Mean Total Operative Time Research Articles

Single-step versus stepwise dilatation technique in percutaneous nephrolithotomy

Objective: To compare single-step dilatation technique with the stepwise (serial) dilatation technique in order to create a nephrostomy tract during percutaneous nephrolithotomy. Methodology: This comparative interventional single-center study was conducted from May 2020 to November 2021 at Basra Teaching Hospital, Iraq. Fifty patients in group A underwent the single-step dilatation and 70 patients in group B were subjected to the stepwise dilatation technique in percutaneous nephrolithotomy. We recorded number of punctures, operation time, complications and success. Results: There were no significant statistical differences in both groups regarding success rate, hospital stay, intra and postoperative complications, and bleeding that required blood transfusion. The stepwise dilatation technique had a considerably longer mean dilatation time than the single-step method did. The single-step dilatation technique had a much shorter mean radiation exposure a shorter mean total operating time than the stepwise strategy. Conclusion: The construction and dilatation of a percutaneous nephrolithotomy nephrostomy tract can be successfully carried out using a single-step dilatation procedure, which requires less radiation exposure, less time during surgery, and shorter dilatation time.

Prospective analysis of impact of learning curve in robotic-assisted rectal surgery in the high-volume Indian tertiary care centre.

Minimally invasive surgery in rectal cancer has gained prominence owing to its various advantages in surgical outcomes. Due to rapid adoption of robotics in rectal surgery, we intended to assess the pace in which surgeons gain proficiency using cumulative summation (CUSUM) technique in learning curve. This was a prospective study of 262 rectal cancer cases who underwent robotic-assisted low anterior resection and abdominoperineal resection (RA-LAR and RA-APR). Parameters considered for the study were console time, docking time, lymph nodal yield, total operative time and post-operative outcomes. We used Manipal technique of port placements and modified centroside docking for the procedure. The mean age of our study was 46.62 ± 5.7 years, the mean body mass index (BMI) was 31.51 ± 3.2 kg/m2. 215 (82.06%) underwent RA-LAR and 47 (17.93%) underwent RA-APR. 2.67% of cases required to open during our initial period. We had three phases of learning curve, initial phase (11th case), plateau phase (29th case) and then phases of mastery (30th case onwards). Our mean total operative time reduced from 5.5 to 3.5 h (210 ± 8.2 min), console time from 4.5 to 2.9 h (174 ± 4.5 min) and docking time from 15 to 9 ± 1 min from 30th case onwards. RA surgeries for rectal cancer have got good oncological and functional outcomes in high BMI, male pelvis and low rectal cancers. Learning curve can be shortened with constant self-auditing of the surgeon and team with each surgeries performed, reviewing the steps and by improving techniques.

Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy.

Uterine myomas are benign tumours frequently seen in women of reproductive age. Myomectomy remains a viable option for treating this condition in women who wish to preserve their uterus. We undertook this study to compare the peri-operative surgical outcomes of Robotic myomectomy (RM) with laparoscopic myomectomy (LM) in Indian patients of uterine myomas after the initial learning curve of RM was achieved. A retrospective chart review was performed for the patients who underwent RM or LM for the treatment of uterine myomas. A total of 177 patients, 116 in the RM group and 61 in the LM group, were included in the study. The mean age in the RM and LM group was 34.31 ± 5.40years and 33.54 ± 4.96years, respectively (p = 0.355). The mean total operative time was marginally more in RM group (127.37 ± 110.67 vs. 120.66 ± 44.27, p = 0.650) but the difference was not statistically significant. Patients in the RM group had significantly less blood loss (115.43 ± 79.43 vs. 340.98 ± 453.9ml, p = < 0.0001), hospital stay (1.28 ± 0.49 vs. 1.92 ± 1.05days, p = < 0.0001), requirement of blood transfusion (93.97 vs. 81.97%, p = 0.031) and requirement of intravenous (IV) analgesia (41.38 vs. 34.43%, p = 0.019) as compared to the patients in the LM group. The Robotic myomectomy significantly reduces blood loss, the duration of hospital stay, and requirement of blood transfusions and IV analgesia as compared to the laparoscopic myomectomy.

