Terms Of Operative Time Research Articles

Physician-Modified TEVAR versus Hybrid Repair of the Proximal Descending Thoracic Aorta.

There are different surgical options for the treatment of proximal lesions of the descending thoracic aorta. The aim of this study was to compare the outcome of physician-modified TEVAR (pmTEVAR) vs. hybrid repair of the thoracic aorta in terms of TEVAR with carotid-subclavian bypass (hdTEVAR). This was a single-centre, retrospective comparative study of all patients who underwent pmTEVAR and hybrid repair of the proximal descending aorta from January 2018 to June 2021. Primary outcomes were technical success, 30-day mortality, perioperative stroke, 30-day reinterventions and supraaortic access related complications. Secondary outcomes were patient survival, late complications, late reinterventions, and bypass/bridging stent patency. A total of 181 patients underwent TEVAR within the period of 42 months. In our study, only patients with proximal landing in zone 2 (n = 39) were included. A total of 5 of 15 pmTEVAR and 8 of 24 hybrid repair operations (33% vs. 33%, respectively) were performed due to aneurysms. Among the rest of the patients, 10 of 15 pmTEVAR and 16 of 24 hybrid operations (67% vs. 67%) were performed due to aortic dissection. Technical success was achieved in 100% of the patients. No significant difference in terms of postoperative complications could be detected in the early and midterm follow up period. The 30-day mortality was 12.5% in the hybrid repair group (n = 3) vs. 6.66% (n = 1) in the pmTEVAR group (p = 0.498). These patients underwent the operation in an emergency setting. No patient died after an elective operation. The causes of early mortality were major stroke (n = 2), haemorrhagic shock (n = 1) in the hybrid group and progredient spinal cord ischemia with tetraplegia and acute respiratory insufficiency (n = 1) in the pmTEVAR group. In conclusion, both therapies are robust techniques, with comparable patency rate and perioperative complications. pmTEVAR appears to be advantageous in terms of operation time and tendency to lower mortality rates.

Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis

To investigate the impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. The clinical data of 50 patients with lumbar spinal stenosis who met the selection criteria between August 2017 and December 2020 were retrospectively analyzed. According to the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP), based on the calculation of the skeletal muscle index (SMI) at the L 3 level, SMI<45.4 cm 2/m 2 (men) and SMI<34.4 cm 2/m 2 (women) were used as the diagnostic threshold, the patients were divided into sarcopenia group (25 cases) and non-sarcopenia group (25 cases). There was no significant difference in gender, age, disease duration, level of lumbar spinal stenosis, surgical fusion level, and comorbidity between the two groups ( P>0.05); the body mass index in sarcopenia group was significantly lower than that in non-sarcopenia group ( t=-3.198, P=0.002). Clinical data of the two groups were recorded and compared, including operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, and complications. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up. The effectiveness was evaluated according to modified MacNab standard. There was no significant difference between the two groups in terms of operation time, intraoperative blood loss, and postoperative drainage volume ( P>0.05). However, the hospitalization stay in sarcopenia group was significantly longer than that in non-sarcopenia group ( t=2.105, P=0.044). The patients were followed up 7-36 months (mean, 29.7 months). In sarcopenia group, 1 case of dural tear and cerebrospinal fluid leakage occurred during operation, as well as 1 case of internal fixator loosening during follow-up; 1 case of incision exudation and poor healing occurred in each of the two groups, and no adjacent segment degeneration and deep vein thrombosis of lower extremity occurred in the two groups during follow-up. There was no significant difference in the incidence of complications (12% vs. 4%) between the two groups ( χ 2=1.333, P=0.513). VAS scores in low back pain and sciatica as well as ODI scores in two groups significantly improved when compared with preoperative results at last follow-up ( P<0.05). The differences of VAS scores in low back pain and ODI scores before and after operation in sarcopenia group were significantly lower than that in non-sarcopenia group ( P<0.05). However, there was no significant difference of that in VAS scores of sciatica between the two groups ( t=-1.494, P=0.144). According to the modified MacNab standard, the excellent and good rate of the sarcopenia group was 92%, and that of the non-sarcopenia group was 96%, showing no significant difference between the two groups ( χ 2 =1.201, P=0.753). Patients with sarcopenia and lumbar spinal stenosis may have longer postoperative recovery time, and the effectiveness is worse than that of non-sarcopenic patients. Therefore, for elderly patients with lumbar spine disease, it is suggested to improve preoperative assessment of sarcopenia, which can help to identify patients with sarcopenia at risk of poor surgical prognosis in advance, so as to provide rehabilitation guidance and nutritional intervention in the perioperative period.

