Terms Of Total Operative Time Research Articles

Comparison of dominant- and non-dominant-hand cateract surgery outcomes by a single surgeon

PurposeTo compare dominant and non-dominant hand phacoemulsification surgery outcomes. MethodsThis retrospective, single-center study included 300 patients who underwent phacoemulsification surgery by a single, right-handed surgeon. The patients were divided into two groups according to whether the surgeon used his dominant or non-dominant hand during surgery. Right eye operations were performed with the right hand, and left eye operations were performed with the left hand. Detailed ophthalmological examinations were performed on all patients preoperatively and postoperatively. Intraoperative phacoemulsification parameters, the presence of intraoperative and postoperative complications, postoperative refractive errors, visual acuity, and surgically induced astigmatism values were compared between the groups. ResultsThere were 171 patients in the dominant hand phacoemulsification group and 129 patients in the non-dominant hand phacoemulsification group. The distributions of age, gender, systemic diseases, and lens opacification were similar between the groups (p>0.05, for all). No statistically significant difference was observed between the two groups in terms of total operation time, phaco power, ellips fx, or ultrasonic time (p>0.05, for all). There was also no significant difference in relation to intraoperative and postoperative complication distributions, postoperative third-month refractive errors, visual acuity, or surgically induced astigmatism values (p>0.05, for all). ConclusionThis study demonstrated that cataract surgery performed by a single surgeon can be effectively and safely performed using both hands on patients in a real operating theater environment. More objective results can be obtained with surgeries performed by a larger number of experienced surgeons.

Single-use digital flexible cystoscope for double J removal versus reusable instruments: a prospective, comparative study of functionality, risk of infection, and costs

BackgroundThe removal of ureteral stent can be performed with disposable or reusable flexible cystoscopes, but limited comparative data are available on functionality, risk of infections, and costs.MethodsWe performed a multicentric, prospective, observational study on patients undergoing in-office ureteral stent removal with Isiris-α® or a reusable Storz™ flexible cystoscope. Study endpoints were the functionality and effectiveness of the devices, the rate of postoperative bacteriuria and UTIs, and the costs of the procedure.ResultsA total of 135 patients were included, 80 (59.2%) treated with reusable cystoscopes and 55 (40.8%) with Isiris-α®. No significant baseline differences between groups were detected. Isiris-α® outperformed the reusable device in terms of quality of vision (p 0.001), manoeuvrability (p 0.001), grasper functionality (p < 0.001), and quality of the procedure (p 0.01). Mean procedure time was shorter with Isiris-α® (p < 0.001) due to a shorter instrument preparation time (p < 0.001). No differences were found in terms of perceived patient pain (p 0.34), nor postoperative bacteriuria or symptomatic UTIs. According to our cost analysis, the in-office procedure performed with Isiris-α® was more expensive (+ 137.8€) but was independent from instrument turnover or disinfection. Among limitations of study we acknowledge the lack of randomization, the use of antibiotic prophylaxis in several patients, and the high rate of missing preoperative urine cultures.ConclusionsIsiris-α® outperforms reusable cystoscopes for in-office ureteral stent removal in terms of total operative time and quality of the procedure, at the cost of being more expensive. No significant differences in postoperative bacteriuria or symptomatic UTIs were found.

Single-incision versus multi-port laparoscopic ileocolic resections for Crohn's disease: Systematic review and meta-analysis.

The aim of this systematic review and meta-analysis is to compare the outcomes of single-incision laparoscopic surgery (SILS) versus multi-port laparoscopy for ileocolic resection in patients with Crohn's disease (CD). A systematic search of multiple electronic databases was conducted. The peri- and post-operative outcomes were evaluated between Crohn's patients undergoing SILS versus multi-port laparoscopy for ileocolic resection. The primary outcomes included operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. Analysed secondary outcomes were conversion rates, ileus occurrence, intra-abdominal abscess formation, return to theatre and re-admissions. Revman 5.3 was used to perform the statistical analysis. Five observational studies with 521 patients (SILS: 211; multi-port: 310) were included in the data synthesis. Patients undergoing SILS had a reduced total operative time compared to multi-port laparoscopy (mean difference [MD]: -16.14, 95% confidence interval: [CI] -27.23 - 5.05, P = 0.004). Post-operative hospital stay was also found to be significantly less in the SILS group (MD: -0.57, 95% CI: -0.73--0.42, P < 0.0001). No significant difference was seen in the anastomotic leak rate (MD: -16.14, 95% CI: 0.18-1.71, P = 0.004) or post-operative wound infections (odds ratio: 0.78, 95% CI: 0.24 - 2.47, P = 0.67) between the two groups. Moreover, all the measured secondary outcomes were comparable. SILS seems to be a feasible alternative to multi-port laparoscopic surgery for ileocolic resection in patients with CD. Improved outcomes in terms of total operative time and length of hospital stay were observed in patients undergoing SILS surgery. Adopting this procedure into routine clinical practice constitutes the next step in the development of minimally invasive surgery.

