Term Surgical Outcomes Research Articles

"Long-term safety and efficacy of injection mitomycin C(MMC) versus sponge application in trabeculectomies".

To compare the long-term safety and efficacy of subconjunctival injection mitomycin C(MMC) with conventional sponge applied MMC during trabeculectomy. Retrospective analysis of 98 eyes of 90 patients who underwent trabeculectomy with Mitomycin C were divided into two groups, group 1- sponge (n = 52) and group 2- Injection(n = 46). Follow-up data were collected on day one, day 15, one month, three months, six months, one year, two years and three years. Data from baseline and follow-up visits were analyzed and compared to study the significant difference in intraocular pressure (IOP), number of antiglaucoma medications (AGM) and best corrected visual acuity (BCVA) . P-value of <0.05 was considered statistically significant. Mean preop IOP was 34.61 ± 13.3 mmHg in group one and 33.07 ± 9.6 mmHg in group two, which reduced to 11.43 ± 3.2 and 11.59 ± 3.2 mmHg at three years (p < 0.001 in both groups) with no significant difference between the groups. Mean number of preoperative AGM was 2.28 ± 0.8 and 2.42 ± 0.7 in group one and two respectively which reduced to 1.19 ± 1.1(p = 0.405) and 0.88 ± 0.9(p = 0.001) at three years. Complete and overall success rates (complete + qualified) were 59.3% and 78.9% in group one and 60.9% and 80.4% in group two at three years. No statistically significant difference was found in complication rates, post-operative interventions, and final visual outcome in both groups. Subconjunctival Injection MMC was a safe and effective alternative to sponge application with comparable long term surgical outcomes.

Long term surgical results and safety profile of the novel CM T Flex scleral fixated intraocular lens.

To report the long term visual outcomes and complications with use of the novel CM-T Flex scleral fixated intraocular lens (CMT-SFIOL). 116 eyes that underwent CMT-SFIOL were reviewed and 57 eyes with CMT-SFIOL that completed a 2-year follow-up were included. Main outcome measures noted were best-corrected visual acuity (BCVA) and complications. Postoperatively, follow-ups were done at 1week (1w), 1month (1m), 1year (1y) and 2-year (2y) intervals. 40 (70.17%) of 57 eyes received CMT-SFIOL for surgical aphakia. Mean follow up was 39.77 ± 8.44months. BCVA for distance & near improved from 1.26 ± 0.84 to 0.76 ± 0.77, 0.50 ± 0.72 and 0.51 ± 0.73 & 1.28 ± 0.58 to 0.98 ± 0.49, 0.92 ± 0.44 and 0.89 ± 0.40 at 1m, 1y and 2y respectively (p < 0.001 for all). At 1w, 10 eyes (17.54%) had corneal edema (CE) and 8 eyes (14.03%) had anterior chamber (AC) reaction. Two eyes (3.50%) had IOP > 30mm Hg and 1 eye (1.75%) had vitreous hemorrhage (VH). At 1m, 3 eyes (5.26%) had CE and 5 eyes (8.77%) had AC reaction. Two eyes (3.50%) had IOP > 30mm Hg and 1 eye (1.75%) had VH. Cystoid macular edema was noted in 3 eyes (5.26%). At 1y and 2y, 2 eyes (3.5%) and 1 eye (1.75%), had CE. No decentration, dislocation, haptic exposure or retinal detachment was noted. No eyes required resurgery. CM-T Flex SFIOL is an effective method to correct aphakia, with reliable and safe long-term results.

P724 Long-term outcomes of exclusive enteral nutrition in the peri-operative period for Crohn’s disease: A seven year follow-up study