New Generation Pulse Modulation in Holmium:YAG Lasers: A Systematic Review of the Literature and Meta-Analysis

(1) Background: New pulse modulation (PM) technologies in Holmium:YAG lasers are available for urinary stone treatment, but little is known about them. We aim to systematically evaluate the published evidence in terms of their lithotripsy performance. (2) Methods: A systematic electronic search was performed (MEDLINE, Scopus, and Cochrane databases). We included all relevant publications, including randomized controlled trials, non-randomized comparative and non-comparative studies, and in-vitro studies investigating Holmium:YAG lithotripsy performance employing any new PM. (3) Results: Initial search yielded 203 studies; 24 studies were included after selection: 15 in-vitro, 9 in-vivo. 10 In-vitro compared Moses with regular PM, 1 compared Quanta’s, 1 Dornier MedTech’s, 2 Moses with super Thulium Fiber Laser, and 1 compared Moses with Quanta PMs. Six out of seven comparative studies found a statistically significant difference in favor of new-generation PM technologies in terms of operative time and five out of six in fragmentation time; two studies evaluated retropulsion, both in favor of new-generation PM. There were no statistically significant differences regarding stone-free rate, lasing and operative time, and complications between Moses and regular PM when data were meta-analyzed. (4) Conclusions: Moses PM seems to have better lithotripsy performance than regular modes in in-vitro studies, but there are still some doubts about its in-vivo results. Little is known about the other PMs. Although some results favor Quanta PMs, further studies are needed.

Novel Application of an Ultrasonic Bone Aspirator for Endoscopic Modified Medial Maxillectomy.

BackgroundEndoscopic modified medial maxillectomy (EMMM) is a surgical technique developed to approach maxillary sinus lesions, such as papilloma and postoperative maxillary cyst, while preserving the postoperative nasal morphology and nasal function. In this technique, a diamond burr is used to remove the bone, which may damage adjacent soft tissue. We developed EMMM using an ultrasonic bone aspirator (UBA) instead of a conventional diamond burr. The purpose of this study was to clarify the effectiveness of the UBA in EMMM in comparison to the conventional diamond burr technique in terms of operative time, intraoperative complications, postoperative symptoms, and recurrence.MethodsThe medical records of all patients who underwent EMMM at Toyama University Hospital between June 2014 and December 2021 were reviewed. Patients who met the inclusion criteria were separated into Group 1, in which the UBA was used for EMMM, and Group 2, in which a drill with a diamond burr was used. Data on patient demographics, operation time, frequency of intraoperative complications and postoperative symptoms, and recurrence were statistically compared between the two groups.ResultsThere were no significant differences between the two groups in the patient demographic data, operative time, postoperative symptoms, or frequency of recurrence. The frequency of intraoperative damage to adjacent soft tissues was significantly lower in patients who underwent EMMM with the UBA in comparison to those who underwent EMMM with a conventional diamond burr.ConclusionThe application of the UBA to EMMM can improve surgical safety and facilitate surgical procedures.

Controversial Role of Robot in Primary and Revisional Bariatric Surgery Procedures: Review of the Literature and Personal Experience.

Laparoscopy is the surgical standard of care for bariatric procedures; however, during the last two decades, the robotic approach has gained increasing interest. It is currently considered a safe and effective alternative to laparoscopy. This literature review investigates the role of the robotic approach for primary and revisional bariatric procedures, with the particular aim of comparing this technique with the standard-of-care laparoscopic approach. The feasibility of robotic dissection and suturing could have potential advantages: robotics may prevent the risk of leak and bleeding and other surgical complications, determining potential benefits in terms of operative time, length of hospital stay, and learning curve. Considering primary procedures, the literature reveals no advantages in robotic versus the laparoscopic approach for adjustable gastric banding and sleeve gastrectomy. Robotic Roux-en-Y gastric bypass is associated with a longer operative time and a shorter hospital length of stay than laparoscopy. The robotic approach in revisional surgery has been proven to be safe and effective. Despite the longer operative time, the robotic platform could achieve a lower bleeding rate compared with laparoscopy. The surgeon’s selection criteria related to referrals to the robotic approach of difficult-perceived cases could represent a bias. In conclusion, robotic surgery can be considered a safe and effective approach in both primary and revisional bariatric surgery, despite the lack of evidence to support its routine use in primary bariatric surgery. However, in revisional bariatric surgery and in surgical complex procedures, the robotic approach could have potential benefits in terms of surgical complications and learning curves.

