Simultaneous Surgery Research Articles

Use of Simultaneous Bilateral Cataract Surgery (SBCS) to Optimize Parameters Affecting the Subjective Perception of the Procedure.

Introduction Simultaneous Bilateral Cataract Surgery (SBCS) is still a relatively controversial procedure. The main objection is the risk of bilateral endophthalmitis or bilateral refractive error. However, SBCS has also some advantages (faster visual rehabilitation, lower risk of nosocomial infection, and lower cost). Performing surgery on both eyes in one session has one additional advantage which has not yet been described in the literature (according to the information available to authors). It allows surgeons to distinguish the effect of minor differences in the surgical protocol on the subjective perception of the procedure more accurately, which is a more suitable method than comparing two independent groups of patients. Purpose To compare the effect of minor changes in the surgical protocol during SBCS on intraindividual subjective perception of surgery (pain, pressure, glare, and perception of the duration of the surgery). Methods During the surgery of the right and left eyes of one patient, we randomly changed one surgical parameter (use of intracameral anesthesia, light intensity of the operating microscope, type of eyelid speculum, creation of the posterior circular capsulorhexis, and communication with the patient during surgery). Patients immediately after both surgeries subjectively evaluated the perception of pain (on the scale 0–10), pressure, and glare (on the scale 0–5) and estimated the duration of the surgery, separately for each eye. Each change was evaluated in a group of 50 patients. Results In the control group with no parameters changed, we noted no difference in subjective perception of the first and second surgery. In subgroups, where we changed the protocol, we detected only minor differences in subjective perception of pain, pressure, glare, and duration of the surgery. Only one statistically significant difference in subjective pain perception was in the subgroup where we used eye intracameral anesthesia (0.34 eyes with intracameral anesthesia, 0.44 eyes with only topical anesthesia). We did not note any statistically significant differences in the perception of the time of surgery. Conclusion SBCS can be used to optimize the parameters of cataract surgery. In our study, we noted a positive effect of intracameral anesthesia on subjective perception of surgery.

P0290 - Simultaneous Bilateral Endoscopic Surgery (SBES): Is it ready for prime time?

P0290 - Simultaneous Bilateral Endoscopic Surgery (SBES): Is it ready for prime time?

Simultaneous Bilateral Thoracoscopic Pneumonectomy for Early Multiple Primary Lung Cancer Feasibility Analysis

Objective: To analyze the feasibility of simultaneous bilateral thoracoscopic lung resection in the treatment of multiple primary lung cancers in the early stage. Methods: The study time range is between March 2019 and March 2021. A sample of 30 patients with early multiple primary lung cancer admitted to this hospital were included, and they were divided into a study group, a control group, and samples within the group using a random number table scheme n=15, patients in the control group underwent staged bilateral thoracoscopic pneumonectomy, and patients in the study group underwent bilateral thoracoscopic pneumonectomy at the same time. The indicators of the two groups were compared and analyzed. Results: There was no significant difference in the operation time and intraoperative blood loss between the two groups (P>0.05). There were significant differences in the VAS score, total length of hospital stay, and total surgical costs on the first day after surgery (P<0.05); there was no significant difference in the two groups' postoperative recovery indicators and the incidence of complications (P>0.05). Conclusion: It is safe and feasible to treat patients with multiple primary lung cancer in both lungs at the same time with simultaneous bilateral thoracoscopic surgery, and is suitable for promotion.

