Total Duration Of Surgery Research Articles

Observations from the first 100 cases of intraoperative MRI – experiences, trends and short-term outcomes

BackgroundWe sought to analyze, in well-defined clinical setting, the first 100 patients treated at the intraoperative MRI (iMRI) hybrid surgical theatre at our facility in a population-based setting to evaluate which pathologies are best approached with iMRI assisted surgeries, as this is not yet clearly defined.MethodsPatients undergoing surgery in the 3T iMRI hybrid surgical theatre at our neurosurgical department between December 2017 to May 2021 were included after informed consent. Demographic, clinical, surgical, histological, radiological and outcome parameters, as well as variables related to iMRI, were retrospectively collected and analyzed. Patients were subdivided into adult and pediatric cohorts.ResultsVarious neurosurgical procedures were performed; resection of tumors and epileptic foci, endoscopic skull base procedures including pituitary lesions, deep brain stimulation (DBS) and laser interstitial thermal therapy (LITT). In total, 41 patients were pediatric. An iMRI scan was carried out in 96% of cases and led to continuation of surgery in 50% of cases, mainly due to visualized remaining pathological tissue (95.2%). Median time to iMRI from intubation was 280 min and median total duration of surgery was 445 min. The majority of patients experienced no postoperative complications (70%), 13 patients suffered permanent postoperative deficits, predominantly visual.ConclusionHerein, we demonstrate the first 100 patients undergoing neurosurgery aided by iMRI at our facility since introduction. Indications for surgery differed between pediatric and adult patients. The iMRI was utilized for tumor surgeries, particularly adult low-grade gliomas and pediatric tumors, as well as for epilepsy surgery and DBS. In this heterogenous population, iMRI led to continuation of surgery in 50%. To establish the benefit in maximizing the extent of resection in these brain pathologies future studies are recommended.Clinical trial numberNot applicable.

Comparison of dexmedetomidine and clonidine as an adjuvant to lignocaine with adrenaline in infiltration anesthesia in tympanoplasty: A randomized controlled trial

Abstract Background: Recent trends in surgical practice involve using local anesthesia for procedures like middle ear tympanoplasty due to its benefits, but patients often experience discomfort. Researchers are investigating alpha-2 agonists like clonidine and dexmedetomidine to enhance pain relief. We conducted a double-blind study comparing dexmedetomidine and clonidine’s effectiveness in extending pain relief after tympanoplasty using local infiltration. Aim and Objective: In light of this context, we undertook a randomized, double-blind investigation to compare the efficacy of dexmedetomidine and clonidine in extending the duration of pain relief via local infiltration for tympanoplasty. Materials and Methods This prospective, randomized, double-blind study was conducted on total of 60 patients belonging to the American Society of Anesthesiologists Class I and II scheduled for tympanoplasty under local anesthesia. All patients were divided into two groups Group LC, received local infiltration with 12 mL of lignocaine (2%) with adrenaline (1:200,000) plus clonidine (1 μg/kg) and Group LD, received local infiltration with 12 mL of lignocaine (2%) with adrenaline (1:200,000) plus dexmedetomidine (1 μg/kg). Results: Both the groups were comparable regarding demographic profile, perioperative hemodynamics, and total duration of surgery. Time of onset of analgesia was faster in Group LD (89.53 ± 5.54 vs. 94.17 ± 6.19 s) (P = 0.0034) and total duration of analgesia was also prolonged in Group LD (562.40 ± 24.82 vs. 332.30 ± 12.39 min) (P < 0.0001). Conclusion: We concluded that in comparison to clonidine, dexmedetomidine is more effective in terms of faster onset and prolongation of total duration of analgesia when used with local infiltration anesthesia.

Development of the multiple scope transition method in robotic pancreaticoduodenectomy.

