Terms Of Operative Time Research Articles

Brain abscess burr hole aspiration in children with congenital heart disease in low facility centers: case series.

This is a prospective cross-sectional study on brain abscess burr hole aspiration in children with congenital heart disease (CHD) performed from January 2018 to March 2019. All patients were operated on through a burr hole, and then received intravenous antibiotics for 6 weeks and orally for 2 weeks either empirically or according to the results of abscess culture, if positive. The follow-up of cranial computed tomography or brain magnetic resonance image with contrast was obtained after 2 months (post-operatively) to assess the effectiveness of the procedure and to look for any residual or recurrent abscesses. Data were collected in a designed data collection sheet and analysed using Statistical Package for the Social Sciences-20. Thirteen patients were found to satisfy inclusion criteria. The most common presenting symptoms were fever (n = 11/13, 84.6%), vomiting (n = 7/13, 53.8%), headache (n = 6/13, 46.2%), convulsions (n = 6/13, 46.2%), focal weakness (n = 3/13, 23.1%), and impaired level of consciousness (n = 1/13, 7.7%). No bacterial growth was detected in two-thirds of the cases (69.2%), while the culture was positive in the remaining one-third (30.8%). The follow-up images showed complete resolution of the abscesses except in one case (n = 1/13, 7.7%), which required a second session of aspiration. One patient died (n = 1/13, 7.7%) on the 19th post-operative day due to severe pneumonia. Aspiration of brain abscess in children with CHD through a burr hole is a safe and effective procedure in terms of operative time, duration of anaesthesia and postoperative complications.

Does repeat laparoscopic hepatectomy without extracorporeal Pringle manoeuvre worsen treatment outcomes?

IntroductionThe Pringle manoeuvre is used in most hospitals to counteract intraoperative haemorrhage in laparoscopic hepatectomy by occluding the flow of blood to the liver. However, in laparoscopic repeat hepatectomy (LRH), outcomes of previous surgery and the influence of other factors frequently make it difficult to occlude the inflow of blood.AimTo discuss the value of inflow occlusion during LRH and provide tips for its performance.Material and methodsSixty-three patients who underwent LRH with or without the Pringle manoeuvre were analysed retrospectively. We investigated the efficacy and safety of the Pringle manoeuvre in LRH. Student’s t and χ2 tests, Mann-Whitney’s U test, Wilcoxon’s signed-rank test, and Fisher’s exact test were used in the statistical analysis.ResultsNineteen patients underwent LRH with the Pringle manoeuvre, and 44 patients underwent LHR without the Pringle manoeuvre. After propensity score matching, there were no significant differences in terms of operative time, estimated blood loss, and postoperative complication rate (p = 0.973, 0.120, and not applicable, respectively). However, the rate of conversion to open repeat hepatectomy (ORH) was significantly lower in the Pringle manoeuvre group (p = 0.034). In many cases, the cause of conversion to ORH was the non-use of inflow occlusion and the resulting inability to control intraoperative haemorrhage. Laboratory data collected after surgery showed no significant difference between the 2 groups regardless of whether blood flow was occluded or not.ConclusionsLRH with the Pringle manoeuvre can be performed safely using various surgical devices. However, it is often challenging to perform the Pringle manoeuvre in patients with a history of cholecystectomy or segment 5 resection of the liver, and caution is required.

Application of simulated puncture in percutaneous nephrolithotomy.

