Surgery Today Research Articles

Eight Year Follow-Up After Gastric Bypass and Sleeve Gastrectomy in a Brazilian Cohort: Weight Trajectory and Health Outcomes.

Despite Sleeve Gastrectomy (SG) being the most commonly performed bariatric surgery today, studies with over 5years of follow-up show that patients undergoing SG have inferior weight loss compared to those undergoing Roux-en-Y gastric bypass (RYGB). The aim of this study was to examine differences in weight loss and the prevalence of weight regain between SG and RYGB up to 8years after surgery. Retrospective study including adult patients undergoing SG or RYGB between 2015 and 2018 at a tertiary center in Brazil. We evaluate the weight trajectory and pre- and postoperative behavior of type 2 diabetes (T2D), hypertension, and dyslipidemia. Differences betwen variables were tested using Student t-test, Mann-Whitney U, Pearson's chi-square or Fisher's exact test as appropriate. The level of significance adopted was p < 0,005. Among 591 patients (40 ± 10years; baseline body mass index 41.7 [IQR 39.1-45]; 83% women), 327 underwent RYGB (55%) and 264 SG (45%). Preoperatively, 14% had T2D, 40% hypertension, and 53% dyslipidemia. The mean total percentage of weight loss was higher in the RYGB group after 8years: 32% compared to 19% after SG (difference 13%, p < 0.004). At 8years, weight regain was also lower in RYGB (23%) compared to SG (39%) (p < 0.001). At 5years postoperatively, the remission rates for T2D, hypertension, and dyslipidemia were 63%, 42%, and 51%, respectively, among the patients who remained in follow-up. Patients undergoing RYGB showed greater weight loss and less weight regain 8years after bariatric surgery compared to those undergoing SG.

Part 1: Pushing the boundaries of neurointerventional surgery: A historical review of the work of Dr Gerard Debrun.

French-American neurointerventionalist and pioneer, Dr Gerard Debrun, laid the groundwork for treatments which have become irreplaceable in neurointerventional surgery today. This article aims to outline the career of Dr Debrun while highlighting his accomplishments and contributions to the field of neurointerventional surgery. We selected relevant articles from PubMed authored or co-authored by Dr Debrun between 1941 and 2023. All included articles discuss the accomplishments and contributions of Dr Debrun. Dr Debrun began his career in France by investigating neurointerventional techniques, most notably the intravascular Detachable Balloon Catheter (DBC). His work was recognized by renowned neurosurgeon Dr Charles Drake, who recruited him to London, Ontario. Dr Debrun created the foundation for homemade manufacturing of DBCs, building on one of the largest series for use of DBCs in cerebrovascular disease. Dr Debrun spent time as faculty at Massachusetts General Hospital (MGH) and Johns Hopkins Hospital, before arriving at the University of Illinois Chicago (UIC) where he remained until his retirement. Dr Debrun's subsequent contributions included the calibrated-leak balloon catheter, pioneering of glue embolization, setting the foundation for preoperative AVM embolizations, and as an early adopter of the Guglielmi detachable coil (GDC), including mastering the balloon remodeling technique for wide neck aneurysms. Dr Debrun established the first integrated neurointerventional surgery program at UIC, establishing a well sought-after fellowship program. Dr Debrun lectured extensively and was a prolific writer on neurointerventional surgery throughout this career. His contributions established the foundation for several techniques which have since become standard practice in present-day neurointerventional surgery.

TYPES OF ROBOTIC SURGERY: ADVANTAGES AND DISADVANTAGES OF CHOOSING THIS PROCEDURE

Introduction: Robotic surgery has become increasingly accessible and is already a reality worldwide. Although several medical specialties have benefited from this technology, urology is the one that has most incorporated the use of robots into surgical procedures. When we talk about robotic surgery, many patients imagine that a robot is used to carry out the procedure autonomously. It must be made clear that it is the surgeon who controls the robot and that this equipment only reproduces the movements of the doctors hands. Methodology: This article is a systematic review, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, which seeks to identify the most widely used types of robotic surgery today, their advantages and disadvantages. Literature review: It is important for centers that apply robotics to follow standardized training, improve reporting and increase patient education in order to reduce errors related to robotic surgery. Robotic surgery should be performed by urological surgeons trained in robotics and with extensive experience in robotic and laparoscopic surgery. It should also not be forgotten that adding robots to the surgical equation can create room for error in an area that is already complex and full of risks. Final thoughts: Robotic surgery is getting better and better as more advanced robots are developed to overcome existing shortcomings. Patients should therefore expect better results from robot-assisted surgery as advanced machines are applied.