Since robotic pancreaticoduodenectomy (R-PD) has emerged as a promising technique for treating periampullary tumors, optimal surgical views across various stages of the surgery are vital. This study aimed to describe the evolution and optimization of the multiple scope transition (MST) method using comprehensive videos and illustrations, particularly from the perspective of the patient-side assistants, to enhance the efficiency and safety of R-PD through its different phases. We retrospectively analyzed 61 patients who underwent R-PD from April 2021 to May 2023. The median total operation duration was 599 min (415-840min). The median scope transition times for redocking from the left to central lower position, transition from the central lower to upper position, and port-hopping from the central to right position were 169s (53-725s), 55s (26-165s), and 120s (41-260s), respectively. Owing to the advancements in the scope transition procedures, these scope transition times became shorter with an increase in the number of experiences. No intraoperative complications relevant to scope transition was reported, and the incidence of significant postoperative complications greater than Grade IIIa of the Clavien-Dindo classification was 8.2%. We reported the established role and evolution of the MST method from the standpoint of the patient-side assistants. The comfortable surgical field expansion provided by the MST method can ensure the safe and widespread application of R-PD.

Risk factors for allogeneic red blood cell transfusion in adult spinal deformity surgery.

Retrospective study. To investigate the risk factors for allogeneic red blood cell (RBC) transfusion in adult spinal deformity (ASD) surgery. Studies have not thoroughly explored the roles of intraoperative hypothermia, autologous blood donation, and hemostatic agent administration, which would provide a better understanding of the risk for perioperative RBC transfusion in ASD surgery. The medical records of 151 patients with ASD who underwent correction surgery between 2012 and 2021 were retrospectively reviewed. Estimated blood loss and perioperative allogeneic transfusion were examined. Patients were categorized into two groups based on whether they received perioperative allogeneic blood transfusion. Logistic regression analysis was employed to investigate the effect of age, sex, blood type, body mass index, American Society of Anesthesiologists' physical status, preoperative hemoglobin level, autologous blood donation, global spine alignment parameters, preoperative use of anticoagulants or antiplatelet medicine and nonsteroidal anti-inflammatory drugs, number of instrumented fusion levels, total operative duration, three-column osteotomy, lateral interbody fusion, pelvic fixation, intraoperative hypothermia, use of gelatin-thrombin based hemostatic agents, and intraoperative tranexamic acid (TXA) with simultaneous exposure by two attending surgeons. The estimated blood loss was 994.2±754.5 mL, and 71 patients (47.0%) received allogeneic blood transfusion. In the logistic regression analysis, the absence of intraoperative TXA use and simultaneous exposure (odds ratio [OR], 26.3; 95% confidence interval [CI], 7.6-90.9; p<0.001), lack of autologous blood donation (OR, 21.2; 95% CI, 4.4-100.0; p<0.001), and prolonged operative duration (OR, 1.6; 95% CI, 1.3-1.9; p<0.001) were significant independent factors for perioperative allogeneic blood transfusion in ASD surgery. Autologous blood storage, intraoperative TXA administration, and simultaneous exposure should be considered to minimize perioperative allogeneic blood transfusion in ASD surgery, particularly in patients with anticipated lengthy surgeries.

Assessment of Functional Outcomes of Femur Treatment Using Modified Thoresen’s Criteria in Terms of Malalignment, Knee Motion, and Associated Symptoms

Comminuted fracture shaft of femur is increasing day by day due to Severe violence by road traffic accident and fall from height in modern civilization and intramedullary nailing sometimes technically not feasible in this type of fracture (AO type-32B3, 32C). Reaming may aggravate the comminution and displaced the comminuted fragments and sometimes difficult in segmental fracture involving metaphyseal region. To assessment of functional outcomes of femur treatment using modified Thoresen’s Criteria in terms of malalignment, knee motion, and associated symptoms. The study was carried out at the Dhaka medical college Hospital over a period of one and half year from September, 2016 to February, 2018. The total number of patients were 24. The mean age of the patients was 33.1±9.9 and the lowest and highest ages were 20-60 years respectively. Age of most (58%) of the patients were below 30 years. Three quarter of the patients (75%) were male and 37.5% were day labourer. Most of the patients (81%) were presented with right sided comminuted femoral shaft fracture. All of the injuries were closed type. In terms of type of fracture, AO type 32C2 were predominant (50%).AO type 32B3, 32C1,32C3 were 12.5%, 12.5% and 25%. Associated injury was found 6 patients that was 25% among 24 patients. Total duration of surgery &lt;90 minute was taken in 41.5% and &gt;90 minutes taken in 58.5% with mean deviation was 105 minutes and standard deviation was 19 minutes. 16 patients (67%) exhibited wide range of knee motion (&gt;120), four (17%) patients slightly restricted knee motion (110-120), two patients (8%) moderately restricted knee motion (90-110) and two patients (8%) extremely restricted knee motion (&lt;90). Evaluation of outcome by The Modified Thoresen’s criteria (1985) 6 months after intervention demonstrated that 29% of the patients had excellent outcome, 57% good outcome, 9.5% fair and 4.5% poor outcome. Assessment of Functional Outcomes of Femur Treatment Using Modified Thoresen’s Criter

