Total Drainage Research Articles

Analysis of the short‐term outcomes of biportal robot‐assisted lobectomy

The present study aimed to assess the short-term consequences of biportal robot-assisted lobectomy, validating its safety and effectiveness. A retrospective analysis evaluated the clinical data and short-term results of 18 patients in the single medical group of the centre who underwent biportal robot-assisted lobectomy plus lymph node dissection from November 2020 to March 2021. Lobectomy and lymph node dissection could be successfully accomplished in all 18 patients with the assistance of a biportal robot; there was no conversion to thoracotomy during the operation. There were 10 males and 8 females with theirages ranging from 37 to 73 (58.83±9.07)years. The total operation time was 74-146 (105.06±18.22)min. Punching time was 2-9 (5.11±1.74)min. Docking time was 8-16 (11.94±2.41)min. Console time was 50-104 (78.06±17.40)min. Chest closing time was 8-17 (10.28±2.74)min. Blood loss was 60-132 (94.11±41.41)ml. The number of lymph nodes dissected was 16-30 (21.78±4.13). Chest tube duration was 2-10 (4.06±1.98)days. Drainage on the first day following surgery was 100-500 (337.22±117.01)ml. Total drainage was 370-1100 (692.78±161.01)ml. Duration of hospital stay was 4-12 (5.89±1.94) days. The median 24 and 72h visual analogue score scores were 4 (3-7) and 3 (2-5). Total cost (¥) was 51 000-85 000 (68 000±10 000), respectively. There was one case of atrial fibrillation and one case of pulmonary infection. The complication rate was 11.11%. No serious complications were recorded after surgery, and no deaths occurred within 30days post-surgery. The final pathological diagnosis revealed 10 cases of squamous cell carcinoma, 7 cases of adenocarcinoma and 1 case of benign disease. The biportal robot-assisted lobectomy was found to be safe and effective in the treatment of lung cancer.

Correlation between C-reactive protein, intravenous hydrocortisone, systemic tranexamic acid and post mastectomy seroma

Background: Breast cancer is the second leading cause of death among women worldwide. Formation of a seroma most frequently occurs after mastectomy and axillary surgery. The objective was to find the correlation between the formation of post modified radical mastectomy seroma and C-reactive protein (CRP) and the effect of preoperative intravenous (IV) hydrocortisone, systemic tranexamic acid.Methods: This prospective study was conducted at Menoufia university hospital on female patients with primary operable breast cancer who were divided to two groups; each included 30 patients: group I received general anesthesia with hydrocortisone therapy (Solu-Cortef 100 mg solution once), systemic tranexamic acid (kapron 5 ml once) and group II received general anesthesia without hydrocortisone nor tranexamic acid. CRP serum levels before surgery and 24 hour after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation and management of seroma.Results: Our results revealed that a significant difference between both groups as regard CRP, the incidence of seroma, time of removing the drain and total collection of the drain in favor to those who received IV hydrocortisone and systemic tranexamic acid.Conclusions: Induction of IV hydrocortisone, systemic tranexamic acid with general anaesthesia during modified radical mastectomy (MRM) are significantly decreasing the level of CRP, the incidence of seroma, time of removing the drain and total collection of the drain.

Direct Bilirubin in Drainage Fluid 3 days after Hepatectomy Is Useful for Detecting Severe Bile Leakage