This study aimed to explore the clinical value of simulated puncture in percutaneous nephrolithotomy in the treatment of complex kidney stones. A total of 120 patients with complex kidney stones who were treated with percutaneous nephrolithotomy in our hospital between March 2017 and March 2020 were enrolled in this study and randomly divided into two groups: the research group and the control group (n = 60 in each). Each subject underwent a dual-source computed tomography (CT) scan of the pelvis and both kidneys before the operation. The research team imported the CT data into Mimics19 software to create a three-dimensional (3D) reconstruction of the skin, bones, kidneys, collecting system, and stones. Based on the 3D reconstruction model, the target renal calyx to be punctured was determined, the best puncture channel was designed, and puncture was simulated. Data regarding the simulated puncture were imported into 3-Matics11 software; the angle and depth of the puncture were measured, and then these data were used to guide percutaneous nephrolithotomy. 3D reconstruction and simulated puncture were not undertaken for the patients in the control group before the operation. The effects of treatment in the two groups were compared. First-stage percutaneous nephrolithotomy was successfully completed in both groups of patients. The outcome was better in the research group than in the control group in terms of operation time, number of punctures required for successful establishment of a percutaneous renal channel, number of percutaneous kidney puncture channels, and intraoperative blood loss, and the differences were statistically significant (p < 0.05 for all). The stone clearance rate was higher in the research group than in the control group, but the difference was not statistically significant (p = 0.471). The incidence of penetrating kidney injury was lower in the research group than in the control group, but the difference was not statistically significant (p = 0.154). For patients due to undergo percutaneous nephrolithotomy for the treatment of complex kidney stones, preoperative simulated puncture helps to improve the puncture accuracy and to reduce the number of punctures required for successful establishment of a percutaneous renal channel, the number of puncture channels, the operation time, and the blood loss, and therefore it is worth promoting.

Laparoscopic Versus Open Retrorectus Mesh Repair of Incisional and Ventral Hernia: A Randomised Clinical Study

Introduction: Hernias are defects or holes in the abdominal wall with protrusion of abdominal contents and are common problems in daily surgical practice. The defects can develop following previous surgical procedure or can be primary in the absence of any past surgery. The operative repair of these hernias can be done by either open procedure or laparoscopic surgery. Aim: To compare the laparoscopic hernia repair with open surgical repair in terms of operative time, hospital stay, pain, complications, cost and recurrence. Materials and Methods: This randomised clinical study was conducted from April 2015 to December 2019. Patients undergoing elective surgery for primary ventral hernias and incisional hernias were included. There were 50 patients who underwent open mesh repair and 50 patients who had laparoscopic repair. The data was analysed using Mann-Whitney U test for continuous variables and Chi-square test for categorical variables. Results: The patients were comparable for age and sex distribution and also the type of hernia, primary ventral or incisional, size of defect and body mass index in both the groups. The patients undergoing laparoscopic mesh repair had significantly less operative time (90 vs 110 minutes, p=0.036), reduced postoperative pain (p=0.001) and decreased hospital stay (3.47 vs 6.43 days p=0.0005). The cost of the laparoscopic surgery was significantly high (p-value 0.0001) basically owing to the cost of mesh and disposable tacker. The recurrence at mean follow-up of 13 months was similar in both the groups. Conclusion: Laparoscopic hernia repair is superior to open repair in select group of patients with small and medium size defects without loss of abdominal domain if cost is not a consideration.

The efficacy and safety of thulium laser resection of bladder tumor versus standard transurethral resection in patients with non muscle-invasive bladder cancer: a systematic review and meta-analysis

Purpose: This study was to analyze the efficacy and safety of thulium laser resection of bladder tumor (Tm-TURBT) versus TURBT for patients with non-muscle-invasive bladder cancer (NMIBC). Materials and Methods: Randomized controlled trial data were retrieved using the MEDLINE, Embase, Web of Science, and the Cochrane Library. We also searched Chinese databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang data and VIP data. Results: A total of sixteen articles including 1662 participants were enrolled into our meta-analysis. We found no significant difference in terms of operation time, urethral stricture, 1-year recurrence rate, overall 1-year recurrence rate and overall 3-year recurrence rate between the two groups. Less intraoperative blood loss and a lower incidence of obturator nerve reflex (ONR), bladder perforation and bladder irritation were identified in Tm-TURBT group than in TURBT group in our analysis. The analysis also demonstrated faster postoperative recovery in terms of the catheterization, bladder irrigation and hospitalization time in Tm-TURBT group. The subgroup analysis was conducted based on different postoperative chemotherapy (epirubicin and non-epirubicin) concerning recurrence rate whereas no significant difference was noted. Conclusion: Tm-TURBT is an efficient and safe treatment for NMIBC and it could be an alternative choice for TURBT. Given that some limitations are clearly identified, more large-scale and well-designed RCTs are needed to confirm our findings.