Comparison between laparoscopic complete mesocolic excision and D2 radical operation in colon carcinoma resection: A propensity score matching analysis.

Surgery remains the most effective treatment for colon cancer. However, there are still controversies regarding the tumor treatment effect, prognosis, and perioperative impact of complete mesocolic excision (CME) surgery in colon carcinoma resection. This study aims to compare laparoscopic complete mesocolic excision (LCME) and traditional open D2 radical surgery in colon carcinoma resection through a retrospective analysis using 1:1 propensity score matching (PSM). 98 cases undergoing LCME or open D2 colon carcinoma resection at our hospital from January 2014 to November 2021 were retrospectively collected. After excluding cases and 1:1 matching using PSM based on baseline clinical data, 86 patients were assigned in research queue. 43 patients were in each group. Two groups were compared for general clinical baseline indicators. Surgical results and postoperative adverse events of patients were also compared. Disease-free survival (DFS) rate and overall survival (OS) rate was analyzed. After 1:1 PSM matching, there was no statistically significant differences in baseline data between the LCME group and D2 group (P> 0.05). LCME was characterized by longer total duration of surgery (P< 0.001), less intraoperative bleeding volume (P< 0.001), more postoperative drainage fluid volume (P< 0.001), greater number of lymph nodes retrieved (P= 0.014). No statistically differences was observed regarding intraoperative blood transfusion, hospital stay, Clavien-Dindo complicating disease classification (all P> 0.05), 1 and 3-year DFS rate (P= 0.84) and OS rate (P⩾ 0.1). LCME had a longer duration of surgery but less intraoperative bleeding volume and more postoperative drainage fluid volume and retrieved lymph nodes compared to D2 radical surgery. LCME surgery is comparable to D2 surgery in terms of postoperative prognosis, but LCME surgery shows a positive trend in the overall survival curve.

Full Robotic Whole Graft Liver Transplantation: A Step Into The Future.

To report the first European series of full robotic whole liver transplantation (RLT) with technical details and future perspectives. Few cases of liver transplantation with a minimally invasive approach using partial grafts have been reported so far, and no cases of robotic whole liver transplantation have been reported in the scientific literature. The adopted technique was full robotic liver hepatectomy, followed by robotic implantation after graft introduction through a small midline incision. Patients presenting with Hepatocellular Carcinoma (HCC) in liver cirrhosis with a small caudate lobe, low degree of portal hypertension, no porto-mesenteric thrombosis, as well as low MELD patients have been considered ideal candidates. Six patients underwent RLT between February and March 2024 at Lisbon and Modena University Liver Transplant Centers. Warm ischemia time during RLT ranged between 55 and 90 min, with a total surgery duration between 440 and 710 min. The median total operative time was 595 (±111,3) minutes. Only one recipient had prolonged hyperbilirubinemia, which was safely treated. The median in-hospital stay was 7.5 days, (±4.8 days). RLT is a promising technique to further reduce the impact of liver transplantation thanks to smaller incision, gentle tissue manipulation, high magnification and precision for vascular and biliary anastomosis, and reduced postoperative pain. This is the first step toward the demonstration of the feasibility of minimally invasive surgery in liver transplantation, although further selection and technical refinements are needed to improve reproducibility.

Epidemiology and first aid measures in pediatric burn patients in northern China during 2016-2020: A single-center retrospective study.