Introduction: The International Study Group of Liver Surgery (ISGLS) definition of bile leakage is an elevated total bilirubin concentration in the drainage fluid after post-operative day (POD) 3, which has been widely accepted. However, there were no reports about direct bilirubin in drainage fluid to predict bile leakage. Methods: Data from 257 patients who underwent hepatectomy were retrospectively reviewed. The optimal cut-off value was investigated using receiver-operating characteristic curves. The predictive power of drainage fluid total bilirubin (dTB) and drainage fluid direct bilirubin (dDB) to predict bile leakage, which was defined using ISGLS grade B or grade C, were compared. Results: ISGLS grade B bile leakage occurred in 16 patients (6.2%). Area under the curve (AUC) of dDB was always higher than that of dTB on each POD. The AUC of dDB was >0.75 on PODs 2, 3, and 5, and then it increased with the increasing POD. The dDB on POD 5 showed the highest accuracy (0.91) and positive predictive value (PPV) (0.67), which was followed by dTB/serum total bilirubin (sTB) on POD 3 (accuracy, 0.91; PPV, 0.33). Because the PPV of dDB increased as the POD increased, dDB was better than dTB for predicting clinically significant bile leakage. dDB on POD 3 showed the highest negative predictive value (0.97). The positive likelihood of dDB increased and the negative likelihood of dDB decreased on the basis of the POD. Among patients with dTB/sTB ≤3 on POD 3, 19.1% of these patients had bile leakage when dDB was >0.44 on POD 3. Conclusions: Measurement of both dDB and dTB, which are easy to perform, can be used to effectively predict clinically significant bile leakage.

Effect of Sewage Sludge and Palm Fiber Co-compost as horticultural substrate on Carob tree (Ceratonia siliqua) growth

The palm (Phoenix dactylifera) is the main species of the main agro-systems of semi-arid and arid bioclimatic stages in Algeria. Its fibers (FP) are widely available and not used. In addition, the available sewage sludge (SS) requires recovery for ecological and economic purposes. To this end, the objective of this work was to formulate a Co-composting (CC) composed of SS and PF as a horticultural substrate (HS) intended for the breeding of the carob tree (Ceratonia siliqua). During the six months of CC, the indicative maturity pa-rameters such as pH, electro conductivity (EC), dissolved O2 and dry matter (DW) showed stability of the product. Four HS composed of 4 different CC-soil (TS) ratios: T (8-2), T (7-3), T (6-4) and T (0-10) were studied in the labor-atory. The best physicochemical characteristics such as total porosity (TP), humidity rate (RH), bulk density (BD), drainage rate (DR), pH and EC were obtained in T (80:20). This same SH also gave the best growth parameters of plants such as root volume (RV), root architecture (RA), number of roots (RN), root length (RL), number of leaves (LN), stem length (SL), fresh aerial and root weight (AFW), (RFW), dry aerial and root weight (ADW) and (RDW). We conclude that T (8: 2) induced the best growth performance of C. siliqua.

Effectiveness of using tranexamic acid in total hip and total knee arthroplasty: Single tertiary center experience.

Objectives:To measure the effectiveness of tranexamic acid (TXA); in total joint arthroplastyin terms of reducing post-operative blood loss.Methods:A retrospective cohort study in which patients who had underwent total hip arthroplasty (THA) and TKA between 2010-2018 in a single tertiary center. Those had received TXA (group 1) and those who had received no-TXA (group 2) were evaluated. Unpaired student’s t-test was used to compare TXA and no-TXA groups for continuous variables and Chi-square test was used for categorical variables. A p-value<0.05 was considered significant.Results:A total of 385 patients were included, 180 patients received TXA, and 205 patients received no-TXA. Post-operative blood loss was significantly less in TXA group (13.41±9.51, p<0.001). Total drainage output was significantly lower in TXA group compared to no-TXA (373.98±246.12 vs. 487.11±307.13 mL, p<0.001). Blood transfusion units were significantly less in TXA group than in the control group (20 units; 11.1% vs. 50 units; 24.4%, p<0.001).Conclusion:Tranexamic acid use in TKA and THA is effective in reducing post-operative blood loss in terms of drop in Hg level, total drainage output and blood transfusion rate.

Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial

(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.

From local measures to regional impacts: Modelling changes in nutrient loads to the Baltic Sea