Comparison of Endonasal and External Septoplasty for Treatment of Buckled Caudal Septal Deviation

To compare endonasal and external septoplasty for type 2 caudal septal deviations in terms of operative time, aesthetic and functional outcome. Descriptive Analysis. ENT Department, Mayo Hospital/ K.E.M.U, Lahore, from October 2019 to October 2020. Record of patients operated for septal deviations in 2019 were retrospectively reviewed. All patients, diagnosed with type 2 caudal septal deviations, were included; while those with marked inferior turbinate hypertrophy, deviated nasal septum after trauma, and those who could not be followed-up, were excluded. Twenty-eight patients, operated by external approach, were placed in group A; and 32 patients, who had endonasal surgery, were placed in group B. Functional outcome was assessed by nasal obstruction symptom evaluation (NOSE) scale; and cosmetic deformity was assessed by visual analog scale (VAS) pre- and postoperatively at six months. Operative time was measured for both the groups. Sixty patients were included. Mean preoperative NOSE scale score for group A was 67.36 ± 8.07 and postoperative was 15.82 ± 3.62 (p<0.001). Mean preoperative NOSE score for group B was 69.40 ± 5.80 and postoperative it was 18.00 ± 3.75 (p<0.001). Mean VAS score for group A preoperative and postoperative was 18.93 ± 7.86 and 76.07 ± 6.85 (p<0.001), respectively. Mean VAS score for group B preoperative and postoperative was 19.69 ± 7.82 and 71.56 ± 8.84, respectively (p<0.001). Mean operative time for group B was 52.25 ± 3.37 minutes, and for group A 115.00 ± 9.91 minutes (p<0.001). The difference in preoperative and postoperative NOSE and VAS scores compared for both groups revealed p-value of 0.952 and 0.044, respectively. Extracorporeal septoplasty resulted in better aesthetic outcome; though endonasal septoplasty had shorter operative time. Both surgical techniques resulted in good functional outcome. Key Words: Nasal septum, Nasal surgical procedures, Deviated nasal septum, Caudal deviation septum, Septoplasty, Septorhinoplasty, Nasal obstruction symptoms evaluation (NOSE) score, Visual analogue scale (VAS).

The Feasibility and Benefits of in Vivo Swine Training Model for Laparoscopic Liver Resections among General Surgery Residents

Background: Laparoscopic liver resections (LLR) are gaining popularity worldwide, however, a proper and efficient training model is lacking, mainly for residents and young surgeons. The aim of our study is to assess the feasibility and benefits of a “step-by-step” training model in LLR created for residents as part of a continuous training program. Methods: From May 2017 to October 2018, 30 residents who previously participated in laparoscopic surgery workshops at “Prof. Sergiu Duca” training centre, Cluj-Napoca, Romania, participated in a “step-by-step” guided LLR protocol workshop on swine (Stage 1) aiming to analyse its feasibility. The protocol consisted of performing cholecystectomy, liver mobilization, minor and major resections. Their performance Results in terms of operative time, blood loss, conversion, trainers' intervention and intraoperative mortality, were recorded. Twenty-four of these residents (6 dropped out as they turned seniors) were later compared to 24 senior surgeons who neither followed the protocol nor performed LLR previously (Stage 2), and to another 24 residents who weren't part of a training program but followed the protocol (Stage 3), aiming to assess its' benefits. Results: All residents fully completed the surgical procedures. Trained residents obtained better operative times and less blood loss compared to senior surgeons (p< 0,017), however, the remaining parameters were comparable. When compared to non-trained residents, the trained ones had significantly better results only in operative times (p< 0,001). Conclusion: A continuous LLR “step-by-step” training program on swine for residents is feasible. It can be successfully applied with clear benefits on practical skills.

HARMONIC SCALPEL VERSUS CONVENTIONAL TECHNIQUE IN TOTAL THYROIDECTOMY (COMPARATIVE STUDY)

