Operative Time Cost Research Articles

Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia.

Inguinal hernia is a common global disease. This study aims to investigate the effectiveness and safety of robot-assisted transabdominal preperitoneal repair (RTAPP) and laparoscopic transabdominal preperitoneal repair (LTAPP) for inguinal hernia. We conducted a thorough search in Cochrane Library, Embase, and PubMed for relevant clinical studies. After applying inclusion and exclusion criteria, the quality of selected studies was assessed using the Jadad scale for randomized controlled studies and the Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using RevMan 5.3 software. A total of ten studies were included, comprising two randomized controlled studies and eight non-randomized controlled studies. Meta-analysis results revealed no statistically significant differences between the RTAPP group and the LTAPP group regarding hospital stay [MD = 0.21 days, 95% CI (-0.09, 0.51), P = 0.17], incidence of seroma [OR = 0.85, 95% CI(0.45, 1.59), P = 0.61], overall complication rate [OR = 1.22, 95% CI(0.68, 2.18), P = 0.51], readmission rate [OR = 1.31, 95% CI(0.23, 7.47), P = 0.76], and recurrence rate [OR = 0.82, 95% CI(0.22, 3.07), P = 0.77]. However, the RTAPP group had longer operation time compared to the LTAPP group [MD = 14.02 minutes, 95% CI (6.65, 21.39), P = 0.0002], and the cost of the RTAPP procedure was higher than that of the LTAPP procedure [MD = $4.17 thousand, 95% CI (2.59, 5.76), P<0.00001]. RTAPP for inguinal hernia is a safe and feasible approach, however, it is associated with increased operation time and treatment costs.

Clinical outcomes of minimally invasive (laparoscopic and robotic) versus open extended cholecystectomy: A multicenter propensity score matched study.

This multicenter study aimed to compare the clinical outcomes of minimally invasive extended cholecystectomy (MI-EC) versus open EC (O-EC) for patients with gallbladder cancer (GBC). Patients who underwent EC (cholecystectomy, wedge resection of the liver bed, and regional lymphadenectomy) for GBC between 2010 and 2020 in three centers were included in the study. The clinicopathological data were compared after propensity score matching. Additional subgroup analysis on laparoscopic and robotic EC (L-EC and R-EC) was performed. A total of 377 patients were included: 308 for O-EC and 69 for MI-EC, respectively. The MI-EC group had a longer operative time (188.9 vs. 238.1 min, p < .001) and shorter hospital stay (9.0 vs. 7.2 days, p = .007), although no differences were found in operative blood loss, complication rate and survival outcome. In subgroup analysis, L-EC patients had a longer operative time (264.4 vs. 202.0 min, p = .001), compared to R-EC patients with comparable perioperative and survival outcomes. Although patients with MI-EC had a longer operation time and higher medical costs, the advantages were enhanced recovery with comparable short- and long-term outcomes. The operation time was less for R-EC patients than for L-EC patients, though the high cost still remains. The surgery type for EC can be selected according to the patient's condition, social status and surgeon's preference.

Comparative analysis of surgical modalities for the gynecomastia treatment: efficiency and aesthetic outcomes.

This retrospective study rigorously compares the clinical efficacy of three surgical methodologies for treating gynecomastia while providing guidance for future surgical modality selection. We analyzed records of 77 gynecomastia patients treated between January 2015 and October 2022. Patients were categorized into three groups: Group A (subcutaneous gland resection via areola incision), Group B (liposuction combined with single-hole endoscopic gland resection), and Group C (liposuction combined with three-hole endoscopic gland resection). Parameters assessed included patient demographics, intraoperative bleeding, surgical duration, hospitalization duration, costs, postoperative drainage, complications, and patient satisfaction. Group A had significantly shorter operation time and lower cost than Groups B and C (P<0.05). There were no significant differences in postoperative drainage (P>0.05). Group A had a higher incidence of subcutaneous fluid complications. All groups achieved 100% overall postoperative efficiency. Group B demonstrated superior outcomes for scarring and patient satisfaction. All three surgical modalities effectively treat gynecomastia. Circumareolar incision subcutaneous gland resection is optimal for mild to moderate cases due to reduced operation time and cost. Liposuction with single-hole endoscopic gland resection and three-hole endoscopic gland resection offers fewer complications and discreet incisions. Notably, the liposuction and single-hole endoscopic approach yielded superior postoperative patient satisfaction, aligning with minimally invasive principles and warranting broad clinical application.

