Surgical Process Research Articles

Tailoring surgical sutures with chitosan and non-thermal atmospheric plasma: biofunctionalization for antimicrobial efficacy and enhanced wound healing

Surgical sutures serve as medical devices designed to facilitate the closure of wounds by securing opposing tissues. While sutures are an integral part of the surgical healing process, also present favorable surfaces for microbial attachment, increasing surgical site infections (SSIs). In this study, sutures that have antimicrobial and improved wound healing properties are described as novel approaches for minimizing SSIs. The absorbable multifilament suture, poly (glycolic-co-lactic acid) (PGLA), and non-absorbable multifilament suture (silk) are treated with non-thermal atmospheric plasma (NTAP) and subsequently coated with chitosan/chitosan nanoparticles (Ch/ChNp). Suture samples are analyzed in terms of antibacterial properties, in vitro bioactivity, wound healing efficiency, mechanical strength, chemical characterization, and surface morphologies. Bacterial adherence of Staphylococcus aureus and Escherichia coli on both sutures is inhibited effectively due to the surface modification after plasma treatment. The NTAP treatment results in reduced wound healing for silk sutures without a selective effect on PGLA sutures. However, subsequent coating with Ch/ChNp significantly enhances wound healing for both sutures. Although the maximum tensile strength decreases after NTAP treatment, improves following the Ch/ChNp coating. Our findings indicate that the developed sutures demonstrate notable antimicrobial properties, enhance wound healing, and hold promise as a potential material for suturing applications.

Fear, anxiety, and knowledge levels of women who underwent gynecologic surgery during the COVID-19 pandemic.

The objective of this study was to evaluate the fear, anxiety, and knowledge level in women who underwent gynecological surgical procedures during the COVID-19 pandemic. This cross-sectional study was conducted on 188 women who underwent a gynecologic surgical operation in Muğla, Turkey. Data were collected by using demographics and obstetric detail form, questionnaire on knowledge, attitudes, and practice toward COVID-19, and State-Trait Anxiety Inventory-I (STAI-I). Most of the women perceived their surgical process as very urgent. Women felt fear mostly for being infected with the virus, and they were afraid of transmitting COVID-19 to another one. The COVID-19 knowledge scores of women who had undergone cancer surgery were statistically significantly higher than others (p=0.017). The STAI-I scores of women increased as their COVID-19 knowledge scores increased (p<0.05). This study demonstrated that women were afraid of COVID-19 infection during gynecological operation and due to hospitalization, sociodemographic characteristics affected the knowledge levels about COVID-19 infection, and the anxiety levels of the women. Planning appropriate interventions to decrease the fear and anxiety of women who undergo gynecological surgery during the pandemic is important to ensure that women adhere to their treatment and follow-up in the postoperative period.

The Effect of Operating Room Tour Video on Pre-Anesthetic Anxiety in Sectio Caesarea Patients

Background: Preoperative anxiety in patients undergoing cesarean sections (CS) can significantly impact both psychological well-being and physiological responses, potentially affecting the success of anesthesia. An educational intervention, such as an Operating Room (OR) Tour video, may alleviate anxiety by familiarizing patients with the surgical environment and process. Purpose: To determine the effect of an Operating Room Tour video on pre-anesthetic anxiety levels in CS patients. Methods: This study employed a pre-experimental design with a pretest-posttest approach to assess the impact of the video on pre-anesthetic anxiety in 30 CS patients at Cilacap General Hospital. Anxiety levels were measured using the Visual Analog Scale for Anxiety (VAS-A) before and after the intervention. Statistical analysis was conducted using the Wilcoxon signed-rank test to evaluate the significance of the change in anxiety levels. Results: The findings revealed a significant reduction in anxiety following the video intervention. Prior to the intervention, 43.3% of participants experienced moderate anxiety, while post-intervention, 66.7% reported only mild anxiety. The Wilcoxon test confirmed the significant impact of the OR Tour video on reducing pre-anesthetic anxiety (p = 0.011, p &lt; 0.05). Conclusion: The use of an Operating Room Tour video is an effective strategy to reduce preoperative anxiety in CS patients. This educational intervention could be a valuable addition to pre-anesthesia care, improving patient comfort and potentially contributing to better surgical outcomes.

Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery.

The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions. Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics. Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/- hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/- fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts. Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.

Influence of Screw Length and Cement Position Within the Injured Vertebra on Fixation Strength in Short-Segment Fixation of Osteoporotic Thoracolumbar Burst Fractures

The prevalence of osteoporotic vertebral fractures has increased with aging populations, necessitating effective treatments such as percutaneous kyphoplasty combined with posterior screw fixation. However, biomechanical research on the effects of using short screws on fixation stability and bone stress or on the impact of bone cement bonding to screws on structural strength is lacking. This study aimed to optimize short-segment fixation strategies for osteoporotic thoracolumbar burst fractures by analyzing the biomechanical effects of pedicle screw length and bone-cement augmentation. Four models of the thoracolumbar spine were established using computed tomography data of a female volunteer: (1) short screws in the injured vertebra without contact with the bone cement, (2) long screws without contact with the bone cement, (3) long screws in contact with the bone cement; and (4) long screws without the bone cement. The four fixation models were simulated under physiological loads. The range of motion, implant stress, and segmental stability were assessed. The three groups containing the bone cement exhibited similar performances in terms of stability and stress distribution, whereas the group without the bone cement exhibited a poorer biomechanical performance. Incorporation of the bone cement enhanced the biomechanical properties of the structure, and short screws in the injured vertebra without contact with the bone cement did not significantly compromise the biomechanical performance. Short screws in injured vertebrae without contact with the bone cement can achieve satisfactory stability and stress distribution. It is feasible to implant short screws in the injured vertebrae, reduce the number of bilaterally injured vertebrae, and inject bone cement through the non-pedicle approach during the surgical procedure, which simplifies the surgical process.

Novel implant design for comminuted posterior wall acetabular fractures.

In recent years, the medical community has witnessed a notable increase in high-energy traumatic injuries, leading to a surge in complex fracture patterns that challenge existing treatment methodologies. Among these, the posterior approach to acetabular fractures stands out for offering direct visualization of the retro-acetabular surface, with current fixation methods relying on 3.5mm low-profile reconstruction plates and various other implants. Despite the effectiveness of these methods, there is a burgeoning demand for a singular, adaptable implant that not only streamlines the surgical process but also optimizes patient outcomes. In an innovative approach to address this need, three-dimensional (3D) models of the posterior acetabular wall were meticulously crafted using AutoCAD® software. The chosen material for the implant was 316L surgical steel for its durability and strength. The design of the implant featured a low-profile mesh structure, which was instrumental in facilitating osteosynthesis. This design allowed for the placement of screws of varying lengths in multiple directions, ensuring the initial reconstruction of the joint in an anatomical position without hindering the placement of the definitive implant. The primary objective was to secure the fixation and stabilization of the fracture by specifically targeting the smaller bone fragments. A comparative analysis was then conducted between this novel plate and a conventional 316L surgical steel, seven-hole, 3.5mm reconstruction plate through finite element analysis. The comparative analysis unveiled that both plates demonstrated comparable deformation capacities, with no significant differences in load-bearing capabilities observed. This finding suggests that the innovative plate can match the performance of traditional plates used in such surgeries. The finite element analysis revealed that the newly developed anatomical plate for posterior wall acetabular fractures meets the necessary physical and mechanical criteria for permanent implementation in patients with these fractures. This breakthrough represents a promising advancement that could simplify surgical procedures and potentially elevate patient outcomes. This study is classified as a Level II, diagnostic study.

Comparison of Oswestry Disability Index Scores Between Surgical Candidates and General Population: Insights into Evaluation Criteria for Spine Surgery.