Sentinel lymphatic biopsy nodes during surgical staging of cancer endometrium

Radicality of surgical operations, high filled at an early stage of endometrial cancer, significantly exceeds the required volume. Taking this into account, identifying sentinel lymphomas number of nodes during surgery today is one of the most pressing issues for correct diagnosis and long-term planning the best treatment. Use of ICG displays shows that the identification of sentinel lymphatic small nodes using the fluorescent method considered a safe and effective method diagnostics

Giant liver cyst associated with cholelithiasis: literature review and state of art

Liver lesions subject to laparoscopic resection are one of the frontiers conquered in surgery today. Even when dealing with surgery, which is often complex, the increase in demand from patients has increased, bringing more and more learning and dexterity to surgery teams with the increasing development of technology. To analytically evaluate the method, based on the most recent publications in the literature, with possible indications and reporting a recently successfully operated case, highlighting the safety, results and fundamental technical aspects. The relevant works from the last 15 years were identified and analyzed in the LILACS and PUBMED databases until August 2023, using the descriptors “ liver resection ”, “ laparoscopic surgery ” and “ liver surgery ”. We don't We found prospective and double-blind studies in the databases, with available data coming from case series, case-control studies and some multicenter studies and meta-analyses. Laparoscopic hepatectomy is a safe surgery and is very standardized in execution, even for major liver resections, with a low morbidity and mortality rate. As an oncological surgical method, it is gaining more and more space without compromising oncological radicality and with advantages for patients. with specific liver diseases. Benign lesions are the best indicated and performed, especially adenoma and cystic lesions, which in the hands of experienced teams have very good results and videolaparoscopic surgery can be considered today as standard treatment.

IJCM_277A: Awareness, Perception and Attitude of Medical Interns and Graduates Towards Robotic Surgery: A Cross-Sectional Study

Background: Robotic surgery is a novel venture in medical sciences that uses robotic systems to assist and carry out surgical procedures and is one of the most discussed topics in surgery today. However, there is paucity of information regarding awareness, attitude and perceptions related to robotic surgery among the future surgical care providers (i.e., interns and postgraduates). Methodology: This cross-sectional study was carried out among all the Medical Interns and the Postgraduates posted in the surgical Departments of KMC Mangalore (General Surgery, OBG, ENT, Ophthalmology, Orthopedics and Anaesthesia) using Universal sampling technique and data were collected using a semi-structured, pre-validated questionnaire consisting of two sections. The collected data were analyzed using SPSS software version 25. The results were summarized as percentages, tables and figures. For comparison across the groups chi-square test was used and a value less than 0.05 was considered statistically significant. Results: One hundred sixty-nine Interns and surgical Postgraduates were included in total in the study with a mean age of 25 years. Among the study participants,57.3% (n=59) of Interns and 57.6% (n=38) of Postgraduates have seen robotic surgery being performed in the past. More than half of the study participants, 66%(n=68) interns and 72.7%(n=48) postgraduates were aware of the Da Vinci robotic surgical system. Among the challenges for mainstreaming robotic surgery, cost was the most important concern among 53.3% (n=57) interns and 53%(n=35) postgraduates. Conclusion: In our study majority of the participants, Interns (64.1%) and Post graduates (84.8%) had a positive outlook towards robotic surgery &amp; believed cost (55.3 % Interns and 53% Post graduates) was one of the major constrains limiting its use

Endoscopic iatrogenic esophageal perforation and management: a retrospective outcome analysis in the modern era

