Significant Differences In Surgical Outcomes Research Articles

An exploratory clinical trial of preoperative non-invasive localization before breast-conserving surgery using augmented reality technology.

This single-center, randomized, prospective, exploratory clinical trial was conducted to assess the clinical efficacy of an augmented reality (AR)-based breast cancer localization imaging solution for patients with breast cancer. This clinical trial enrolled 20 women who were diagnosed with invasive breast cancer between the ages of 19 and 80, had a single lesion with a diameter ≥5 mm but ≤30 mm, had no metastases to other organs, and had not received prior chemotherapy. All patients underwent mammography, ultrasound, computed tomography, and magnetic resonance imaging for preoperative assessment. Patients were randomly assigned to ultrasound-guided skin marking localization (USL) and AR-based localization (ARL) groups (n=10 in each group). Statistical comparisons between USL and ARL groups were made based on demographics, radiologic features, pathological outcomes, and surgical outcomes using chi-square and Student t-tests. Two surgeons performed breast-conserving surgery on 20 patients. Histopathologic evaluation of all patients confirmed negative margins. Two independent pathologists evaluated the marginal distances, and there were no intergroup differences in the readers' estimates (R1, 6.20±4.37 vs. 5.04±3.47,P = 0.519; R2, 5.10±4.31 vs. 4.10±2.38,P = 0.970) or the readers' average values (5.65±4.19 vs. 4.57±2.84,P = 0.509). In comparing the tumor plane area ratio, there was no statistically significant difference between the two groups in terms of either reader's mean values (R1, 15.90±9.52 vs. 19.38±14.05,P = 0.525; R2, 15.32±9.48 vs. 20.83±12.85,P = 0.290) or the overall mean values of two readers combined (15.56±9.11 vs. 20.09±13.38,P = 0.388). Convenience, safety, satisfaction, and reusability were all superior in the AR localization group (P <0.001) based on the two surgeons' responses. AR localization is an acceptable alternative to ultrasound-guided skin marking with no significant differences in surgical outcomes.

Abstract PO1-23-05: Exploratory clinical trial of preoperative non-invasive localization before surgery in breast cancer patients using augmented reality technology

Abstract Purpose: A single-center, randomized, prospective exploratory clinical trial to assess the clinical efficacy of augmented reality(AR)-based breast cancer localization medical imaging solution in patients with breast cancer Methods: This prospective exploratory clinical trial enrolled 20 women who were diagnosed with invasive breast cancer between the ages of 19 and 70, had a single lesion or multifocal lesion with a lesion size of 5mm or more and 30mm or less, had no metastasis to other organs, and had not received prior chemotherapy. All patients underwent mammography, ultrasound, CT, and MRI for preoperative assessment. Patients were randomly assigned to US-guided skin marking (control) and SKIA-breast (AR localization) groups of 10 each. Result: Two surgeons performed breast-conserving surgery on twenty patients. Pathologic evaluation of all patients confirmed negative margins. Two independent pathologists evaluated marginal distance, and neither the two reader's estimates (R1, 6.20±4.37 vs. 5.04±3.47, p=0.519; R2, 5.10±4.31 vs. 4.10±2.38, p= 0.970) nor the two reader's average values (5.65±4.19 vs. 4.57±2.84, p= 0.509) showed any difference between the two groups. In comparing the tumor plane area ratio, there was no statistically significant difference between the two groups for the two readers (R1, 15.90±9.52 vs. 19.38±14.05, p=0.525; R2, 15.32±9.48 vs. 20.83±12.85, p=0.290) and the two reader's mean values (15.56±9.11 vs. 20.09±13.38, p=0.388). Based on the two surgeons' responses, convenience, safety, satisfaction, and reusability were all superior in the AR localization group (p=0.000). Conclusion: AR localization is an acceptable alternative to US-guided skin marking with no significant differences in surgical outcomes. Citation Format: Minah Lee, Jun Woo Lee, Woosung Lim, Joohyun Woo, Hyun-Goo Kim, Se Hyun Paek, SangHui Park, Ji Min Kim, Jin Chung, Jee Eun Lee, Jeoung Hyun Kim. Exploratory clinical trial of preoperative non-invasive localization before surgery in breast cancer patients using augmented reality technology [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-23-05.