A mixed-methods investigation with both retrospective and prospective components. Determine the mean Oswestry Disability Index (ODI) scores for individuals who underwent surgical intervention compared to a non-surgical population and identify threshold values that distinguish between these groups. The Oswestry Disability Index (ODI) quantifies disability in patients with low back pain and commonly serves as a significant determinant in lumbar spine pathology and surgical outcomes. An empirically established ODI threshold can aid in optimizing surgical decision-making processes. This study retrospectively analyzed 557 patients who consulted with a spine surgeon and subsequently underwent lumbar spine surgery from 2019 to 2023. Additionally, ODI scores were surveyed from 797 individuals in the general American population using the CloudResearch Connect platform, with participants matched for age and sex according to US census data. Mean ODI scores stratified by age group and sex were calculated for each cohort. Receiver Operating Characteristic (ROC) analysis was utilized to ascertain ODI cutoff values for different demographics. The retrospective cohort demonstrated a higher disability level with an overall mean ODI of 34.7 (95% CI [33.1, 36.2]) for ages 18-89. In contrast, the general population surveyed had a mean ODI of 14.4 (95% CI [13.3, 15.4]). An ROC-derived ODI threshold of 16.5 within the comprehensive age group of 18-89 exhibited a sensitivity of 0.84 and a specificity of 0.68. The ODI values identified in this study offer benchmarks that can assist in the evaluation process for spine surgery. These findings highlight the importance of considering ODI scores as part of a comprehensive clinical evaluation, rather than as standalone indicators for surgical intervention. Further prospective validation of these findings and their integration into clinical practice is recommended for future research.

Lessons from Covid-19 and the potential benefit of the implementation of Axon’s personal electronic health records (PEHR) into aesthetic care, plastic and reconstructive surgery

BackgroundCovid-19 pandemic highlighted the need for implementing Personal Electronic Health Records (PEHR) for patients’ data management. Furthermore, this pandemic underscored the relevance for integrated and interoperable Electronic Health Records (EHR) to support disease surveillance, hospital capacity planning and resource management (Peek N, Sujan M, Scott P (2020) Digital health and care in pandemic times: impact of COVID-19. BMJ Health Care Inf 27(1):e100166. https://doi.org/10.1136/bmjhci-2020-100166). Due to the lack of comprehensive patients’ record in plastic, reconstructive and aesthetic surgery, Axon’s myHealth app offers a break-through patient-centric design allowing patients to be in control of their records and updating them in real-time for their plastic and aesthetic care providers to have a clearer understanding of patients’ history and progress from pre-op to post-op.MethodsThe Axon Dublin survey took place during Covid-19 pandemic in two phases: Phase 1 aimed to assess the feasibility of patients integrating the Axon myHealth application into their clinical visits. Testing occurred in a clinical environment, where patients were encouraged to download and use the Axon system with a health practitioner (HP) present. Phase 2 focused on home testing, evaluating patients’ willingness to manage their health remotely with HP assistance. This phase included self-testing activities such as performing rapid Covid-19 antigen tests, recording medical history, and measuring blood pressure at home.ResultsThe Axon Dublin Study aimed to assess patient engagement, clinical impact, and cost-effectiveness of the Axon myHealth application. Over 85% of patients showed interest in owning a Personal Electronic Health Record. Notably, 36% continuously monitored chronic conditions. Clinical decisions, informed by patient data, saw 61.9% compliance. Noteworthy, 23% of hypertensive participants required immediate medication changes. Patient self-capture of data reduced consultation time. Public health implications were significant, with 39% vaccinated and 31% reporting complications. High user satisfaction (97%) demonstrated the app’s effectiveness in infection control and chronic care.ConclusionsOffering patients the ability to update and control their data is a growing interest, with a clear need in plastic and aesthetic surgery to have a better understanding of a patient’s medical past and progress throughout the surgical process and period. This platform, which is time and cost efficient, can only facilitate personalised care and improve outcomes while maintaining patient’s confidentiality.Level of evidenceNot gradable.

