Significant Reduction In Operative Time Research Articles

The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy

To compare surgical outcomes and complications of 334 women who underwent total laparoscopic hysterectomy with or without the use of barbed sutures for vaginal cuff closure. A retrospective study was conducted on a cohort of women who underwent total laparoscopic hysterectomy for benign gynecologic diseases at Dae-Jeon St. Mary's Hospital, between May 2009 and May 2016. Surgical outcomes and complications were compared between the two groups. A total of 334 women were included: 212 cases of vaginal cuff suture performed with traditional suture material and 122 cases of vaginal cuff suture performed with the barbed suture. No difference in major complications including vaginal bleeding and vaginal cuff dehiscence was found between the two groups, with a significant reduction in operative times for the barbed suture group (P=0.002). Underlying clinical variables including diabetes, pelvic adhesion, and obesity showed no significant differences in complication rate. Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material.

Uniportal non-intubated lung metastasectomy.

More than 15 years ago, we started a program of uniportal video-assisted thoracoscopies (VATS) lung metastasectomy in non-intubated local anesthesia. Hereby we present the short and long-term results of this combined surgical-anesthesiological technique. Between 2005 and 2015, 71 patients (37 men and 34 women) with pulmonary oligometastases, at the first episode, underwent uniportal VATS metastasectomy under non-intubated anesthesia. Four patients (5.6%) required intubation for intolerance. Mean number of lesions resected per patient was 1.51. There was no mortality. The study group demonstrated a significant reduction of operative time from the beginning of the experience (P=0.001), good level of consciousness at Richmond scale and quality of recovery after both 24 and 48 hours. Median hospital stay was 3 days and major morbidity rate was 5.5%. Both disease-free survival and overall survival were similar to those achieved with intubated surgery. VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Long-term results were similar.

Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra Leone.

In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to evaluate the number of caesarean sections needed to be performed by associate clinicians until there is no further significant reduction in operation time. This prospective study evaluates the first 50 caesarean sections performed by trainees between January 2011 and June 2016. Primary outcome was total operating time in minutes (incision to suturing time). Secondary outcomes were length of hospital stay, surgical site infections, estimated operative bloodloss and in-hospital postoperative mortality. A total of 1174 caesarean sections performed by 24 trainees were analysed. Total operation time significantly reduced during the first 15 operations from mean (SD) operation time 72 (27)-51 (18)min after 15 procedures (p<0.001). Estimated bloodloss did not significantly vary among the first 50 caesarean sections. Surgical site infections were reported in 3.7% of the operations, which was higher during the first 15 operations (6.8%) compared to the following 35 operations (2.3%). Length of stay reduced from median (range) 9 (2-39)-6 (2-127)days after 15 operations, but there was no reduction in maternal mortality. While gaining experience, the operation time of associate clinicians significantly reduced during the first 15 caesarean sections. Estimated bloodloss is not related to trainees experience.

Bipolar dissection technique in parotid gland surgery

Background: Parotid gland surgery (PGS) has to manage the balancing act between sufficient radicality and preservation of functional structures. While many studies evaluate post-therapeutic complication due to different extent of surgery, the current study introduces bipolar dissection (BP) being a fast and safe preparation technique.Methods: Analysis of clinical parameters (age, sex, tumour entity, treatment modalities, facial nerve palsy, bleeding, saliva fistula and Frey’s syndrome) of 319 consecutively included patients who underwent extracapsular dissection and superficial/total/radical parotidectomy. Subgroup analysis was done according to the preparation technique (cold vs BP).Results: Facial nerve palsy rate increased with the extent of PGS (p < .0001). There were no differences in the risk of post-operative bleeding, salivary fistula and Frey’s syndrome. BP resulted in a significant reduction of operation time (p = .04), postoperative bleeding (p = .001) and salivary fistula (p = .045) when compared with cold preparation.Conclusions: Ubiquitous available BP allows fast and safe PGS regardless its extent.