Abstract Background Exclusive enteral nutrition (EEN) is a recommended first-line treatment for Crohn’s disease flares in the paediatric population. Its use has yet to translate widely to the adult population. There is growing evidence for the use of EEN in the pre-operative setting to downstage the disease process and improve short term surgical outcomes. Little is known in this context regarding the long term effects of pre-operative EEN. Our study reports on follow up data for a cohort of patients who underwent surgery following pre-optimisation with EEN compared to those who did not. We assessed long term complications, disease recurrence and disease control as our key outcomes. Methods We carried out a seven year follow up study of the patients included in a retrospective, matched cohort trial conducted in a single, tertiary care, inflammatory bowel disease centre, in the UK. Patients pre- optimised with EEN prior to surgery were compared to a matched control cohort. Results Median follow up period was seven and six years for EEN and control groups respectively. Patients in the EEN group were more likely to be on maintenance medical therapy compared to control (73.47% vs 46.67%, p=0.005), however, admission rates and clinical recurrence rates were similar between groups (32.65% vs 24.66%, p=0.33 and 71.43% vs 65.58%, p=0.42). There was a moderate difference in complication rates beyond six months in favour of the EEN group (5.55% vs 17.80%, p=0.08). EEN patients were more likely to need further surgery however, this observation was not sustained when surgery for peri-anal disease was excluded (22.45% vs 13.69%, p=0.21) Conclusion Pre-optimising patients with EEN prior to Crohn’s disease surgery may improve short term surgical outcomes, it is unlikely to improve long term disease outcomes, based on results from this study.

Long term surgical outcomes of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF)

Long term surgical outcomes of thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF)

Long term surgical outcomes of vaginal colposuspension using the Uphold Lite™ mesh system vs. vaginal vault uterosacral ligament suspension for treatment of apical prolapse

ObjectiveThe aim of this study is to compare long-term outcomes (7–10 years) between vaginal hysterectomy with uterosacral ligament suspension (VHUSLS) and sacrospinous hysteropexy with the Uphold™ Lite mesh System (SHU) for management of apical prolapse. MethodsPatients undergoing VHUSLS or SHU from 2008 to 2012 at a single tertiary referral center were included. Patients were contacted, asked to return for physical examination, and to complete the Pelvic Floor Distress Inventory (PFDI-20) questionnaire. Our primary outcome was anatomic failure defined as Stage 2 POP or higher of any compartment. The secondary outcome was subjective changes in symptoms based upon PFDI-20 responses. ResultsTwo-hundred and two women were identified to have undergone the index surgeries from 2008 to 2012. Sixty-three agreed to return for follow up symptom evaluation and examination (30 VHUSLS and 33 SHU). Baseline characteristics were similar between groups. Clinical cure was high for both groups reaching 93.4 % and 94.0 % for the VHUSLS and SHU groups, respectively (p = 0.721). Anatomical success was lower with 44.7 % and 66.7 % of patients in the VHUSLS and SHU groups, respectively, meeting criteria for success (p = 0.138). There were no mesh complications among patients returning for exams. However, two patients who were contacted and were not interested in this study reported mesh complications and need for additional surgeries. Anterior vaginal wall support was noted to be significantly better supported for SHU (Ba −2.03 ± 0.75 vs −1.42 ± 0.92, p = 0.008). There were no differences between groups for overall PFDI-20 scores postoperatively. However, SHU patients reported higher rates of stress urinary incontinence compared to VHUSLS patients. ConclusionIn women with apical prolapse, VHUSLS and SHU afford similar long-term outcomes. SHU patients reported higher rates of stress urinary incontinence.

Integration of effort for secure pancreaticoduodenectomy improved surgical outcomes: Historical observational study

To study the impact of strategies focusing attention on the safety of pancreaticoduodenectomy (PD) on postoperative outcome. Since 2012, tailored pancreaticoenterostomy, modification of stent insertion and organized drain management were applied according to risk for postoperative pancreatic fistula (POPF). Patients who performed PD after 2012 were enrolled into the prospective cohort, named experimental group (EG), and those who performed prior 2012 were enrolled into the historical control cohort (HG). Short term surgical outcomes were analyzed. HG included 90 patients and EG included 85 patients. Overall rate of Clinically relevant (CR)-POPF was 13.7% (24/175), 18.9% in HG (17/90) and 8.2% in EG (7/85), respectively (p=0.049). Postoperative delayed gastric emptying, rate of postoperative bleeding, length of hospital stay, and mortality rate did not show any difference between groups. Postoperative complications of Clavien-Dindo 3 or higher were significantly reduced in the EG (22.2% vs 8.2%, p=0.012). After the application of a new surgical policy and management, CR-POPF rate and high-grade complication rate decreased by more than half.

Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study

ObjectiveTo compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan.DesignRetrospective cohort study.SettingData from the Japanese National Clinical Database (includes data on >95% of surgeries performed in...

351. SUPERIOR MEDIASTINAL DISSECTION DURING MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER—A MULTICENTER PROPENSITY SCORE MATCHED (PSM) ANALYSIS

Abstract Minimally invasive esophagectomy (MIE) is currently the preferred approach of surgery for esophageal cancer. Systematic superior mediastinal lymphadendectomy along bilateral recurrent laryngeal nerve is enhanced by the magnified view in thoracoscopy, and is increasingly performed to achieve complete nodal dissection. Both participating centers began MIE with systematic superior mediastinal dissection in recent 5 years. In the current study, we aim to compare the short- and medium-term outcomes of MIE with or without superior mediastinal dissection. Consecutive patients who received MIE for esophageal cancers from 2004 to 2021 were recruited, data were collected from a prospectively maintained database. Patients were divided into ‘systematic superior mediastinal dissection’ and ‘control’ groups, and propensity score matching was performed with age, tumor location, tumor stage and neoadjuvant therapy. Total 157 patients were recruited, 67 (42.7%) in the extended superior mediastinal dissection group. After PSM, 48 patients were identified in each group. Short term surgical outcomes as well as medium term survival results were compared. Operative time was significantly longer with extended superior mediastinal dissection. Higher number of lymph nodes were yielded in total and from the superior mediastinum. Recurrent laryngeal nerve palsy developed in 52.1% and 43.8% of the MIE with or without extended dissection respectively, but significantly fewer palsies required intervention in the extended dissection group. Higher rate of anastomotic leakage was observed in the extended dissection group, but there was no difference in the overall severe adverse event (&amp;gt; = Grade III: 31.3% vs 35.4%). There was no statistical difference in the survival, but a trend towards improved 2 year disease-free survival was observed. Minimally invasive esophagectomy with systematic superior mediastinal dissection achieved a higher lymph node yield and a trend towards improved disease free survival. The overall adverse event rate was similar with conventional dissection. While better cancer staging could be achieved with extended dissection, further research is required to confirm the oncological benefit of extended dissection.

500. DEVELOPMENT AND VALIDATION OF INTRAOPERATIVE RADIATION FIBROSIS SCORE (IRFS) IN PATIENTS UNDERGOING TRANSTHORACIC ESOPHAGECTOMY POST NEOADJUVANT CHEMORADIATION FOR ESOPHAGEAL CANCER

Abstract Esophagectomy performed for cancers of esophagus is a challenging surgery. Post radiation fibrosis makes identification of critical structures difficult. The exact relationship between radiation dose and timing of surgery to the intraoperative difficulty remains to be tested. Surgical videos of transthoracic esophagectomy for carcinoma esophagus post neoadjuvant chemoradiation were reviewed and IRFS score was calculated based on three factors (esophageal pleural thickening, periesophageal planes, periadenitis). The IRFS score was then correlated with the radiation dose, interval between radiation completion and surgery, surgery duration, pathological response, major intraoperative complications and short term surgical outcomes. Primary objective: Correlation of radiation dose and timing of surgery with the IRFS. Secondary objectives: To study for correlation between surgery duration, pathological response, major intraoperative complications and short term surgical outcomes with IRFS Surgical videos of 100 patients were analysed. IRFS score which comprises of esophageal pleural thickening, periesophageal planes and periadenitis is a unique tool of assessing surgical difficulty which can be used to correlate radiation doses and interval to surgery. Further studies are required to validate it against post operative outcomes.

Profiling Gingivoperiosteoplasty (GPP): A Cross-Sectional Analysis Using a Nationally Validated Pediatric Surgery Database