Comparative Study of Surgical Outcome of Linear Stapled Versus Manual Anastomosis Technique During Reversal of Loop Ileostomies

Objective: To compare the surgical outcomes of linear stapler versus manual anastomosis for the reversal of loop ileostomies Subjects and methods: This randomized control trial was conducted in the department of General Surgery at Liaquat University Hospital Jamshoro, from June 2018 to May 2019. All the patients with an age of 14 to 45 years of either gender, having typhoid perforation, and having undergone ileostomy in an emergency after 6–12 weeks of previous surgery were included. All patients were divided into two groups. Patients in group A were reversed with a linear stapler (LS), and the others were reversed through manual suturing (MS). Patients were followed for two weeks during Hospital stay and were discharged on clinically stable condition with normal bowel movements and no complication. Outcome was measured in terms of operative time, hospital stays, and postoperative complications in both groups. All the data was recorded in the predesigned proforma and analyzed by SPSS version 26. Results: A total of 218 patients were studied; the most common age group was 15–30 years in both groups, and males were in the majority in both groups. Anastomosis leakage occurred in 3.7% of patients in group A, while none was found in group B. The infection rate was significantly lower at 13.8% in group A compared to group B at 34.9% (p-0.001). Intestinal obstruction was observed in 1.8% of patients in group A compared to 8.3% in group B (p-0.002). Prolonged Hospital stay was significantly higher in group B (8.7%) (p- 0.001). Conclusion: It was concluded that stapler anastomosis is the safe, most reliable, and adaptable surgical tool for ileostomy reversal. It consumed very less operative time with very lower rate of complications and less time for follow-up as compared to manual suturing. Keywords: Reversal loop ileostomies, linear stapler, manual anastomosis

Laparoscopic Appendectomy VS Open Appendectomy at Jeddah National Hospital Saudi Arabia; A Comparative Study

Objective: To compare the laparoscopic appendectomy (LA) with open appendectomy (OA) in terms of operative time, complications, and hospital stay. Patients and Methods: This comparative study was done at Jeddah National Hospital, KSA. All the patients aged more than 12 years, both genders, and those who were admitted with appendicitis to the surgical department and underwent surgical treatment were included. The study duration was one year, from November 2019 to October 2020. All the patients were divided into two groups. Patients who underwent laparoscopic appendectomies were put in LA group, while those who underwent open appendectomies were kept in OA group. All the patients were observed during hospital stays and comparative treatment outcomes were observed in terms of the pain, number of hours required for the return of bowel function, operative time, infection and hospital stays. A study proforma was used for the data collection and SPSS version 26 was used for the data analysis. Results: A total of 100 cases were comparatively studied, and the overall age of the patients was 33.34+7.23 years. Males were dominant as compared to females. Average operating time was lower in LA group as 37.11+8.41 minutes, compared to the OA group 47.45+4.34 minutes (p-0.001). The average post-operative hospital stay was 1.88+0.62 days in LA group, compared to the OA group 2.14+0.90 days, without a significant difference (p-0.098). Post operative infection was statistically insignificant in both groups as one case in the LA group and in cases of the OA group (p-558). Conversion to an open procedure was required in one case with extensive cecal adhesions and retrocecal gangrenous appendicitis with local peritonitis. 70% patients of LA group, returned to their normal routine life within 10 days and the remaining started doing their normal activities within 15 days, while in the OA group, 60% of patients returned to normal activity and 40% returned to work after 20 days. No mortality was found in either group. Conclusion: Laparoscopic appendectomy was observed to be a time-saving procedure, which depends on skills, patient selection, and availability of the laparoscope. It is safe when compared to open appendectomy. It shortens the hospital stay, allows for an earlier return to oral feeding, normal routine work, and results in fewer post-operative complications. Keywords: Laparoscopic, Open, Appendectomy, Hospital stay, pain, infection

Clinical Outcomes of Revision Total Knee Arthroplasty after High Tibial Osteotomy and Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis.