Simultaneous Robotic Single-Position Surgery (SR-SPS) with Oblique Lumbar Interbody Fusion: A Case Series

The oblique lateral interbody fusion (OLIF) procedure is an important component of the surgeon's armamentarium for the treatment of degenerative spinal conditions. OLIF with posterior spinal fixation frequently is performed and requires additional time because the patient is flipped to a prone position and redraped. We report a series of cases in which robotic-assistance was used for a 2-surgeon workflow in which OLIF and single lateral position posterior spinal fixation were performed at the same time, termed simultaneous robotic single position surgery (SR-SPS). Data were collected retrospectively from medical records of 13 consecutive patients who underwent SR-SPS by a single surgeon at an academic center between June and December 2020. Instrumentation accuracy, total operating room time, estimated blood loss, length of stay, and complications were assessed. A total of 13 patients whose mean age was 64.1 years (range 46-84 years) underwent SR-SPS over a 6-month period. Average follow-up was 10.3 months. All patients were treated for degenerative spine disease. The average operative duration was 111.2 ± 25.2 minutes. A total of 60 pedicle screws were placed bilaterally in the lateral position with an accuracy rate of 95.0%. Complications included 1 postoperative seroma, and 1 patient required reoperation 3 months postoperatively due to a fall. We report the first case series describing SR-SPS. Our study shows that this method can reduce operative time while ensuring accurate and timely screw placement with minimal complications.

Feasibility of radical gastrointestinal tumor resection with simultaneous off-pump coronary artery bypass surgery for patients with severe heart problems: A retrospective cohort study from a single institutional database.

Clinical treatment of gastrointestinal neoplasms in patients with severe coronary stenosis is difficult, and it remains controversial to perform staged or simultaneous surgeries. The purpose of this study was to retrospectively analyze the feasibility and indications for simultaneous gastrointestinal tumor resection and off-pump coronary artery bypass (OPCAB) graft surgery. Data collected from a total of five patients, including three patients with gastric cancer and two patients with colorectal cancer, who underwent simultaneous radical cancer resection and OPCAB between September 2010 and October 2019, were retrospectively analyzed. Among these patients, one had an incomplete colonic obstruction. All patients had severe coronary stenosis, and one experienced acute heart failure before surgery. OPCAB was performed first, followed by the radical cancer resection. All five patients were discharged from hospital without perioperative death, major cardiovascular events or anastomotic leakage. The mean postoperative hospital stay was 9.4 days. One patient experienced slight gastrointestinal bleeding after surgery, which improved with conservative treatment. After a mean follow-up of 39 months, two patients with gastric cancer died from tumor metastasis at 28 months and 37 months, while the remaining three patients did not have tumor recurrence or metastasis. None of the patients experienced myocardial ischemia. It is safe and feasible to perform simultaneous OPCAB and gastrointestinal surgeries on the premise of strictly controlling the indications for patients with gastrointestinal tumors complicated with severe coronary artery stenosis.

Simultaneous bilateral opening-wedge high tibial osteotomy with structural allograft impaction results in excellent early recovery and pain reduction similar unilateral osteotomy

BackgroundPatients suffering from bilateral combined medial osteoarthritis and varus alignment of the knee are eligible for bilateral high tibial osteotomy (HTO) in two-staged surgery. The impact of bilateral HTO surgery on rehabilitation and early outcomes have not yet been reported in the literature, even though these features are decisive in establishing whether a patient is preferably treated in one or two stages. MethodsA total of 29 patients were followed after simultaneous bilateral HTO surgery. Numeric Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score – Physical Function Short Form (KOOS-PS) and Lysholm scores were recorded at 3, 6 and 12 months. Results were compared with outcomes of unilateral HTO surgery to asses the additional impact of simultaneous bilateral HTO surgery on the early rehabilitation and recovery of simultaneous bilateral HTO surgery. ResultsThree months after surgery, NRS pain scores decreased from 60.5 to 40.9 and subsequently to 30.4 and 24.3 after 6 and 12 months, respectively. KOOS-PS scores improved from 50.0 to 44.3 after 3 months, to 33.9 and 29.8 after 6 and 12 months, respectively. Lysholm scores did not improve after 3 months (45.2–44.2), but significantly improved after 6 and 12 months (66.1 and 75.7, respectively). Compared with unilateral HTO surgery, similar improvements were seen after 6 and 12 months. ConclusionSimultaneous bilateral HTO surgery generates similar clinical outcomes compared with unilateral HTO surgery and moreover it does not excessively prolong time to achieve these outcomes. It is safe and presumably a more effective approach to treat patients suffering bilateral medial osteoarthritis and varus alignment of the knee compared with two-staged surgery.