IntroductionIatrogenic esophageal perforation (IEP) is a severe adverse event (AE) of upper endoscopy procedures (UEPs) associated with morbidity. Management has shifted from surgery to endotherapy with clip closure (CC), self-expanding metal stent (SEMS), and vacuum therapy (VT). Limited analyses measure outcomes during contemporary interventional endoscopy periods.MethodsIEPs associated with EGD, upper EUS, small bowel enteroscopy (SBE), and ERCP at a 3-hospital academic center from January 2011 to December 2023 were identified retrospectively from a centralized AE database. Additional information was obtained from medical records. Statistical analysis was performed using Microsoft Excel and STATA.ResultsThirty-two IEPs from 26 EGDs, 4 EUS, 1 SBE, and 1 ERCP were identified. IEPs occurred mostly after dilation (bougie N = 7; balloon, N = 5) or foreign body removal (N = 6). Most IEPs occurred in the lower esophagus (N = 10) or gastroesophageal junction (N = 8). Diagnosis was made at a median 2 h after the injury by endoscopy (N = 14), CT scan (N = 12), esophagram (N = 5), or x-ray (N = 1). Initial treatment included conservative therapy alone (N = 7), CC (N = 3), SEMS (N = 14), SEMS plus CC (N = 3), or surgery (N = 3). Eleven patients required additional treatment including repeat SEMS or adjustment (N = 4) or VT (N = 1). No surgical interventions were required after 2013. The median hospital stay was 3 days. Disposition included discharge to home (N = 25), long-term care facility (N = 2), 4 deaths (12.5% of IEPs), and 1 unknown.ConclusionsIEPs are rare and occur throughout the esophagus after any UEP. The majority are recognized immediately and managed with endotherapy, or rarely, surgery today. These characteristics likely explain the low mortality in this study.

Decision regret up to 6years after sleeve gastrectomy.

Sleeve gastrectomy (SG) is one of the most popular types of weight loss surgery today but is neither risk-free nor universally effective. We previously demonstrated that 5% of Roux-en-Y gastric bypass (RYGB) patients and up to 20% of gastric banding patients report overall regret 4years after surgery. This study explores patients' attitudes toward their decision to have SG and decision regret rates up to 6years postoperatively. We surveyed 185 patients who were at least 6months post-SG (response rate 30%). We used a modified version of the Decision Regret Scale developed by Brehaut et al. We converted responses to a 0-100 scale so that higher scores (> 50) reflect greater regret. We characterized patients who expressed having overall decision regret (score > 50) vs. those who did not (≤ 50). Demographic and preoperative clinical information was extracted from the online medical records. Of 185 SG patients, only 13 (7%) reported regret scores > 50 (i.e. high decision regret). Mean time from SG to survey completion was 41months (range 6-76months). Unadjusted comparisons between the two groups revealed that patients with high regret scores had lower mean weight loss (32.1% vs. 48.9% EBMIL), and reported less improvement in quality-of-life (QoL), such as physical health (46.2% vs. 93.5% "somewhat" or "significantly" improved). The two groups were similar in short-term complications, but those reporting overall regret were more likely to report GI complaints such as bloating (61.5% vs. 30.4%). Finally, patients with regret scores > 50 were more likely to be further out from SG (median time since surgery 61.8 vs. 41.1months). In our study, very few patients reported regret (7%) up to 6years postoperatively, in line with prior reports after RYGB. Those with regret reported poorer QoL.

Female pioneers in orthopaedic surgery

In a male-dominated professional specialty, it is important to shine a light on the female pioneers in orthopaedics who have been the first of their kind in Britain. From Garrett Anderson to Clare Marx, these women have left a legacy contributing not only to the techniques and equipment used in surgery today but, by breaking through glass ceilings, have encouraged a change in the gender perception of orthopaedics. In an evolving profession, we celebrate these successful women and the incredible lengths they have gone to, in challenging the status quo and diversity issues. This article aims to highlight some of these role models, who may not thus far have received the recognition they deserve, and to encourage us to learn from their legacy to create a more inclusive culture in medicine.