Strategi Membangun Brand Community Di Media Sosial Untuk Perusahaan E-Commerce Dalam Meningkatkan Omset Penjualan

E-commerce is a contact of trade transactions between the seller and the buyer by using internet media. The advantage gained by using transactions through E-commerce is to increase revenue by using online sales that are cheaper and also at the same time operational costs such as paper, catalog printing can be minimized Big online business companies in Indonesia, such as bukalapak.com olx.co.id, lazad com, and the like have started to reap profits. Online business becomes an exciting business, not just for its founders, but for users, as well as buyers. To increase sales turnover E-commerce company utilize brand community in social media in face of increasingly competitive competition, main factor in brand community is formation of communication. The communication relationship does not need to be active but at least its existence can be determined. This means that the communication that occurs can be through social media.

Short-term clinical outcomes and five-year survival analysis of laparoscopic-assisted transanal natural orifice specimen extraction versus conventional laparoscopic surgery for sigmoid and rectal cancer: a single-center retrospective study.

The cosmetic benefits of natural orifice specimen extraction (NOSE) are easily noticeable, but its principles of aseptic and tumor-free procedure have caused controversy. We conducted a retrospective analysis of the clinical data of patients who underwent laparoscopic-assisted transanal NOSE or conventional laparoscopic surgery (CLS) for sigmoid and rectal cancer at our hospital between January 2018 and December 2018. The study aimed to compare the general characteristics, perioperative indicators, postoperative complications, and five-year follow-up results between the two groups. A total of 121 eligible patients were enrolled, with 52 underwent laparoscopic-assisted transanal NOSE and 69 underwent CLS. There were no significant differences observed between the two groups in terms of gender, age, body mass index (BMI), TNM stage, etc. (P > 0.05). However, the NOSE group exhibited significantly shorter total incision length and longer operation time compared to the CLS group (P < 0.05). There were no statistically significant differences observed between the two groups in terms of positive rate of bacterial culture, incidence rates of intraabdominal infections or anastomotic leakage (P > 0.05). Furthermore, during follow-up period there was no statistically significant difference observed between these two groups concerning overall survival rate and disease-free survival outcomes (P > 0.05). The management of surgical complications in CLS is exemplary, with NOSE presenting a sole advantage in terms of incision length albeit at the cost of prolonged operative time. Therefore, NOSE may be deemed appropriate for patients who place high emphasis on postoperative cosmetic outcomes.

Simulation and Application of Windowing for High-Grade Steel Thick-Wall Casing in Ultradeep Wells: A Case Study of ST102 Well

Windowing processes in ultradeep wells (> 7000 m) with high steel grade (TP155V) and thick-wall (15.83 mm) casing not only face complex underground environments with high temperature and pressure but also have the difficulty of long operation time and high cost. To improve the success rate and operational efficiency, CAE software was used to establish the casing windowing side-drilling simulation model and optimize the windowing milling cone. Field applications were used to further demonstrate the simulation results. The main conclusions are as follows. The simulation shows that the milling shoulder and the outer circle of the cone top are the main working faces in window opening and window repair. The conical milling cone has the largest windowing stress, highest windowing efficiency, and regular shape of the window. A casing with a depth of 7473 m, wall thickness of 15.83 mm, and steel grade TP155V was successfully windowing using six conical milling cone in the ST102 well, taking 51.76 h, and generating 94 kg iron chips in total; the average milling speed was 0.06 m/h; The casing windowing progress can be determined by observing the return state of the cuttings. ST102 well set three records in China for the deepest drilling depth, highest steel grade, and thickest wall thickness.