Study RegionOur study region is the Baltic Sea Drainage Basin (BSDB), which covers an area of 1.8 Mio km2 distributed over 14 countries in northern Europe. Study FocusWe use a large-scale hydrological and nutrient transport model (E-HYPE) to model basin-wide impacts of measure scenarios on the Baltic Sea, where eutrophication is a critical issue for the marine ecosystem. We constructed measure scenarios based on stakeholder acceptance, established in workshops in different regions around the Baltic. These measures include local stream reach to catchment scale measures aiming to reduce nutrient transport into the stream network (buffer strips, stormwater ponds) and measures aiming to reduce regional nutrient source releases (fertiliser leaching rates, rural household emissions). New Hydrological Insights for the RegionNutrient load reductions are often needed to reduce eutrophication and improve overall surface water quality in fresh-water and enclosed bays and seas, where dilution is limited and load emissions have long residence times. To reduce riverine nutrient loads, remediation measures are necessary, e.g. establishment of buffer strips or improved wastewater treatment. Such measures are, however, typically not designed to target nutrient load reductions at sea outlets, but rather focus on local improvements. Here, we show that measures, notwithstanding other meliorating ecosystem benefits, must include reductions in load emissions across large basin areas to impact integrated net loads into coastal sea basins, because reduction measures that only target nutrient delivery to the stream network typically cannot be implemented in a significant enough proportion of the total drainage area of large coastal river basins. Our impact scenarios show BSDB-wide nutrient reductions of up to 9 % for nitrogen and phosphorus compared to a reference scenario, if load emissions are reduced in the scenario assumptions.

Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: A propensity score–matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma

BackgroundThe transoral endoscopic thyroidectomy vestibular approach has been demonstrated to have similar surgical outcomes as open thyroidectomy for selected papillary thyroid carcinomas. This study aimed to evaluate and compare the surgical outcomes and safety of the transoral endoscopic thyroidectomy vestibular approach with those of open thyroidectomy in the treatment of papillary thyroid carcinoma with a diameter between >1 cm and ≤3.5cm. MethodsWe retrospectively reviewed all patients who had papillary thyroid carcinoma that was between >1 cm and ≤3.5 cm in diameter and who had undergone the transoral endoscopic thyroidectomy vestibular approach (n = 96) or an open thyroidectomy (n = 425) from January 2017 to June 2020. We then performed 1:1 propensity score matching, yielding 78 matched pairs. Afterward, surgical outcomes and follow-up data were compared between the 2 matched groups. ResultsCompared with the matched open thyroidectomy group, the papillary thyroid carcinoma group had a significantly longer operative time (P < .001), more blood loss (P < .05), higher postoperative white blood cell count (P < .05), higher C-reactive protein (P < .001), more total drainage volume (P < .001), increased surgical cost (P < .05), better cosmetic satisfaction (P <.001), lower scar self-consciousness (P < .001), and better quality of life (P < .001). We observed no significant differences in the incidence of other outcomes, including the number of retrieved lymph nodes and metastatic central lymph nodes, the rate of intraoperative recurrent laryngeal nerve signal weakened and parathyroid autotransplantation, visual analog scale scores for pain, drainage duration, postoperative hospital stay, rate of complications, and oncologic completeness. We observed no conversion to open thyroidectomy and no intraoperative capsular disruption in the transoral endoscopic thyroidectomy vestibular approach group. There was 1 case of persistent nodal disease in the transoral endoscopic thyroidectomy vestibular approach group. No recurrence was observed in the 2 groups during the follow-up period. ConclusionThe transoral endoscopic thyroidectomy vestibular approach is feasible in selected patients with papillary thyroid carcinoma, not only because it is cosmetically advantageous but also because it is surgical and oncologically safe and may be an optional surgical method for treating papillary thyroid carcinomas having a diameter between >1 cm and ≤3.5 cm.

Study of modified subcutaneous lumbar spine index as a predictor for short-term effectiveness in transforaminal lumbar interbody fusion