Utility of radiotherapy for the management of local tumor progression in patients with early breast cancer

The generally accepted standard in early breast cancer surgery today is breast-conserving surgery with external beam radiation therapy, which is comparable in results to previously widely performed radical mastectomy and even has an advantage in terms of overall survival and control. Until now, there are areas of discussion and a number of questions remain related to the methodology of irradiation of patients with breast cancer, namely: is it advisable to irradiate the axillary zone after radical resection for early breast cancer? Does irradiation of axillary lymph nodes provide regional control comparable to lymphadenectomy, and whether it can be an alternative to lymph node dissection? Whether provides an irradiation of axillary lymph nodes comparable with regional lymph node dissection the control over patients with a positive sentry lymph node? A lot of studies have been published so far, answers to questions derived from what we present in this work.

Eponyms Describing Soft Tissue Pathologies in Orthopedic Hand Surgery.

Orthopedic surgery literature utilizes numerouseponyms, and they have become commonplace among orthopedic surgeons and the general public alike. These eponyms can have important historical implications and their history is often overlooked by the physicians using such terms.This paper seeks to specifically explore the origins of eponyms in orthopedic soft tissue diseases involving the upper extremity. Shedding light onto the origin of these eponyms can provide greater respect and understanding of their use in orthopedic surgery today.

Consideration of Tissue Deformation through an Electrode Displacement in a Monopolar Coagulation Model

In today's surgery, high-frequency electrical currents are often used to achieve various effects, one important being the heating of tissue to stop bleeding. However, the physical processes of tissue heating are complex and not fully understood. This complicates medical device approval with the settings used for such applications. Therefore, a simulation approach can help provide evidence. In this contribution, we present a modification of a model already presented and described in a previous investigation. By incorporating continuum mechanics into our model, we were able to simulate the deformation of the tissue due to electrode displacement. The resulting deformed configuration was then used to simulate Joule heating by applying a constant direct current voltage and to analyze the effect of varying the electrode displacement depth on the heat distribution result. Our results show that the contact area of the electrode to the tissue plays a crucial role in heating the tissue. This is because the tissue heats up more slowly with a large contact area than with a small one, resulting in significantly greater heat propagation to deeper tissue regions.

Update on preoperative evaluation and optimisation.

The patients presenting for surgery today often belong to the extremes of age, have multiple co-morbidities, and undergo complex surgeries. This makes them more prone to morbidity and mortality. A detailed preoperative evaluation of the patient can contribute to reducing this mortality and morbidity. There are various risk indices and validated scoring systems and many of them need to be calculated using preoperative parameters. Their key objective is to identify patients vulnerable to complications and to return them to desirable functional activity as soon as possible. Any individual undergoing surgery should be optimised preoperatively, but special considerations should be given to patients with comorbidity, on multiple drugs, and undergoing high-risk surgery. The objective of this review is to put forth the latest trends in the preoperative evaluation and optimisation of patients undergoing noncardiac surgery and emphasise the importance of risk stratification in these patients.

Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes.

Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or hemiarch replacement by ministernotomy and full sternotomy in our clinic are presented. Between January 2017 and October 2019, a series of operations including aortic root, ascending aorta, and aortic arch replacements were performed on 278 patients. The ministernotomy technique was used in 25 of them. Twenty patients who underwent full sternotomy were selected and matched to this group for comparison. The ministernotomy group had a longer cross-clamping time (128.3±30.8 vs. 104.7±23.4 min, P=0.007) but the total operating time was similar in the two groups (249.76±28.56 vs. 248.25±37.53 min, P=0.879). The number of red blood cell (RBC) transfusions per patient was higher in the full sternotomy group (4.65±3.74 vs. 2.44±1.85 unit, P=0.020). The ministernotomy group had shorter ventilation times (7.60±4.88 vs. 32.30±32.25 h, P<0.001) and shorter ICU stay (1.56±0.58 vs. 3.35±1.46 d, P<0.001). The 30-day mortality was 0% in the ministernotomy group. Early results of our study show that, in combined or isolated aortic root, ascending aorta, and aortic arch surgeries, ministernotomy can be applied with relatively safety and low mortality and morbidity rates.