Noncystoscopic Removal of Double-J Stent in Women: Feasibility and Safety

ObjectivesTo evaluate the feasibility and safety of a simple non-cystoscopic method previously applied in children for removing double-J stents applied in women by comparing the hospitalization time, operation time, costs, complications, and success rate. Methods180 women who underwent either cystoscopic or non-cystoscopic double-J stent removal in a randomized manner. They were randomly assigned 1:1 to groups of cystoscopic double-J stent removal (n = 90) or non-cystoscopic double-J stent removal (n = 90). The age ranged from 19 to 72 years. After the removal of the double-J stent, the operation time, costs, complications, and success rate were compared between the two groups. ResultsThe operation time of the non-cystoscopic group was lower than that of the cystoscopic group (6.0(5.0,7.0) minutes VS 2.0(2.0,3.0) minutes, P<0.001). The hospitalization costs of the non-cystoscopic group were significantly shorter than that of the cystoscopic group (1361.2(1331.4,1379.2) Yuan VS 873.9(868.5,896.1) Yuan, P<0.001). There were no complications such as infection and massive bleeding in the two groups during and after the operation. Most non-cystoscopic double-J stent removal can succeed in less than three attempts (88/90). All patients in the non-cystoscopic group used this technique to remove the double-J stent. ConclusionsNon-cystoscopic removal of double-J stent has the advantages of short operation time and low hospitalization costs. It is a safe and feasible minimally invasive method to replace cystoscopic removal of the double-J stent.

Thermo-economic assessment of air conditioner utilizing direct evaporative cooling: A comprehensive analysis

As concerns regarding energy consumption and environmental impact continue to grow, the need for efficient and sustainable cooling technologies becomes increasingly significant. Among various alternatives, direct evaporative cooling (DEC) has emerged as a promising solution due to its energy-efficient operation and low environmental footprint. This paper aims to provide a comprehensive thermo-economic assessment of a 5.25 kW capacity split air conditioner (SAC) integrated with direct evaporative cooling, focusing on evaluating its performance, energy consumption, coefficient of performance(COP), and economic viability. A numerical model is developed to determine the reduction in the condenser inlet air temperature due to direct evaporative cooling. The ambient temperature (30–45 ⁰C), relative humidity (20–80 %), and evaporator temperature (3–12 ⁰C) are taken as the design variables. Box–Behnken design (BBD) technique of response surface methodology is applied for multi-objective optimization. The COP, total cost rate (TCR), and total exergy destruction (E˙D,t) are set as the objective functions. Cooling capacity, life period, operation time, interest rate, maintenance factor, and electricity cost are taken as constants. The thermoeconomic optimization evolved maximized COP enhancement of 68.94 %, and reduction in TCR and ED,t by 26.12 % and 57.23 %, respectively. The water consumption to energy saving ratio varies from 5.5 to 9.8 L/kWh for different months of the cooling season. The thermoeconomic performance and sustainability of DECSAC is observed to significantly improve compared to conventional SAC specifically in hot-dry climates. The simple payback of the proposed system ranges between 1.21 to 2.99 years depending upon the operating conditions.

Favorable impact of a novel endoscopic auxiliary system (NEAS) on fluoroscopy-guided lithotripsy for difficult bile duct stones: A pilot study.

Laser lithotripsy under fluoroscopic guidance is difficult to perform and risky due to its invisibility. In this study we aimed to investigate the efficacy and safety of a novel endoscopic auxiliary system (NEAS)-assisted lithotripsy under fluoroscopy for treating difficult common bile duct (CBD) stones. Patients with difficult CBD stones who were treated with NEAS-assisted laser lithotripsy (NEAS group) or conventional mechanical lithotripsy (ML) under fluoroscopy (ML group) were retrospectively evaluated. The primary outcome was the complete stone clearance rate and the secondary outcomes included operation time, complications, and medical cost. Seventeen patients were treated with NEAS-assisted laser lithotripsy and 144 patients underwent ML. Using the propensity score matching analysis, 17 pairs of cases treated with NEAS-assisted lithotripsy and ML were included. Patients in the NEAS group showed a higher stone clearance rate than the ML group (94.1% vs 58.8%, P = 0.039), as well as shorter operation time (41.9 min vs 49.4 min, P < 0.001) and lower medical cost (USD 4607 vs USD 5014, P < 0.001). There was no significant difference in the complication rate between the two groups (5.9% vs 17.6%, P = 0.601). NEAS-assisted fluoroscopy-guided laser lithotripsy is feasible and safe, which may be a promising technique in fluoroscopy-guided laser lithotripsy for difficult CBD stones.