Multidisciplinary Management of Descending Necrotizing Mediastinitis: Is Thoracoscopic Treatment Feasible?

Background: Descending necrotizing mediastinitis (DNM) is a life-threatening condition, generally caused by downward dissemination of oropharyngeal infections through cervical fascial planes. Mediastinal drainage is conventionally achieved by thoracotomy, but a Video-Assisted Thoracoscopic Surgery (VATS) approach is gaining interest due to the reduced invasiveness of procedure. We aimed to evaluate the effectiveness of VATS treatment in patients with DNM. Methods: We conducted a retrospective multicenter study including patients with descending mediastinitis that underwent mediastinal drainage through VATS (VATS group) or thoracotomy (thoracotomy group), both in association with cervical drainage. Patients with mediastinitis secondary to cardiac, pulmonary, or esophageal surgery were excluded. The intergroup differences regarding surgical outcome and postoperative morbidity and mortality were compared. Results: A total of 21 patients were treated for descending mediastinitis during the study period. Cervicotomy and thoracotomy were performed in 15 patients (71%), while cervicotomy and VATS were performed in 6 patients (29%). There were no significant differences in surgical outcome, postoperative morbidity, and mortality between groups. VATS treatment was not associated with a higher complication rate. Patients in the VATS group had a shorter operative time (p = 0.016) and shorter ICU stay (p = 0.026). Conclusions: VATS treatment of DNM is safe and effective. The comparison with thoracotomy showed no significant differences in postoperative morbidity and mortality. The VATS approach is associated with a shorter operative time and ICU stay than thoracotomy.

Effectiveness of indirect revascularization for adult hemorrhagic moyamoya disease: a 10-year follow-up study.

The optimal surgical approach for hemorrhagic moyamoya disease (hMMD) continues to be a topic of debate. The authors' prior research demonstrated that both combined and indirect revascularization were efficacious. However, questions remain regarding the long-term prognosis consistency between these two treatments. Therefore, the objective of this study was to evaluate and compare the enduring effects of these surgical modalities on adult hMMD, extending the findings of the authors' previous studies. The authors recruited patients diagnosed with hMMD between 2010 and 2015. The patients were categorized into two groups: those who underwent combined revascularization (superficial temporal artery-middle cerebral artery bypass alongside dural reverse application) and those who underwent indirect revascularization (encephaloduroarteriosynangiosis [EDAS]). The primary and secondary endpoints of this study were instances of rebleeding, confirmed with CT scan, and death resulting from rebleeding, respectively. The authors estimated rebleeding-free and death-free survival rates by utilizing the Kaplan-Meier survival method. They used Cox regression to adjust for confounders and to evaluate the effects of the varying surgical modalities on the endpoints. After an average follow-up period of 114 months, 35 patients (28.6%) experienced 40 rebleeding events, yielding an average annual incidence of 3.5%. Of the 79 patients who received combined revascularization, 17 (21.5%) experienced rebleeding events. Similarly, of 43 patients who underwent EDAS, 18 (41.9%) experienced rebleeding events (p = 0.018). Most rebleeding instances occurred 61-120 months after surgery (21 patients [60%]), followed by 12-60 months (11 patients [31.4%]). Multivariate survival analysis highlighted significant differences in surgical outcomes (HR 0.33, 95% CI 0.15-0.74, p = 0.007). The authors observed that 8 patients (10.1%) died of rebleeding events in the combined group, as well as 10 patients (23.3%) in the EDAS group. Despite the lack of a statistically significant difference in mortality (p = 0.051), multivariable survival analysis found a significant difference (HR 0.31, 95% CI 0.10-0.97, p = 0.044). High rebleeding rates persist in adult hMMD patients, even after revascularization. Combined revascularization proved superior to EDAS in preventing long-term rebleeding. In contrast, EDAS alone did not display a clear effect on reducing long-term rebleeding rates.