Posterior hamstring harvest improves aesthetic satisfaction and decreases sensory complications as compared to the classic anterior approach in anterior cruciate ligament reconstruction surgery

PurposeThe use of the posterior approach for harvesting hamstring grafts has recently become popular thanks to new all-inside techniques and retrograde drills. This study aims to compare the classic anterior approach with the posterior approach in the popliteal fossa.MethodsRetrospective comparative study of 100 consecutive cases of primary ligamentoplasty performed using ipsilateral semitendinosus autograft with at least one year of follow-up. 50 patients with anterior approach (group A) and 50 patients with posterior approach (P). Ratio men/women: 9/1. Mean age: 32 ± 13 years. Mean operative time: 64.88 ± 12.28 min.Study variablesGraft harvest time; intraoperative complications (semitendinous [ST] tendon cut); postoperative neurological complications (allodynia, paresthesia, pain) or hematoma in the donor area; atrophy of the operated thigh compared to the contralateral thigh, postoperative VAS score, aesthetic satisfaction and overall satisfaction.ResultsGraft harvest time of 9.5 min in group A versus 5.25 min in group P (p < 0.05). Sensory complications: 16% in group A versus 2% in group P (p < 0.05). Regarding the patient’s evaluation of the aesthetic result of the surgery, 80% in group A and 92% in group P were very satisfied, 16% in group A and 8% in group P were satisfied and 4% in group A and no patients in group P not very satisfied (p < 0.05). No significant differences were found in terms of total operative time, postoperative joint movement, atrophy of the operated thigh, postoperative VAS, or overall patient satisfaction.ConclusionsThe posterior approach to harvesting the ipsilateral hamstring graft obtained better results than the anterior approach in terms of aesthetic satisfaction of the patient, lower rate of neurological complications (allodynia, paresthesias and hypoesthesia in the anterior region of the knee and leg) and shorter hamstring harvest time.Level of evidenceIV.

TP6.2.6 A meta-analysis and systematic review of Laparoscopic versus open hepatectomy for malignant liver tumours in the elderly patients

Abstract Aims To evaluate comparative outcomes of laparoscopic versus open hepatectomy for malignant liver tumours in elderly patients. Methods A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing laparoscopic (LH) versus open hepatectomy (OH) for both primary and metastatic malignant liver tumours in the elderly were included. Total operative time (minutes), need to perform Pringle’s manoeuvre, blood loss (ml), requirement for blood transfusion intra-operatively/post-operatively, post-operative complications, R0 resection rate, specimen resection margin (mm), re-operation rate, length of hospital stay (LOS), and 90-day mortality were the evaluated outcome parameters. Results Twelve studies reporting a total number of 1762 patients who underwent laparoscopic (n = 831) or open (n = 931) hepatectomy were included. OH group was associated with a significantly higher number of post-operative complications compared to LH (P = 0.00001). Complications such as post-operative liver failure (P = 0.02), ascites formation (P = 0.002), surgical site infection (P = 0.02), blood loss (P = 0.03), blood transfusion rate (P = 0.05) and LOS (P = 0.00001) were significantly higher in the OH group when compared to LH. There was no significant difference between the two groups in terms of total operative time (P = 0.53), bile leak (P = 0.12), R0 resection rate (P = 0.36), re-operation (P = 0.70) and 90-day mortality (P = 0.11). Conclusion Laparoscopic liver resections are safe with at least equal or superior peri-operative outcomes in the elderly population. Importantly, oncological outcomes are also comparable with open surgery. This approach needs to be utilised wherever possible to provide optimal healthcare in an aging population.

Laparoscopic versus open hepatectomy for malignant liver tumours in the elderly: systematic review and meta-analysis.