Retrospective study on the modified Uhl technique of closed reduction and percutaneous pin in the treatment of Colles' fracture

To retrospectively assess the advantages of the modified Uhl technique in the treatment of Colles' fracture guided by the principles of Chinese osteosynthesis (CO) concept. A retrospective study was conducted on 358 patients with Colles' fracture treated with the modified Uhl technique of closed reduction and percutaneous pin between January 2016 and June 2021. Out of these, 120 eligible cases were selected and categorized into two groups according to different surgical methods:the closed reduction and percutaneous pin group, and the open reduction group. Sixty-eight patients in the closed reduction and percutaneous pin group were treated with the modified Uhl technique, while fifty-two patients in the open reduction group were treated with open reduction and internal fixation using plates. The modified Sarmiento imaging score, Gartland-Werley wrist score, operation time, hospital stay, and treatment costs between the two groups were compared at a 6-month postoperative follow-up. There were no significant differences in terms of gender, age, affected side, injure factors, time of injury to surgery, Sarmiento imaging score, and Gartland-Werley wrist joint score (P>0.05). The closed reduction and percutaneous pin group exhibited an operation time of (35.88±14.11) minutes, hospitalization stay of (9.78±2.48) days, and treatment costs of (16 074.91±1 964.48) yuan, while the open reduction group demonstrated comparatively longer operation time of (65.48±14.26) minutes, hospitalization stay of (15.88±2.00) days, and treatment costs of (20 451.27±1 760.22) yuan (P<0.01). The modified Uhl technique presents notable advantages in the management of Colles' fracture, including reliable fixation, less trauma, shorter operation time, less pain, shorter hospital stay, and cost-effectiveness. This technique exhibits promising potential for broader clinical application. However, it is important to note that the pin could potentially damage tendons, and in cases of Colles' fractures with osteoporosis and comminuted fragments, additional techniques may be required for reliable fixation.

244 Major Laparoscopic Versus Robotic Surgery – a Systematic Review of Randomised Controlled Trials

Abstract Aim To systematically review randomised controlled trials comparing robotic and laparoscopic surgical approaches in major surgery. Method Embase, Medline and Cochrane Library were searched from their inception to September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic surgery in major general surgical, urological and gynaecological procedures. Short-term, health-related quality-of-life, surgical ergonomics, and long-term outcomes were compared. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Forty-eight studies, across fifteen procedures, involving 7588 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In selected studies, robotic surgery was associated with a lower rate of complication (8.3%, n = 4), shorter length of postoperative stay (10.4%, n = 5), and lower conversion rate (6.3%, n = 3), while laparoscopic surgery was associated with shorter operative time (37.5%, n = 18) and lower total cost (20.8%, n = 13). Eight studies found robotic surgery to be associated with superior health-related quality-of-life outcomes. Only six studies included long-term outcomes, with no significant differences between groups, while two studies reported on surgical ergonomics, one each reporting benefits in laparoscopic and robotic groups. Conclusions Robotic surgery is at least non-inferior in terms of short-term mortality and morbidity when compared to laparoscopic surgery, with potential benefits in post-operative recovery, and patient-reported outcomes, especially apparent in complex resection procedures. Future studies should focus incorporate metrics of surgical ergonomics, long-term outcomes and formal quality-of-life assessment, to further elucidate where the robotic platform can lead to patient benefits, as its adoption increases.

Modified alveolar ridge preservation to promote the osteogenesis of the distal surface of second molar after mandibular impacted third molar extraction: a preliminary study.

