating needle was used for simultaneous localization. The localization success, surgical resection, and locating needle unhooking rates of multiple pulmonary nodules were analyzed. The complication incidence, localization time, operation time, anesthesia time, post-isolation nodule search time, and postoperative hospital stay length were analyzed. In addition, the patients’ anxieties about the puncture localization were evaluated.ResultsThe intraoperative CT scans successfully showed all pulmonary nodules. The localization success, unhooking, and nodule resection rates were 98.5% (129/131), 1.5% (2/131), and 100% (131/131), respectively. The median times of the localization, operation, anesthesia, post-isolation pulmonary nodule search, and hospital stay were 19 min [interquartile range (IQR): 15–30 min], 98 min (IQR: 80–110 min), 149.5 min (IQR: 126–171 min), 3.5 min (IQR: 1–5 min), and 6 d (IQR: 4–9 d), respectively. The incidences of pneumothorax and pulmonary hemorrhage were 20.0% (12/60) and 13.3% (8/60), respectively. The self-rating anxiety scale score of the patients was 53.6 ± 6.1.ConclusionThe hybrid operating room could be beneficial in accurately localizing multiple pulmonary nodules with reasonable safety and patient tolerance, and it is applicable to uniportal VATS.

A PROSPECTIVE STUDY ON THE INCIDENCE AND RISK FACTORS OF WOUND DEHISCENCE OF EMERGENCY LAPAROTOMY SURGERIES IN A TERTIARY CARE HOSPITAL

Introduction: Abdominal wound dehiscence is one the major complications of emergency laparotomy. It can range from minor wound gap to more serious emergency condition like burst abdomen and intensive care. It is one of the major causes of morbidity and mortality in emergency surgeries. Several risk factors have been identified as possible causes of wound dehiscence. Materials and Methods: The prospective observational study was conducted on 80 patients undergoing midline laparotomy in the emergency surgency. Informed written consent was obtained from all the participants after approval from the ethical committee of the institution. Complete evaluation of all patients with thorough history and clinical examination was done. Preoperative investigations were reported and underlying corrections were done. After proper resuscitation and preparation, patients were sent to operation room for surgery. Results: Out of the 80 cases on which emergency laparotomy were done, wound dehiscence was observed in 13 cases (16.25%). The highest incidence was found in the elderly age group (>60years) and highest in the emergency laparotomies indicated for bowel perforation with peritonitis. Timing of presentation and duration of surgery along with lab abnormalities like anemia, low serum albumin, uremia is thought to predispose to wound dehiscence. Intra-abdominal distension and paralytic ileus was also predisposing factors in post-operative period. Conclusion: abdominal wound dehiscence especially when done in emergency setting had higher risk of wound dehiscence due to less time for correction of underlying causes and lack of sterile techniques due to higher load of emergency cases. Emphasis has to be given in the reducing the modifiable risk factors.

The effect of few historical data on the performance of sample average approximation method for operating room scheduling

AbstractWe model the scheduling problem of a single operating room for outpatient surgery, with uncertain case durations and an objective function comprising waiting time, idle time, and overtime costs. This stochastic scheduling problem has been studied in diverse forms. One of the most common approaches used is the sample average approximation (SAA). Our contribution is to study the use of SAA to solve this problem under few historical data using families of log t distributions with varying degrees of freedom. We analyze the results of the SAA method in terms of optimality convergence, the effect of the number of scenarios, and average computational time. Given the case sequence, computational results demonstrate that SAA with an adequate number of scenarios performs close to the exact method. For example, we find that the optimality gap, in units of proportional weighted time, is relatively small when 500 scenarios are used: 99% of the instances have an optimality gap of less than 2.6 7% (1.74%, 1.23%) when there are 3 (9, many) historical samples. Increasing the number of SAA scenarios improves performance, but is not critical when the case sequence is given. However, choosing the number of SAA scenarios becomes critical when the same method is used to choose among sequencing heuristics when there are few historical data. For example, when there are only three (nine, many) historical samples, 99% of the instances have less than 25.38% (13.15%, 6.87%) penalty in using SAA with 500 scenarios to choose the best sequencing heuristic.