Background: Thyroid gland is a highly vascular organ. So, doing thyroidectomy requires good hemostasis even for the small blood vessels either through conventional tie technique which is time-consuming or through the use of a harmonic scalpel. Objective: To evaluate the real benefits of the Harmonic Scalpel in total thyroidectomies when compared with conventional ligation, in terms of operative time, postoperative drainage, and complications. Patients and methods: This randomized, prospective observational study was carried out at Al-Zahraa University Hospital, Al-Azhar University, Cairo, Egypt. Written informed consents were obtained from Seventy-six patients with benign goiter disorders who were scheduled for elective total thyroidectomy during a period from August 2019 to October 2020. Thirty eight patients were submitted to conventional thyroidectomy (group A), and thirty eight underwent thyroidectomy using a harmonic scalpel (group B). Results: There was no statistical difference between the two groups as regards demographic data, hospital stay, recurrent laryngeal nerve injury, and hypocalcemia, but there was a statistically significant difference as regards operative time (76.9±15.1 min in group A versus 89.23±17.68 in group B) and drainage volume (111.75±56.57 mls in group A versus 89 ± 16.21 mls in group B). Conclusion: Harmonic scalpel for total thyroidectomy is a better choice compared to the conventional tie technique as regards operative time and postoperative drainage volume.

Experience in forecasting long-term settlements of energy facilities based on monitoring data analysis

The article discusses the problem of predicting the long-term settlement of reactor compartments of nuclear power plant with a long history of operation and ongoing creep processes. The features of determining the time of the primary consolidation and the application of the parameters of the secondary consolidation are considered. With regard to the existing buildings of the reactor compartments of a nuclear power plant, a forecast of long-term deformations of the base was made, from the present time to 2062, which is the end of the operation period. The analysis and comparison of the obtained results with the data of geotechnical monitoring were also carried out. Analytical forecasting showed a high accuracy in determining the end time of filtration consolidation, however, a comparison of the values of the obtained creep settlements to date and the rate of their development shows significant differences, which makes it necessary to take into account the real picture of deformation for further forecasting in terms of operation time. Possible technological reasons for discrepancies in the results of calculations and geotechnical monitoring are analyzed, as well as theoretical reasons like imperfections of the analytical method used and the possible application of modern numerical methods.

Surgical Invasiveness of Single-Segment Posterior Lumbar Interbody Fusion: Comparing Perioperative Blood Loss in Posterior Lumbar Interbody Fusion with Traditional Pedicle Screws, Cortical Bone Trajectory Screws, and Percutaneous Pedicle Screws.

Study DesignSingle-center retrospective study.PurposeThis study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS).Overview of LiteratureIntraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness.MethodsThis study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF).ResultsNo significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group (210.1 mL; range, 50–367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260–760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180–890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145–637 mL) than in the PS-PLIF (639.6 mL; range, 285–1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270–950 mL; p=0.005) groups.ConclusionsBased on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.

Learning Curve and Clinical Outcome of Biportal Endoscopic-Assisted Lumbar Interbody Fusion.

Interbody fusion is a common surgical technique for diseases of the lumbar spine. Biportal endoscopic-assisted lumbar interbody fusion (BE-LIF) is a novel minimally invasive technique that has a long learning curve, which can be a barrier for surgeons. Therefore, we analyzed the learning curve in terms of operative time and evaluated the outcomes of BE-LIF. A retrospective study of fifty-seven consecutive patients who underwent BE-LIF for degenerative lumbar disease by a single surgeon from January 2017 to December 2018 was performed. Fifty patients underwent a single-level procedure, and 7 underwent surgery at two levels. The mean follow-up period was 24 months (range, 14–38). Total operative time, postoperative drainage volume, time to ambulation, and complications were analyzed. Clinical outcome was measured using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) score for back and leg pain, and modified Macnab criteria. The learning curve was evaluated by a nonparametric regression locally weighted scatterplot smoothing curve. Cases before the stable point on the curve were designated as group A, and those after the stable point were designated group B. Operative time decreased as the number of cases increased. A stable point was noticed on the 400th day and the 34th case after the first BE-LIF was performed. All cases showed improved ODI and VAS scores at the final follow-up. Overall mean operative time was 171.74 ± 35.1 min. Mean operative time was significantly lower in group B (139.7 ± 11.6 min) compared to group A (193.4 ± 28.3 min). Time to ambulation was significantly lower in group B compared to group A. VAS and ODI scores did not differ between the two groups. BE-LIF is an effective minimally invasive technique for lumbar degenerative disease. In our case series, this technique required approximately 34 cases to reach an adequate performance level.