Objective: Compare short term surgical outcomes and trends in cleft lip repair with or without gingivoperiosteoplasty (GPP). Design: Retrospective review of the ACS NSQIP-Pediatric database from 2014 to 2019. Patients: Patients between 2 and 18 months of age undergoing any initial cleft lip repair, with or without GPP, were selected via relevant CPT® codes. Main Outcome Measures: Patient demographics, comorbidities, 30-day readmissions and post-operative complications are assessed. Results: From 2014 to 2019, a total of 6269 patients were identified, of which 6.67% underwent GPP (n = 418). Patients undergoing GPP were significantly older with an average age of 9 months compared to 5 months in the non-GPP group ( P &lt; .001). Co-morbidities were similar amongst both cohorts, although patients undergoing GPP were more likely to have a higher ASA class ( P = .006), cardiac risk factors ( P = .012) and syndromic diagnosis ( P &lt; .001). There were no differences in 30-day short term surgical outcomes. GPP was associated with increased operative time by ~25 minutes when compared to cleft lip repair alone ( P &lt; .001). Conclusion: GPP was not associated with increased 30-day postoperative complications, readmission, reoperation, or total length of hospital stay, and was associated with an increased operative time of 25 minutes. Children undergoing GPP were significantly older in age and were more likely to have a higher ASA class/cardiac risk factors.

Clinical Presentation of Intestinal Obstruction in Pregnancy and Management Challenges: Case Series

Introduction: Abdominal emergencies during pregnancy (excluding obstetric emergencies) occur on one out of 500-700 pregnancies. Since they are relatively rare patients should be referred and managed in tertiary level centres where surgical, obstetrical and neonatal cares are available. To our understanding there are no detailed descriptive series of occurrences of intestinal obstruction in pregnancy emanating from (Low and middle income countries) LMIC including Tanzania. Case Presentation: Herein, we present four cases of intestinal obstruction in pregnancy that was managed at a tertiary level centre in a Northern Tanzania. We share experiences and challenges in the surgical management and short term surgical outcomes. Conclusion: Clinical presentations may be atypical and misleading due to pregnancy-associated anatomical and physiologic alterations which often lead in diagnostic uncertainty and therapeutic delays with increased risk of maternal and fetal morbidity.

105. Long Term Surgical and Patient Reported Outcomes After Cross Face Nerve Graft Reconstruction in Pediatric Facial Paralysis

Purpose: Free functioning muscle transfer is the gold standard for pediatric facial paralysis reconstruction and using the contralateral facial nerve for neurotization via a cross face nerve graft enables spontaneous smile restoration. Outcomes of pediatric facial reanimation beyond 10 years are not known, including how smiles change with aging and how adult patients report their facial function and quality of life. This study evaluated long term surgical and patient-reported outcomes for adults who underwent facial reanimation as children. Methods: This cross-sectional study enrolled patients who underwent facial reanimation with a staged cross face nerve graft and free gracilis muscle transfer as children at least 10 years ago. FACE-Gram software was used to quantify commissure excursion on frontal photographs in repose and maximal smile at three time points: preoperative, early postoperative within 2 years, and current (long term follow up). Patient-reported outcomes were evaluated quantitatively using the FaCE Scale and FACE-Q instruments for patient satisfaction, and qualitatively with semi-structured interviews. Results are reported as mean ± SD and parametric statistical analysis was performed with alpha of 0.05. Results: Eighteen patients who underwent facial reanimation as children more than 10 years ago were included (14 females, 5 males; 10 congenital, 8 acquired; age at stage 1 surgery 7.4 ± 3.6 years). Commissure excursion was measured as -1.3 ± 3.5 mm preoperatively, 5.9 ± 2.3 mm postoperatively within 2 years, and 7.6 ± 3.5 mm at long term follow up (mean 20.5 ± 6.9 years). Commissure excursion increased 7.2 ± 4.9 mm from preoperative to early postoperative time points (p<0.0001) and did not significantly increase or decrease at long term follow up (p>0.05). For patient reported outcomes, mean FaCE scale score for facial movement was 44/100 when including eyebrow function and 79/100 when excluding eyebrow function. Mean FaCE scale scores were 63/100 for eye comfort and 81/100 for social function. On the FACE-Q Satisfaction with Outcome scale, 17/18 respondents somewhat agreed or definitely agreed with the statement, “I am pleased with the result.” On the FACE-Q Social Function scale, 16/18 respondents somewhat agreed or definitely agreed with the statement, “I feel confident when I meet a new person.” Conclusions: Pediatric facial reanimation with cross face nerve grafting improves commissure excursion and this is maintained with aging. Adult patients report overall high satisfaction and social functioning. Ongoing ocular issues remains a problem for many patients, underscoring the importance of refining techniques for reanimation of the eye.