Clinical Analysis of Improved Lateral Approach Lesion Clearance, Autologous Iliac Bone Interbody Fusion, and Posterior Internal Fixation for Lumbar Tuberculosis

Objective: To explore the clinical efficacy of improved lateral approach lesion clearance, autologous iliac bone interbody fusion, and posterior internal fixation for treating lumbar tuberculosis. Methods: Thirty lumbar tuberculosis patients enrolled from January 2022 to June 2023 were selected and divided into two groups based on the surgical method. The control group (15 cases) underwent traditional posterior open lesion clearance and conventional lumbar posterior reconstruction surgery. The observation group (15 cases) received improved lateral approach lesion clearance, autologous iliac bone interbody fusion, and posterior internal fixation. Comparisons were made on surgical conditions, time to ambulation after surgery, complication rates, laboratory test results, ASIA scores, VAS scores, ODI index, and cure rates. Results: The observation group had superior surgical outcomes compared to the control group, with shorter time to ambulation after surgery (P &lt; 0.05). The complication rate in the observation group was lower than in the control group (P &lt; 0.05). Laboratory test results post-surgery were better in the observation group (P &lt; 0.05). ASIA scores were higher in the observation group (P &lt; 0.05). There were no significant differences in VAS scores and ODI index between the two groups (P &gt; 0.05). The cure rate was higher in the observation group (P &lt; 0.05).Conclusion: Improved lateral approach lesion clearance, autologous iliac bone interbody fusion, and posterior internal fixation for lumbar tuberculosis resulted in a smooth surgical process, faster recovery, and better safety. This method improved laboratory results, neurological function, and cure rates.

Asuhan Keperawatan pada Tn. A dengan Diagnosa Medis Post Operasi Soft Tissue Tumor (STT) Flank Sinistra di Ruang Mawar 2 RSUD Dr. Soeselo Kabupaten Tegal

Tumor is a disease that is currently one of the health problems that causes death, soft tissue tumor or soft tissue tumor is an abnormal lump that is formed due to the growth of new cells (Irsal et al., 2020). The signs and symptoms in soft tissue tumor patients include pain due to the surgical process. The purpose of this writing is to find out and provide nursing care to Mr. A with a medical diagnosis post-operative soft tissue tumor (STT) left flank in the rose room 2 RSUD dr. Soeselo Tegal Regency in accordance with nursing standards. The methods used are descriptive methods and data collection methods. From the case review, it was found that Mr. A complains of pain. Three diagnoses were found, namely acute pain, impaired physical mobility and knowledge deficit. Interventions are prepared based on the theory of SDKI, SLKI and SIKI as well as on the client's condition and can be implemented.

Management of Patients with Colorectal Cancer through Fast-Track Surgery.

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. CRC is considered a priority public health issue due to its incidence and the high associated costs. Surgery is the predominant therapeutic approach for CRC. Given the involvement of the intestinal tract in the surgical process, there is a significant increase in postoperative morbidity rates, and the average length of hospital stay (LOS) tends to lengthen. In this research, we employed the Lean Six Sigma (LSS) methodology, specifically utilizing the DMAIC cycle, to identify and subsequently examine the effects of fast-track surgery on hospitalization times for interventions related to CRC at the AORN "Antonio Cardarelli" Hospital in Naples (Italy). The process analysis, guided by the DMAIC cycle, facilitated a reduction in the median LOS from 14 days to 12 days. The most notable improvement was observed in the 66-75 age group without comorbidities. The LSS approach provides methodological rigor, as previously recognized, enabling substantial enhancements to the process. This involves standardizing outcomes, minimizing variability, and achieving an overall reduction in the LOS from 14 to 12 days.

Instagram and Achilles tendon surgery: Evaluation of patients' perceptions of surgery