Comparison of surgical outcomes of transoral robotic and endoscopic thyroidectomy: A systematic review and network meta-analysis.

This study aimed to compare surgical outcomes of transoral robotic thyroidectomy (TORT) and transoral endoscopic thyroidectomy vestibular approach (TOETVA), concurrently compared with conventional transcervical thyroidectomy (CTT). A network meta-analysis, comprising 23 studies, was performed in this study. The operative time of the CTT group was significantly shorter than that of the TOETVA and TORT groups. The hospital stay of the TOETVA group was significantly longer than that of the CTT group. Rates of transient recurrent laryngeal nerve palsy and total complications were higher in association with TOETVA than with TORT. No significant differences were found between the three groups in intraoperative blood loss, retrieved lymph nodes, postoperative pain, and other complications. Cosmetic satisfaction was significantly superior with TORT and TOETVA than with CTT. Compared with CTT, TOETVA and TORT showed superior cosmesis but no significant difference in surgical outcomes except for operative time and hospital stay.

Surgical Outcomes in Patients with Intermittent Exotropia with Siblings Who Underwent Surgery by the Same Surgeon

Purpose: We evaluated surgical outcomes in pediatric patients with intermittent exotropia with and without a family history of exotropia surgery performed by the same surgeon.Methods: We conducted a retrospective review of the medical records of pediatric patients aged ≤ 18 years who underwent surgery for intermittent exotropia between September 2015 and December 2021. We compared surgical outcomes between patients with and without a family history of exotropia surgery performed using 1:1 propensity score matching. A successful surgical outcome was defined as achieving alignment between an exodeviation of 10 prism diopters (PD) and an esodeviation of 4 PD.Results: This study included 60 patients with a family history of exotropia surgery and 60 matched controls with no such history. Notably, the log-rank test revealed no significant differences in surgical outcomes between the two groups (&lt;i&gt;p&lt;/i&gt; = 0.622). Furthermore, clinical characteristics, including the onset of exotropia, degree of ocular deviation, and age at surgery, were similar between first- and second-born siblings. Furthermore, no significant differences were observed in surgical outcomes between the two groups (&lt;i&gt;p&lt;/i&gt;= 0.540).Conclusions: Patients with a family history of exotropia surgery do not exhibit significantly different surgical outcomes compared to those with no such history. In addition, no significant differences were observed in surgical outcomes between the first- and second-born siblings.

Single-incision versus conventional multiport laparoscopic cholecystectomy in acute cholecystitis according to disease severity: single center retrospective study in Korea.

The safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis (AC) has not yet been confirmed. This single-center retrospective study included patients who underwent laparoscopic cholecystectomy (LC) for AC between April 2010 and December 2020. Propensity scores were used to match patients who underwent SILC with those who underwent conventional multiport LC (CMLC) in the entire cohort and in the two subgroups. A total of 1,876 patients underwent LC for AC, and 427 (22.8%) underwent SILC. In the propensity score-matched analysis of the entire cohort (404 patients in each group), the length of hospital stay (2.9 days vs. 3.5 days, p = 0.029) was shorter in the SILC group than in the CMLC group. No significant differences were observed in other surgical outcomes. In grade I AC (336 patients in each group), the SILC group showed poorer surgical outcomes than the CMLC group, regarding operation time (57.6 minutes vs. 52.4 minutes, p = 0.001) and estimated blood loss (22.9 mL vs. 13.1 mL, p = 0.006). In grade II/III AC (58 patients in each group), there were no significant differences in surgical outcomes between the two groups. Postoperative pain outcomes were also not significantly different in the two groups, regardless of severity. This study demonstrated that SILC had similar surgical and pain outcomes to CMLC in patients with AC; however, subgroup analysis showed that SILC was associated with poor surgical outcomes than CMLC in grade I AC. Therefore, SILC should be carefully performed in patients with AC by experienced hepatobiliary surgeons.