Identification of the intersegmental plane by arterial ligation method during thoracoscopic segmentectomy

BackgroundThoracoscopic segmentectomy is a common surgical procedure in thoracic surgery today. However, identifying the intersegmental plane is difficult in the surgical process. Therefore, we evaluated the feasibility of the arterial ligation method for determining the intersegmental plane and compared the demarcation status with the intravenous indocyanine green (ICG).MethodsWe retrospectively reviewed the records of 35 patients with peripheral small lung nodules who underwent thoracoscopic segmentectomy between May and December 2020. First, the preoperative three-dimensional reconstruction was performed to distinguish the location of lung nodules and the anatomical structures of targeted segmental arteries, veins, and bronchi. Second, the targeted segmental arteries were ligated, and the intersegmental plane was determined by the inflation-deflation technique. The waiting time for the appearance of the inflation-deflation line was recorded. Thirdly, the intersegmental plane was identified again using the ICG fluorescence method. Finally, the consistency of the two intersegmental planes was evaluated.ResultsThe intersegmental planes were successfully observed in all patients using the arterial ligation method. Thirty-four patients underwent segmentectomy as planned, and one patient finally underwent lobectomy due to insufficient surgical margin. The waiting time for the appearance of the intersegmental plane by arterial ligation method was 13.7 ± 3.2 min (6–19 min). The intersegmental planes determined by the arterial ligation method and the ICG fluorescence method were comparable, with a maximum distance of no more than 5 mm between the two planes. The mean operative duration was 119.1 ± 34.9 min, and the mean blood loss was 76.9 ± 70.3 ml. No evident air leakage was found during the operation. Only one patient experienced a prolonged air leak (≥ 5 days) during the postoperative recovery. No atelectasis occurred in all cases. The chest tube duration was 3.1 ± 0.9 days.ConclusionThe arterial ligation method can efficiently and accurately identify the intersegmental plane, comparable to the ICG fluorescence method.

Main Principles of Vitrectomy Using Intraocular Tamponades - A Basic Course in Surgery.

This article is intended to clearly present the basic principles for the use of intraocular tamponades in vitreous/retinal surgery in the event of retinal detachment and other pathologies using additional video footage. It examines the various gases, silicone oils and perfluorocarbon liquids with their indications, administration and in particular intraoperative handling including pitfalls and complications. Characteristic animations show the principles of use in surgery in a comprehensible way. The two lead authors dedicate this article to their teacher Prof. Dr. V.-P. Gabel, who in the early 1990s successfully established the first vitrectomy courses for ophthalmologists at Regensburg University Eye Clinic each year. Many colleagues who still work in retinal surgery today first started learning about this segment on these courses. The other coauthors participated under his supervision in annual vitrectomy wet labs run by the German Academy of Ophthalmology.

Diversity and demographics of APSA members: Understanding our identity

IntroductionThere are existing healthcare disparities in pediatric surgery today. Identity and racial incongruity between patients and providers contribute to systemic healthcare inequities and negatively impacts health outcomes of minoritized populations. Understanding the current demographics of the American Pediatric Surgical Association and therefore the cognitive diversity represented will help inform how best to strategically build the organization to optimize disparity solutions and improve patient care. Methods1558 APSA members were sent an anonymous electronic survey. Comparative data was collected from the US Census Bureau and the Association of American Medical Colleges. Results were analyzed using standard statistical tests. ResultsOf 423 respondents (response rate 27%), the race and ethnicity composition were 68% non Hispanic White, 12% Asian American and Pacific Islander, 6% Hispanic, 5% multiracial, and 4% Black/African American. Respondents were 35% women, 63% men, and 1% transgender, androgyne, or uncertain. Distribution of sexual identity was 97% heterosexual and 3% LGBTQIA. Religious identity was 50% Christian, 22% Agnostic/Atheist, 11% Jewish, 3% Hindu, and 2% Muslim. 32% of respondents were first-generation Americans. Twenty-four different primary languages were spoken, and 46% of respondents were conversational in a second language. These findings differ in meaningful ways from the overall American population and from the population of matriculants in American medical schools. ConclusionThere are substantial differences in the racial, gender, and sexual identity composition of APSA members compared with the overall population in the United States. To achieve excellence in patient care and innovate solutions to existing disparities, representation, particularly in leadership is essential. Type of studySurvey; original research. Level of evidenceLevel IV.