Open Transforaminal Lumbar Interbody Fusion (TLIF) for post-discectomy spondylodiscitis: Our experience

Introduction: Post operative lumbar Spondylodiscitis after lumbar discectomy surgery is well known complication with has a variable incidence rate, usually less than 1%.1 Post op spondylodiscitis is an infection of nucleus pulposus , annulus fibrosis with sometimes secondary involvement of cartilaginous end plates and vertebral bodies following lumbar disc surgeries.2 Early diagnosis of discitis based on clinical, laboratory, radiological findings and appropriate management is essential to reduce morbidity. Aim: Retrospective review of patients undergoing transforaminal lumbar interbody fusion (TLIF) for post-op discitis to evaluate clinical outcome and complications. Material and Methods:All patients undergone TLIF for post-lumbar discectomy spondylodiscitis at our institute from sept'13 to sept'17 were included in our study. All patients had moderate to severe lumbar backage. Initialy a course of conservative treatment with broad spectrum I .V antibiotics was given followed by surgery. On follow up patients were assessed with physical examination and radiographs. Outcome were measured in terms of operative time, blood loss, and surgical complications. Parameters like Visual analogue scale(VAS) for pain,modified Rankin scale (mRS) were evaluate before and after surgery and on subsequent follow up visits. Results: Modified Rankin scale (mRS) and VAS enhanced in all patients. Conclusion: Postoperative spondylodiscitis can be successfully managed with transforaminal lumbar interbody fusion (TLIF) and posterior spinal instrumentation. There is significant pain relief and good functional outcome after surgery. Keywords: Spondylodiscitis, Post discectomy infection, Transforaminal Lumbar Interbody Fusion (TLIF), Lumbar disc infection.

The impact of robotics in liver surgery: A worldwide systematic review and short-term outcomes meta-analysis on 2,728 cases.

The dissemination of robotic liver surgery is slow-paced and must face the obstacle of demonstrating advantages over open and laparoscopic (LLS) approaches. Our objective was to show the current position of robotic liver surgery (RLS) worldwide and to identify if improved short-term outcomes are observed, including secondary meta-analyses for type of resection, etiology, and cost analysis. A PRISMA-based systematic review was performed to identify manuscripts comparing RLS vs open or LLS approaches. Quality analysis was performed using the Newcatle-Ottawa score. Statistical analysis was performed after heterogeneity test and fixed- or random-effect models were chosen accordingly. After removing duplications, 2728 RLS cases were identified from the final set of 150 manuscripts. More than 75% of the cases have been performed on malignancies. Meta-analysis from the 38 comparative reports showed that RLS may offer improved short-term outcomes compared to open procedures in most of the variables screened. Compared to LLS, some advantages may be observed in favour of RLS for major resections in terms of operative time, hospital stay and rate of complications. Cost analyses showed an increased cost per procedure of around US$5000. The advantages of RLS still need to be demonstrated although early results are promising. Advantages vs open approach are demonstrated. Compared to laparoscopic surgery, minor perioperative advantages may be observed for major resections although cost analyses are still unfavorable to the robotic approach.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity.

Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients' body mass index (BMI) and visceral fat area (VFA). Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups (P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR (P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR (P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR (P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups (P = .017, < .001, and < .001, respectively). LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

Robotic versus laparoscopic hysterectomy; comparison of early surgical outcomes

Objective:To compare early surgical outcomes of robotic assisted laparoscopic hysterectomy with laparoscopic hysterectomy for benign diseases, in terms of operation time, estimated blood loss (EBL), perioperative complications, hospital stay and first gas discharge.Material and Methods:Medical records of 146 patients who either underwent laparoscopic (n=84) or robotic assisted laparoscopic hysterectomy (n=62) for benign diseases were extracted from records. Demographic characteristics and operation time, EBL, length of hospital stay and first gas discharge were compared between the groups.Results:Mean age and mean body mass index of both groups were comparable. The difference in the mean EBL was not statistically significant between laparoscopic (91±65 mL) and robotic group (80±37 mL, p=0.43). The difference in the mean first gas discharge time was not statistically different between laparoscopic (15±5 hours) and robotic group (17±6 hours, p=0.33). The length of hospital stay was comparable between groups (1.4±0.5 vs 1.5±0.7 days, p=0.64). The mean operation time was longer for the robotic group (150±180 minimum) when compared with laparoscopic group (105±18 minimum, p<0.01). The mean uterine weight of the robotic group was significantly heavier compared with laparoscopic group (234±157 grams vs 153±119 grams, respectıvely, p<0.01).Conclusion:Early surgical outcomes of robotic assisted laparoscopic and laparoscopic hysterectomy were comparable in terms of EBL, first gas discharge and hospital stay. Operation time was longer for robotic hysterectomy.