IBC-Oxford University2023_BJSOral_24Comparison of postoperative GERD after LSG with omentopexy versus LSG without omentopexy, incidence of peri-operative GERD LSG in East Asia.

Abstract Background Gastroesophageal Reflux Disease (GERD) is known as the most common long-term complication after laparoscopic sleeve gastrectomy (LSG). The pathophysiology is assumed that the sleeved stomach after LSG is prone to be herniated through the hiatus with high intra- abdominal pressure in obese patients. The omentopexy is thought to make the remnant stomach fixed in abdominal cavity to decrease GERD symptom. Objectives This study aims to compare postoperative GERD after LSG with omentopexy versus LSG without omentopexy as well as to report incidence of peri-operative GERD LSG in East Asia with obesity. Methods This was a single-center retrospective comparative study. Patients with severe obesity (BMI &amp;gt; 35 or &amp;gt; 30 with second metabolic disease) who underwent LSG between January 2019 and June 2021 in Seoul National University Bundang Hospital were enrolled. Patient data were collected preoperatively and at postoperative 1 year. At each time point, body weight, laboratory tests and esophagogastroduodenoscopy were assessed. The patients were asked if anti-reflux medication including proton-pump inhibitor was taken and responded to GERD questionnaire. The validated Korean version of GERD-Q questionnaire was utilized. Laparoscopic sleeve gastrectomy was performed in the usual manner, with or without omentopexy. Omentopexy was defined as the suturing the stapled stomach to the omentum which must include upper part of the sleeve. Electric medical and surgical records were evaluated by the surgeons who were specialized in gastrointestinal surgery. The primary outcome was GERD incidence evaluated by three criteria: LA classification on esophagogastroduod enoscopy, GERD-Q score and anti-reflux medication history. Results During the study period, 106 and 62 patients were enrolled in the LSG with omentopexy group (LSGO) and LSG without omentopexy group (LSGWO) respectively. The baseline demographics did not significantly differ from each group. The mean age of LSGO group was 37.8 years (standardized deviation [SD] 11.0 years] and that of LSGWO group was 38.4 years [SD 10.9 years] (p=0.959). The LSGO and LSGWO groups were comprised of 34.0% and 35.5% men (p=0.868). There were no significant differences in surgical outcomes and postoperative complications between two groups. On GERD, there was no significant difference in LA classification and anti-reflux medication proportion between two groups after postoperative 1 year. However, LSGO group showed significantly less GERD-Q score (mean, SD; 6.57, 1.56) than LSGWO group (mean, SD; 7.91, 3.0) (p=0.02), which represented less subjective GERD symptoms in LSGO group. Conclusion People with obesity who underwent laparoscopic sleeve gastrectomy combined with omentopexy showed less GERD symptoms 1 year after operation than those who without omentopexy.

Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights.

Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. Level III.

Analysis and evaluation of patient-specific three-dimensional printing in complex septal myectomy.

This study aimed to assess the effectiveness of three-dimensional printing (3DP) in patients with complex hypertrophic cardiomyopathy requiring combined transaortic and transapical septal myectomy. We created 3DP models for 7 patients undergoing this surgery approach between June and October 2022 using silicone-like resin and conducted mock operations. The models were compared with echocardiography to identify abnormal muscle bundles and heart structures. These patients were then compared with a 1:2 matched group without 3DP, considering age, sex and additional operations. The models mostly presenting with midventricular obstruction showed high consistency with original computed tomography data (r = 0.978, P < 0.001). 3DP identified more abnormal muscle bundles than echocardiography, primarily between the interventricular septum and apex. Excised specimens in mock operations mirrored those in actual myectomies. While cardiopulmonary bypass time was not significantly different, a near-20-min decrease was observed in the 3DP group (135.5 ± 31.1 vs 154.4 ± 36.6 min, P = 0.054). While no significant differences in surgical outcomes were observed, 3DP appeared to enhance the visualization and understanding of spatial structures (average Likert scale score 4.0), potentially contributing to surgical proficiency (overall rating score 3.9). The use of 3DP may offer additional value in the preparation and execution of operations for complex hypertrophic cardiomyopathy cases.