Comparison of Different Doses of Dexmedetomidine as Adjuvant for Infraumbilical Surgery in Patients Receiving Bupivacaine Spinal Anesthesia: A Randomized Controlled Trial.

Infraumbilical surgery today is done preferentially under subarachnoid block. The relatively short duration of analgesia is a limiting factor which is overcome by adding an adjuvant to intrathecal bupivacaine. We aimed to determine optimum dose of intrathecal dexmedetomidine as adjuvant to 0.5% hyperbaric bupivacaine in infraumbilical surgery. A parallel group, double blind, randomized controlled trial was done with 105 adult patients posted for infraumbilical surgery under subarachnoid block. All subjects received 3.0 mL (15.0 mg) of 0.5% hyperbaric bupivacaine. Groups D5.0, D7.5, and D10.0 (n = 35 each) received additionally 5.0, 7.5, and 10.0 mcg intrathecal dexmedetomidine as adjuvant. The onset time of sensory block, its peak level and time to this level, maximum motor block and time to it, total duration of analgesia (time to first rescue), and vital parameters were recorded at intervals. Postoperative analgesia was assessed by visual analog scale score at 15 and 30 minutes, then every 30 minutes until 2 hours and then every hour until 6 hours. Treatment emergent adverse events (bradycardia, hypotension, and sedation) were documented. Maximum sensory level achieved was higher in Group D10.0 than in the other two groups. There was significant and dose-dependent shortening of the mean time to peak sensory block (3.9, 3.3, and 2.9 min; P ＜ 0.001) and peak motor block (5.6, 5.3, and 4.8 min; P ＜ 0.001), and prolongation of postoperative analgesia duration (206.9, 220.8, and 244.0 min; P ＜ 0.001) with escalating doses (5.0, 7.5, and 10.0 mcg, respectively) of dexmedetomidine. Hemodynamic effects and adverse events were comparable in the three groups. Intrathecal dexmedetomidine (10.0 mcg), as adjuvant to 0.5% hyperbaric bupivacaine (15.0 mg), facilitates rapid onset sensory and motor block and prolongs duration of postoperative analgesia in spinal anesthesia without significant adverse effects. Although absolute differences are modest, the results are better compared to 5.0 and 7.5 mcg doses.

A SAGES technology and value assessment and pediatric committee evaluation of mini-laparoscopic instrumentation.

The TAVAC and Pediatric Committees of SAGES evaluated the current use of mini-laparoscopic instrumentation to better understand the role this category of devices plays in the delivery of minimally invasive surgery today. The role of mini-laparoscopic instrumentation, defined as minimally invasive instruments of between 1 and 4mm in diameter, was assessed by an exhaustive review of the peer reviewed literature on the subject between 1990 and 2021. The instruments, their use, and their perceived value were tabulated and described. Several reported studies propose a value to using mini-laparoscopic instrumentation over the use of larger instruments or as minimally invasive additions to commonly performed procedures. Additionally, specifically developed smaller-diameter instruments appear to be beneficial additions to our minimally invasive toolbox. The development of small instrumentation for the effective performance of minimally invasive surgery, while perhaps best suited to pediatric populations, proves useful as adjuncts to a wide variety of adult surgical procedures. Mini-laparoscopic instrumentation thus proves valuable in selected cases.

Evaluation of the Results of Treatment of Patients with Hernias of the Anterior Abdominal Wall

Herniology, including in our country, is one of the most rapidly developing branches of surgery today. New technologies, techniques, endoprostheses are being developed and introduced into clinical practice, clinical studies are being conducted, and the evidence base is being improved. Dozens of conferences, schools, master classes devoted to the problem of hernia surgery are organized annually in Uzbekistan, professional organizations are actively working, uniting dozens, if not hundreds of surgeons calling themselves herniologists. It is all the more surprising that so far not a single study has been conducted in our country that would allow us to assess the scale of the problem.