The objective of the retrospective study was to explore whether the use of a modified alveolar ridge preservation technique impacts osteogenesis on the distal surface of the second molar after mandibular third molar (M3) extraction. A total of 54 patients were enrolled in this study and divided into three different groups, including modified alveolar ridge preservation (MARP) group, traditional tooth extraction (TRA) group, and classical guided bone regeneration (GBR) group. In this study, MARP was designed with the highlights of the preservation of the alveolar bone superior and lingual to M3. These patients chose different surgical methods according to their own wishes for past infection or in order to prevent pericoronitis, and the operation time and surgical cost of each group were recorded. The periodontal conditions of the ipsilateral mandibular second molar (M2) and the height of its distal alveolar bone were measured during the postoperative follow-up. The probing depth, clinical attachment level, and osseous defect depth on the distal surface of the ipsilateral M2 in the MARP group were better than those of the TRA group at any time of the follow-up (P < 0.05 for all), but there was no statistical difference in the measurements when compared to the GBR group at 6months after operation (P > 0.05 for all). Thus, MARP therapy not only improves the regeneration of periodontal osseous defects distal to the M2 after M3 extraction but also reduces the operation time and surgical cost. This paper introduces a modified surgical method that can not only economically and effectively remove the impacted mandibular third molar but also obtain stable osteogenesis.

Is Full-Endoscopic Transforaminal Lumbar Interbody Fusion Superior to Open Transforaminal Lumbar Interbody Fusion for Single-Level Degenerative Lumbar Spondylolisthesis? A Retrospective Study.

In this study, we evaluate the clinical efficacy and safety of full-endoscopic transforaminal lumbar interbody fusion (TLIF) for treatment of single-level lumbar degenerative spondylolisthesis. Fifty-three patients were divided into two groups according to the surgical techniques: Full endoscopic (Endo)-TLIF (n = 25) and TLIF (n = 28). Clinical efficacy was evaluated pre- and postoperatively. The operation time, operative blood loss, postoperative amount of serum creatine phosphokinase (CPK), postoperative drainage volume, postoperative hospital stay time, total cost, and operative complications were also recorded. Compared with the TLIF group, the Endo-TLIF group had similar intraoperative blood loss, less postoperative increased CPK, less postoperative drainage volume, and shorter postoperative hospital stay, but longer operative time and higher total cost. The postoperative visual analog scale (VAS) scores of back and leg pain and Oswestry Disability Index (ODI) scores significantly improved compared with the preoperative scores in both two groups; more significant improvement of postoperative VAS scores of back pain and ODI scores were shown in the Endo-TLIF group at the 1-month follow-up (p < 0.05). No difference was found in the intervertebral fusion rate between the two groups. The Endo-TLIF has similar clinical effect compared with the TLIF for the treatment of lumbar degenerative spondylolisthesis. It also has many surgical advantages such as less muscle trauma, less postoperative back pain, and fast functional recovery of the patient. However, steep learning curve, longer operative time, and higher total cost may be the disadvantages that limit this technique. Also, the Endo-TLIF treatment of patients with bilateral lateral recess stenosis is considered a relative contraindication.

Laparoscopic versus robotic abdominal and pelvic surgery: a systematic review of randomised controlled trials.

The current evidence is inconclusive on whether robotic or laparoscopic surgery is the optimal platform for minimally invasive surgery. Existing comparisons techniques focus on short-term outcomes only, while potentially being confounded by a lack of standardisation in robotic procedures. There is a pertinent need for an up-to-date comparison between minimally invasive surgical techniques. We aimed to systematically review randomised controlled trials comparing robotic and laparoscopic techniques in major surgery. Embase, Medline and Cochrane Library were searched from their inception to 13th September 2022. Included studies were randomised controlled trials comparing robotic and laparoscopic techniques in abdominal and pelvic surgery. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Short-term, health-related quality of life, and long-term, outcomes were analysed. Forty-five studies, across thirteen procedures, involving 7364 patients were included. All of the studies reported non-significant differences in mortality between robotic and laparoscopic surgery. In majority of studies, there was no significant difference in complication rate (n = 31/35, 85.6%), length of postoperative stay (n = 27/32, 84.4%), and conversion rate (n = 15/18, 83.3%). Laparoscopic surgery was associated with shorter operative time (n = 16/31, 51.6%) and lower total cost (n = 11/13, 84.6%). Twenty three studies reported on quality of life outcomes; majority (n = 14/23, 60.9%) found no significant differences. There were no significant differences between robotic surgery and laparoscopic surgery with regards to mortality and morbidity outcomes in the majority of studies. Robotic surgery was frequently associated with longer operative times and higher overall cost. Selected studies found potential benefits in post-operative recovery time, and patient-reported outcomes; however, these were not consistent across procedures and trials, with most studies being underpowered to detect differences in secondary outcomes. Future research should focus on assessing quality of life, and long-term outcomes to further elucidate where the robotic platform could lead to patient benefits, as the technology evolves.