Background/Aim: The primary objective of this study was to conduct comprehensive research and analysis of patient-generated content related to Achilles tendon surgery on the social media platform Instagram. The aim was to gain deeper insights into patients' experiences during the perioperative period, which may contain valuable information pertinent to their condition, information of which the physicians may be unaware. Methods: A search was conducted on the Instagram database, covering a period of 78 months from February 2015 to August 2021. Posts utilizing the hashtags "#achillessurgery" and "#achillesrepair" were included in the analysis. Posts were assessed using a binary scoring system, considering variables such as tone, media format, return to work, rehabilitation or physical therapy, return to sports, images related to the ankle (e.g., scars, stitches, casts, dressings, walking boots), activities of daily living, and pain. Results: A total of 500 posts were reviewed, and a positive tone was observed in 77.8% of these. The average Instagram like ratio for these posts was computed as 9%. Statistical analysis revealed a significant relationship between post content and tone status (P=0.001). Specifically, within the positive tone group, informative content about the disease was comparatively lower and statistically significant when compared to exercise training and patient experience (P=0.001). Additionally, exercise training posts were found to be significantly lower than patient experience posts (P=0.001) within the positive tone group. In contrast, within the negative tone group, patient experience posts were significantly higher compared to informative content and exercise training posts (P=0.001). Moreover, the quantity of informative posts markedly surpassed the number of posts related to exercise training (P=0.001). Conclusion: In the positive tone category, people tended to emphasize personal experiences and participate in posts related to exercise training rather than actively seeking or exchanging information about the disorder. On the other hand, within the negative tone group, individuals were more likely to share adverse experiences, pursue support, and seek a deeper understanding from others. Their priority may also lie in sharing and gaining information specifically about the disorder. Our exploration of the use of social media platforms to delve into patient perspectives on Achilles tendon surgery provides an alternative insight into patients' experiences with the surgical process. By comprehending the content shared by patients on social media, surgeons may gain an improved opportunity to assess and address the surgical experience of their patients more effectively, ultimately contributing to enhanced patient care.

Ten-year experience of laparoscopic partial splenectomy for patients with splenic benign lesions

BackgroundThe increasing comprehension of spleen function has led to the gradual endorsement of laparoscopic partial splenectomy (LPS) as a treatment option for benign spleen lesions. However, it is important to note that the LPS technique remains challenging. This study explores the standardized process and surgical techniques in LPS, aiming to promote the application of this technique. MethodsThe clinical data of 20 patients with benign cystic or solid spleen lesions who underwent LPS at Shunde Hospital, Southern Medical University were retrospectively collected. Data include age, gender, imaging data, surgical process, and postoperative complications. Additionally, the surgical techniques and standardization process were recorded in detail. ResultsAll 20 cases completed LPS without conversion to laparotomy or splenectomy. The surgical time was 162.25 ± 37.96 min, the intraoperative blood loss was 93.00 ± 58.40 mL, no blood products were transfused during the operations, and the removed volume of the spleen was about 34.75 ± 12.19 %. There were no postoperative complications such as intra-abdominal bleeding, intra-abdominal infection, pancreatic fistula, and residual splenic infarction. Postoperative pleural effusion occurred in four cases, and symptoms improved after symptomatic treatment. The postoperative hospital stay was 7.0 ± 1.4 days. There were no perioperative deaths. The residual splenic vessels were normal during the follow-up period, and no vascular embolism occurred. ConclusionsLPS is a safe, feasible, and effective surgical method for patients with benign cystic or solid spleen lesions. Subsequently, mastering related surgical techniques and standardized surgical procedures can control the surgical risks in suitable cases, making LPS the standard procedure for treating benign spleen diseases.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees Part 3: Objective Assessment and Surgical Decision-Making.

Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. After an auditory-perceptual speech evaluation by a speech-language pathologist, objective assessment of the VP port is required to determine the need for surgical intervention. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 3, the authors focus on the modalities for objective VP port assessment, including both direct and indirect methods. Direct imaging techniques such as videofluoroscopy, nasoendoscopy, and MRI are detailed for their strengths and limitations in visualizing VP port function and preoperative planning. Indirect assessments, including nasometry and aerodynamic measurements, are also briefly discussed. The decision-making process for surgical intervention is explored, emphasizing factors such as the severity and etiology of VPD, VP closure patterns, palatal length, orientation of the levator veli palatini, and other patient-specific considerations. The authors review the surgical options for repair including palatoplasty procedures (Furlow palatoplasty, straight-line intravelar veloplasty, and palatal lengthening buccal myomucosal flaps) and pharyngoplasty procedures (posterior pharyngeal flaps and sphincter pharyngoplasty), highlighting their indications, techniques, and potential complications. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.

The Long Haul to Surgery: Long COVID Has Minimal Burden on Surgical Departments.