Simultaneous Orthognathic Surgery With Asian Double Eyelid Suture Blepharoplasty.

The main objective of contemporary orthognathic surgery is to correct dentofacial deformities. Nonetheless, many adjunct procedures to enhance the esthetic outcome in orthognathic surgical cases have been successfully incorporated to improve patient satisfaction. The authors report our preliminary experience of performing simultaneous orthognathic surgery with Asian double eyelid suture method blepharoplasty in the same surgical setting. This case series report includes all 19 consecutive cases presenting to the Chang Gung Craniofacial Center for combined orthognathic surgery with Asian double eyelid suture method blepharoplasty. The double eyelid crease height was measured as the vertical line between the upper eyelid margin (eyelid lash) and the upper eyelid crease, observed at the mid-pupillary line with the eyes in primary gaze. There were no complications or relapse reported within this time period. There was significant improvement in the left and right mid-pupillary double eyelid crease height postsurgery. There were no statistically significant differences between the left and right mid-pupillary double eyelid crease heights after surgery indicating good eyelid crease height symmetry bilaterally was obtained. Orthognathic surgery combined with suture method blepharoplasty can be safely performed in the same surgical setting without inappropriate rise in costs or operating room time. This case series demonstrates that excellent esthetic results can be obtained in simultaneous bimaxillary orthognathic surgery with suture method Asian blepharoplasty.

The Fate of the Tricuspid Valve in Rheumatic Mitral Valve Surgery: When and How to Touch?

Objective: Indications for concomitant surgery for tricuspid valve involvement in rheumatic mitral valve surgery is limited in the literature. We aimed to investigate the long-term course of unrepaired tricuspid valves during rheumatic mitral valve surgery in addition to characteristics of surgical technique in tricuspid repair. Methods: The data of all patients who underwent mitral valve replacement due to rheumatic pathology between January 2011 and December 2014 were evaluated. Besides mitral valve replacement, patients were divided into three groups: non-repair (Group I), concomitant tricuspid valve repair either with DeVega annuloplasty (Group II) or ring annuloplasty (Group III). A total of 333 patients were included in the study. Primary outcomes as; the rate of severe tricuspid valve regurgitation in long-term, re-intervention requirement for the tricuspid valve, and long-term functional capacity of the patients were assessed. Results: The mean age was 45.2±9.7 years (min 18, max 60, female 69.1%). Tricuspid valve repair was performed in 178 patients (53.4%). Of them, 100 patients (30%) received De Vega suture annuloplasty, while 78 (23.4%) were treated with the ring annuloplasty. In the late period, severe tricuspid valve regurgitation and the need for reintervention were not observed in group III, also there was a statistically significant difference compared to the other groups (p <0.001 and 0.05; group I and II, respectively). In terms of functional capacity, the incidence of NYHA III and IV in group III was significantly lower in the late-term compared to the other groups(p= 0.02). Conclusions: Simultaneous tricuspid valve surgery should be performed with mitral valve surgery in patients with rheumatic heart disease. The long-term results of ring annuloplasty are superior to the suture (de Vega) annuloplasty for rheumatic tricuspid regurgitation. Table. Long term results according to tricuspid valve intervention type (in surviving patients) Non repair(n=151) TDVA(n=94) Ring annuloplasty(n=75) p-value Follow-up (years) 3.7 (2.3-4.7) 3.7 (2.1-4.2) 3.1 (2.3-4.4) 0.59 NYHA Class III/IV 47 (31.1) 32 (34.0) 12 (16.0) 0.02* Echocardiography findings EF (%) 60 (50-65) 60 (55-65) 60 (50-65) 0.55 LVESD (cm) 3.6 (3.0-4.3) 3.2 (3.0-3.9) 3.2 (3.0-4.0) 0.11 LVEDD (cm) 5.0 (4.6-5.5) 5.0 (4.6-5.2) 4.9 (4.7-5.2) 0.53 LAD (cm) 4.2 (3.9-4.7) 4.5 (4.0-4.8) 4.6 (4.2-5.2) <0.001* PAP (mmHg) 35 (1-45) 35 (35-45) 30 (25-35) <0.001* TR degreeMildModerateSevere 81 (53.6)36 (23.8)23 (15.6) 54 (57.4)28 (29.8)8 (8.5) 39 (52.0)15 (20.0)0 <0.001* Need for reintervention for the tricuspid valve 7 (4.6) 2 (2.1) 0 0.05* EF: ejection fraction, NYHA: New York Heart Association, PAP: pulmonary artery pressure, LAD: left atrium diameter, LVESD: left ventricular end-systolic diameter, LVEDD: left ventricular end-diastolic diameter, TDVA: tricuspid de Vega annuloplasty, TR: tricuspid regurgitation.