A comparative study of clinical outcome in ALT free flap reconstruction using superficial or deep and single or dual recipient vein anastomosis in different sites

AbstractBackgroundDuring the free flap surgery obtaining a suitable recipient vein is an important factor for successful outcome. As in all other flaps even in ALT flap, single or double venous anastomosis, superficial or deep venous anastomosis is still a matter of debate among the micro vascular surgeons. Though dual vein anastomosis is a time‐tested method, single vein anastomosis has the advantage of reducing the operative time and hospitalization cost. Similarly, in situation where the deep veins are dubious superficial veins are savior. This study explores the outcome of ALT flap using different system of recipient veins.Patients and MethodsRetrospective analysis of the 54 free ALT flaps performed over a period of 5 years from June 2017 till June 2022, was carried out. Out of 54, 38 (63%) were male patients and 16 (37%) were females. The outcome of the flaps was evaluated in single or dual anastomosis group. Similarly, the outcome of the flaps with deep or superficial vein anastomosis was also evaluated. The flaps outcomes are evaluated as favorable (successful as well as partial loss are considered as favorable) and unfavorable (complete loss of the flap).ResultsAmong the 54 flaps, 31 patients had lower limb reconstruction, majority were post‐traumatic defects. Twenty patients had head and neck reconstruction following post malignancy excision. Three patients had upper‐limb reconstruction for post traumatic and burn injury defects. The outcome was analyzed. Twenty patients had dual vein anastomosis, 90% (18 out of 20) of patients had favorable outcome and 10% (2 out of 20) had unfavorable outcome. Thirty‐four patients underwent single vein anastomosis, 94% had favorable outcome and 6% had unfavorable outcome. The result was not statistically significant as p &lt; .05. Seven patients underwent superficial vein recipient anastomosis, and all flaps were (100%) successful and no failure, whereas out of 27 patients who had undergone deep vein anastomosis 25 (92%) had favorable outcome and 2 (8%) had unfavorable outcome. The results were not statistically significant as p &gt; .05.ConclusionAs in other free flaps venous anastomosis compromise is the cause for flap failure in majority of the times. Whenever possible, dual vein anastomosis should be considered. But when impervious, single vein anastomosis can be resorted to without any hesitation. Similarly, unavailability of deep veins should not deter the surgeons. Superficial veins were a savior in such situation and can be advantageous too.

Efficacy of Flowable Collagen Hemostat Evaluated in Preclinical Models of Liver Injury and Spinal Cord Exposure.

Excessive bleeding in trauma and surgical settings leads to increased operative time, reoperation rates, and overall healthcare costs. A wide range of hemostatic agents have been developed to control bleeding that can vary considerably in type of hemostatic action, ease of application, cost, risk of infection, and dependence on patient coagulation. Microfibrillar collagen-based hemostatic materials (MCH) have yielded beneficial results in a variety of applications. A new flowable collagen product, containing a modified MCH flour, but in a more convenient flowable delivery system, was evaluated for hemostatic efficacy in preclinical models of solid organ injury and spinal cord exposure. The primary objective of this study was to compare the hemostatic potential and local tissue responses to this novel, flowable collagen-based hemostatic agent to the original flour formulation to confirm that the new method of delivery did not interfere with the hemostatic properties of the MCH flour. When observed visually, the flowable MCH flour mixed with saline (FL) provided more precise application and uniform coverage to injured tissues compared to the dry MCH flour alone (F0). All of the treatments (FL, F0, and gauze) exhibited comparable Lewis bleed grade at all three time points evaluated in the capsular resection liver injury model (bleed grade: 1.0-1.3; p> 0.05 in all cases). FL and F0 exhibited comparable 100% acute hemostatic efficacy and similar long-term histomorphological properties (up to 120 days) in a capsular resection liver injury in pigs, while gauze resulted in significantly lower rates of acute hemostatic efficacy (8-42%, p<0.05 in all cases). In an ovine model of dorsal laminectomy and durotomy, FL and F0 again exhibited comparable results without any neurological effects. Flowable microfibrillar collagen was shown to yield favorable short- and long-term outcomes in two representative applications where hemostatic efficacy is critical to surgical success.