Implementation of a Vessel Sealing Device in a Centre for Thyroid Surgery: Risk and Economic Profit

This study investigated whether the use of the vessel sealing device LigaSure Small Jaw™ is cost-effective and safe in thyroid surgery despite the high cost of material. We analysed the results of 224 thyroid operations performed by the same surgeon in three time intervals. We included thyroidectomies and bilateral near-total resections (including Dunhill surgery). Minimally-invasive resections (MIVAT), unilateral resections or subtotal resections (remains > 2 ml), patients with recurrent goiter, operations with neck dissections and sternotomies were excluded. In 72 procedures carried out during the first interval (1/2011 - 6/2011), the surgeon only used the clamp-and-tie technique. In the other two intervals (II: 7/2012 - 12/2012, n = 81 and III: 1/2014 - 6/2014: n = 71), the LigaSure Small Jaw was used. We investigated operation time (cut-seam time) and the complication rates between the groups (transient/permanent laryngeal nerve palsy, severe bleeding causing reoperation and hypocalcaemia, defined as Ca < 2.0 mmol/l). Differences were calculated with the t-test and the Wilcoxon rank test. Values are given as mean ± SEM. Specimen weight and the indication for surgery (nodular goiter or Basedow's disease) were comparable in all groups, but there were fewer thyroidectomies performed in the first interval (p = 0.009). There was no difference in complication rates between the groups, such as the rate of transient laryngeal nerve palsy in % (I: 2.17; II: 1.92; III 1.44) and postoperative hypocalcaemia in % (I: 20.8; II: 21.0; III 15.5). The use of the LigaSure Small Jaw in thyroidectomy procedures led to a significant reduction of operation time (II: Δ 27.4 min; III: Δ 25.6 min; p = 0.0001) compared to interval I. This was also found for bilateral near-total resections (II: Δ 24.3 min; III Δ 32.1 min; p = 0.0001). The InEK calculation for thyroidectomy procedures estimated personnel expenses in the OR to be about 1233 €. A 31-min reduction in operation time would save 440 € of personnel expenses. The use of the LigaSure Small Jaw during thyroid surgery is safe and cost-effective for thyroidectomy procedures and bilateral near-total resections.

Posterior retroperitonoscopic adrenalectomy; a back door access with an unusually rapid learning curve.

Posterior retroperitonoscopic adrenalectomy (PRA) has become a standard approach to the adrenal gland. The aim of this study was to report an initial experience with the procedure following a proper preparatory phase highlighting the rapidity, safety and effectiveness by which it could be introduced into a surgeon's practice. Between May 2015 and July 2016, 14 PRAs were performed in 14 patients (9 females and 5 males). The average age was 46years, BMI: 25.5kg/m2, and ASA score: 2. Indications included: incidenatloma (n=5), Conn's adenoma (n=5), and Cushing's adenoma (n=4). Lesions were on average 3.3cm in size. Outcomes of interest included: operative time (OT), conversion rate, postoperative morbidity and mortality rates, and the length of hospital stay. Mean OT was 87.5min (range 35-150min). A significant reduction in OT occurred after the sixth procedure and was progressive thereafter. After the tenth case, the OT became less than 1h. No conversion was required. No intra- or post-operative complications occurred, and mortality was zero. All patients commenced oral intake and ambulated following full recovery from anesthesia. The mean length of hospital stay was 3days (range 2-6days). PRA offers a direct access to the adrenal gland allowing for target-oriented dissection. Cognitive reorientation to the anatomy of this back door access and an adequate learning curve could be rapidly achieved by experienced and properly prepared laparoscopic surgeons.

PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL OF LIGASURETM VERSUS CONVENTIONAL HEMORRHOIDECTOMY FOR GRADE III AND IV HEMORRHOIDS

Background: Performing hemorrhoidectomy with LigaSure™ vessel sealing system is a rapid and simple new technique. The aim of this study was to evaluate LigaSure™ hemorrhoidectomy (LH) to open hemorrhoidectomy (OH) performed by the conventional diathermy. Patients and methods: One hundred and sixteen patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure™ or open conventional diathermy hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, complications, need for analgesics and time to achieve complete wound healing. Results: The LigaSure™ group achieved a significant reduction in operative time, blood loss, first postoperative day pain score, seventh day pain score and overall pain score. Patients in the LigaSure™ group required less pethidine analgesia on the first postoperative day. Time to achieve complete wound healing were shorter in the LigaSure™ group. There was no difference in postoperative complications. Conclusion: LigaSure™ hemorrhoidectomy provides a valid alternative to conventional hemorrhoidectomy. Based on our results, further studies addressing long-term functional results are needed to prove that LigaSure™ hemorrhoidectomy is the ideal method of hemorrhoidectomy for the patients.