Perioperative Outcomes, Comorbidities, and Complications following Total Shoulder Arthroplasty in Wheelchair Users: A Retrospective Cohort Analysis of a Nationwide Database.

Impaired shoulder function hinders the ability of wheelchair users to maintain independence. The current state of the literature delineates the risks and benefits of surgical techniques for the management of shoulder pathologies. To the best of our knowledge, there is no study that has investigated complications following total shoulder arthroplasty (TSA) in wheelchair users. Utilizing the PearlDiver Mariner national administrative database, 72,108 patients were identified who underwent TSA with a concurrent diagnosis of a rotator cuff tear. Two matched cohorts, one of wheelchair users and one of non-wheelchair users, were created. Due to limitations within PearlDiver, one-year outcomes, including comorbidity and complication rates and readmission statistics, were compared between the two cohorts. Each matched cohort of 869 patients underwent TSA with a concurrent diagnosis of a rotator cuff tear. The rate of readmission in wheelchair users was greater than in non-wheelchair users (24.05% vs. 9.55%, OR: 3.00, CI: 2.279, 3.946). Patients in the wheelchair cohort exhibited higher rates of complications and comorbidities (p < 0.001). Among the most likely to be readmitted after TSA were patients with osteoarthritis, pulmonary heart disease, rheumatoid arthritis, and hypertension (p < 0.05). Significant differences in surgical outcomes existed between wheelchair and non-wheelchair users in terms of preoperative comorbidities, postoperative complications, and readmission rates.

Patient, operative and pain management factors influencing inpatient compared with surgical day care mastectomy procedures at a community hospital.

The COVID-19 pandemic highlighted the importance of maximizing same-day discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia. We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications. A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, p = 0.001), bilateral mastectomy (91% v. 9%, p = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, p = 0.04). Preoperative acetaminophen (83% v. 17%, p < 0.001), multilevel intercostal block (83% v. 17%, p < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, p < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications. We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting.

Is vagotomy necessary in palliative surgery for incurable advanced gastric cancer?: a retrospective case–control study

BackgroundThe interplay between the nervous system and cancer plays an important role in the initiation and progression of gastric cancer. Few studies have presented evidence that the sympathetic nervous system inhibits the occurrence and development of gastric cancer while the parasympathetic nervous system promotes the growth of gastric cancer. To investigate the effect of vagotomy, which is the resection of a parasympathetic nerve innervating the stomach, on the progression of gastric cancer, a retrospective study was conducted comparing the prognosis of simple palliative gastrojejunostomy (PGJ) and palliative gastrojejunostomy with vagotomy (PGJV).MethodsFrom January 01, 2000, to December 31, 2021, the medical records of patients who underwent PGJ or PGJV because of gastric outlet obstruction due to incurable advanced gastric cancer at the Yeungnam University Medical Center were retrospectively reviewed. Patients were divided into two groups: locally unresectable gastric cancer (LUGC) or gastric cancer with distant metastasis (GCDM), according to the reason for gastrojejunostomy, and factors affecting overall survival (OS) were analyzed.ResultsThere was no significant difference in surgical outcomes and postoperative complications between the patients with PGJV and patients with PGJ. In univariate analysis, vagotomy was not a significant factor for OS in the GCDM group (HR 1.14, CI 0.67–1.94, p value 0.642), while vagotomy was a significant factor for OS in the LUGC group (HR 0.38, CI 0.15–0.98, p value 0.045). In multivariate analysis, when vagotomy is performed together with PGJ for LUGC, the OS can be significantly extended (HR 0.25, CI 0.09–0.068, p value 0.007).ConclusionsWhen PGJ for LUGC was performed with vagotomy, additional survival benefits could be achieved with low complication risk. However, to confirm the effect of vagotomy on the growth of gastric cancer, further prospective studies using large sample sizes are essential.

Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients.

Patients with cirrhosis and splenomegaly often have coagulation dysfunction which affects treatment and prognosis. This study explores the status, grading, and treatment strategies of coagulation dysfunction in patients with liver cirrhosis and splenomegaly. A retrospective cohort study was conducted on the clinical data on consecutive patients with cirrhosis and splenomegaly treated at Hainan General Hospital, China, from January 2000 to December 2020. Starting research in January 2022. Among 1522 patients included into this study, 297 (19.5%) patients had normal results in all five coagulation tests (prothrombin time, prothrombin activity, activated partial thromboplastin time, thrombin time, and fibrinogen), and 1225 (80.5%) had coagulation dysfunction in at least one of these tests. There were significant differences (P < 0.05) in treatment efficacy on these patients for three of these five coagulation tests, with the exception of prothrombin activity and thrombin time. When coagulation dysfunction was classified into grades I, II, and III based on scores from the three significant coagulation tests, prothrombin time, activated partial thromboplastin time, and fibrinogen, significant differences in surgical outcomes were found among the three grades of coagulation dysfunction and between grades I and III (P < 0.05). The operative mortality rate in patients with grade III in treating liver cancer, portal hypersplenism, and/or splenomegaly was 6.5%. There was no significant difference between patients with grades I and II (P > 0.05). Approximately, 80% of patients with liver cirrhosis and splenomegaly had coagulation dysfunction. Surgery is feasible for grade I and II patients. For grade III patients, nonsurgical treatment should be given first, and surgery should only be considered when the coagulation function returns to normal or near-normal levels after treatment. This trial is registered with MR-46-22-009299.

MP07-04 OUTCOMES AND PATIENT CHARACTERISTICS FOR SACROCOLPOPEXIES PERFORMED BY UROLOGY VS GYNECOLOGY

You have accessJournal of UrologyCME1 Apr 2023MP07-04 OUTCOMES AND PATIENT CHARACTERISTICS FOR SACROCOLPOPEXIES PERFORMED BY UROLOGY VS GYNECOLOGY Rishabh Simhal, Kerith Wang, Maria D'Amico, Courtney Capella, Radhika Ragam, Yash Shah, Joon Yau Leong, Whitney Smith, Patrick Shenot, and Alana Murphy Rishabh SimhalRishabh Simhal More articles by this author , Kerith WangKerith Wang More articles by this author , Maria D'AmicoMaria D'Amico More articles by this author , Courtney CapellaCourtney Capella More articles by this author , Radhika RagamRadhika Ragam More articles by this author , Yash ShahYash Shah More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Whitney SmithWhitney Smith More articles by this author , Patrick ShenotPatrick Shenot More articles by this author , and Alana MurphyAlana Murphy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacrocolpopexies (SCP) are performed by both urologists and gynecologists; however, the majority are performed by gynecologists. We aim to elucidate if there is a difference in patient demographics and surgical outcomes based on surgeon specialty. METHODS: Open and minimally invasive SCPs performed between 2006-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database using CPTs 57280 and 57425. Frailty was calculated using the NSQIP modified frailty index (mFI-5), a previously validated 5-item score including points for diabetes, functional status, chronic obstructive pulmonary disease, heart failure, and hypertension, and the revised surgical Risk Analysis Index (RAI-rev), a validated score which accounts for patient comorbidities, age, and functional status. Univariate analysis was performed using student’s t-test and Pearson’s chi-square to compare operative parameters, patient frailty and demographics, surgical outcomes, and mortality. RESULTS: We identified 8,944 SCPs from 2006-2020. Gynecology performed 81% of cases, and urology performed 19% (p<.001). Urologists tended to perform more minimally invasive cases compared to gynecologists (84% vs 77%, p<.001). Between urologists and gynecologists, there were no significant differences in surgical outcomes, minor complications (surgical site infection, pneumonia, urinary tract infection, bleeding, or acute kidney injury), major complications (deep vein thrombosis, stroke, renal failure, myocardial infarction, pulmonary embolism, septic shock, deep wound infections, or cardiac arrest), 30-day reoperations, 30-day hospital readmissions, nor 30-day mortality. However, urology patients tended to be older (65 vs 61 years, p<.001) and frailer by mFI-5 (0.7 vs 0.5, p<.001, higher score indicating more frailty) and RAI-rev (19.4 vs 17.1, p<.001, higher score indicating more frailty). CONCLUSIONS: We found no difference in 30-day surgical outcomes for SCPs performed by urologists compared to gynecologists. However, urologists tend to perform more minimally invasive procedures and operate on older, more frail patients. This finding highlights differences in practice patterns between two specialties and warrants further studies. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e85 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishabh Simhal More articles by this author Kerith Wang More articles by this author Maria D'Amico More articles by this author Courtney Capella More articles by this author Radhika Ragam More articles by this author Yash Shah More articles by this author Joon Yau Leong More articles by this author Whitney Smith More articles by this author Patrick Shenot More articles by this author Alana Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes and risk factors for failure of trabeculectomy in glaucomatous patients in Southwest China: a 325 eyes analysis.