Aesthetic reconstruction of onco-surgical maxillary defects using free scapular flap with and without CAD/CAM customized osteotomy guide

BackgroundReconstruction of the maxillary defects following tumor ablation remains to be a challenge for surgeons. Virtual surgical planning (VSP), intraoperative cutting guides and stereolithographic models provides the head and neck reconstructive surgeon with powerful tools for complex reconstruction planning. Despite its use in fibular osteocutaneous reconstruction, application to the scapular free flap has not been as widely reported. The aim of this study was to compare aesthetic results and operation time of free scapular flap, with and without computer-aided design and computer-aided manufacturing (CAD/CAM) customized osteotomy guide, for reconstruction of maxillary defects.MethodsIn this prospective randomized controlled clinical trial study, we randomly assigned 22 patients with maxillary defects who were scheduled to undergo maxillary reconstruction with either free scapular flap with CAD/CAM customized osteotomy guide; study group (n = 11) or free scapular flap without CAD/CAM customized osteotomy guide; control group (n = 11). All patients were followed up for 3 months. The aesthetic outcome, operation and ischemic times were evaluated and compared.ResultsAesthetic outcomes were evaluated objectively by means of differential surface area (sagittal and axial) measurement, which showed improved aesthetic outcome (contour symmetry) in the study group with a mean of (241.39 ± 113.74 mm2), compared to patients in control group with a mean of (358.70 ± 143.99 mm2). There were significant differences between the two groups (P < 0.05). Aesthetic outcomes were also evaluated subjectively by means of visual analogue scale (VAS) and patient’s satisfaction score (PSS). The postoperative aesthetic appearance was better in the study group with more patients satisfied than that in control group and there were statistically significant differences (P = 0.039). The mean total operative time was 678.81 min and 777.18 min in the study group and control group respectively (P < 0.05) and the mean ischemia time was 133.18 min and 195.72 min for study group and control group respectively (P < 0.05). The ischemia time and total operative time were shorter in the study group compared to those in the control group and there were no flap losses in both groups.ConclusionThe use of CAD/CAM prefabricated cutting guides facilitates scapular flap molding and placement, minimizes ischemic time and operating time as well as improves aesthetic outcomes.Trialregistration This trial was registered at ClinicalTrials.gov. Registration number: NCT03757286. Registration date: 28/11/2018

Modified robotic ventral rectopexy with folded single titanized mesh suspension for the treatment of complex pelvic organ prolapse.

The incidence of complex pelvic organ prolapse in female patients is about 38%, and this disorder entails social and sexual restrictions. Treatment for this disorder is complex because it can enhance other, latent, problems. The aim of the present study is to describe a new robotic-assisted technique to simultaneously treat prolapses of different compartments with the use of a single titanized polypropylene mesh. All patients referred from January 2018 to March 2019 to the Proctologic and Pelvic Floor Clinical Centre who were affected by complex pelvic organ prolapse underwent modified robotic ventral rectopexy with a folded single mesh (RVR-FSM). The anatomical and functional outcomes were respectively evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) grading system and Wexner scores of constipation and incontinence. The satisfaction rate was investigated using a five-point scale (1=not satisfied to 5=extremely satisfied). Twenty-two women underwent RVR-FSM with a homogeneous follow-up of 12 months. The mean total operation time was 148 min, without any robot-related or other intraoperative complications. No mesh-related complications occurred. The POP-Q grade improved for every patient, with complete resolution of bulging symptoms in 21 patients (95.4%) at 1year of follow-up. The Wexner constipation score showed a significant improvement, while the incontinence score slightly improved at 1year after surgery. The use of a single mesh that can be folded was shown to provide significant improvement in functional and anatomical results associated with patient satisfaction. The robotic approach allows surgeons to perform an easier procedure with correct and deep mesh fixation.

Nitinol Shape Memory Staple Fixation of Lisfranc Fractures is Safe and Efficacious