A case of simultaneous laparoscopic surgery for double cancer comprising multiple early gastric cancer and advanced sigmoid colon cancer after revascularization

BackgroundTraditionally, the surgery for simultaneous double cancer of the stomach and colon required a large incision to the upper and lower region of the abdomen. In this case, an artificial blood vessel was located under the skin after revascularization. Considering ischemia due to graft compression by incision retractor during laparotomy, this was difficult to do. This is a report on laparoscopic surgery for simultaneous double cancer of the stomach and colon after revascularization.Case presentationA 69-year-old man had early gastric cancer and advanced sigmoid colon cancer. He had suffered from thromboangitis obliterans and has undergone revascularization many times due to poor blood flow in his lower limbs. He had had some artificial blood vessels inserted under the skin, confirmed by blood vessel construction image by preoperative computed tomography (CT). There was a bypass vessel from the left axillary artery to the left femoral artery under the skin of the left thoracoabdominal. In addition, there were two bypass vessels from the left external iliac artery to the right femoral artery under the skin of the lower abdomen. One of the two bypasses was occluded. In the blood flow to the intestinal tract, the inferior mesenteric artery was already occluded. Peripheral blood flow in the common iliac artery depended on blood flow from the artificial blood vessel, and blood flow from the internal iliac artery to the rectum was poor. Laparoscopic Hartmann’s operation was performed for Stage II B (UICC 8th Edition) sigmoid colon cancer. Because the blood flow in the intestinal tract on the anal side was poor, we thought that anastomosis was at a high risk for leakage. Laparoscopic total gastrectomy was also performed simultaneously for two Stage I (UICC 8th edition) gastric cancers in the cardia and body. The location of the port site and stoma was carefully determined preoperatively to prevent damage and infection to the artificial blood vessels. Minimal invasive surgery was performed using laparoscopic surgery.ConclusionsLaparoscopic surgery with small incisions is useful for patients with double cancer who need an approach to the upper and lower abdomen. Furthermore, laparoscopic surgery has less interference on graft in patients with artificial blood vessels under the skin by intraperitoneal approach.

Simultaneous Robotic Single-Position Surgery With Oblique Lumbar Interbody Fusion With Software Planning: 2-Dimensional Operative Video

The use of robotic guidance for spinal instrumentation is promising for its ability to offer the advantages of precision, accuracy, and reproducibility. This has become even more important in the era of lateral interbody surgery because spinal robotics opens up the possibility of a straightforward workflow for single-position surgery in the lateral position. We present here a case of a 72-yr-old woman who presented with an L4-5 spondylolisthesis with axial back pain and radiculopathy. She subsequently underwent an L4-5 oblique lumbar interbody fusion with L4-5 bilateral posterior instrumentation in a single lateral position (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Due to the oblique lateral approach and posterior robotic assistance, both surgeons were able to work simultaneously for increased efficiency. To our knowledge, this is the first video demonstrating a two-surgeon simultaneous robotic single-position surgery with oblique lumbar interbody fusion using a spinal robotic platform. There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

Endolymphatic Sac Surgery And Posterior Semicircular Canal Fenestration For Meniere's Disease.