To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients. A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure. A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg (P<0.0001) and 3.0±0.9 to 0.9±1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure. The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.

Impact of Weight Gain on Surgical Outcomes and Quality of Life among Women after Sling Surgeries

To investigate the impact of body weight gain after sling surgeries on outcomes in women with stress urinary incontinence. A single-center, retrospective study. Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taiwan. A total of 248 women who underwent sling surgeries from 2010 to 2015 were reviewed. Patients who gained more than 10% body weight were compared with those with stable body weight. Midurethral sling surgery with single-incision, transobturator, or retropubic slings. Objective success was defined as no urine leakage during the stress test in the filling phase of urodynamic studies. De novo overactive bladder (OAB) was defined as the appearance of urgency, frequency, and/or nocturia, with or without urinary incontinence after midurethral sling surgery persisting after 6 months. Quality of life evaluations included the short forms of the Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7. A total of 248 women who underwent sling surgeries and had complete weight measurement and evaluation data before and after the surgeries were included, of whom 47 gained body weight, and 201 had a stable body weight. The median follow-up duration was 18 months (range, 6-47 months). There were no significant differences in surgical outcomes between the 2 groups regarding objective cure rate (86% vs 87%, p=.834), 1-hour pad test (4.5 ± 17.8 vs 3.6 ± 18.6 g, p=.770), or postoperative quality of life (Urogenital Distress Inventory-6: 1.9 ± 2.8 vs 2.8 ± 3.2, p=.122; Incontinence Impact Questionnaire-7: 1.8 ± 3.9 vs 2.6 ± 4.3, p=.307). A trend toward increased de novo OAB rate was observed, although this finding was not adequately powered. Weight gain after sling surgeries did not influence surgical outcomes, but there was a nonsignificant trend toward increased OAB in the weight gain group. It may be beneficial to counsel patients with regard to body weight maintenance after sling surgeries.

Clinical significance of postoperative subcutaneous emphysema after video-assisted thoracoscopic surgery for esophageal cancer.