Category: Trauma; Midfoot/Forefoot; Sports Introduction/Purpose: Surgical treatment of Lisfranc fractures has evolved from arthrodesis or transarticular screw fixation to joint preserving modalities (suture buttons and/or dorsal spanning plates), the latter commonly requiring removal due to metalwork irritation and to restore motion at the 1st-MTPJ. Shape memory staples formed from Nitinol exploit its biomechanical properties of; low Young's modulus, super elasticity and high ductility. To produce a robust implant that generates greater compressive forces at its distal end compared to traditional 316L stainless steel compression staples. Permitting the construction of a rigid fixation for Lisfranc fractures that is achieved with transarticular screws or plate fixation, but is mobile and elastic as with suture buttons. This study aims to assess the surgical outcomes of staple fixation in acute Lisfranc fractures. Methods: A prospective study to assess for union and necessity for revision surgery was completed for consecutive Lisfranc fractures treated with Nitinol shape memory staple fixation from June 2020 at a single U.K. Level 1 Major-Trauma-Centre. All operations were performed or supervised by a single fellowship trained Major Trauma Foot &amp; Ankle Surgeon through a EHL bed approach to access the base of the 2nd MT and cuneiforms. Relevant joints were debrided and reduced, held with K-wires and reduction clamps to allow for the placement of the staples. A triangular configuration for the placement of three staples (2nd MT to Middle Cuneiform, 2nd MT to Medial Cuneiform, Middle to Medial Cuneiform). Reduction of the Lisfranc complex was confirmed on intra-operative fluoroscopy. Patients were non-weight bearing for 4 weeks with appropriate VTE prophylaxis. Staples were placed so as to not penetrate the plantar cortex and inter-cuneiform instability was assessed and confirmed intra- operatively. Results: Results from 19 consecutive patients were analysed, consisting of 9 men 10 women, with a mean age of 44 years (19-76). Seven patients sustained high energy trauma. Mean time to theatre was 18 days (5-28) from date of injury. Mean total operative time was 70 minutes, (27-154) with an mean tourniquet time of 63 minutes. An mean length of follow-up was 13.5-months (range 6-20 months), with a 100% union rate on weight-bearing radiographs and no incidences of post-operative complications requiring further medical or surgical intervention. No patients reported symptomatic implant irritation which required consideration of metalwork removal. The average FADI score was 73/104 (70%) at longest follow-up. Conclusion: Nitinol shape memory staple fixation of Lisfranc fractures is safe and efficacious, removing the necessity for metalwork removal as is commonly seen with dorsal bridging plates whilst maintaining the structural rigidity of plate/trans-articular screw fixation at the same time as allowing for physiological motion at the 1st-MTPJ. Patient reported outcome measures of this technique demonstrate equitable outcomes to more conventionally used techniques. This is the largest series of shape memory alloy staple fixation of acute Lisfranc injuries the authors are aware of and demonstrates that this technique should be considered a part of a surgeons' armamentarium when treated Lisfranc injuries.

Laparoscopic versus open groin hernia repair in older adults: a systematic review and meta-analysis.

Groin hernia repair is a common surgical procedure and includes both open and laparoscopic techniques. Studies comparing outcomes of laparoscopic versus open groin hernia repair specifically in the geriatric population are lacking. This study compares the outcomes of laparoscopic versus open groin hernia repair techniques in older adults. A literature search was conducted in each of the five selected databases up till June 2021: PubMed (MEDLINE), EMBASE, CINAHL, Cochrane and PsychInfo (OVID). Outcomes measured included but were not limited to total length of hospital stay, mean total operative time, intraoperative complications, post-operative complications such as wound infection, seroma formation, chronic pain, mesh infection and recurrence of inguinal hernia. A total of five articles were included in the final analysis. The length of postoperative hospitalization stay was shorter in patients who underwent laparoscopic hernia repair (95% CI: -1.50 to -0.72; P < 0.01, I2 = 79%). The laparoscopic repair group had a significantly smaller number of patients who sustained postoperative wound infections (95% CI: 0.02 to 0.47; P=0.003, I2 = 0%), and lower incidence of chronic pain (95% CI: 0.14 to 0.37, P < 0.01, I2 = 46%). Analysis of the remaining outcomes did not reveal any statistically significant differences between open and laparoscopic hernia repair. The results of this analysis showed a shorter length of stay, lower wound infection rates and lower chronic pain with laparoscopic groin hernia repair as compared to open repair in older adults. Future prospective studies examining the impact of age on the relationship between surgical approach (open versus laparoscopic) and surgical outcomes are needed.

Does Adipose Tissue Thickness Affect the Duration of Rotator Cuff Operations?