Objective: To evaluate the efficiency and safety of the simultaneous endolymphatic sac drainage (ELSD) and posterior semicircular canal fenestration (PSCF) primary on the vestibular function as an new therapeutic strategy in the patients with medically refractory Meniere's disease (MD).Study Design: retrospective follow-up study.Setting: University Clinic of Otolaryngology.Methods: Twenty-six patients with MD with severe vertigo and disability who underwent ELSD and PSCF in the same time in the period of 1988 and 2007 were reviewed. The main outcome measures were frequency of vertigo, functional disability according the guidelines for diagnosis and evaluation of therapy in MD. The canal paresis was evaluated by caloric test. The degree of reduced vestibular response rates as an indicators of the vestibular function were compared before and after surgery.Results: The preoperative audition was already altered in all cases except in 8 patients who had no significant changes in hearing threshold. The mean value of vertigo attacks before operation was 8.6. After 3 years of surgery only one patient (3.8%) had one vertigo attack. Functional level was highly ameliorated except in two patients who presented functional level 2 or B in the late postoperative period. The mean caloric testing duration after 3 years postoperatively showed that the 50% of the patients approaching the normal results.Conclusion: Based on the results of simultaneous endolymphatic sac surgery and posterior canal fenestration, they are effective methods for treatment of the refractory Meniere's disease. Endolymphatic sac surgery enables drainage of endolymphatic fluid and the fenestration of the posterior semicircular canal enables the distension or dilatation of the membranous canal in the decompressed perilymphatic space across the perilymphatic leak at the level of the new fenestra, and, so, appearing of certain decrease of the endolymphatic pressure. Both techniques at the same time decrease the pressure in the case of the endolymphatic hydrops.

Fast-track surgery and enhanced recovery after surgery concepts after their application in hernia repair

The growing number of surgical interventions that occur worldwide, along with the increasing prevalence of general somatic pathology, keeps current the problem of preventing complications during surgery and in the postoperative period. An efficient solution to this problem is to determine the risk of surgery, directed preoperative preparation, taking into account the comorbidity, optimization of surgery and postoperative rehabilitation. Fast-track surgery and enhanced recovery after surgery programs have significant potential for improving outcomes of surgery. These programs are widely used in various fields of surgery, but their effectiveness in herniology, especially in the performing simultaneous surgeries, there are very few reports, and the results of individual studies are contradictory. The review provides an analysis of holistic strategies of fast-track surgery and enhanced recovery and individual measures to assess the effectiveness of their impact on the immediate results of surgical interventions.

The role of computed tomography in optimizing the surgical treatment of ventral hernias

In spite of a high informative value, spiral computed tomography is currently an additional optional examination and it is not included in domestic and foreign preoperative examination protocols.&#x0D; Purpose – assessing the feasibility of spiral computed tomography in the complex of presurgery examination of patients with ventral hernias. Materials and methods. The paper deals with analyzing the diagnostic findings of 35 patients with ventral hernias treated at Surgery Department of Municipal Non-Commercial Enterprise of Kharkiv Regional Council “Regional Clinical Hospital” during 2018–2019 period. All patients were operated on after compulsory and additional examinations according to the existing guidelines. Spiral computed tomography was an additional examination for all patients. The frequency of symptoms detected by means of computed tomography and confirmed during surgery was analyzed.&#x0D; Results. Most of the signs revealed during tomography and associated with the combined abdominal pathology, were completely confirmed by laparoscopic exploration of the abdominal cavity and pelvis. Spiral computed tomography was of particular value in patients clinically diagnosed with chronic appendicitis. When assessing the ventral hernia, it was possible not only to clearly determine its content and location towards the abdominal line, but also, before surgery, to calculate the width and length of the hernia gate and the volume of the organs in hernia sac. Unlike ultrasonography, computed tomography makes it possible to thoroughly evaluate the dimensions of the hernia gate and the state of the muscular aponeurotic layer of the anterior abdominal wall. Not least important is diagnosing the combined abdominal pathology, including the oncological one, which has no clinical manifestations but still has to be exposed to surgery.&#x0D; Conclusions. In the complex of preoperative examination of patients with ventral hernias, spiral computed tomography provides useful information on the anatomical features of ventral hernia and the combined abdominal pathology that requires surgical intervention. These data aid in planning a favorable type of hernioplasty of ventral hernia and simultaneous surgery. Spiral computed tomography is recommended to be added to the standard protocol of presurgery examination of patients with ventral hernias.