To explore the value of modified subcutaneous lumbar spine index (MSLSI) as a predictor for short-term effectiveness of transforaminal lumbar interbody fusion (TLIF) in treatment of lumbar degenerative disease (LDD). Between February 2014 and October 2019, 450 patients who were diagnosed as LDD and received single-segment TLIF were included in the study. Based on the MSLSI measured by preoperative lumbar MRI, the patients were sorted from small to large and divided into three groups ( n=150). The MSLSI of group A was 0.11-0.49, group B was 0.49-0.73, and group C was 0.73-1.88. There was no significance in gender, age, disease duration, diagnosis, surgical segment, and improved Charlson comorbidity index between groups ( P>0.05). There were significant differences in the subcutaneous adipose depth of the L 4 vertebral body and body mass index (BMI) between groups ( P<0.05). The operation time, intra-operative blood loss, length of incision, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, total drainage volume, antibiotic use time after operation, walking exercise time after operation, hospital stay, the incidences of surgical or non-surgical complications in the three groups were compared. Pearson correlation analysis was used to analyze the correlation between MSLSI and BMI, and partial correlation analysis was used to study the relationship between MSLSI, BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L 4 vertebral body and complications. The Receiver Operating Characteristic (ROC) curve was used to evaluate the value of SLSI and MSLSI in predicting the occurrence of complications after TLIF in treatment of LDD. There was no significant difference in operation time, length of incision, antibiotic use time after operation, walking exercise time after operation, drainage tube placement time, drainage volume on the 1st day after operation, drainage volume on the 2nd day after operation, and total drainage volume between groups ( P>0.05). The amount of intra-operative blood loss in group C was higher than that in groups A and B, and the hospital stay was longer than that in group B, with significant differences ( P<0.05). Surgical complications occurred in 22 cases (14.7%), 25 cases (16.7%), and 39 cases (26.0%) of groups A, B, and C, respectively. There was no significant difference in the incidence between groups ( χ 2=0.826, P=0.662). The incidences of nerve root injury and wound aseptic complications in group C were higher than those in groups A and B, and the incidence of nerve root injury in group B was higher than that in group A, with significant differences ( P<0.05). There were 13 cases (8.7%), 7 cases (4.7%), and 11 cases (7.3%) of non-surgical complications in groups A, B, and C, respectively, with no significant difference ( χ 2=2.128, P=0.345). There was no significant difference in the incidences of cardiovascular complications, urinary system complications, central system complications, and respiratory system complications between groups ( P>0.05). There was a correlation between MSLSI and BMI in 450 patients ( r=0.619, P=0.047). Partial correlation analysis showed that MSLSI was related to wound aseptic complications ( r=0.172, P=0.032), but not related to other surgical and non-surgical complications ( P>0.05). There was no correlation between BMI, improved Charlson comorbidity index, subcutaneous adipose depth of the L 4 vertebral body and surgical and non-surgical complications ( P>0.05). ROC curve analysis showed that the area under ROC curve (AUC) of MSLSI was 0.673 (95%CI 0.546-0.761, P=0.025), and the AUC of SLSI was 0.582 (95%CI 0.472-0.693, P=0.191). MSLSI can predict the short-term effectiveness of TLIF in treatment of LDD. Patients with high MSLSI suffer more intra-operative blood loss, longer hospital stay, and higher incidence of nerve root injury and postoperative incision complications.

Morphometric Analysis of Khag Micro-Watershed in North-West Himalayas of Kashmir Using GIS and Remote Sensing Techniques

Morphometric analysis is of vital importance in any hydrological research and is inevitable in development and management of watershed. Using the watershed as the main unit of morphometric characterization is the most logical choice, as well as geomorphological and hydrological processes take place within the drainage basin. A critical assessment and evaluation of morphometric parameters of Khag micro-watershed was accomplished through measurement of relief, linear and aerial aspects using Geographical Information System (GIS). The watershed boundaries, aspect, slope, digital elevation model (DEM), profile graph of topography, drainage order and drainage density mapswere generated for detailed study of micro-watershed using Shuttle Radar Topographic Mission (SRTM) data. The study area was designated as fourth order basin with the drainage area of 34.32 km2 and shows dendritic drainage pattern. The total length, drainage density and mean bifurcation ratio (Rb) were found to be 38.84 km, 1.13km/km2 and 1.73, respectively. The Khag micro-watershed showed the greater Rb value, which directs a strong structural control in the runoff pattern. A decrease in the stream frequency of flow was also observed with an increase in the order of flow. The shape parameters such as circulatory ratio, elongation ratio, length of over land flow, form factor and drainage texture of Khag micro-watershed were 0.42, 0.56, 0.43 km, 0.24 and 1.66, respectively. The Khag micro-watershed is elongated in shape and dendritic in drainage pattern. This can be attributed to the fact that the lithology and structural controls are more or less uniform. Relative relief and ruggedness number were 0.065 and 2.39 and are likely to subject the micro watershed to maximum soil erosion that demands, instantaneous soil conservation measure to be taken by watershed managers for its stability and sustainability. These studies area advantageous for the planning of rainwater harvesting and the management of the catchment area.