Many patients infected with the SARS-CoV-2 virus (COVID-19) continue to experience symptoms for weeks to years as sequelae of the initial infection, referred to as "Long COVID". Although many studies have described the incidence and symptomatology of Long COVID, there are little data reporting the potential burden of Long COVID on surgical departments. A previously constructed database of survey respondents who tested positive for COVID-19 was queried, identifying patients reporting experiencing symptoms consistent with Long COVID. Additional chart review determined whether respondents had a surgical or non-routine invasive procedure on or following the date of survey completion. Outcomes from surgeries on patients reporting Long COVID symptoms were compared to those from asymptomatic patients. A total of 17.4% of respondents had surgery or a non-routine invasive procedure in the study period. A total of 48.8% of these patients reported experiencing symptoms consistent with Long COVID. No statistically significant differences in surgical outcomes were found between groups. The results of this analysis demonstrate that Long COVID does not appear to have created a significant burden of surgical disease processes on the healthcare system despite the wide range of chronic symptoms and increased healthcare utilization by this population. This knowledge can help guide surgical operational resource allocation as a result of the pandemic and its longer-term sequelae.

VNOTES scarless and painless endometrial cancer staging surgery.

Sentinel lymph node dissection is performed in endometrial cancer surgery instead of staging surgery, particularly when the disease is advanced and confined to the uterus. The aim of this study is to share our sentinel lymph node detection rates via the vaginal natural orifice transluminal endoscopic surgery method with the literature and to demonstrate a safer and more comfortable surgical treatment process. The analysis includes the patients who underwent surgery sentinel lymph node dissection for endometrial cancer utilizing indociyanin green in our center between January 2022 and June 2024. In all, of 24 endometrial cancer patients underwent surgery sentinel lymph node dissection, nonendometrioid (serous) pathology was observed in only 1 (4%) patient, our other patients (96%) had endometrioid adenocarcinoma pathology. The rates of our sentinel lymph node dissection bilateral and symmetric are 96% (23/24), 94% (22/24), and 79% (19/24), respectively. We would like to emphasize that we successfully used vaginal natural orifice transluminal endoscopic surgery approach on four of our patients who were unsuitable for laparoscopic and robotic surgery due to pain scores of 2 at the 12th hour after surgery and low lung capacity. Vaginal natural orifice transluminal endoscopic surgery and sentinel lymph node dissection will be considered as surgical options in other gynecological cancers due to the comfort it brings to the patient in endometrial cancer.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees-Part 1: Anatomy and Physiology.

The velopharyngeal (VP) port separates the nasopharynx from the oropharynx and is bordered by the velum, lateral pharyngeal walls, and posterior pharyngeal wall. Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the VP port, affecting speech and swallowing. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism; (2) fundamental speech terminology and principles of perceptual speech assessment for VPD; and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 1, the authors focus on the anatomy and physiology of the velopharyngeal port, the anatomy of cleft palate, and the causes of VPD. There are 3 types of VPD: velopharyngeal insufficiency, involving structural deficits; velopharyngeal incompetence, resulting from neuromuscular issues; and velopharyngeal mislearning, due to maladaptive speech habits. VPD is commonly associated with cleft palate due to anatomic disruptions that impair velopharyngeal function. However, there are numerous causes of noncleft VPD, including congenital or acquired structural defects, neuromuscular conditions, and developmental/behavioral factors. Diagnosis and management of VPD require a multidisciplinary approach involving, at a minimum, surgeons and speech-language pathologists. Plastic surgery trainees often receive education on the surgical treatment of VPD, but without a foundational knowledge of the disease spectrum and speech pathology, the complex terminology can impede a thorough understanding of its diagnosis and management. This series serves as an accessible resource, providing the foundational knowledge required for surgical trainees new to this topic.

Demystifying Velopharyngeal Dysfunction for Plastic Surgery Trainees Part 2: Speech Fundamentals and Perceptual Speech Assessment.