Burn and scald injuries are the fourth most common type of trauma. Pediatric burns account for a high proportion of the total number of burn patients and impose a high burden on public health. Understanding the epidemiology of pediatric burns can help improve science education and reduce the incidence of burn injuries. This study is a single-center retrospective study. One thousand five hundred and twenty-seven pediatric burn patients admitted to our burn center from January 2016 to December 2020 were included. Demographic and epidemiological data of included patients were extracted and analyzed. The correlations of categorical data were tested by the Chi-square tests, and differences of continuous data were tested by the Kruskal-Wallis tests. A p-value of less than 0.05 was considered to be statistically significant. The results showed that children under 3 years of age were most susceptible to burn and scald injuries. Burn injuries were most likely to occur in the season of winter and at the place of home. 56.6% of included patients did receive first aid measures, while 1.8% received gold-standard first aid. Clinical variables related to the severity of injuries were statistically different between patients with and without cooling measures in first aid. Linear regression models showed that emergency treatment of burns in children and adolescents was associated with outcome indicators, including number of operations, total operation duration per total burn surface area (TBSA), cost per TBSA, and length of stay per TBSA. This study summarized the epidemiology and outcomes of pediatric burn patients admitted to a burn center in northern China. Adopting cooling measures in first aid can reduce the severity of injuries and reduce the burden on the medical system. Education on burn prevention and first aid measures to caregivers of children, especially preschool children, should be strengthened.

3D exoscopic versus microscopic superficial temporal artery to middle cerebral artery bypass surgery for moyamoya disease – a comparative series

PurposeSuperficial temporal artery to middle cerebral artery (STA-MCA) direct bypass surgery is the most common surgical procedure to treat moyamoya disease (MMD). Here, we aim to compare the performance of the 3D exoscope in bypass surgery with the gold standard operative microscope.MethodsAll direct STA-MCA bypass procedures performed at a single university hospital for MMD between 2015 and 2023 were considered for inclusion. Data were retrospectively collected from patient files and surgical video material. From 2020 onwards, bypass procedures were exclusively performed using a digital three-dimensional exoscope as visualization device. Results were compared with a microsurgical bypass control group (2015–2019). The primary endpoint was defined as total duration of surgery, duration of completing the vascular anastomosis (ischemia time), bypass patency, number of stiches to perform the anastomosis, added stiches after leakage testing of the anastomosis and the Glasgow outcome scale (GOS) at last follow-up as secondary outcome parameter.ResultsA total of 16 consecutive moyamoya patients underwent 21 STA-MCA bypass procedures. Thereof, six patients were operated using a microscope and ten patients using an exoscope (ORBEYE® n = 1; AEOS® n = 9).Total duration of surgery was comparable between devices (microscope: 313 min. ± 116 vs. exoscope: 279 min. ± 42; p = 0.647). Ischemia time also proved similar between groups (microscope: 43 min. ± 19 vs. exoscope: 41 min. ± 7; p = 0.701). No differences were noted in bypass patency rates. The number of stiches per anastomosis was similar between visualization devices (microscope: 17 ± 4 vs. exoscope: 17 ± 2; p = 0.887). In contrast, more additional stiches were needed in microscopic anastomoses after leakage testing the bypass (p = 0.035).ConclusionTaking into account the small sample size, end-to-side bypass surgery for moyamoya disease using a foot switch-operated 3D exoscope was not associated with more complications and led to comparable clinical and radiological results as microscopic bypass surgery.

Outcomes of the Electrothermal Bipolar Vessel Sealing Device and Electrocautery in Modified Radical Mastectomy Patients.