Aim: Accurate estimation of operation time will reduce operating room costs and increase patient satisfaction. In recent studies, authors have found that thicker adipose tissue at the operation site is associated with a higher rate of complications. However, there is no study in the literature investigating the effect on operation time of an increase in adipose tissue thickness. This present study hypothesized that thicker adipose tissue in shoulder surgeries would prolong the operation time, therefore the study was planned accordingly.Material and Methods: Preoperative magnetic resonance images of patients applied with rotator cuff repair between 2015 and 2020 were independently evaluated by two observers. The acromial fat thickness was measured as the fat thickness of the operation area, and the scapular fat tissue thickness as the fat thickness of the region relatively far from the operation area. The data obtained were evaluated using multivariate analysis and a binary logistic regression model.Results: Evaluation was made of a total of 106 patients. The mean total operation time was 89±33 mins. The mean acromial fat thickness was 12.2±4.89 mm and the mean scapular fat thickness was 27.9±12.5mm. The increase in acromial fat thickness was determined to have extended the operation time (OR=5.75, 29.21, p&amp;lt;0.05).Conclusion: The thickness of fat tissue in the surgical area is one of the factors affecting operating time. Patients can be informed about the risk of prolonged surgery time and associated complications before surgery and costs can be reduced by optimizing operating room planning. In addition, it should be considered that tendinous pathologies may be more common in individuals with increased adipose tissue thickness and thus contribute to prolonging the operation time.

Laparoscopically Harvested Omental Flap for Immediate Total Breast Reconstruction; Lessons Learnt Through Ten-Year Experience in a Tertiary Oncology Center.

Background. Most of the publications about Laparoscopically harvested omental flap after skin sparing mastectomy were case reports or case series. Most of them were designed for partial breast reconstruction and were lacking long-term follow-up for cosmetic results, oncologic safety, and detailed methodology. Our study aimed at highlighting the place of this method of reconstruction with long-term oncologic safety and cosmetic outcome. Methods. This study included 95 women who were candidates for skin-sparing mastectomy. Those with body mass index below 25 and above 40, those with omental resection or expected marked adhesions were excluded. All patients were consented to then undergo breast reconstruction using pedicled laparoscopically harvested omental flap. Results. The mean BMI was 34. The mean tumor size was 3.4cm. The mean total operative time was 129 minutes. Inadequate volume occurred in 12 patients (13%). The mean total drainage output was 750ml with 8.7% incidence of seroma. Partial breast envelop necrosis was encountered in 5 cases. Partial flap loss occurred in 2 patients. Fat necrosis occurred in 11 cases. Mastectomy and abdominal complications were accepted. Local recurrence was met in one patient and distant metastases occurred in 3 cases. 83.7% of patients expressed excellent and good aesthetic outcomes. Conclusion. When skin sparing mastectomy is chosen with suitable body mass index, laparoscopically harvested omental flap is a very safe and attractive option for total breast reconstruction with a minimal donor site morbidity, satisfactory cosmetic outcome with no compromise of the oncologic safety.

Intramedullary nailing of concurrent ipsilateral fractures of the tibia and femur: primary synchronous nailing versus staged osteosynthesis with temporizing external fixation.

The optimal timing to definitive osteosynthesis in the polytraumatized patient remains an unanswered question. Early total care, damage control orthopaedics, and early appropriate care have been described to manage the fractures in these patients, but there is a paucity of literature specific to ipsilateral tibial and femoral fractures. We sought the perioperative outcomes of primary simultaneous intramedullary nailing (IMN) versus temporizing external fixation (EF) of both fractures. A chart review of all patients who sustained fractures of the ipsilateral femur and tibia that were definitively treated with (IMN) from January 2010 to December 2020 was performed. Patients who underwent initial EF and those that were primarily treated with IMNs were examined. IMNs and EF were the initial treatment in 23 and 16 patients, respectively. The mean (range) injury severity score (ISS) was 23.3 (33) in the EF group vs. 18.5 (34) in the IMN group, (p = 0.0686). The EF group had a higher total transfused units of packed red blood cells 7.4 vs. 2.8, the mean initial operative time was 236 vs. 282.6 (min), (p = 0.7399), a longer mean total operative time 601.78 vs. 236 (min), and longer mean length of stay 15.6 vs. 11 (days), (p < 0.5). Rates of complications were not significantly different between groups. Primary IMN is as safe as provisional EF in the adequately resuscitated patient with ipsilateral femoral and tibial fractures. This implies the fixation of both fractures into a single surgery without increasing perioperative complications, and decreasing total hospital stay in patients with sufficient preoperative resuscitation.