Velopharyngeal dysfunction (VPD) is the inability to achieve proper closure of the velopharyngeal (VP) port, affecting speech and swallowing. The gold standard for diagnosis is auditory-perceptual speech evaluation by a specialized speech-language pathologist. This 3-part series provides a comprehensive discussion on (1) the anatomy and physiology of the velopharyngeal mechanism, (2) fundamental speech terminology and principles of perceptual speech assessment for VPD, and (3) techniques for objective evaluation of the VP port and surgical decision-making process. In part 2, the authros begin with the concepts and terminology required to understand the perceptual speech assessment of VPD, including resonance, articulation, and the differentiation between consonants and vowels. We review the types of speech samples used for evaluation such as single-word articulation tests, syllable repetition, sentence repetition, and spontaneous connected speech. Finally, we discuss the auditory-perceptual speech assessment for VPD, including the assessment of resonance, nasal air emission, articulation, and voice quality. The use of rating scales like the Pittsburgh Weighted Speech Scale (PWSS) and the Cleft Audit Protocol for Speech-Augmented-Americleft Modification (CAPS-A-AM) is highlighted. In addition, the significance of intraoral examinations, visual-tactile-auditory evaluations, and the assessment of voice quality are covered. Most textbook chapters discussing this topic assume a foundational knowledge of speech-language pathology, which a surgical trainee may lack. This study aimed to bridge the gap between surgical training and speech pathology, providing a comprehensive resource to enhance the understanding and management of VPD.

ThP8.11 - Causes of delay to surgical interventions in patients with transient ischaemic attack and stroke

Abstract Aims The UK National Institute for Health and Care Excellence (NICE) guidelines and vascular society of surgery Great Britain and Ireland (VSGBI) emphasize the importance of scheduling carotid endarterectomy (CEA) within 2 weeks of symptom onset to reduce the risk of recurrent stroke. However the National vascular Surgery report for 2023 showed that this target was met in only 52% of patients. This study aimed to examine the possible causes of these delays. Methods This study analysed patient or hospital-derived factors impacting the timing of surgical intervention for patients with symptomatic carotid disease. A retrospective database was established to gather data on CEAs performed during an 8-month interval (January to August 2023) at a major teaching hospital. Results 36 patients underwent CEA; 13 (36.1%) received the procedure within 2 weeks of symptom onset, while 23 (63.9%) experienced delays. The main reasons for not meeting the two-week timeframe were associated with surgical scheduling, patient presentation, and referral processes. Specifically, among the 23 patients facing delays, 10 (43.5%) were due to surgical scheduling, 6 (26.1%) encountered delays in presenting to medical services, 5 (21.7%) were affected by delayed patient referral or review, and 2 (8.7%) were from lack of patient fitness. None however ended up with recurrent stroke while awaiting surgery on best medical management. Conclusions Prompt surgical intervention can reduce the risk of recurrent strokes. 63.9% of CEAs encountered delays, primarily associated with surgical scheduling. Prioritised pooled lists may be the answer.

Surgical instrument tray optimization process at a university hospital: A comprehensive overview

ObjectiveThis study presents the results of a surgical instrument tray optimization process implemented across all surgical specialties within the largest university hospital in Denmark. MethodsData was extracted from a comprehensive instrument optimization process including all Operating Rooms at Aarhus University Hospital. Adopting a holistic perspective, the optimization process, involved aligning instrument trays across various surgical specialties. This included: a) Reduction in number of instruments, b) Consolidation or separation of trays, c) Modularization - introducing modular trays for specific purposes, and d) Standardization - standardizing commonly used instruments across specialties. Instruments per tray, total number of instruments, and changes in the number of trays were compared against existing tray contents to identify discipline-specific changes. ResultsSome specialties made substantial alterations to tray structures, while others primarily reduced number of instruments in existing trays. Across all specialties, optimization resulted in 17 % decrease in number of tray types (p = 0.01, 95%CI:1.0–6.8), 1 % increase in total number of trays (p = 0.36, 95%CI:-11.9–4.8), 18 % decrease in number of instruments per tray (p = 0.0002, 95%CI: 3.2–7.6) and 16 % reduction in total number of instruments for all specialties (p < 0.0001, 95%CI:404–758). ConclusionThis study underscores complexity of instrument tray design. The approach employed at Aarhus University Hospital, involving interdisciplinary experts in an iterative design process, demonstrated the feasibility of redesigning instrument trays with significant reduction in content. Additionally, data suggests that reducing the number of instruments could lead to a decrease in workload within the Central Sterile Supply Specialty. This presents opportunity to minimize wasted resources and streamlining cleaning processes for unused instruments.