Introduction With the rising trends in breast cancer throughout the world, the traditional modus of intraoperative tissue dissection using a scalpel, scissors, or electrocautery needs to be re-evaluated in the wake of newer modalities, such as electrothermal bipolar vessel sealing (EBVS) devices, which may theoretically reduce the postoperative complications and morbidity in these patients. Aimand objective The objective of this study is to compare an EBVS device to electrocautery (diathermy) in modified radical mastectomy (MRM), based on selected intraoperative and postoperative outcomes. Study procedure This was a comparative cross-sectional section study that included 60 patients with operable breast cancer (stages I and II, TNM classification, and post-neoadjuvant stage III disease). Patients were divided into two groups for surgery: one group underwent an MRM using the EBVS device (Group A), while the other group had the procedure performed using conventional electrocautery (Group B), as per the surgeon's choice depending on theatre slot and equipment availability. Intraoperatively, the total operative time, time for raising the flaps, time taken for breast tissue dissection, time for axillary dissection, and blood loss were recorded. Postoperative parameters included total drainage volume, number of days of drainage, seroma formation, and other complications. Patients were followed up for one month after surgery, with early postoperative complications such as wound infection, upper limb lymphedema, seroma, flap necrosis, and nerve injuries being documented. Results The groups were found to be comparable in terms of the age distribution, TNM staging, stage grouping, and nodal status of the patients. The EBVS device group demonstrated statistically significant advantages in total operative time, axillary dissection time, flap raising time, breast tissue dissection time, intraoperative blood loss, total drainage volume, and days of drainage. However, no statistically significant difference was found between the two devices in terms of seroma formation, early postoperative complications, and duration of postoperative stay at the hospital. Conclusion While the use of EBVS in MRM provides a considerable decrement in the total operative duration, duration of the various steps of surgery, intraoperative blood loss, and postoperative volume and duration of drainage, these devices do not offer an evident advantage in terms of the postoperative complications or morbidity.

Feasibility and Safety of Percutaneous Puncture Guided by a 5G-Based Telerobotic Ultrasound System: An Experimental Study.

To evaluate the feasibility and safety of percutaneous puncture guided by a 5th generation mobile communication technology (5G)-based telerobotic ultrasound system in phantom and animal experiments. In the phantom experiment, 10 simulated lesions were punctured, once at each of two angles for each lesion, under the guidance of a telerobotic ultrasound system and ultrasound-guided freehand puncture. Student's t test was used to compare the two methods in terms of puncture accuracy, total operation duration, and puncture duration. In the animal experiment, under the guidance of the telerobotic ultrasound system, an 18G puncture needle was used to puncture 3 target steel beads in the liver, right kidney, and right gluteal muscle, respectively. The animal experiment had no freehand ultrasound-guided control group. After puncture, a CT scan was performed to verify the position of the puncture needle in relation to the target, and the complications and puncture duration, etc., were recorded. In the phantom experiment, the mean accuracies of puncture under telerobotic ultrasound guidance and conventional ultrasound guidance were 1.8 ± 0.3mm and 1.6 ± 0.3mm (P = 0.09), respectively; therefore, there was no significant difference in the accuracy of the two guide methods. In the animal experiment, the first-attempt puncture success (the needle tip close to the target) rate was 93%. Polypnea occurred during one puncture. No other intraoperative or postoperative complications were observed. Puncture guided by a 5G-based telerobotic ultrasound system has shown good feasibility and safety in phantom and animal experiments.

The Influence of Regional Socioeconomic Features On the Distribution of Financial Resources For Higher Education

The article is devoted to solving the problem of “budgetary financial adequacy of higher education” in China through a fairer, uniform, and sufficient distribution of financial costs for higher education among the provinces of this country, considering significant differences in the natural, economic, and social conditions of development in various regions. Currently, in China, the calculation of standard financial costs for the education sector is carried out according to the legal requirements of the Budget Department of the Ministry of Finance, taking into account the number of people studying at the corresponding level of education, the cost norm for this level of education, and the deviation coefficient. Instead, this article proposes a more comprehensive and rational approach that considers regional differences in the cost of living and the financial burden on higher education institutions, increasing the government’s responsibility for supporting a balanced distribution of financial resources for higher education. To take into account regional differences, it is proposed to use a system of indices for the difference in the costs of regional development, which includes three main categories of indicators: natural factors (the complexity of the terrain and the share of the area planted with forests), economic factors (the index of prices for raw materials, GDP per capita, freight traffic, and the total duration of operation of urban public transport), and social factors (population density in municipal areas, number of graduates of general education colleges and universities). To determine the fair size of budgetary expenditures on higher education, it is proposed to make adjustments to the index of differentiation of regional development expenditures, which combines these indicators using the geometric regression average benchmark method (without including a constant term). A higher value of this index means that the region needs more resources to achieve the same level of development as another region, so the standard budget expenditures for higher education should be higher for it. For all provinces in China, the coefficient of financial adequacy of higher education was calculated as the ratio between the standard financial costs of higher education (calculated according to the proposals outlined in this article) and the actual costs incurred. It is proposed that this coefficient be used as a basis for optimizing their distribution. The article emphasises the need to form a strategy for financing higher education in China, which should be based on a dynamic permanent adjustment of the amount of allocated financial resources depending on changes in the regional social and economic conditions of development of each province, an effective institutional mechanism that would allow adapting this strategy to endogenous and endogenous changes in China’s economy, optimisation of horizontal transfer payments and partnership assistance programs, and incentive mechanisms for local governments to invest in higher education.