Endoscopic Adenoidectomy with Microdebrider Versus Conventional Adenoidectomy

Background: Adenoidectomy is one of the most common surgical procedures performed in children in Bangladesh. Though conventional curettage is highly popular as it has the advantage of being cost effective and continues to be a commonly used method especially in developing countries but Microdebrider has opened the new horizon in this arena. To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider.&#x0D; Materials and methods: This is randomized single blinded comparative study, which was performed in the Medical Center Hospital, Chattogram from August 2019 to July 2020. A total of 60 patients were randomly divided into two groups. Group I underwent conventional curettage adenoidectomy while Group II underwent endoscopic- assisted powered adenoidectomy. Duration of surgery, amount of intra-operative bleeding, adequateness of removal and damage to the adjacent structures were assessed and compared between two groups. All patients were followed for 12 months. Statistical analysis was done using statistical software package SPSS v 22.0. Data were represented as mean ± SD. Continuous variables were compared using the were using the t test while nonparametric data were compared using Mann-Whitney U test. The c2 test was used to compare the nominal data. A p value &lt;0.05 was considered statistically significant. Ethical directives from the Managing Body of Medical Centre Hospital, Chattogram for this study was obtained.&#x0D; Results: in our study, we observed approximately almost three times more mean blood loss and total operating time in the endoscopic-assisted powered procedure compared to the conventional technique (149 and 56 ml, respectively, 63 and 27 min, respectively). Nine (30%) cases in group I had more than 50% residual adenoid tissue while 20 – 50% of residual adenoid tissue was documented among 7 patients (23%). Postoperative pain was found to be significantly higher in group I compared to group II. In both groups, recovery time ranged from 24-48 hour with a mean of 33.6 hour in group I and 36 hour for group II. 23 patients (77%) in group I presented with residual disease in the 3 months follow up period, where number of patients with the exact instance in group II was 0.&#x0D; Conclusion: Endoscopic assisted adenoidectomy may appear more handy over conventional curettage. But precise peri-operative care and awareness are required to attain the successful outcomes.&#x0D; JCMCTA 2022 ; 33 (1) : 88-92

The Clinical and Safety Outcomes of 27 Gauge Pars Plana Vitrectomy in Eyes With Macular Hole.

ObjectiveTo report the clinical, visual, and safety outcomes of 27 gauge pars plana vitrectomy (27G PPV) in eyes with full thickness and lamellar macular hole (MH). MethodologyThis retrospective cross-sectional study, conducted at the ophthalmology department of Shifa International Hospital, Islamabad, was done on 89 eyes of 85 patients who underwent 27G PPV for full-thickness and lamellar MH with a postoperative follow-up period of six months. ResultsThe mean age was 61.9 ± 17.3 years with 57.3% being males. Most of the eyes had idiopathic stage III full-thickness MH (n=34, 38.2 %). The total mean operating time was 42.5 ± 19.8 minutes. During surgery, 48 (53.9%) eyes had concurrent phacoemulsification. Hexafluoroethane was the most commonly used tamponade agent (n=81, 91%). Postoperatively, the primary closure rate was 93.2% (n=83) while the final closure rate was 100% (n=6) either by prolonged posturing (n=3, 3.3%) or by an additional procedure involving autologous internal limiting membrane (ILM) transplant (n=3, 3.3%). The complication rate was 2.2% including iatrogenic retinal tear (n=1, 1.1%) and raised IOP (n=1, 1.1%). The overall best-corrected visual acuity (BCVA) improved significantly from 1.20 ± 0.67 to 0.31 ±0.17 (p=<0.001).ConclusionAs per this study, 27G PPV is a practical and efficient surgical system with substantial anatomical success, minimal complication, and considerable visual recovery rates in eyes with full thickness and lamellar MH. We suggest 27G PPV with ILM peeling and medium-acting intraocular gas as the standard procedure for MH.

Is Robotic-assisted partial nephrectomy an efficacious and safe procedure for removal of stage T1 renal tumors?