RANDOMIZED CONTROL TRIAL OF CONVENTIONAL LAPAROSCOPIC VERSUS SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Background:From big incision to minimally invasive multiport classic laparoscopic cholecystectomy (CLC) and now to single incision laparoscopic cholecystectomy (SILC) surgeryhas travelled a long way. There are proposedadvantages and potential disadvantages of SILC compared to the gold standard CLC. However, debate still exists whether SILC has anything more to offer. We compared various parameters of patient satisfaction, quality of life and short term surgical outcomes between CLC and SILC. Method: RCT was conducted forduration of one year. Patients were assigned into SILC and CLC groups. Operative time, length of hospital stay, quality of life (SF 36 questionnaire), patients overall and cosmetic satisfaction and postoperative pain using 10-point visual analogue scale (VAS) were assessed.The data analysis was done using software SPSS version20.0. Results: A total of 36 patients (28 women and 8 men) with mean age 39.88±11.99 yearswere allocated into SILC (n=18) and CLC (n=18) groups.The mean operative time for SILC was significantly longer than CLC (66.33 vs 46.50 minutes, P=0.001). VAS recorded higher pain in first 24 hours postoperatively in SILC than CLC group (4.467 vs 2.667, P=0.06). However, at the time of discharge patients in CLC had greater pain than SILC group (0.22 vs 0.133, P&gt;0.99).No significant variability was seen in length of hospital stay (SILC 3.60 vs CLC 3.38 days, P=0.47). The QOL on first follow up visit showed statistically significant difference in two of the domain of SF 36, namely vitality and bodily pain. Patients overall and cosmetic satisfaction showed no superiority of SILC over CLC. Conclusions:Although patient prefers SILC in wake of cosmetic reasons, still it is a long way off from replacing CLC. Larger operative time and lack of standardization makes SILC still an evolving procedure and judicious patient selection is must for better outcome.

Comparison of short term surgical outcomes according to immediate postoperative serum glucose level in non-diabetic pancreatic resection patients

Okjoo LEE, Woo Hyun JUNG, So Jeong YOON, Ji Hye JUNG, Sang Hyun SHIN, Jin Seok HEO, Yong Chan SHIN, Chang-Sup LIM, In Woong HAN*. Ann Hepatobiliary Pancreat Surg 2022;26:S62. https://doi.org/10.14701/ahbps.2022S1.OP-1-4

Orbital volume changes during growth and development in human children assessed using cone beam computed tomography

ObjectivesTo measure growth-related changes in orbital volume from childhood to the late teenage years using cone-beam computed tomography (CBCT) scans.MethodsThis retrospective cohort study involved 65 (24 male, 41 female) healthy Caucasian children (ages 6–18 years) with existing serial craniofacial CBCT scans. CBCT scans were available for 292 orbits. Each orbit was transformed into a closed space with well-defined boundaries, and orbital volume was measured using manual segmentation. A novel statistical analysis was applied to extract the maximum amount of longitudinal information from the data. Intra- and inter-operator correlation coefficients were calculated from replications performed on a random subset of 10% of the sample.ResultsOrbital volume increased at a rate of 1–2% annually until the late teenage years. Intra- and inter-operator agreement between repeated measurements were >90%.ConclusionsOrbital volume increases by 1–2% per year throughout childhood continuing until the late teenage years. This annual increase is large enough to be clinically relevant as it may lead to less-than-optimal long term surgical outcomes when reconstructive surgery for the pediatric anophthalmic socket is required.

Oncological outcomes and Quality of life in Locally Advanced and Recurrent Rectal cancer patients following Pelvic Exenteration

Background: Pelvic exenteration remains the standard treatment option for locally advanced and recurrent rectal cancer, although it is a complex surgical procedure associated with morbidity. This review aims to look at short term and long term surgical outcomes, oncological outcomes, and quality of life after pelvic exenteration

Comparison of Short Term Surgical Outcomes According to Immediate Postoperative Serum Glucose Level in Non-Diabetic Pancreatic Resection Patients

Introduction: Regulation of postoperative blood glucose level has been shown better prognosis in many studies. However, impact of regulation of blood glucose level in major pancreatic surgery patients who were not diagnosed with diabetes is not established currently. The purpose of this study was to discuss the relevance of the immediate postoperative blood glucose level and short term postoperative outcomes of major pancreatic surgery in non-diabetic patients.