As more high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are performed, orthopaedic surgeons realize that more HTO and UKA failures will require revision to total knee arthroplasty (TKA) in the future. To systematically evaluate the clinical outcomes of TKA after HTO and TKA after UKA, the Embase, PubMed, Ovid, Web of Science, and Cochrane Library databases were searched for studies investigating revision TKA after HTO and UKA published up to June 2021. RevMan version 5.3 was used to perform the meta‐analysis. The revision TKA after HTO and revision TKA after UKA groups were compared in terms of operative time, range of motion (ROM), knee score, postoperative complications, postoperative infection, revision, and revision implants used. Nine studies were ultimately included in the meta‐analysis. Results revealed that the knee score for the revision TKA after HTO group was better than that of the revision TKA after UKA group (MD 4.50 [95% CI 0.80–8.20]; p = 0.02). The revision TKA after HTO group had a lower revision rate (OR 0.65 [95% CI 0.55–0.78]; p < 0.00001) and fewer revision implants used (OR 0.11 [95% CI 0.05–0.23]; p < 0.00001). There were no statistical differences in operation time (MD ‐2.00 [95% CI −11.22 to 7.21]; p = 0.67), ROM (MD ‐0.04 [95% CI ‐3.69–3.61]; p = 0.98), postoperative complications (OR 1.41 [95% CI 0.77–2.60]; p = 0.27), or postoperative infections (OR 0.89 [95% CI 0.61–1.29]; p = 0.53). To conclude, the revision rate of revision TKA after UKA was greater, and more revision implants were required. It is important for orthopaedic surgeons to preserve bone during primary UKA.

A Tandem Robotic Arm Inverse Kinematic Solution Based on an Improved Particle Swarm Algorithm.

The analysis of robot inverse kinematic solutions is the basis of robot control and path planning, and is of great importance for research. Due to the limitations of the analytical and geometric methods, intelligent algorithms are more advantageous because they can obtain approximate solutions directly from the robot’s positive kinematic equations, saving a large number of computational steps. Particle Swarm Algorithm (PSO), as one of the intelligent algorithms, is widely used due to its simple principle and excellent performance. In this paper, we propose an improved particle swarm algorithm for robot inverse kinematics solving. Since the setting of weights affects the global and local search ability of the algorithm, this paper proposes an adaptive weight adjustment strategy for improving the search ability. Considering the running time of the algorithm, this paper proposes a condition setting based on the limit joints, and introduces the position coefficient k in the velocity factor. Meanwhile, an exponential product form modeling method (POE) based on spinor theory is chosen. Compared with the traditional DH modeling method, the spinor approach describes the motion of a rigid body as a whole and avoids the singularities that arise when described by a local coordinate system. In order to illustrate the advantages of the algorithm in terms of accuracy, time, convergence and adaptability, three experiments were conducted with a general six-degree-of-freedom industrial robotic arm, a PUMA560 robotic arm and a seven-degree-of-freedom robotic arm as the research objects. In all three experiments, the parameters of the robot arm, the range of joint angles, and the initial attitude and position of the end-effector of the robot arm are given, and the attitude and position of the impact point of the end-effector are set to verify whether the joint angles found by the algorithm can reach the specified positions. In Experiments 2 and 3, the algorithm proposed in this paper is compared with the traditional particle swarm algorithm (PSO) and quantum particle swarm algorithm (QPSO) in terms of position and direction solving accuracy, operation time, and algorithm convergence. The results show that compared with the other two algorithms, the algorithm proposed in this paper can ensure higher position accuracy and orientation accuracy of the robotic arm end-effector. the position error of the algorithm proposed in this paper is 0 and the maximum orientation error is 1.29 × 10–8. while the minimum position error of the other two algorithms is −1.64 × 10–5 and the minimum orientation error is −4.03 × 10–6. In terms of operation time, the proposed algorithm in this paper has shorter operation time compared with the other two algorithms. In the last two experiments, the computing time of the proposed algorithm is 0.31851 and 0.30004s respectively, while the shortest computing time of the other two algorithms is 0.33359 and 0.30521s respectively. In terms of algorithm convergence, the proposed algorithm can achieve faster and more stable convergence than the other two algorithms. After changing the experimental subjects, the proposed algorithm still maintains its advantages in terms of accuracy, time and convergence, which indicates that the proposed algorithm is more applicable and has certain potential in solving the multi-arm inverse kinematics solution. This paper provides a new way of thinking for solving the multi-arm inverse kinematics solution problem.

Robot-assisted thoracic surgery for lung cancer patients with incomplete fissure.