Background Robotic surgery has now evolved as an emerging tool for better and easy operative techniques. The quest for trifecta comprising warm ischemia time less than 25 minutes, negative surgical margins and no perioperative complications seems to be better accomplished by robotic partial nephrectomy, which is likely to become the new standard for minimally invasive partial nephrectomy. Materials &amp; Methods It is a prospective observational study over 18 months in patients aged more &gt; 18 years with a renal tumour of clinical stage T1 coming for robotic partial nephrectomy. A total of 40 patients were included in the study who underwent robotic-assisted partial nephrectomy for renal tumours less than 7 cm in size. The duration of the study was from July- 2018 to December-2019 and their follow up period was 3 months post-surgery. Results Of the 40 patients, the mean age was 52.3 ± 11.91 years. 28 (70%) patients were males and remaining 12 (30%) were females. 11 (27.5%) tumours were situated in the anterior upper pole, 9 (22.5%) in the anterior lower pole, 8 (20%) in the posterior upper pole, 7 (17.5%) in the posterior lower pole and interpolar tumours were 5 in number (12.5%). 24 (60%) tumors were ≥ 50% exophytic, 11 (27.5%) were &lt; 50% exophytic and 5 (12.5%) were purely endophytic in nature. Maximum nephrometry score was 5a amounting to 10 (25%) patients and 5p tumours were the second most common amounting to 7 (17.5%) patients. The mean console time was noted to be 84.40± 12.05 mins. The mean total operative time was noted to be 167.00 ± 21.116 minutes. Mean Warm Ischemia Time (WIT) was recorded to be 27.28 ± 5.923 minutes. The mean blood loss was 145.75±61.075 ml. The mean length of hospital stay was 4.27 ± 0.78 days. None of the cases was converted to open partial/radical nephrectomy and none had positive surgical margins in the histopathology reports. Conclusion Our study shows that Robotic Assisted Partial Nephrectomy (RAPN) is an efficacious and safe surgery in stage T1 renal tumours (tumour size &lt;7 cm) to achieve complete oncological clearance by minimal access technique.

The Multi-Institutional Experience in Single-Port Robotic Transvesical Simple Prostatectomy for Benign Prostatic Hyperplasia Management.

Single-port (SP) robotic-assisted simple prostatectomy (RASP) through the transvesical approach is a novel surgical option in the management of large prostatic glands. We present the first multi-institutional study to further assess the perioperative and postoperative outcomes of SP RASP. From February 2019 to November 2021, 91 consecutive patients of 3 separate institutions underwent transvesical RASP using the da Vinci® SP robotic surgical system. Surgeries were performed by 3 experienced surgeons. Through a suprapubic incision and transvesical access, the SP robot is docked directly into the bladder, and the prostatic enucleation is performed. Prospective data collection, including baseline characteristics, perioperative and postoperative outcomes, was performed. The mean followup period was 4.6 months. The mean (SD) prostate volume was 156 (62) ml. The mean (SD) total operative time was 159 (45) minutes, and the median (IQR) estimated blood loss was 100 (50, 200) cc. The median (IQR) postoperative hospital stay was 21.0 (6.5, 26.0) hours; however, 42% of all patients were discharged the same day. The median (IQR) Foley catheter duration was 5 (5, 7) days. Only 3 patients (3%) developed Clavien grade 2 postoperative complications. At 9-month followup, the median (IQR) International Prostate Symptom Score and quality of life score were 4 (2, 5) and 0 (0, 1), respectively, with a mean (SD) maximum flow rate and post-void residual of 21 (17) ml/second and 40 (55) ml, respectively. In a multi-institutional setting, the SP RASP promotes a pain-free procedure, same-day discharge, short Foley catheter duration, low complication rate and quick recovery.

Efficacy of Combined Hiatal Hernia Repair and Transoral Incisionless Fundoplication for Giant Paraoesophageal Hernias: Technique and Early Results.

Data is limited on hybrid transoral incisionless fundoplication (TIF) and hiatal hernia repair in giant paraoesophageal hernia (GPEH). We aimed to assess the safety, patient satisfaction, and symptom resolution following a hybrid paraoesophageal hernia (PEH) repair and TIF in patients with GPEH. All single-session hybrid TIF combined with minimally invasive PEH repair performed between February 2020 and June 2021 were evaluated. Procedures were performed in the operating room under general anesthesia with robotic or laparoscopic PEH repair followed by TIF. Twelve patients underwent combined surgical hiatal hernia repair and TIF. Primary presenting symptoms included heartburn (75.0%), dysphagia (41.7%), and chronic anemia from Cameron's ulcers (16.7%). The mean hernia defect size was 5.0 cm (range 3.0 to 6.0 cm). Hiatal hernia repairs were performed robotically in 7 patients and laparoscopically in 5 patients. The total mean operative time was 254 minutes (range: 180 to 390 min). One patient reported postoperative dysphagia requiring endoscopic dilation postdischarge with a resolution of symptoms. No gas-bloat symptoms were reported. All patients reported complete resolution of presenting symptoms at the time of follow-up. Postoperative mean follow-up for 4 patients at 6 months with upper endoscopy and pH testing showed an intact valve with no evidence of esophagitis or acid reflux. In our experience, hybrid hiatal hernia repair and TIF is a safe and effective therapeutic option for patients with GPEH. This hybrid procedure allows for more expeditious completion of the repair and results in lower rates of postfundoplication dysphagia and gas-bloat. Furthermore, this approach requires a less extensive surgical dissection on the greater curvature of the stomach, thereby minimizing the risk of vagal nerve injury and bleeding from the short gastric vessels.

Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system

ObjectiveTo report the clinical outcomes of a 25-gauge, beveled-tip, 10,000 cuts-per-minute (cpm) microincisional vitrectomy surgery (MIVS) system.MethodsProspective case series of eyes undergoing primary pars plana vitrectomy (PPV) for common vitreoretinal indications. Main outcome measures were: rate of achieving surgical objectives, operative times, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE).ResultsThe surgical objectives were achieved in all eyes. Mean total operative time (TOT), core, shave and total vitrectomy times were 1891 ± 890, 204 ± 120, 330 ± 320, 534 ± 389 s, respectively. Mean number of surgical steps was 4.3 ± 1.5. Mean number of ancillary instruments used was 4.5 ± 1.9. Mean CDVA improved by 0.53 ± 0.56 logMAR units (P < 0.001) 3 months postoperatively. AE included elevated IOP (8%), hypotony (6%), and re-detachment (2%). Majority (82%) had no postoperative discomfort. The number of surgical steps demonstrated a positive correlation with TOT (p < 0.05), number of ancillary instruments used (p < 0.05), and postoperative Day 1 IOP (p < 0.05). The number of times ancillary instrumentation was used demonstrated a positive correlation with TOT (p < 0.05).ConclusionBeveled-tip, 10,000 cpm MIVS system effectively and safely performs common VR procedures of varying complexity and may reduce operative times and use of ancillary instrumentation.

30-Day outcomes analysis of surgical management of radial head fractures comparing radial head arthroplasty to open reduction internal fixation

IntroductionRadial head arthroplasty and open reduction internal fixation are two commonly utilized treatment options for radial head fractures. The purpose of this study is to assess the incidence of and risk factors for short-term complications following radial head arthroplasty and open reduction internal fixation of radial head fractures. MethodsThe American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients that underwent radial head arthroplasty or open reduction internal fixation for radial head fractures between January 1st, 2015 and December 31st, 2017. The incidence of various 30-day complications, including unplanned readmission, reoperation, non-home discharge, mortality, surgical/medical complications, and extended length-of-stay were compared between the two propensity matched groups. Multivariate logistic regression was used to identify independent risk factors for various short-term complications. ResultsAfter propensity matching, a total of 435 patients were included in our analysis. 250 patients underwent radial head arthroplasty, and 185 patients underwent open reduction internal fixation. Arthroplasty treated patients had a significantly longer mean total operative time (p = .031) and length-of-stay (p = .003). No significant 30-day complications differences were found for unplanned readmission, reoperation, non-home discharge, mortality, surgical complications or medical complications. Independent risk factors for any complications of both procedures included a history of chronic obstructive pulmonary disease and American Society of Anesthesiologists class III. Significant risk factors for length-of-stay greater than two days included a history of bleeding disorder and American Society of Anesthesiologists class III. ConclusionOur study revealed there were no significant differences in 30-day perioperative surgical or medical complications from either surgical treatment of radial head fractures; however, radial head arthroplasty treated patients were met with a significantly longer length-of-stay and longer duration of operating time. We also identified risk factors that were independently associated with higher rates of complications regardless of treatment type.

Operative and Survival Outcomes of Robotic-Assisted Surgery for Colorectal Cancer in Elderly and Very Elderly Patients: A Study in a Tertiary Hospital in South Korea.