Laparoscopic versus open nephrectomy in resource-constrained developing world hospitals: a retrospective analysis

BackgroundLaparoscopic nephrectomy is the standard of care for nephrectomy in most developed countries. Its adoption in our setting has been limited due to lack of equipment and expertise. This paper sets out to show that laparoscopic nephrectomy is technically feasible in the state sector in South Africa.MethodsA retrospective chart review was performed of all patients having undergone nephrectomy over a five-year period at two state hospitals in KwaZulu-Natal Province, South Africa. Demographic information, pre-operative imaging findings, operative information and post-operative outcomes were analysed.ResultsNephrectomy was performed in 196 patients. Open nephrectomy (ON) was the intended surgical approach in 73% (n = 143) and laparoscopic nephrectomy (LN) in 27% (n = 53). The conversion rate from LN to ON was 11% (n = 6). For malignancies, there was no difference in surgical resection margin status across the ON, LN and conversion groups; however, tumour size was larger in the conversion group compared to the LN group. Estimated blood loss and transfusion rates were lower in the LN group. The average length of hospital stay was shorter in the LN group (5 vs 10 days). High dependency unit (HDU) admission rate was lower in the LN group (12.1%) compared to the ON group (50%) and the conversion group (40%). No difference in high-grade complications was noted between the ON and LN groups, and more patients in the LN group (82.5%) had no complications compared to the open group (9.9%).ConclusionLN is non-inferior to ON in terms of operative time, oncology outcomes and high-grade complications. LN is superior in terms of blood loss, transfusion rate, length of hospital stay and overall complication rate. LN appears to show technical feasibility in the state sector and highlights the need for laparoscopic training.

The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study.

Background To report the overall results and the learning curve (LC) in salvage robot-assisted radical prostatectomy (sRARP) patients, in terms of morbidity, oncological and functional outcomes in a single surgeon tertiary-referral center. Methods One hundred and twenty patients underwent sRARP by a single surgeon (V.P.) from 2008 to 2018. To assess the trends in the learning experience they were sub-divided in 4 groups of 30 consecutive patients based on date of surgery. The Kaplan- Meier method and regression models were used to identify survival estimations and predictors of potency, continence and biochemical failure (BCF) at 12 months. Results As the learning experience for sRALP increased operative time (OT) was significantly shorter (from 139,5 to 121 min) and the amount of nerve-sparing (NS) undertaken increased (from 46 to 80%). While complications rate remained stable, estimated blood loss (EBL) and radiographic anastomotic leaks (RAL) decreased through the groups (from 124 to 69 ml and 40% to 16,7%, respectively). BCF and continence rates at 12 months after sRARP were similar among groups (23-36% and 36,7-50%, respectively) and chance of potency rates tended to increase (from 3,3% to 16-23%) but was not statistically significant. In a multivariate analysis, predictors for BCF were PSM and GS 8-10. Non-radiation primary treatment was the unique predictor of continence at 12 months after sRARP. Conclusions Our data may suggest a decreasing trend in terms of OT and EBL through the sRARP learning curve. While morbidity remained stable through the time, radiographic anastomotic leaks trended towards a decline. A higher degree of NS was observed through the groups and there was a slight correlation trend between surgical expertise and potency recovery. PSM and GS 8-10 were predictors of BCF and non-radiation primary treatment predicted a better continence after sRARP.

Comparative Evaluation of Outcomes After Standard versus “Modified Large PCNL”- Is Larger Better…?