To evaluate comparative outcomes of laparoscopic versus open hepatectomy for malignant liver tumours in elderly patients. A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov, and Science Direct. Comparative studies comparing laparoscopic (LH) versus open hepatectomy (OH) for both primary and metastatic malignant liver tumours in the elderly were included. Total operative time (minutes), need to perform Pringle's manoeuvre, blood loss (ml), the requirement for blood transfusion intra-operatively/post-operatively, post-operative complications, r0 resection rate, specimen resection margin (mm), re-operation rate, length of hospital stay (LOS), and 90-day mortality were the evaluated outcome parameters. Twelve studies reporting a total number of 1762 patients who underwent laparoscopic (n = 831) or open (n = 931) hepatectomy were included. OH group was associated with a significantly higher overall number of post-operative complications compared to LH (P = 0.00001). Complications such as post-operative liver failure (P = 0.02), ascites formation (P = 0.002), surgical site infection (P = 0.02), blood loss (P = 0.03), blood transfusion rate (P = 0.05), and LOS (P = 0.00001) were significantly higher in the OH group when compared to LH. There was no significant difference between the two groups in terms of total operative time (P = 0.53), bile leak (P = 0.12), r0 resection rate (P = 0.36), re-operation (P = 0.70), and 90-day mortality (P = 0.11). Laparoscopic liver resections are safe with at least equal or superior peri-operative outcomes in the elderly population, although available data regards mainly the results of minor resections. Laparoscopic major resections in the elderly population should be carefully evaluated and preferably performed in expert centres.

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.

Projection marking to optimize antegrade femoral intramedullary nailing

Objective To evaluate the projection marking which was designed to improve the surgical efficiency of antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures. Methods A total of 198 patients (158 femoral intertrochanteric fractures and 40 femoral shaft fractures) were analyzed retrospectively who had been treated at Department of Orthopedics, The First Affiliated Hospital to Wenzhou University from January 2012 to January 2016. They were 61 males and 137 females, aged from 13 to 95 years (mean, 65.4±14.6). By AO classification, there were 55 cases of type 31-A1, 103 cases of type 31-A2, 21 cases of type 32-A2 and 19 cases of type 32-A3. The intertrochanteric fractures which had been treated from January 2012 to May 2013 with no projection marking were assigned into group A1 (n=61) while the shaft fractures which had been treated in the same period with no projection marking into group B1 (n=12); the intertrochanteric fractures which had been treated from May 2013 to January 2016 with projection marking were assigned into group A2 (n=97) while the shaft fractures which had been treated in the same period with projection marking into group B2 (n=28). Comparisons were made between groups A1 and A2, and between groups B1 and B2 in terms of total operative time, total number of fluoroscopy, complications, Harris hip score (HHS), and pain and symptoms scores in Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months after operation. Results The 198 patients were followed up for 3 to 18 months (average, 7.0 months). The total operative time (56.5±6.6 min) and the total number of fluoroscopy (26.6±6.2 times) in group A2 were significantly less than those in group A1 (59.2±9.2 min and 31.4±9.9 times) (P 0.05). Conclusion The self-designed designed method of projection marking can reduce operative time and number of intraoperative fluoroscopy in the antegrade femoral intramedullary nailing for femoral intertrochanteric and shaft fractures. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Projection marking

A comparative study of scalpel and surgical diathermy incision in elective operations of head and neck cancer

The aim of the study was to assess the outcome of patients following use of scalpel or surgical diathermy in elective skin incision of head and neck cancer. 80 patients undergoing surgery for various head and neck cancers were analyzed retrospectively from Jan 2002 to May 2005 and divided into two groups, matched for age, sex, stage and histopathology according to the method used to perform incision, i.e., scalpel or surgical diathermy. Blood loss, total operative time, blood transfusions, wound related complications and cosmetic assessments of the scar were compared. The two groups did not differ significantly in relation to patients or wound characteristics in terms of total operative time and quantity of blood transfusions. There was significantly less blood loss in the diathermy group compared with the scalpel group. There was no difference between the groups in wound complications and cosmetic results before discharge and at 1-month follow-up. There is no change in wound complication rate and scar formation even after application of heat during use of surgical diathermy. Therefore, surgical diathermy is safe and as effective as scalpel during elective skin incision of head and neck cancer.