IMPACT OF THE HARMONIC SCALPEL HEMOSTASIS IN TOTAL THYROIDECTOMY IN COMPARISON WITH CONVENTIONAL HEMOSTATIC TECHNIQUE

Traditional haemostatic technique in thyroidectomy may cause some damages to surrounding tissues and it is time consuming. It is believed that these damages and the time can be reduced using ultrasonic dissector devices like Harmonic Scalpel. In this study, we investigate the benefits of harmonic Scalpel haemostasis (HS) versus conventional haemostatic techniques (CT) in total thyroidectomy. Analysis of patient’s data was done for cases with total thyroidectomies performed between 2011and 2015 by the same surgeons using either the conventional technique (Clamp and Tie technique) or the harmonic scalpel for haemostasis. Gender, age, preoperative clinical information, histopathology results,and procedure type were analyzed. and according to the type of haemostatic techniques the collected patient’s data was divided in to two groups; conventional group (CT group) in which the haemostasis was done with Clamp and Tie technique and harmonic scalpel group (HS group) in which the haemostasis was done with Harmonic Scalpel (Sonicbeat Olympus). The outcome and the complications of the both procedures were analyzed statistically and compared. The use of harmonic scalpel in total thyroidectomy significantly decreases mean operative time by (-37.635 min) 60.49±7.78 SD for HS group vs 98.13±14.165 SD for CT group with very significant P-value (0.0000). Statistical significant difference in the mean volume of postoperative drainage in (ml) through redivac drain observed between the two groups; 63.02±19.91SD for HS group and 72.50±22.79 SD for CT group with significant P-value (0.0000). There were no significant difference in the other parameters of the outcome and complications after total thyroidectomy in both groups. It is concluded from this study that main impact of harmonic scalpel in total thyroidectomy is the significant reduction in operative time and its use is safe and not associated with increase in the rate of the complications.

Use of Nonmuscle Cutting Lumbotomy Incision for Single Site Laparoscopic Retroperitoneal Donor Nephrectomy: A Novel Approach

Introduction: Laparoscopic donor nephrectomy has become the standard method of retrieval of donor kidneys from living donors. However, it has the disadvantage of breaching the peritoneal cavity with attendant risks of injury to intraperitoneal organs as well as long-term risk of adhesive intestinal obstruction. Retroperitoneal laparoscopic donor nephrectomy (RPLDN) is not popular, as it requires a muscle cutting incision for retrieval of donor kidney, thereby minimizing the benefits of laparoscopy. However, a single port RPLDN performed through lumbotomy can provide a nearly ideal approach to donor kidneys.1 This study provides the first experience in the literature of performing a single port RPLDN through lumbotomy incision. Methods: Between November 2014 and December 2015, 231 patients underwent laparoscopic donor nephrectomy at our institute. Of the 231 patients, 50 voluntary kidney donors were offered translumbar RPLDN. And 12 of the 50 patients consented for single port translumbar RPLDN. Mean donor age was 39.6±7.7, M:F 3:9, left: right 10:2, and mean body mass index was 21.86±2.64. Technique of nephrectomy—Kidney was approached through 6 cm curved lumbotomy incision nearly parallel to sacrospinalis muscle with donor in lateral position. Alexis® port with rubber glove was used as a single port with two 10 mm and two 5 mm ports placed in the finger of gloves.2 Renal vessels and ureter were ligated with double Hemolok® clips as a standard policy for all donors at our institute. Kidney was taken out through the Alexis retractor after removing the glove. Visual analogue score (VAS) was used to evaluate severity of pain in the postop period. Results: RPLDN was effectively carried out in all patients. No patient required conversion to open or transperitoneal approach. An additional port for retraction was required in the two of the first three cases. No special angulated instruments were required. Only one patient had double renal artery (8.3%) and all patients had single renal vein and ureter. No intra/perioperative complications were encountered. Mean operating time was 200.7+65 minutes (range 130–322). There was significant reduction in operative time after the initial experience. Mean warm ischemia time was 5+1.28 minutes (range 3–8 minutes). Average blood loss during surgery was 55.4+18 mL (range 30–100 mL). Mean graft kidney weight was 129.5+25 g (range 85–168 g). Mean analgesic requirement (tramadol) in postoperative period was 281.8+189.4 mg (range 100–800 mg). Mean VAS on postop day (POD) 0 and POD 1 was 5.6+1.5 and 3.9+0.9, respectively. Mean hospital stay was 2.5 days (range 2–3 days). All recipients had good initial renal function and the mean creatinine at discharge was 1.34+0.4 mg/dL. Conclusions: Single site translumbar RPLDN is a feasible alternative approach to donor surgery and can avoid inherent risks associated with the transperitoneal technique. A larger comparative study is required to know the potential benefits of this route over the transperitoneal approach. No competing financial interests exist. Runtime of video: 9 mins 58 secs