Robot-assisted thoracic surgery has gradually been accepted as an alternative treatment for early-stage non-small-cell lung cancer (NSCLC) owing to its advantages. However, severe incomplete interlobar fissure may lead to a high rate of conversion and postoperative morbidity. This retrospective study was conducted to assess the safety and efficiency of robot-assisted lung resection for patients with incomplete fissures (IFs). A retrospective review of medical records was performed in our institution from March 2021 to November 2021, and 207 patients with NSCLC who underwent robot-assisted anatomic lung resection were included in this study. Patients were divided into the IF group and the complete fissure (CF) group according to the level of fissure, which was determined based on the anatomical classification of pulmonary fissures. The number of patients in the IF and CF groups was 87 and 120, respectively. In univariate analysis, there were no statistically significant differences between the two groups in terms of operative time (p = 0.66), intraoperative blood loss (p = 0.26), chest tube duration (p = 0.41), incidence of prolonged air leakage (PAL, p = 0.49), or length of postoperative hospital stay (p = 0.25). No patients experienced bronchopleural fistula, pneumonia, or cardiovascular complications. The total cost in the IF group was higher than that in the CF group (¥83,655 ± 13,314 versus ¥78,211 ± 11,980, p = 0.002). IF does not increase the difficulty of lung cancer surgery with robotic platforms. Robot-assisted anatomic lung resection using the tunnel technique is an effective and safe method for IF patients.

MP44-15 EARLY EXPERIENCE WITH VACUUM ASSISTED URETERAL ACCESS SHEATHS

You have accessJournal of UrologyCME1 May 2022MP44-15 EARLY EXPERIENCE WITH VACUUM ASSISTED URETERAL ACCESS SHEATHS Daniel Wong, and Alana Desai Daniel WongDaniel Wong More articles by this author , and Alana DesaiAlana Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vacuum assisted ureteral access sheaths (V-UAS) have been eagerly adopted with the hopes of improved surgical outcomes. Reports from outside the US have found increased stone free rates, decreased operative times, and decreased infectious complications with V-UAS. However there have been no data published from the US. Herein, we report our findings 1 year after implementation of Clearpetra V-UAS at our institution. METHODS: From May 2020 to September 2021, all unilateral ureteroscopy cases by a single surgeon using a V-UAS (Clearpetra) were retrospectively reviewed. These were compared to matched cases using an institutional database of stone cases from 2016 to May 2020, when Clearpetra became available. Cases were matched based on regular ureteral access sheath use, surgeon, stone burden, preexisting ureteral stent, preoperative UTI, and neurogenic bladder. Outcomes of interest were stone free rate as determined by follow up ultrasound or CT scan within 3 months of procedure and postop infection defined by T >38°C, WBC >12K or <4K, HR >90, or UTI within 30 days of procedure. RESULTS: There were 27 unique V-UAS cases identified. Randomly matched cases were compared for operative time, stone free rate, infectious complications, and 30-day unplanned encounters. There were no differences in any outcomes of interest (Figure 1). CONCLUSIONS: V-UAS performed on par with standard ureteral access sheaths. There was no increase in complication rate or unplanned encounters, indicating V-UAS is a safe treatment option. V-UAS offered no benefit in terms of operative time, stone free rate, or infectious complications in this initial cohort. It remains to be seen whether there is an optimal stone characteristic for V-UAS or whether V-UAS requires an initial learning curve for improvement. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e758 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wong More articles by this author Alana Desai More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Comparative Study of Single Clip Laparoscopic Cholecystectomy (SCLC) and Conventional Laparoscopic Cholecystectomy (CLC)

Background: Theoretical benefits for use of one clip laparoscopic cholecystectomy are Less operative time, Less bleeding, Early post operative recovery, Cost factor , Less spillage of stones, Less chances of converting into open cholecystectomy , Less pain post operatively and Less amount of CO2 used. Thus, a study was undertaken to compare the advantages of Single clip laparoscopic cholecystectomy (SCLC) over conventional laparoscopic cholecystectomy (CLC). Material and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent CLC and Group 2 patients underwent SCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: Out of 100 patients 15 were males and 85 were females. Among them, 5 males and 45 females underwent CLC using electrocautery while 10 males and 40 females underwent SCLC. Mean age of males were 47.60 ± 3.36 and females were 45.20 ± 15.82 in CLC group and mean age of males were 48.50 ± 14.49 and females were 46.73 ± 16.16 in SCLC group . Present study showed that there was significant less Operative Time, Less Mean CO2 used, less Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average Length of hospital stay, less Intra Op. Stone spillage, less Use of Drain and Post op. Complications in SCLC as compared to CLC but there was no significant difference in Conversion to Open Cholecystectomy in both groups. Conclusion: Study showed clear cut benefits of SCLC over CLC in terms of operative time , intra operative stone spillage , intra operative blood loss , amount of CO2 used , post operative pain and post operative complications