A comparison of coblation and modified monopolar tonsillectomy in adults

ObjectiveTo compare the intraoperative records and postoperative clinical outcomes of adults who underwent coblation and modified monopolar tonsillectomy tonsillectomies.Materials and methodsAdult patients with tonsillectomy were randomly divided into the coblation and modified monopolar tonsillectomy groups. The estimated blood loss, postoperative pain score, operation time, post-tonsillectomy hemorrhage (PTH), and cost of disposable equipment were compared.ResultsPain intensity in the coblation and monopolar groups was similar on postoperative days 3 and 7. However, the mean maximum pain score in the monopolar group was significantly higher compared to the coblation group on postoperative days 1 (P < 0.01) and 2 (P < 0.05).Secondary PTH occurred in 7.1% (23/326) of patients in the coblation group and 2.8% (9/327) of patients in the monopolar group (P < 0.05).ConclusionAlthough pain was significantly increased on postoperative days 1 and 2 in the modified monopolar tonsillectomy group, the operation time, secondary PTH, and medical costs were significantly decreased compared to the coblation technique group.

Comparison of robotic right colectomy and laparoscopic right colectomy: a systematic review and meta-analysis.

For right colon surgery, there is an increasing body of literature comparing the safety of robotic right colectomy (RRC) with laparoscopic right colectomy (LRC). The aim of the present systematic review and meta-analysis is to assess the safety and efficacy of RRC versus LRC, including homogeneous subgroup analyses for extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). PubMed, Web of Science, Embase, and Cochrane Library databases were searched for studies published between January 2000 and January 2022. Length of hospital stay, operation time, rate of conversion to laparotomy, time to first flatus, number of harvested lymph nodes, estimated blood loss, rate of overall complication, ileus, anastomotic leakage, wound infection, and total costs were measured. Forty-two studies (RRC: 2772 patients; LRC: 12,469 patients) were evaluated. Regardless of the type of anastomosis, RRC showed shorter length of hospital stay, lower rate of conversion to laparotomy, shorter time to first flatus, lower rate of overall complications, and a higher number of harvested lymph nodes compared with LRC, but longer operative time and higher total costs. In the IA subgroup, RRC had a shorter length of hospital stay, longer operative time, and lower rate of conversion to laparotomy compared with LRC, with no difference for the remaining outcomes. In the EA subgroup, RRC had a longer operative time, lower estimated blood loss, lower rate of overall complications, and higher total costs compared with LRC, with the other outcomes being similar. The safety and efficacy of RRC is superior to LRC, especially when an intracorporeal anastomosis is performed. Most included articles were retrospective, offering low-quality evidence and limited conclusions.

Comparison of Modified Cap-Assisted Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in Treating Intraluminal Gastric Gastrointestinal Stromal Tumor (≤20 mm).