Simultaneous Bariatric Surgeries in Females with Neoplasm of the Reproductive System and Morbid Obesity

Introduction. The frequency of occurrence of morbid obesity and neoplasms of the female reproductive system is very high and these conditions aggravate each other. Therefore, it is relevant to simultaneously perform laparoscopic bariatric operations and radical interventions for benign and malignant tumors of the female reproductive system in such cases. The experience of such simultaneous interventions is still small and in the available literature is limited to the description of single cases. The primary issues are the fundamental possibility of combining the two stages in one operation, the technical aspects of such interventions, and the assessment of perioperative safety and immediate results.The aim of the study was to create a technique of simultaneous surgical treatment of the pelvic organs neoplasms and morbid obesity in females, to assess the perioperative safety and immediate results of such simultaneous operations.Methods. The authors present their experience and the first results of simultaneous laparoscopic sleeve gastrectomy and hysterectomies in 9 women with malignant and benign neoplasms of female genitals, suffering from morbid obesity. A method of simultaneous combined surgical treatment of neoplasms of female genitals and morbid obesity has been developed and described.Results. The proposed technique allowed performing two interventions during one procedure in a minimum time, technically in the simplest way without additional complications and risks. The duration of simultaneous operations averaged 162.7 21.8 min., the average blood loss was 247.6 31.0 ml, the pain syndrome on the first day was moderately expressed, no serious complications were observed.Conclusions. The results obtained demonstrated that the morbidity and perioperative safety of simultaneous operations are comparable to those with separate performance of such operations with certain benefits.

Simultaneous or staged operation for tandem spinal stenosis: surgical strategy and efficacy comparison

BackgroundTandem spinal stenosis (TSS) has a complex clinical presentation, and there is no consensus on the optimal surgical strategy. This study retrospectively compared the efficacy of different staged operations and simultaneous decompression for patients with TSS.MethodsWe reviewed data from 132 patients with TSS who received surgical procedures from January 2011 to June 2018. Patients were classified into three groups according to the most symptomatic area of compression (group C: first-stage surgery for cervical compression; group L: first-stage surgery for lumbar compression; group CL: simultaneous surgery for both). Medical records were reviewed for age, gender, comorbidities, operation time, combined estimated blood loss, and time of hospitalization. The JOA-C, JOA-L, NDI, and ODI scores, and complications were also examined.ResultsPostoperative outcomes were followed for 32.1 ± 5.4 months. There were significant differences in the re-operation rate and the interval time between the two types of staged operations (p = 0.005 and p = 0.001, respectively). There were no significant differences in gender (p = 0.639), operation time (p = 0.138), combined estimated blood loss (p = 0.116), or complications (p = 0.652) among the three groups, while the simultaneous group was significantly younger (p = 0.027), with fewer comorbidities (p < 0.001) and a shorter hospitalization time (p < 0.001). At the final follow-up, the JOA-C and JOA-L scores were increased, while the NDI and ODI scores were decreased, compared with the preoperative scores.ConclusionsTSS can be effectively managed by either simultaneous or staged decompressions. First-stage surgery for cervical stenosis significantly lowers the requirement for second-stage lumbar surgery. One-stage simultaneous decompression is safe and effective with the advantage of reduce hospitalization time, without an increase in operative time or bleeding. However, the surgical indications should be strictly controlled and is recommended for younger patients with fewer comorbidities.