Predictors of surgical intervention in patients with inflammatory bowel disease (two-center study)

BackgroundSixty percent of Crohn’s disease (CD) patients require intestinal resection, and 20% of ulcerative colitis (UC) patients undergo proctocolectomy for medically refractory disease. Scarcity of literature about predictors for surgical intervention in inflammatory bowel disease (IBD) encouraged the conduction of this study to assess risk factors for surgical intervention in IBD patients.ResultsThis cohort study included 80 Egyptian inflammatory bowel disease patients recruited from two medical centers. Patients were classified into two groups, 40 patients each, according to their need for surgical intervention to control inflammatory bowel disease. The two groups were compared regarding age of onset, type and location of disease, smoking, extraintestinal manifestations, perianal disease, granuloma, severity scores, stool calprotectin, complete blood count, erythrocyte sedimentation rate, C-reactive protein, and serum albumin at diagnosis for Crohn’s disease patients.Twelve ulcerative colitis and 28 Crohn’s disease patients required surgical intervention in the form of total colectomy (30%), fistulectomy (32.5%), resection anastomosis (17.5%) or abscess drainage (20%). Perianal disease, smoking, and disease severity scores showed high significant differences (P value < 0.001); disease type and presence of granuloma showed statistically significant difference (P value < 0.05) between both groups. But, patient age at onset, location of the disease or extraintestinal manifestation had no statistical significance (P value > 0.5). Surgical interventions were more likely to be needed in patients with higher stool calprotectin level, C-reactive protein, erythrocyte sedimentation rate, and lower serum albumin for Crohn’s disease patients (P value < 0.001 for each).ConclusionSmoking, perianal disease, higher severity scores, stool calprotectin, C-reactive protein, and erythrocyte sedimentation rate levels are predictors of surgical treatment.

Zoning based cascade infrastructure system design for urban waterlogging prevention

With the development of global climate change and urbanization in China, urban waterlogging caused by rainstorm has a serious impact on the safety of people’s life and property and the development of social and economic. Based on the hydraulic model, taking Xining City as an example, a set of multi-layer flood prevention infrastructure construction technology system is proposed, in which the microscale-drainage-system mainly includes the sponge transformation of building blocks, the construction of sponge park; the mesoscale-drainage-system mainly includes the transformation of pipe system for different return periods, the transformation of combined flow and separate flow system; the macroscale-drainage-system mainly includes utility tunnel system, natural and artificial storage facilities. Through quantitative evaluation of rainstorm with 50 year return period, under the construction of microscale-drainage-system and mesoscale-drainage-system with different return period index, the total drainage capacity increased from 1.407 million m3 to 1.573 million m3 and 1.830 million m3. The total accumulated water is 1.073 million m3 and 0.816 million m3 respectively, which are less than 1.173 million m3 of macroscale-drainage-system new storage capacity.

Comparison of two different surgical strategies for breast cancer patients treated with mastectomy plus sentinel lymph node biopsy.