Advantages of Two Clips Laparoscopic Cholecystectomy (TCLC) and Conventional Laparoscopic Cholecystectomy (CLC): A Comparative Study

Background: Laparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. Thus, a study was undertaken to compare the advantages of Two Clips Laparoscopic Cholecystectomy (TCLC) over conventional laparoscopic cholecystectomy (CLC). Material and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent CLC and Group 2 patients underwent TCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: In the present study among 100 patients, 19 were males and 81 were females. Among them,5 males and 45 females underwent CLC using electrocautery while 14 males and 36 females underwent TCLC.Mean age of males were 47.60 ± 3.36 years and females were 45.20 ± 15.82 years in CLC group and mean age of males were 45.36 ± 14.53 and females were 45.25 ± 15.97 in TCLC group. Present study showed that there was significant less Operative Time, Less Mean CO2 used, less Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average Length of hospital stay, less Intra Op. Stone spillage, less Use of Drain and Post op. Complications in TCLC as compared to CLC but there was no significant difference in Conversion to Open Cholecystectomy in both groups. Conclusion: Study concluded that TCLC had advantage over CLC in terms of operative time ,intra operative stone spillage , intra operative blood loss , amount of CO2 used , post operative pain and post operative complications

Comparison of Single Clip Laparoscopic Cholecystectomy (SCLC) and Two Clip Laparoscopic Cholecystectomy (TCLC): A randomized control study

Background: Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. This study was undertaken to compare the advantages of Single clip laparoscopic cholecystectomy (SCLC) and Two Clip Laparoscopic Cholecystectomy (TCLC). Material and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent SCLC and Group 2 patients underwent TCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: Among the total 100 patients, 24 were males and 76 were females. Among them, 10 males and 40 females underwent single clip laparoscopic cholecystectomy (SCLC) while 14 males and 36 females underwent Two Clips laparoscopic cholecystectomy (TCLC). Mean age of males were 48.50 ± 14.49 and females were 46.73 ± 16.16 in SCLC group while mean age of males were 45.36 ± 14.53 and females were 45.25 ± 15.97 in two clips laparoscopic cholecystectomy group. Present study showed that there was more Operative Time, more Mean CO2 used, more Approx. Blood Loss, more Intra Op. Stone spillage and more Use of Drain but less Average pain score at 6 and 24 hours and less Average Length of hospital stay in DCLC group as compared to SCLC group but this difference was not statistically significant. Similarly in both group equal number of patients Convered to Open Cholecystectomy and there was no Post op. Complications in both groups. Conclusion: Study concluded that there was no statistically significant difference among both SCLC and DCLC groups in terms of operative time , intra operative stone spillage , Use of Drain, intra operative blood loss , amount of CO2 used , post operative pain, Conversion to Open Cholecystectomy and post operative complications.

A Randomized Control Study to Compare the Clipless Laparoscopic Cholecystectomy (CLLC) and Conventional Laparoscopic Cholecystectomy (CLC)

Background: Present study was undertaken to compare the advantages of Clipless Laparoscopic Cholecystectomy (CLLC) over conventional laparoscopic cholecystectomy (CLC). Material and methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent CLC and Group 2 patients underwent CLLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: In the present study among 100 patients, 19 were males and 81 were females. Among them, 5 males and 45 females underwent CLC using electrocautery while 14 males and 36 females underwent CLLC. Mean age of males were 47.60 ± 3.36 years and females were 45.20 ± 15.82 years in CLC group and mean age of males were 53.07 ± 18.96 and females were 44.44 ± 15.41 in CLLC group. Present study showed that there was significant less Operative Time, Less Mean CO2 used, less Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average Length of hospital stay, less Intra Op. Stone spillage and less Use of Drain in CLLC as compared to CLC but there was no significant difference in Conversion to Open Cholecystectomy and Post op. Complications in both groups. Conclusion: Study concluded that CLLC had significant advantage over CLC in terms of operative time ,intra operative stone spillage , intra operative blood loss , amount of CO2 used , post operative pain and Use of Drain

Comparison of Haemorrhoidectomy Using Ligasure with Open (Milligan Morgan Haemorrhoidectomy)