Simultaneous Uniportal video-assisted thoracic surgery of bilateral pulmonary nodules

BackgroundSurgical resection is an appropriate treatment option for synchronous bilateral pulmonary nodules with ground-glass opacities. The applicability of simultaneous uniportal video-assisted thoracic surgery is not fully understood. We evaluated the feasibility and safety of performing such surgeries at our hospital.MethodsClinical data of 35 patients who underwent simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery at our hospital were reviewed retrospectively.ResultsSimultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery was performed for 35 patients (15 men, 20 women); 97 nodules were operated on, and the average nodule diameter was 11.4 mm (range, 1–38 mm). Computerized tomography showed that most nodules had ground-glass opacity (52/97, 53.6%); solid nodules (24/97, 24.7%) and nodules with mixed ground-glass opacity (21/97, 21.7%) were noted. Surgical resection included lobar-sublobar resection (11/35, 31.4%) and sublobar-sublobar resection (24/35, 68.6%). Wound infection and postoperative 30-day mortality were not observed. Pneumonia was the major postoperative complication, with a higher incidence in the lobar-sublobar group (6/10, 60%) than in the sublobar-sublobar group (4/25, 16%; P = 0.016). Pneumonia did not correlate with operative time (mean, 262.3 ± 108.1 vs. 261.9 ± 87.5 min, P = 0.991), duration of chest drainage (mean, 7.0 ± 4.0 vs 5.4 ± 2.1 days, P = 0.124), and postoperative hospital stay (mean, 10.2 ± 3.6 vs 10.2 ± 6.4 days, P = 0.978). The mean follow-up time was 8 (range, 3–22) months. Recurrence of primary lung cancer or mortality was not noted at the final follow-up.ConclusionsSimultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery is feasible and safe for appropriate patients. Simultaneous lobar-sublobar pulmonary resection for bilateral nodules can increase the risk of developing pneumonia.

Simultaneous surgery for synchronous liver metastases of colorectal cancer: analysis of survival and negative prognosis factors

Aim. To improve the surgical treatment results among patients with synchronous liver metastasis of colorectal cancer. Materials and methods. From 2012 to 2019, the analysis of the results of treatment of 60 patients with colorectal cancer and synchronous metastatic liver disease was carried out. The study sample was divided into 2 groups of patients. The group 1 consisted of 30 patients who got simultaneous resection of liver metastases and primary colorectal cancer. The group 2 consisted of other 30 patients who got stage resections: surgery for the primary tumor at the first stage, and liver surgery for metastases at the second.Results. The median operative time was 340 ± 21.1 minutes in the group 1. In the group 2 it was 255 ± 21.1 minutes and only the liver resection stage was assessed. The median blood loss in patients of the group 1 was 520,0 [200,0;800,1] ml, in the group 2 it was 500,0 [175,0;1300,0] ml. In general, we identified 5 cases of complications. In the postoperative period, 4 patients died. The average follow-up period is 23 months. One-year survival in group 1 was 92.6%, in group 2 – 100%, three-year – 85.2% and 89.6%. One-year disease-free survival in group 1 is 70%, in group 2 – 83.3%, three-year disease-free survival – 43.3% and 36.7%.Overall and disease-free survival rates didn’t differ significantly between the two treatment strategies. We detected significant effect on the disease-free and overall survival of regional lymph nodes metastasis (both p &lt; 0.05).Conclusion. The long-term and immediate results of simultaneous surgery of synchronous liver metastasis of colorectal cancer are comparable to the results of the staged method of treatment. It indicates the safety and effectiveness of simultaneous procedure.

Comparison of Outcomes in Unilateral and Bilateral Pediatric Cochlear Implants: Our Experience.