Consequences of Peritoneal Tears During Hand-assisted Retroperitoneoscopic Nephroureterectomy

To evaluate the possible effects of peritoneal tears during hand-assisted retroperitoneoscopic nephroureterectomy (HARN). Between October 2003 and June 2008, HARN and open bladder cuff excision were performed in 110 patients, 20 of whom had peritoneal tears during the operation. Our policy is not to close the peritoneal defect. We compared the intraoperative and postoperative criteria among the peritoneum-preserved or peritoneum-violated group to evaluate the impacts of peritoneal tears during and after HARN. All procedures were successful except 2 open conversions in cases without peritoneal tears because of vascular injuries. There was no significant difference in age, American Society of Anesthesiologists class, or body mass index between the 2 groups. Both groups were similar in terms of total operative time (166 vs 137 minutes, P = .06), estimated blood loss (196 vs 268 mL, P = .51), hospital stay (9.1 vs 12.1 days, P = .41), and postoperative analgesia requirements (28.6 vs 28.5 mg morphine equivalent, P = .51). Compared with the peritoneum-preserved group, peritoneal violation during HARN was associated with a heavier specimen weight (308 vs 193 g, P = .01), and 1 patient in the violation group developed small bowel obstruction 3 weeks after the surgery. Most peritoneal tears during HARN may be safely managed without peritoneal closure. Bowel obstruction from internal herniation is rare but is too significant to be ignored. To prevent this morbidity, peritoneal tears of a selected size need either repair or enlargement.

Laparoscopic partial nephrectomy with suture repair of the pelvicaliceal system

Objectives Laparoscopic partial nephrectomy is emerging as a viable minimally invasive nephron-sparing option for select patients with an exophytic renal tumor. With increasing experience, we are applying laparoscopic partial nephrectomy to tumors invading more deeply into the renal parenchyma, necessitating intentional caliceal entry to ensure an adequate margin of resection. In this prospective study, we assessed the safety and efficacy of such substantive renal parenchymal resections that incorporate laparoscopic suture repair of the collecting system. Methods Since August 1999, laparoscopic partial nephrectomy was performed in 64 patients with a renal tumor. Our technique routinely involved transient clamping of the renal artery and vein, caliceal suture repair (if necessary), and renal parenchymal suture repair. Intraoperative and postoperative data from the group requiring caliceal repair (group 1, n = 27) were compared with those not requiring caliceal repair (group 2, n = 37). The mean tumor size was 3.4 ± 1.6 cm in group 1 and 2.6 ± 0.9 cm in group 2 ( P = 0.02). The mean depth of tumor invasion into the renal parenchyma was 1.5 ± 0.8 cm in group 1 and 0.9 ± 0.3 cm in group 2 ( P = 0.15). Results Laparoscopic partial nephrectomy was technically successful in all 64 cases without any open conversions. Both groups 1 and 2 were comparable in terms of total operative time (3.2 ± 0.9 hours versus 2.7 ± 1.0 hours, P = 0.06), tumor excision time (5.9 ± 1.8 minutes versus 6.0 ± 1.9 minutes, P = 0.97), and estimated blood loss (241 ± 306 mL versus 258 ± 342 mL, P = 0.27). Pelvicaliceal suture repair was associated with a longer warm ischemia time (30.2 ± 5.4 minutes versus 19.4 ± 4.9 minutes, P <0.0001), and a greater hospital stay (3.0 ± 1.7 days versus 1.8 ± 1.2 days, P = 0.003). No patients in group 1, and 1 patient in group 2, developed an asymptomatic perinephric urinoma that was drained percutaneously. On pathologic examination, inked surgical margins were negative for cancer in all but 1 case; the width of the parenchymal margin on histologic examination was 0.5 ± 0.4 cm in group 1, and 0.4 ± 0.3 cm in group 2 ( P = 0.59). The mean preoperative and postoperative serum creatinine was 1.1 and 1.2 mg/dL in group 1 and 1.0 and 1.1 mg/dL in group 2, respectively ( P = 0.4). During a mean follow-up of 9.5 ± 3.5 months in group 1 and 15.7 ± 4 months in group 2, no renal unit developed irreversible ischemic damage or local cancer recurrence. Conclusions Laparoscopic partial nephrectomy can be performed safely and efficaciously for select invasive renal tumors with intrarenal extension, even up to the collecting system. Intentional caliceal entry in such cases can be effectively repaired in a watertight manner by laparoscopic freehand suturing, albeit with longer mean operative and warm ischemia times, without adverse renal functional sequelae.