Postoperative subcutaneous emphysema (SE) is a possible complication of thoracoscopic or laparoscopic surgery. This study investigated the risk factors and clinical significance of SE after video-assisted thoracoscopic surgery for esophageal cancer (VATS-e). This study included 135 patients who underwent VATS-e with artificial CO2 pneumothorax. Based on the X-ray images on the first postoperative day, patients were divided into two groups: N/L group (no SE or SE localized at the thoracic area, n = 65) and SE group (SE extended to the cervical area, n = 70). We compared clinicopathological features, surgical findings, and short-term outcomes between the two groups. In SE group, there were more patients who received neoadjuvant chemotherapy compared to N/L group. SE group had significantly lower preoperative body mass index. SE group had more frequently two-lung ventilation than N/L group. Multivariate analysis demonstrated that low BMI, NAC, and two-lung ventilation were independent risk factors for SE extended to the cervical area. Although pulmonary complication was relatively frequent in SE group, there were no significant differences in surgical outcomes between two groups, and all patients had SE disappeared within 21days without serious complications. Despite extension to the cervical area, SE had a modest impact on the short-term result of VATS-e with artificial CO2 pneumothorax.

Surgical outcome predictor analysis following hand-assisted or pure laparoscopic transperitoneal nephroureterectomy using the Taiwan upper urinary tract urothelial carcinoma database.

PurposeTaiwan has a high incidence of upper tract urothelial carcinoma (UTUC). This study aimed to compare the surgical outcomes following transperitoneal hand-assisted laparoscopic nephroureterectomy (TP-HALNU) and transperitoneal pure laparoscopic nephroureterectomy (TP-LNU) from the Taiwan nationwide UTUC collaboration database using different parameters, including surgical volumes.Materials and methodsThe nationwide UTUC collaboration database includes 14 hospitals in Taiwan from the Taiwan Cancer Registry. We retrospectively reviewed the records of 622 patients who underwent laparoscopic nephroureterectomy between July 1988 and September 2020. In total, 322 patients who received TP-LNU or TP-HALNU were included in the final analysis. Clinical and pathological data and oncological outcomes were compared.ResultsOf the 322 patients, 181 and 141 received TP-LNU and TP-HALNU, respectively. There were no differences in clinical and histopathological data between the two groups. No differences were observed in perioperative and postoperative complications. There were no significant differences in oncological outcomes between the two surgical approaches. In the multivariate analysis, the cohort showed that age ≥70 years, positive pathological lymph node metastasis, tumors located in the upper ureter, and male sex were predictive factors associated with an increased risk of adverse oncological outcomes. A surgical volume of ≥20 cases showed a trend toward favorable outcomes on cancer-specific survival [hazard ratio (HR) 0.154, p = 0.052] and marginal benefit for overall survival (HR 0.326, p = 0.019) in the multivariate analysis.ConclusionAlthough different approaches to transperitoneal laparoscopic nephroureterectomy showed no significant differences in surgical outcomes, age, sex, lymph node metastasis, and tumor in the upper ureter in the following period were predictive factors for oncological outcomes. Higher surgical volume did not impact disease-free survival and bladder recurrence-free survival but was associated with improved overall survival and cancer-specific survival. Exploration of unknown influencing factors is warranted.

Comparison of Quality of Life between Patients Undergoing Submental Endoscopic Thyroidectomy and Conventional Thyroidectomy: A Prospective Controlled Clinical Trial.

The objectives of this study were to compare the surgical outcomes and quality of life between patients undergoing submental endoscopic thyroidectomy and those undergoing conventional thyroidectomy. The surgical outcomes and quality of life were recorded. Forty-eight patients were included in the study. Their ages ranged from 20 to 60 years. All patients underwent lobectomy, isthmectomy, or the combination of lobectomy and isthmectomy. Most histological diagnoses were benign (85.42%). The submental endoscopic thyroidectomy group showed better scores in the energy/fatigue, emotional wellbeing, and general health domains (p = 0.006, 0.041, and 0.004, respectively). There were no statistically significant differences in surgical outcomes between the submental endoscopic thyroidectomy and conventional thyroidectomy groups (p > 0.05). Submental endoscopic thyroidectomy is feasible, and permits a better quality of life in terms of the energy/fatigue, emotional wellbeing, and general health domains.