A modified cap-assisted endoscopic mucosal resection (mEMR-C), introduced in this study, was a novel variation of the standard EMR. We aimed to compare the outcomes of mEMR-C and endoscopic submucosal dissection (ESD) for the treatment of small (≤20 mm) intraluminal gastric gastrointestinal stromal tumors (gGISTs). This retrospective study included 43 patients who underwent mEMR-C and 156 patients who received ESD at Nanjing Drum Tower Hospital. Baseline characteristics, adverse events, and clinical outcomes were compared between the 2 groups. Univariate and multivariable analyses were conducted to adjust for confounders. After propensity score matching using sex, year, location, and tumor size, outcomes were compared with 41 patients in each group. A total of 199 patients underwent endoscopic resection and the en bloc resection rate was 100%. The complete resection rate was comparable in both groups ( P = 1.000). Approximately 9.5% of all patients had a positive margin. There was no significant difference in positive margin for patients undergoing mEMR-C or ESD (9.3% vs 9.6%, P = 1.000). No difference in adverse events in both groups ( P = 0.724). The mEMR-C was associated with shorter operation time and lower cost than the ESD. Recurrence was reported in 2 patients at 1 and 5 years after ESD during a median follow-up of 62 months. No metastasis and disease-related death were identified in both groups. Propensity score matching analysis revealed similar results. The mEMR-C was found to be the preferable technique for small (≤20 mm) intraluminal gGISTs with shorter operation time and lower cost as compared with ESD.

MP39-10 SIMULTANEOUS BILATERAL PCNL: IS IT COST-EFFECTIVE?

You have accessJournal of UrologyCME1 Apr 2023MP39-10 SIMULTANEOUS BILATERAL PCNL: IS IT COST-EFFECTIVE? Kevin Wymer, Ben Johnson, Austen Slade, Daniel Heidenberg, Mitchell Humphreys, Karen Stern, and Marcelino Rivera Kevin WymerKevin Wymer More articles by this author , Ben JohnsonBen Johnson More articles by this author , Austen SladeAusten Slade More articles by this author , Daniel HeidenbergDaniel Heidenberg More articles by this author , Mitchell HumphreysMitchell Humphreys More articles by this author , Karen SternKaren Stern More articles by this author , and Marcelino RiveraMarcelino Rivera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Large, bilateral stone burden can present a unique challenge for both the urologist and patient. When bilateral PCNL is warranted, surgical timing can lead to differences in stone free rate (SFR), complications, and costs. This study compares the cost-effectiveness of simultaneous versus staged PCNL. METHODS: A decision-analytic Markov model was used to assess the cost-effectiveness of simultaneous (bilateral PCNL during a single operative episode for the index procedure) and staged (unilateral PCNL for the index procedure followed by a separate procedure for a contralateral PCNL) PCNL for the management of large, bilateral stone burden. Model probabilities and outcomes for index procedures, including SFR, complications, operative time, and hospital length of stay (LOS), were drawn from a large-volume, single-center cohort. Outcomes for secondary procedures and utility values were obtained from the literature. Primary outcomes included costs from a Medicare standpoint with the addition of operative time and LOS costs, effectiveness (quality adjusted life years, QALYs), and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to evaluate the robustness of the model. RESULTS: At 1 year following the index procedure, costs (inclusive of index procedure, secondary procedures, and complications) per patient were $52,585 and $61,687 for simultaneous and staged PCNL, respectively. In addition to being less costly, simultaneous PCNL also resulted in slightly higher QALYs (.982) compared to staged PCNL (.977). On one-way sensitivity analyses (Figure), staged PCNL became cost-effective if the SFR increased from 56% to 88% (40% greater per renal unit relative to simultaneous PCNL) or the cost of unilateral PCNL decreased approximately 50% to $4,699 ($16,266 less than simultaneous PCNL). CONCLUSIONS: Even when assuming a modest reduction in SFR (62% vs. 44% per renal unit), longer index procedure OR time (177 vs. 116 minutes) and LOS (3.2 vs. 2.3 days) and slightly higher major (6.2% vs. 5.5%) and minor (27.2% vs. 21.3%) complication rates at index procedure, simultaneous bilateral PCNL was both less costly and more effective at 1 year follow up relative to staged bilateral PCNL. This offers further support of simultaneous bilateral PCNL in the proper clinical setting. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e538 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Wymer More articles by this author Ben Johnson More articles by this author Austen Slade More articles by this author Daniel Heidenberg More articles by this author Mitchell Humphreys More articles by this author Karen Stern More articles by this author Marcelino Rivera More articles by this author Expand All Advertisement PDF downloadLoading ...