Aim: To compare between haemorrhoidectomy using ligasure versus conventional haemorrhoidectomy in terms of operative time, bleeding and post-operative pain. Study design: Controlled randomized trial Place and duration of study: Department of Surgery, DHQ Hospital Abbottabad from 1stJuly 2018 to 31stDecember 2020 Methodology: One hundred and twenty patients were enrolled. Patients were allocated to two groups and haemorrhoidectomy done with ligasure (LS, group A) and conventional method i.e. Milligan Morgan haemorrhoidectomy (MMH, group B) and each group comprised 60 patients. In group A pedicals were coagulated with the ligasure rather than transfixed as in group B (MMH). Operative time and per operative bleeding recorded during surgery while postop pain score recorded using visual analogue score (0-10) especially during first defecation. Results: The mean age of 46±16.36 years were studied and 79.1% were males. In group A 72.5% patients were males and 27.5% females compared to 67.5% males and 32.5% females in group B. 87.5% of patients had 3rd degree hemorrhoids in group A while 89.4% had the same disease in group B. Operative time was between 20-35 minute in group A compared to 10-30minutes in group B. In group A 75% observed mild pain as recorded on VAS, 25% had moderate pain at time of first defecation while in group B 69.4% patients had moderate pain on VAS, 25.6% experienced mild pain and another 5% reported severe pain during defecation. Mean blood loss was 104.21±41.45 ml in both populations, in group A it was 83.59±34.34 ml while in group B it was 124.84±37.56 ml. Mean VAS of both populations was 3.55±2.05 while mean time of operation was 36.35±7.22.Using independent sample T test, there was statistically significant (P=0.000) difference on all three parameters between two groups. Conclusions: Haemorrhoidectomy using ligasure is safe and causes minimal bleeding, requires less operative time and is associated with less pain compared with conventional scissors dissection, and is a good alternative to diathermy excision. Keywords: Haemorrhoidectomy, Ligasure (LS), Conventional haemorrhoidectomy

Indications, Feasibility, and Safety of TST STARR Plus Stapler for Degree III Hemorrhoids: A Retrospective Study of 125 Hemorrhoids Patients

BackgroundStapler hemorrhoidopexy (SH) has been widely accepted for hemorrhoids patients because of its low postoperative pain, but it is also associated with a high recurrence rate. The recurrence might be due to failure to completely remove the prolapsed tissue or insufficient removal capacity of the instruments. Removing more prolapsed tissue to reduce the recurrence is believed to benefit more severe prolapsed hemorrhoids patients.MethodsWe evaluated the short- and long-term safety and efficacy in 125 hemorrhoids patients who underwent SH in 2013–2015. Eighty patients had prolapsed tissue less than half of the circular anal dilator (CAD) and underwent a procedure for prolapsing hemorrhoids (PPH), while the remaining 45 patients with hemorrhoid prolapse greater than half of the CAD were treated with a tissue selection therapy stapler stapled transanal rectal resection plus (TST STARR+).ResultsThere were no significant differences between the two groups in terms of operative time, hospitalization time, overall satisfaction or complications. At follow-up of up to 4 years after surgery, there was no significant difference in recurrence rates between TST STARR+ group and PPH group (5.2% vs. 4.7%, p < 0.05). The mean width and volume of the resected tissues were significantly larger in the TST STARR+ group than in the PPH group (4.8 vs. 2.9 cm, 10.2 vs. 4.4 cm3, P < 0.05).ConclusionThe TST STARR+ procedure can remove more hemorrhoidal tissue than PPH and it is better suited for patients with severe annular prolapsed hemorrhoids greater than half of the CAD. It has the advantages of convenient to operate, rapid recovery, fewer complications, and long-term satisfactory results.

Comparison of Open and Closed Lateral Sphincterotomy in Patients with Chronic Anal Fissure

Background: The results and complications of open versus closed lateral sphincterotomy in patients with chronic anal fissure were compared in this prospective study. Objective: The purpose of this study was to evaluate the outcomes of open lateral internal sphincterotomy and closed lateral internal sphincterotomy with a cataract knife in terms of operation time, postoperative pain, faecal and flatus incontinence, and hospital stay.&#x0D; Materials and Methods: This study included a total of 80 patients with chronic anal fissures. Closed sphincterotomy. They were monitored for eight months after surgery. The two groups' There are 40 patients who will get an open lateral sphincterotomy and 40 who will have a c outcomes and complications were compared and statistically analyzed.&#x0D; Result: The two groups were compared on post-operative complications such as pain, bleeding, infection, incontinence, and recurrence. The Closed Group Experienced Less Pain, Bleeding, and Incontinence to Flatus (P 0.04), but there was no difference in the incidence of infection or recurrence between the two group.&#x0D; Conclusion: In the treatment of chronic anal fissures, closed lateral internal sphincterotomy is superior than open sphincterotomy. Chronic Fissure, Closed Method, Lateral Sphincterotomy, Open Method.

Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study.

ObjectiveDisplaced intra-articular tongue-type fractures are often treated with surgical interventions, and there is a lack of consensus regarding the surgical approach. This retrospective cohort study aimed to compare percutaneous cannulated screw (PCS) fixation and plating with a minimally invasive longitudinal approach (MILA) after closed reduction for the treatment of tongue-type calcaneal fractures.Materials and MethodsA total of 77 patients with intra-articular tongue-type calcaneal fractures between September 2015 and July 2019 were included in this study. They were randomly allocated into two groups: PCS fixation (n = 32) and MILA (n = 45). The outcome measures included demographic variables, operation time (OT), preoperative time (POT), hospital stay time (HST), blood loss, visual analog scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores, postoperative complications, and imaging parameters. The patients were clinically examined at 1, 3, 6, and 12 months, with a final follow-up period of 27 months.ResultsNo significant differences were observed during the follow-up in calcaneal length, height, Gissane's and Böhler's angles, VAS scores, AOFAS hindfoot scores, or complication rates between the two groups. However, the postoperative VAS scores in the PCS group were significantly lower than those in the MILA group (p < 0.05). Furthermore, the OT, POT, and HST in the PCS group were significantly shorter than those in the MILA group (p < 0.05). Blood loss was lower in the PCS group than those in the other group (p = 0.044). However, postoperative calcaneal widening was significantly smaller in the MILA group than that in the PCS group (p < 0.001).ConclusionsAfter closed reduction for the treatment of tongue-type calcaneal fractures, PCS fixation was superior to MILA in terms of OT, POT, HST, blood loss, pain, and degree of comfort. Meanwhile, MILA has the advantage of restoring the calcaneal width. Under the same rehabilitation program, the two approaches showed similar abilities in maintaining the closed reduction.

Thulium laser enucleation of prostate versus laparoscopic trans-vesical simple prostatectomy in the treatment of large benign prostatic hyperplasia: head-to-head comparison.

ABSTRACTObjectives:To compare thulium laser enucleation of prostate (ThuLEP) versus laparoscopic trans-vesical simple prostatectomy (LSP) in the treatment of benign prostatic hyperplasia (BPH).Materials and Methods:Data of patients who underwent surgery for “large” BPH (>80mL) at three Institutions were collected and analyzed. Two institutions performed ThuLEP only; the third institution performed LSP only. Preoperative (indwelling catheter status, prostate volume (PVol), hemoglobin (Hb), Qmax, post-voiding residual volume (PVR), IPSS, QoL, IIEF-5) and perioperative data (operative time, enucleated adenoma, catheterization time, length of stay, Hb-drop, complications) were compared. Functional (Qmax, PVR, %ΔQmax) and patient-reported outcomes (IPSS, QoL, IIEF-5, %ΔIPSS, %ΔQoL) were compared at last follow-up.Results:80 and 115 patients underwent LSP and ThuLEP, respectively. At baseline, median PVol was 130 versus 120mL, p <0.001; Qmax 9.6 vs. 7.1mL/s, p=0.005; IPSS 21 versus 25, p <0.001. Groups were comparable in terms of intraoperative complications (1 during LSP vs. 3 during ThuLEP) and transfusions (1 per group). Differences in terms of operative time (156 vs. 92 minutes, p <0.001), Hb-drop (-2.5 vs. −0.9g/dL, p <0.001), catheterization time (5 vs. 2 days, p <0.001) and postoperative complications (13.8% vs. 0, p <0.001) favored ThuLEP. At median follow-up of 40 months after LSP versus 30 after ThuLEP (p <0.001), Qmax improved by 226% vs. 205% (p=0.5), IPSS decreased by 88% versus 85% (p=0.9), QoL decreased by 80% with IIEF-5 remaining almost unmodified for both the approaches.Conclusions:Our analysis showed that LSP and ThuLEP are comparable in relieving from BPO and improving the patient-reported outcomes. Invasiveness of LSP is more significant.