Two separated incisions are generally adopted in breast cancer patients treated by mastectomy plus sentinel lymph node biopsy (SLNB). However, one-incision procedure is also applied in clinical practice. The outcomes of the two different surgical strategies remain unknown. This issue needs to be investigated. The medical records of breast cancer patients who underwent a mastectomy combined with an SLNB were reviewed retrospectively. Group A comprised patients who received a single incision for both the mastectomy and SLNB. Group B comprised patients who received a second incision for the SLNB. Demographics and outcomes were compared between the two groups. There were 280 female patients divided into Groups A (n = 130) and B (n = 150) included in this study. Preoperatively, the two groups were similar in demographics for age, tumor size, tumor location, body mass index, pathologic type, and cancer stage (P > 0.05). Group A showed shorter surgical times (129.5 ± 29.0 vs. 136.7 ± 21.9min), less postoperative upper limb numbness (12.3% vs. 25.3%), and more harvested sentinel lymph nodes (3.2 ± 1.1 vs. 2.7 ± 1.0) than Group B (P < 0.05). There were no significant differences for intraoperative blood loss, total postoperative drainage amount, hospital stay, upper limb motility, upper limb pain, upper limb edema, number of metastatic sentinel lymph nodes, follow-up time, or recurrent cases (P > 0.05). The one-incision approach for a breast cancer mastectomy plus SLNB has several advantages over the two-incision approach, including a shorter surgical time, decreased upper limb numbness, and the harvesting of more sentinel lymph nodes. Further prospective randomized controlled clinical trials should be designed to verify the current findings.

Perioperative management of wounds with nanosilver dressing after neoadjuvant chemotherapy for breast cancer

Neoadjuvant chemotherapy (NAC) can improve the success rate of breast cancer surgery; however, most patients have obvious negative thoughts about NAC. Failure to effectively relieve these negative emotions or thoughts will adversely affect the quality of life of the patients after treatment. Therefore, a majority of nursing staff are committed toward reducing patients’ negative emotions through good perioperative management as well as improving the treatment effects and postoperative quality of life of patients. A good perioperative management of breast cancer should include postoperative wound and patient psychological care. This study found that patients using nanosilver dressings have greatly reduced total wound drainage, drainage tube removal time, and postoperative complications within four days after surgery and that the rate of wound healing was obviously improved. This suggests that nanosilver dressings can improve the rate of wound healing and reduce the risk of complications. At the same time, we found that postoperative negative emotions of patients receiving comprehensive care were effectively relieved and their mental flexibility was also improved. In addition, the quality of sleep, quality of life, and nursing satisfaction of patients receiving comprehensive care were significantly higher than those receiving traditional care models. This shows that the comprehensive care model is capable of reducing the negative emotions of patients during the perioperative period and also helps to improve the quality of life of patients after surgery. Therefore, this study demonstrates that the use of nanosilver dressings as a comprehensive care model can reduce the risk of negative emotions and complications in addition to improving the rate of wound healing and postoperative quality of life.

Safety profile of preoperative administration of low-molecular-weight heparin on minimally invasive lung cancer surgery: a randomized controlled trial

BackgroundVenous thromboembolism remains a common but preventable complication for cancerous lung surgical patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. This study was designed to investigate the safety profile of preoperative administration of low-molecular-weight-heparin (LMWH) for lung cancer patients.MethodsFrom July 2017 to June 2018, patients prepared to undergo lung cancer surgery were randomly divided into the preoperative LMWH-administration group (PRL) for 4000 IU per day and the postoperative LMWH-administration group (POL) with same dosage, all the patients received thromboprophylaxis until discharge. Baseline characteristics including demographics and preoperative coagulation parameters were analyzed, while the endpoints included postoperative coagulation parameters, postoperative drainage data, hematologic data, intraoperative bleeding volume and reoperation rate.ResultsA total of 246 patients were collected in this RCT, 34 patients were excluded according to exclusion criterion, 101 patients were assigned to PRL group and 111 patients belonged to POL group for analysis finally. The baseline characteristic and preoperative coagulation parameters were all comparable except the PRL group cost more operation time (p = 0.008) and preoperative administration duration was significantly longer (p < 0.001). The endpoints including postoperative day 1 coagulation parameters, mean and total drainage volume, drainage duration, intraoperative bleeding volume and reoperation rate were all similar between the two groups. Moreover, coagulation parameters for postoperative day 3 between the two groups demonstrated no difference.ConclusionPreoperative administration of low-molecular-weight-heparin demonstrated safety and feasibility for lung cancer patients intended to receive minimally invasive surgery.Trial registration: ChiCTR2000040547 (www.chictr.org.cn), 2020/12/1, retrospectively registered.

Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis

A thymic epithelial tumour is the most common primary tumour in the anterior mediastinum of adults. A few retrospective studies compared the short-term outcomes between robotic-assisted thymectomy (RAT) and video-assisted thymectomy (VAT). So, it is necessary to conduct a meta-analysis to further compare these 2 surgical techniques. EMBASE, Medline and Web of Science were used. Thesaurus terms and medical subject headings were used in Medline and EMBASE, respectively. The Newcastle-Ottawa scale was used for grading because the included studies were all case-control studies. Nine studies were included in the meta-analysis with a total of 723 patients, including 315 patients in the RAT group and 408 patients in the VAT group. The meta-analysis [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.06-0.94; P = 0.041], indicating that RAT yielded a significantly lower rate of conversion compared with VAT. Duration of drainage with RAT was significantly less than that with VAT (weighted mean difference = -1.10; 95% CI -1.98 to -0.22; P = 0.014). The pooled analysis (weighted mean difference = -103.6; 95% CI -199.21 to -7.98; P = 0.034) suggested that patients in the RAT group had less drainage than those in the VAT group. The recurrence rates in both groups were comparable (OR 0.19, 95% CI 0.03-1.20; P = 0.078). RAT has advantages over VAT in terms of short-term outcomes such as shorter duration of drainage, less total drainage and a lower rate of conversion. The recurrence rate was comparable between the 2 techniques. Therefore, RAT could be considered as an alternative treatment for diseases of the thymus.

Effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery.

Background:In facial contour surgery, due to the narrow field of vision in the oral approach and the abundant blood supply to the maxillofacial area, hemostasis is not easy. The purpose of this study was to evaluate the hemostatic effect of soluble hemostatic gauze.Methods:We organized a prospective randomized study of 282 patients receiving facial contouring surgery (4 types of procedures in total) during 2016.1.1 to 2018.12.30. For each type of procedure, patients were randomly divided into study group (received hemostatic gauze) and control group (received sterile gauze). Two groups were compared for each type of procedure regarding 5 major perioperative variables: intraoperative blood loss, operation time, 24-hour postoperative drainage volume, total postoperative drainage volume, and postoperative drainage time. Correlation between variables was analyzed.Results:Compared with control group, the study group had higher amount of intraoperative blood loss in mandibular angle ostectomy (MAO) (P < .01) and mandibular angle-body-chin curved ostectomy procedures (P < .05), less total postoperative drainage volume in MAO (P < .01) but not in malarplasty with MAO and partial masseter muscle resection along with MAO procedures. No significant difference was observed between respective study and control groups regarding operation time, 24-hour postoperative drainage volume, and postoperative drainage time in any of the 4 types of surgery. In all 4 types of procedures, a strongly positive correlation was observed between total drainage volume and 24-hour drainage volume in both the study and control groups (r: 0.88–0.97, P < .01).Conclusion:The effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery is associated with the type of surgery, which can reduce the risk of postoperative bleeding in MAO. However, for surgery with relatively large amount of intraoperative and postoperative bleeding, the hemostatic gauze had a limited postoperative hemostasis efficacy, which needs further evaluation.

Intravenous tranexamic acid reduce postoperative drainage and pain after open elbow arthrolysis: a randomized controlled trial.

Open elbow arthrolysis (OEA), which has become an established treatment for post-traumatic elbow stiffness (PTES), requires complete release of contracture tissue and wide excision of ectopic bone, which results in extensive bleeding. The aim of the present study is to evaluate the efficacy of intravenous tranexamic acid (TXA) on postoperative drainage, calculated blood loss, and early clinical outcomes in patients undergoing OEA. A double-blind, randomized, placebo-controlled trial including 96 patients undergoing OEA was undertaken. Patients received intravenously either 100 mL saline (placebo group, n = 48), or 100 mL saline plus 1 g TXA (TXA group, n = 48) before skin incision. The primary outcome was the drainage volume on postoperative days (PODs) 1-3. Secondary outcomes included the calculated blood loss, elbow pain score measured by visual analog scale (VAS), elbow function valued by Mayo Elbow Performance Score (MEPS), and rate of complications after OEA. Mean total postoperative drainage volume (TXA group: 182 mL vs. placebo group: 214 mL, P = .003) and mean calculated total blood loss (TXA group: 582 mL vs. placebo group: 657 mL, P = .004) were significantly lower in the TXA group. No transfusions were necessary in either group. Mean VAS pain scores in elbow motion showed marked differences between both groups on POD 1 (TXA: 5 vs. placebo: 6, P = .003) and POD 2 (TXA: 4 vs. placebo: 5, P = .023) but not in other postoperative time points. No differences were detected in complications, such as pin-related infection, hematoma, new or exacerbation of ulnar nerve symptoms, and recurrent heterotopic ossification. At the 6-month follow-up, no statistical differences were found between the 2 groups with respect to the elbow functions including range of motion, VAS score, and MEPS. Intravenous administration of TXA significantly decreased the postoperative drainage volume and the total estimated blood loss and alleviated the elbow pain with motion during early postoperative days in patients undergoing OEA.