Euvolemic off pump coronary surgery further improves early postoperative outcomes.

Background:Fluid resuscitation during Off-Pump Coronary Surgery (OPCABG) is still not protocolized and depends on multiple variables. We are exploring in this study whether a restrictive or euvolemic approach has any impact on short term surgical outcomes following OPCABG.Methods:It is a retrospective study of 300 patients analyzed based on the intraoperative fluid requirement with 150 patients in each group (Group I: Fluid <2 Litres, Group II: Fluid >2 Litres).Results:Multivariable analysis showed echocardiography variables such as E/e ratio, LA volume index, and atrial fibrillation (AF). LA volume index is related to the higher fluid requirement. Group II had significantly higher ventilation time (P < 0.05), drain output (P = 0.05), drain removal time (<0.05), inotropic requirement, and diuretic use.Conclusion:The requirement of the intraoperative fluid was associated with various factors including diastolic dysfunction (left atrial volume index, left ventricle mass index, E/e ratio) and preoperative dual antiplatelet use. Group II patients had longer ventilation time, diuretics use, high drain output, and required drains for a longer period of time. Although there was no statistical difference among two groups as far as postoperative AF concerned, a reversal of AF to sinus rhythm was delayed in group II patients.

Popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome (PAES) is an uncommon cause of lower extremity exertional claudication due to external compression of vascular structures in the popliteal fossa. A developmental anomaly due to an aberrant relationship of the artery with the surrounding myofascial structures contributes to the vascular compromise. PAES presents in younger, athletic patients without atherosclerotic risk factors. Typical presentation of unilateral or bilateral, intermittent claudication in the feet and calves specifically after exercise and relieved by rest in a young person should prompt further evaluation. Early diagnosis and intervention is essential for preventing thromboembolic complication and in worst cases limb loss. Initial tests with Ankle Brachial indices or Doppler ultrasound with provocative maneuvers will prompt more definitive cross sectional imaging studies. CTA or MRA also with provocative maneuvers has a high sensitivity and specificity and will clinch the diagnosis. There are six subtypes based on the relationship of the vascular structure with surround myofascial structures. CTA and MRA can characterize the subtypes and guide surgical planning. Catheter directed thrombolysis may be attempted adjunctively to reduce surgical thrombectomy or resolve distal emboli; however, myotendinous decompression with or without vascular repair is the definitive treatment. Long term surgical outcomes are satisfactory when the distal circulation is preserved.

Short-term surgical outcomes after Monopolar- versus Bipolar Transurethral Resection of the Prostate

Abstract Background Transurethral resection of prostate (TURP) is currently the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), as this procedure results in the best improvement in symptoms and urine flow rate (1). Aim of the Work to compare between the two techniques used for transurethral resection of the prostate; Monopolar versus Bipolar resection as regards short term surgical outcomes, perioperative complications and early changes in quality of life.. Patients and Methods Randomized controlled study with simple randomization (1:1) of 80 patients with BPH candidate for transurethral resection of the prostate, 40 patients underwent M-TURP, and other 40 patients underwent B-TURP, their age mean age of paients included in our study 57-61 years old, mean prostate size 68-71 gm. Results Comparing intra-operative data in monopolar and bipolar TURP groups, our study reported that there was statistically significant decrease in volume of irrigation and operative time in B-TURP group in comparison to M-TURP group. although intra-operative complications; bleeding, electrolytes disturbance, fever and LUTS were lower in BTURP group; however, did not reach statistically significant. In M-TURP group ,there was statistically significance increase in change Hb, and time of post-oprative irrigation, IPSS in compared to B-TURP group. While in respect to PVR, time of catheterization and hospital stay, there was no statistically significant difference data among the two studied groups. Conclusion Bipolar TURP represents a promising endoscopic treatment for patients with BPH with decrease in volume of irrigation and reduced operative time, and less incidence of TUR syndrome, intraoperative bleeding, and postoperative complications .However, further investigations are needed with larger, preferably randomized multicentric controlled trials to confirm the results of this study in the future.