The aim of our study is to compare the outcomes in unilateral and bilateral cochlear implants in pediatric age and also between simultaneous and sequential cochlear implant surgery. This retrospective study was carried out with 83 children aged between 12months to 2.5years which included 41 children with bilateral Cochlear implants and 42 with unilateral implants. Out of these 41 children, 21 were simultaneous and 20 were sequential cochlear implant. All the children were operated at civil hospital Gandhinagar, Gujarat, India. CAP, SIR, localization, traffic noise and speech in noise scores were assessed at regular intervals over the period of 4years. Also the drug administration time, surgical time, operating room time were assessed for simultaneous and sequential cochlear implant surgery. Children with bilateral simultaneous implants fared significantly better with CAP, SIR, localization, speech noise and traffic noise scores than sequential bilateral implants and unilateral implants with a significant difference of means t tests between the two groups. Simultaneous cochlear implant surgery is associated with reduced surgical time, operating room time, it shortens the total in patient stay. There is less of drug administration and bilateral ones are stimulated simultaneously. Bilateral cochlear implants perform better with respect to auditory perception skills and spontaneous speech when compared with unilateral implants, but simultaneous surgery is better and safe option for pediatric cochlear implantation.

Modified surgical technique for lamellar macular holes with lamellar hole-associated epiretinal proliferation (LHEP).

To evaluate the efficacy and safety of lamellar hole-associated epiretinal proliferation embedding technique with modification in the surgical management of degenerative lamellar macular hole (LMH). There is retrospective case series of consecutive eyes who underwent pars plana vitrectomy with LHEP embedding with internal limiting membrane (ILM) inversion technique for degenerative LMH. Primary outcome measure was improvement in foveal contour and central foveal thickness (CFT). Secondary outcome measures were changes in best corrected visual acuity (BCVA), status of outer retinal layers (external limiting membrane-ELM & ellipsoid zone-EZ) and complications. Ten eyes were operated by modified LHEP embedding technique. Mean age was 65.8 ± 5.3years with 1:1 male to female ratio. Simultaneous cataract surgery was done in 70% cases. Mean follow-up duration was 7.9 ± 0.87months. 80% (8/10) eyes had improvement in foveal contour to normal appearance with increase in residual foveal thickness from 90.2 ± 26.83 microns to CFT of 226 ± 35.44 microns at 6months (p = 0.0054). Mean BCVA improved from 0.69 ± 0.19 logMAR to 0.32 ± 0.29 logMAR (p = 0.012). External limiting membrane (ELM) and ellipsoid zone (EZ) defects were present in four eyes (40%) pre-operatively. At the final visit 2 eyes (20%) had persistent defect in both ELM & EZ. None of the eyes progressed to full-thickness macular hole following surgery. The modified surgical technique of LHEP Embedding with ILM inversion is demonstrated to provide satisfactory results with reduced risk of complications for degenerative LMH. Larger and long-term follow-up studies are needed to establish this technique as standard surgical procedure for LMH with LHEP.

Horizontal bone augmentation and simultaneous implant placement using xenogeneic bone rings technique: a retrospective clinical study

This study evaluated the use of bone ring technique with xenogeneic bone grafts in treating horizontal alveolar bone defects. In total, 11 patients in need of horizontal bone augmentation treatment before implant placement were included in this retrospective study. All patients received simultaneous bone augmentation surgery and implant placement with xenogeneic bone ring grafts. We evaluated the postoperative efficacy of the bone ring technique with xenogeneic bone grafts using radiographical and clinical parameters. Survival rates of implants were 100%. Cone-beam computed tomography revealed that the xenogeneic bone ring graft had significantly sufficient horizontal bone augmentation below the implant neck platform to 0 mm, 1 mm, 2 mm, and 3 mm. It could also provide an excellent peri-implant tissue condition during the 1-year follow-up after loading. The bone ring technique with xenogeneic bone ring graft could increase and maintain horizontal bone mass in the region of the implant neck platforms in serious horizontal bone defects.