Outcomes of Surgical Repair of Total Anomalous Pulmonary Venous Drainage: Role of Primary Sutureless Technique.

To evaluate the surgical outcomes of total anomalous pulmonary venous drainage focusing on survival, postoperative and pulmonary venous obstruction. Further investigate the role of primary sutureless technique in patients with preoperative pulmonary venous obstruction. Consecutive patients underwent total anomalous pulmonary venous drainage repair in our institution during Jan 2000 to Dec 2019 were enrolled into this retrospective analysis. Since 2016, sutureless repair was regularly applied in patients with preoperative pulmonary venous obstruction. All patients with preoperative pulmonary venous obstruction referred before 2016 had underwent traditional repair. A total of 95 patients were included. During follow-up time of 85months, main endpoints were documented in 21 patients, including 9 (9.5%) early deaths, 3 (2.3%) late deaths and 9 (9.5%) postoperative pulmonary venous obstructions. Preoperative pulmonary venous obstruction was presented in 26 (27.4%) patients with more emergent surgery (14/26 vs 3/69, P < 0.001) was required. Main endpoints occurred more in patients with preoperative pulmonary venous obstruction (4/26 vs 5/69, P = 0.004). Patients experienced sutureless technique had a lower incidence of postoperative PVO at follow-up (0/11 versus 4/11, P = 0.045). Outcomes of surgical repair for total anomalous venous drainage are satisfactory. However, preoperative pulmonary venous obstruction may be accompanying unfavorable early deaths and postoperative pulmonary venous obstruction. Propensity matching analysis showed that sutureless technique was benefit for postoperative pulmonary venous obstruction without longer cardiopulmonary bypass and aortic cross-clamp time.

Intraoperative botulinum toxin injection for superficial partial parotidectomy: A prospective pilot study.

Sialocele and salivary fistula are not serious but troublesome complications after parotidectomy. Various modalities have been introduced to prevent postoperative saliva-related complications. However, clinical trials assessing the prophylactic use of botulinum toxin (BTX) for parotidectomy have not been conducted yet. Herein, we report a pilot study investigating the safety and efficacy of intraoperative BTX (iBTX) injection in partial superficial parotidectomy (PSP). Patients with benign parotid tumour were prospectively recruited for this clinical trial from 2017 to 2019. The study participants underwent PSP with iBTX injection. We retrospectively reviewed the clinical information of all the consecutive patients who underwent PSP without iBTX from 2013 to 2019. These patients were divided into two groups: the iBTX group (n=36) and the control group (n=54). Permanent facial palsy was not observed in either group. Two patients (3.7%) had transient marginal palsy in the control group but none had it in the iBTX group. The incidence of sialocele was significantly lower in the iBTX group than in the control group (2.8% vs. 20.4%, P<.05). Although the incidence of salivary fistula was lower in the iBTX group than in the control group (0% vs. 7.4%), no significant difference was determined between the two groups (P=.147). Total drainage volume was significantly lower in the iBTX group than in the control group (55.0mL vs. 116.6mL, P<.001). iBTX injection may be safe and effective in reducing sialocele and postoperative drainage in PSP. It might be a useful option to prevent saliva-related complications after PSP.