Materials and Methods Data of all patients ≥75 years who underwent a robotic-assisted curative resection in Korea University Anam Hospital, Seoul, South Korea, between January 2007 and January 2021 were extracted from a prospectively maintained colorectal cancer database. Patients were subdivided into the three groups according to the age: youngest-old (YO: 75–80 years), middle-old (MO: 81–85), and oldest-old (OO: ≥86 years). Intraoperative findings, postoperative, and oncological outcomes were compared between the groups. Results Seventy-six consecutive patients (female 52.6%) were included; mean age was 80 years (SD 0.33); mean body mass index (BMI), 23.8 20.9 kg/m2 (SD 3.58); mean total operative time, 279 min (SD 80.93); mean blood loss, 186 ml (SD 204.03); mean postoperative length of stay, 14 days (SD 12.03). Major complications were seen in 2.1% of patients. The 30-day mortality rate was 0%. Average number of lymph node harvested was 20.9 (SD 12.33). Postoperative complications were not statistically different between the groups. Mean follow-up time for cancer-specific survival (CSS) was 99.28 months for the YO, 72.11 months for MO, and 31.25 months for OO groups (p = 0.045). The CSS rates at 5 years were 27.0%, 21.0%, and 0%, respectively. Recurrence risk was 10.50 times higher in the OO group than the others (adjusted HR, 95% CI 1.868–59.047, p = 0.008). In the multivariable analysis, TNM stage was not a risk factor for CSS in all groups. The number of the harvested nodes was a protective factor for recurrence (HR of 0.932, 95% CI 0.875–0.992, p = 0.027) and CSS (HR of 0.928, 95% CI 0.861–0.999, p = 0.047) in elderly patients. Conclusion Robotic surgery is highly feasible in elderly and very elderly colorectal cancer patients, providing a favorable operative safety profile and an acceptable cancer-specific survival outcome.

Transanal Total Mesorectal Excision for Malignant Rectal Lesion: A Prospective Cohort Study

AIMS: The main outcome of this study was to use the transanal total mesorectal excision (TaTME) technique for rectal cancer resection and to assess as a primary endpoint the short-term oncological outcome; in terms of circumferential resection margin, longitudinal resection margins (proximally and distally), and lymph nodes (LN) retrieval, while secondary endpoints were operative time, estimated blood loss, length of hospital stay, cost per case, and overall complication rate. METHODS: This was a prospective cohort study. Forty patients were included and subjected to TaTME from May 2018 to January 2020 and patients were followed up for a period of 6 months. RESULTS: Primary endpoint: Depending on the post-operative specimen pathological assessment; circumferential resection margin (CRM) was free in all patients, proximal resection margins had a mean 14.37 2.87 cm, distal resection margins had a mean 2.08 ± 0.4 cm and LNs retrieval had a mean 13.27 ± 5.9, and number of positive LNs had a mean 2.40 ± 3.77. Secondary endpoints: Mean total operative time (from induction of anesthesia till skin closure) was 179.10, estimated blood loss (using gauze visual analog plus what was obtained in the OR suction device) was 133.67 66.59 ml, the length of hospital stay (admission till discharge) was 5.27 ± 1.08 days, cost per case had a mean (in 1000 USD) 2.95 ± 0.12, and overall complication rate was 10%. CONCLUSION: TaTME represents a promising complementary technique to laparoscopic TME in the step of low rectal dissection.

Advanced Laparoscopic Adenomyomectomy Technique for Focal Uterine Adenomyosis by Three-step Approach.

Owing to the increasing trend of preserving fertility in adenomyomectomy, the need for laparoscopic adenomyomectomy has increased. This study aimed to introduce a new surgical technique, an advanced laparoscopic adenomyomectomy technique, and to evaluate its efficacy, benefits, and safety in focal uterine adenomyosis. From February 1, 2019 to February 29, 2020, 47 patients who underwent laparoscopic adenomyomectomy using the new surgical technique were enrolled in the study. The inclusion criteria were: (1) Focal-type adenomyosis, diagnosed by ultrasound or magnetic resonance imaging that was refractory to medical treatments. (2) A strong desire to preserve the uterus. All the operations were performed by a single surgeon with a uniform technique. The mean patient age was 40.53 ± 5.93 years (median 38.5, range 32-47). The mean diameter of the adenomyoma lesions was 4.57 ± 1.21 cm and the mean weight of the excised lesions was 40.53 ± 35.65g (range, 15-209 g). The mean total operation time was 70.11 ± 15.05 minutes. The mean estimated blood loss was 88.88 ± 20.0 mL (20 - 500 ml). There was no conversion to laparotomy or major complications requiring reoperation. At the seven-month follow-up, there was complete remission of dysmenorrhea and menorrhagia in 97.4% and 88.9% of the patients, respectively. The new advanced laparoscopic adenomyomectomy technique with a three-step approach could be a safe and effective therapeutic method.