Objectives To comparatively evaluate the outcomes of standard percutaneous nephrolithotomy (PCNL) versus a 36 Fr PCNL in terms of operative time, complications, hospital stay, and stone free rates. Patients and Methods The data of 125 PCNL cases, out of the 168 PCNLs done from January 2014 to December 2015, was retrospectively analyzed within two subsets, namely group-A (standard PCNL with 22-32 Fr Amplatz) and group-B (modified large PCNL with 36 Fr Amplatz). The demographic profile, stone characteristics, operative and laboratory parameters, and stone clearance rate were analyzed to determine the safety and efficacy of the modified large PCNL as against standard PCNL. Results Group-A comprised 88 patients with 100 renal units, while group-B comprised 37 patients with 45 renal units. The mean age of the patients in Group-A was 49.1 + 13.1 years, and in Group-B was 52.4 + 11.4 years (range 25-84 years) with a male to female ratio of 4:1. 54.5% and 75.7% unilaterally intervened, group-A and group-B patients respectively, required &lt; 90 minutes for the procedure. Nine patients (10.2%) each of unilaterally and bilaterally intervened group-A cases had an operative time that exceeded 120 minutes compared to only two (5.4%) bilaterally intervened group-B cases. For patients with stone burden &gt;1000 mm2, there was statistically significant (p = &lt; 0.0001) higher complete stone clearance rates with the 36Fr PCNL compared to standard PCNL. Conclusion Our retrospective analysis revealed that 36 Fr PCNL is safe and efficacious in carefully selected patients with large stone burdens providing the advantage of better stone-free rates, less operative time, lesser need for additional punctures without increasing blood transfusion and complications rates. However, more extensive prospective randomized trials are needed to confirm this perceived benefit.

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

Safety and efficacy of robot-assisted versus open pancreaticoduodenectomy: a meta-analysis of multiple worldwide centers.

The objective of the study is to compare the safety and efficacy of robot-assisted pancreaticoduodenectomy (PD) with open PD. The PubMed, EMBASE and Cochrane Library databases were searched for the literature available from their respective inception dates up to May 2020 to find studies comparing robot-assisted pancreaticoduodenectomy (RPD) with open pancreaticoduodenectomy (OPD). The RevMan 5.3 statistical software was used for analysis to evaluate surgical outcome and oncology safety. The combination ratio (RR) and weighted mean difference (WMD) and their 95% confidence intervals (CIs) were calculated using fixed-effect or random effect models. 18 cohort studies from 16 medical centers were eligible with a total of 5795 patients including 1420 RPD group patients and 4375 OPD group patients. The RPD group fared better than the OPD group in terms of estimated blood loss (EBL) (WMD = - 175.65, 95% CI (- 251.85, - 99.44), P < 0.00001), wound infection rate (RR = 0.60, 95% CI (0.44, 0.81), P = 0.001), reoperation rate (RR = 0.61, 95% CI (0.41, 0.91), P = 0.02), hospital day (WMD = - 2.95, 95% CI (- 5.33, - 0.56), P = 0.02), intraoperative blood transfusion (RR = 0.56, 95% CI (0.42, 0.76), P = 0.0001), overall complications (RR = 0.78, 95% CI (0.64, 0.95), P = 0.01), and clinical postoperative pancreatic fistula (POPF) (RR = 0.54, 95% CI (0.41, 0.70), P < 0.0001). In terms of lymph node clearance (WMD = 0.48, 95% CI (- 2.05, 3.02), P = 0.71), R0 rate (RR = 1.05, 95% CI (1.00, 1.11), P = 0.05), postoperative pancreatic fistula (RR = 1, 95% CI (0.85, 1.19), P = 0.97), bile leakage (RR = 0.99, 95% CI (0.54, 1.83), P = 0.98), delayed gastric emptying (DGE) (RR = 0.79, 95% CI (0.60, 1.03), P = 0.08), 90-day mortality (RR = 0.82, 95% CI (0.62, 1.10), P = 0.19), and severe complications (RR = 0.98, 95% CI (0.71, 1.36), P = 0.91), and there were no significant differences between the two groups. Robotic surgery was inferior to open surgery in terms of operational time (WMD = 80.85, 95% CI (16.09, 145.61), P = 0.01). RPD is not inferior to OPD, and it is even more advantageous for EBL, wound infection rate, reoperation rate, hospital stay, intraoperative transfusion, overall complications and clinical POPF. However, these findings need to be further verified by high-quality randomized controlled trials.