Comparative study between Harmonic FOCUSTM to clamp and tie technique for total thyroidectomy

Background: Thyroid surgery has undergone many changes during the past 2 decades, including the introduction of new surgical techniques such as endoscopic or video-assisted approaches, anesthesia care, intraoperative nerve monitoring and new hemostatic toolsObjectives: to assess the efficacy and safety of Harmonic Focus shears in total thyroidectomy compared with conventional surgical technique.Patients and methods: prospective study conducted from October 2011 till January 2016, two handers and nine patients with benign and malignant thyroid diseases, scheduled for total thyroidectomy in a governor and private hospitals were enrolled randomly into 2 groups, group A consists of 105 patient who undergone a total thyroidectomy using a harmonic FOCUSTM , and group B consists of 104 patients who underwent total thyroidectomy with conventional surgical technique.Results: Eleven patients had papillary thyroid carcinoma: 6 (5.7%) of them in group A and 5(4.8%) in group B. Eighty seven (82.9%) patients in group A had non toxic MNG, and 12(11.4%) patients had toxic MNG, 90 (86.5%) patients in group B had non toxic MNG while the other 9 (8.7%) had toxic MNG. Mean operative time was significantly lower in group A compared to Group B (100+/- 34 vs. 119+/- 30mins, respectively). In group A mean calcium level at first post-operative day was 8.36 +/- 0.54 mg/dl. In group B mean value was 8.12+/- 0.56 mg/dl. This difference was not statistically significant. There were no significant difference between the two groups concerning transient hypocalcemia requiring calcium and Vitamin D therapy: 11(10.5%) patients in group A versus 12(11.5%) in group B. No permanent hypocalcemia was found in both groups. Two patients had transient vocal cord palsy in group A(1.9%) versus 3 patients in group B (2.8%)Conclusions: The HF is a reliable, comfortable and safe instrument alternative to knot tying technique, very suitable hand-piece for total thyroidectomy. It creates a clean, bloodless surgical field, and there is an advantage for the surgeon to use a single tool for both dissection and hemostasis. Moreover, the HF is a time-saving option, allowing for a significant reduction of operative time, without affecting parathyroid function, need for medical therapy, and hemostasis in the early post-operative period.

A comparison of surgical outcomes and complications between hemostatic devices for thyroid surgery: a network meta-analysis.

This meta-analysis compared harmonic scalpel and LigaSure® systems with the conventional clamp-and-tie technique in thyroidectomy. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until December 30, 2015. Randomized controlled studies (RCTs) or two-arm prospective studies were included. The primary outcome was operation time. The data were evaluated both by pair-wise meta-analyses and network meta-analysis within a Bayesian framework using Markov chain Monte Carlo methods. Compared with the conventional hemostasis, there was a significant reduction in operation time with harmonic scalpel (HS) and LigaSure (LS) (difference in means=-24.27min, 95% CI -28.11 to -20.44min, P<0.001; and difference in means=-13.08min, 95% CI -16.88 to -9.27min, P<0.001, respectively). For total thyroidectomy and hemi-thyroidectomy, subgroup pair-wise meta-analyses found a reduction of 26.31 and 21.90min in operation time for harmonic scalpel, and a reduction of 12.77 and 17.48min for LigaSure, respectively. Among studies with mixed total and hemi-thyroidectomy, no significant difference in operation time was seen between harmonic scalpel and the conventional hemostasis (P=0.313). Network meta-analysis also found harmonic scalpel and LigaSure to have less operation time than the conventional hemostasis, and that harmonic scalpel was associated with a significant 9.78min reduction in operation time than LigaSure which was not seen in pair-wise comparison. Harmonic scalpel had significantly less risk of definitive recurrent laryngeal nerve palsy, intra-operation blood loss, and post-operation bleeding than the conventional hemostasis. LigaSure was associated with significantly less intra-operative blood loss than the conventional hemostasis (P=0.023). There was no significant difference among three different procedures in rates of transient recurrent laryngeal nerve palsy. This study found that harmonic scalpel and LigaSure decreased operation time compared with the conventional hemostasis and that harmonic scalpels was associated with the lowest operation time.

Laparascopic Sacropexy Using a Titanized Polypropylene Mesh

Introduction and Objectives: The aim of this study was to describe our initial single surgeon experience with laparoscopic sacropexy (LSC) using a titanized polypropylene mesh (pfm, Germany). The titanized polypropylene mesh is a compound material with a covalent bound nanotechnologic titanium layer and laser-cut mesh edges. We evaluated our first 20 consecutive patients undergoing LSC including our learning curve. Materials and Methods: Between June 2009 and April 2010, we performed 20 laparoscopic sacropexies using a titanized polypropylene mesh. The video describes our surgical technique and data were analyzed with respect to average operation time, hospitalization, complications, and postoperative outcome. Results: Mean operation time for LSC was 196 minutes (range: 96–316 minutes). A significant reduction of operation time was seen after 11 procedures. The mean hospitalization after laparoscopic sacropexy was 6.3 days. No major complications were observed. Two patients had to be converted to open sacropexy. Reoccurrence of the prolapse did not occur in any patient. Biocompatibility of the titanized polypropylene mesh was excellent as no erosions were observed to this date. Conclusions: Despite a time-consuming learning curve, LSC using a titanized polypropylene mesh was associated with a low complication rate and no observed mesh erosion. No competing financial interests exist. Runtime of video: 7 mins 30 secs This video was presented in 2013 at the American Urological Association Meeting in San Diego, California.

The impact of team familiarity and surgical experience on operative efficiency: a retrospective analysis.

The independent impact of individual surgical experience and team familiarity on surgical performance has been widely studied; however, the interplay of these factors and their relative, quantified, contributions to performance is poorly understood. We determined the impact of team familiarity and surgeon, and cumulative team experience on operative efficiency in total knee replacement. Retrospective analysis of all total knee replacements conducted at the host institution in 1996-2009. Multivariate generalised-estimating-equation regression models were used to adjust for patient risk and clustering. Tertiary care academic hospital. All patients undergoing TKR at the host institution in 1996-2009. Operative efficiency. A total of 4276 total knee replacements were completed by 1163 different surgical teams. The median experience level was 17.6 years for consultant surgeons and 3.7 years for trainee surgeons. After patient-risk adjustment, consultant surgical experience (p < 0.0001), trainee surgical experience (p < 0.05), cumulative team operative experience (p < 0.0001) and team familiarity (p < 0.0001) were associated with significant reductions in operative time. Surgical experience and team familiarity demonstrated concave and linear relationships with operative time, respectively. For a consultant surgeon, the expected reduction in operative time after 25 years in practice was 51 min, compared to a 21-min reduction over the span of 40 collaborations with the same team members. Surgical experience and team familiarity display important and distinct relationships with operative time in total knee replacement. Appreciation of this interplay may serve to guide implementation and allocation of procedure-specific quality improvement strategies in surgery.

Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study

The aim of this single-center, prospective, randomized, parallel-group study was to compare Dienogest and Danazol as endometrial preparation in patients who have to undergo hysteroscopic surgery for submucous myomas. We enrolled 80 consecutive eligible patients, in reproductive age, affected by submucous myomas. Pre- and posttreatment characterization of endometrium was performed by hysteroscopic visual observation and histologic confirmation. The enrolled patients were randomly assigned to two groups: 40 were treated with 2 mg of Dienogest/die, 40 with 100 mg of Danazol/die, both orally for 5 weeks, starting on day 1 of menstruation. Posttreatment comparison of endometrial patterns showed a significant more marked effect of Dienogest, respect to Danazol, in atrophying endometrium (“normotrophic non-responders” versus “hypotrophic”–“atrophic”, p = 0.028). Intraoperative data showed no significant difference between the two groups for cervical dilatation time (p = 0.326), while in the Dienogest group, we found a significant reduction of operative time (p = 0.001), infusion volume (p = 0.001), and severity of bleeding (p = 0.042). Moreover, Dienogest caused less side effects (p = 0.008). According to our data analysis, Dienogest, respect to Danazol, is more effective for the preparation of the endometrium in patients who have to undergo hysteroscopic surgery for submucous myomas, and causes less side effects.

Retroperitoneoscopic nephrectomy for benign nonfunctioning kidneys: Training and outcome.

Introduction:Between the two techniques of laparoscopic nephrectomy, retroperitoneoscopy has certain distinct advantages over transperitoneal access but may be a more difficult technique to learn. We present our experience of training novices in retroperitoneoscopic nephrectomy with a good outcome, making it a standard of care for nephrectomy at our institute.Methods:The aim of this study was to report the initial experience, learning curve, and outcome of retroperitoneoscopic nephrectomy by novices under a mentored approach. The series included four novice urologists. The data from the initial forty retroperitoneoscopic nephrectomies performed by each of them were reviewed.Results:Retroperitoneoscopic nephrectomies were successfully completed by novices in 88.1% (141/160) of the patients. Nine cases (5.6%) required the mentor's help because of nonprogression, and ten cases (6%) required conversion to open nephrectomy. The median operative time of all surgeons decreased with increased surgical experience. There was some intersurgeon variation in the learning curve ranging from 10 to 30 cases, but all surgeons showed a significant reduction in operative time across consecutive sets of ten cases. Seven cases required mentor help in the initial series (7/80) and only two in later half of cases (2/80). All minor complications were also significantly less in the later series.Conclusions:The present series represents the effectiveness of training in retroperitoneoscopic nephrectomy of novices by a responsible team and with the standard protocol and surgical steps. Through effective mentoring, the steep learning curve associated with retroperitoneoscopic nephrectomy has been overcome, making it standard of care for nephrectomy at our institute.

Efficacy and Safety of Tension-Free Vaginal Tape-Secur Mini-Sling Versus Standard Midurethral Slings for Female Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Purpose:To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI).Methods:A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register.Results:Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (P<0.00001), lower objective cure rate (P<0.00001), and higher intraoperative complication rate, compared with TVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22–1.08; P=0.08), objective cure rate (OR, 0.49; 95% CI, 0.22–1.09; P=0.08), or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT.Conclusions:This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur.

Development and Evaluation of Smart Secondary Controls Using iPad for People with Hemiplegic Disabilities

Objective: The purpose of this study was to develop and evaluate smart secondary controls using iPad for the drivers with physical disabilities in the driving simulator. Background: The physically disabled drivers face problems in the operation of secondary control devices that accept a control input from a driver for the purpose of operating the subsystems of a motor vehicle. Many of conventional secondary controls consist of small knobs or switches that physically disabled drivers have difficulties in grasping, pulling or twisting. Therefore, their use while driving might increase distraction and workload because of longer operation time. Method: We examined the operation time of conventional and smart secondary controls, such as hazard warning, turn signal, window, windshield wiper, headlights, automatic transmission and horn. The hardware of smart secondary control system was composed of iPad, wireless router, digital input/output module and relay switch. We used the STISim Drive3 software for driving test, customized Labview and Xcode programs for interface control of smart secondary system. Nine subjects were involved in the study for measuring operation time of secondary controls. Results: When the driver was in the stationary condition, the average operation time of smart secondary devices decreased 32.5% in the normal subjects (p Conclusion: The smart secondary devices using iPad for people with hemiplegic disabilities showed significant reduction of operation time compared with conventional secondary controls. Application: This study can be used to design secondary controls for adaptive vehicles and to improve the quality of life of the people with disabilities.

Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation.

Introduction The ability to treat fracture with open reduction and internal fixation (OR/IF) has dramatically revolutionized the approach to mandible fracture. With OR/IF, the postoperative role of rigid maxillomandibular fixation (MMF) has declined, but it is used to maintain proper occlusion until internal fixation of the fracture is achieved. Objective To assess intraoperative manual MMF during OR/IF of selected cases of mandibular fractures. Methods This prospective study was conducted on 80 patients with isolated mandibular fractures managed by OR/IF using two titanium miniplates. The patients were classified into two groups: a control group (40 patients) treated by OR/IF after intraoperative rigid MMF followed by immediate MMF removal, and a study group (40 patients) treated by rigid MMF, which was replaced by temporary intraoperative manual MMF (3MF) until plate fixation. Results There were no significant differences of the postoperative complication and dental occlusion, although a highly significant reduction of operative time was achieved in the 3MF group. Patient who received the 3MF technique had statistically significantly better average intrinsic vertical mouth opening in the early postoperative period (1 week after surgery), and normal mouth opening could be achieved in all cases in both groups 8 weeks after surgery. Conclusions Intraoperative rigid MMF is not mandatory and can be replaced in selected cases of fracture mandible by manual maintenance of proper dental occlusion until hardware fixation, gaining the advantages of shorter operative time and less risk of blood-transmitted diseases to the surgical team and the patient in addition to the benefits of immediate postoperative mandible mobilization.

Surgical learning curves and operative efficiency: a cross-specialty observational study

ObjectivesTo evaluate the learning curves of three high-volume procedures, from distinct surgical specialties.SettingTertiary care academic hospital.ParticipantsA prospectively collected database comprising all medical records of patients undergoing isolated coronary artery bypass...

Intraoperative skull-femoral traction in posterior spinal arthrodesis for adolescent idiopathic scoliosis: the impact on perioperative outcomes and health resource utilization.

Retrospective, single-center cohort study. To study how the systematic use of intraoperative skull-femoral traction (IOSFT) in posterior arthrodesis for adolescent idiopathic scoliosis impacts perioperative outcomes and health resource utilization. Large scoliosis curves have been associated with increased morbidity and utilization of health resources. When used with reliable neurophysiological monitoring, IOSFT has shown to be safe and to reduce curve magnitude intraoperatively. Thus, we hypothesized that the systematic use of IOSFT may contribute to reducing health resource utilization by reducing curve magnitudes intraoperatively. Seventy-three consecutive patients with adolescent idiopathic scoliosis who underwent single-stage posterior spinal arthrodesis from 2008 to 2012 at a tertiary children's hospital were identified. Forty-five patients were operated with IOSFT (traction group) and 28 patients were operated without IOSFT (nontraction group). Outcome measures included operative time, calculated blood loss, blood transfusion requirement, traction-related complications, and cost comparisons. Operative time was 375.6 minutes for the traction group (P=0.0001) and 447.6 minutes for the nontraction group. Calculated blood loss was significantly less in the traction group (P=0.027). Thirty-three percent of patients in the traction group required blood transfusion compared with 64% of patients in the nontraction group (P=0.01, absolute risk reduction of 31%). There was no significant difference in curve magnitude correction (P=0.49). There were no significant complications with the use of traction. There was a significant reduction in cost per surgical procedure in the traction group (P=0.0003). The systematic use of IOSFT in posterior spinal arthrodesis for adolescent idiopathic scoliosis contributed to significant reductions in health resource utilization, with no added morbidity. Further research is warranted to investigate the generalizability of these findings. 4.