Temporary Portocaval Shunt Provides Superior Intraoperative Hemodynamics and Reduces Blood Loss and Duration of Surgery in Live Donor Liver Transplantation: A Randomized Control Trial.

To compare intraoperative hemodynamic parameters, blood loss, renal function, and duration of surgery with and without temporary portocaval shunt (TPCS) in live donor liver transplantation (LT) recipients. Secondary objectives were postoperative early graft dysfunction, morbidity, mortality, total intensive care unit, and hospital stay. Blood loss during recipient hepatectomy for LT remains a major concern. Routine use of TPCS during LT is not yet elucidated. This study is a single-center, open-label, randomized control trial. The sample size was calculated based on intraoperative blood loss. After exclusion, a total of 60 patients, 30 in each arm (TPCS vs no TPCS) were recruited in the trial. The baseline recipient and donor characteristics were comparable between the groups. The median intraoperative blood loss ( P = 0.004) and blood product transfusions ( P < 0.05) were significantly less in the TPCS group. The TPCS group had significantly improved intraoperative hemodynamics in the anhepatic phase as compared with the no TPCS group ( P < 0.0001), requiring significantly less vasopressor support. This led to significantly better renal function as evidenced by higher intraoperative urine output in the TPCS group ( P = 0.002). Because of technical simplicity, the TPCS group had significantly fewer inferior vena cava injuries (3.3 vs 26.7%, P = 0.026) and substantially shorter hepatectomy time and total duration of surgery (529.4 ± 35.54 vs 606.83 ± 48.13 min, P < 0.0001). The time taken for normalization of lactate in the immediate postoperative period was significantly shorter in the TPCS group (median, 6 vs 13 h; P = 0.04). Although postoperative endotoxemia, major morbidity, 90-day mortality, total intensive care unit, and hospital stay were comparable between both groups, tolerance to enteral feed was earlier in the TPCS group. In live donor LT, TPCS is a simple and effective technique that provides superior intraoperative hemodynamics and reduces blood loss and duration of surgery.

The effects of 3D/Full HD and 2D/Ultra HD imaging systems on suturing skills during total laparoscopic hysterectomy: a prospective cohort study.

2D/Ultra HD and 3D/Full HD imaging systems can provide surgeons with more accurate and detailed views of the surgical site. We aimed to compare the effects of 2D/Ultra HD and 3D/Full HD laparoscopy systems on laparoscopic suturing skills during total laparoscopic hysterectomy. In this prospective cohort study, patients were recruited from a tertiary hospital, and demographic data and surgical data were recorded. The primary outcome measures were the durations of the total operation and vaginal cuff closure. Secondary outcome measures were colpotomy duration, total number of sutures placed, duration of first, second, third and fourth sutures, mean suturing duration, total operation duration, the surgeon's perception of difficulty during the vaginal cuff suturing and complications. The 3D/Full HD (n = 39) and 2D/Ultra HD (n = 42) groups were compared in terms of age, BMI, number of previous abdominal surgeries, number of previous cesarean sections, and type of delivery were examined. Both groups were considered homogeneous. The 3D/Full HD group was found to be superior in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD group (p < 0.05 for all). In conclusion, the use of 3D/Full HD laparoscopy systems can lead to improved surgical outcomes in terms of colpotomy duration, duration of the first, second, and third suture, mean suturing duration, vaginal cuff closure duration, and difficulty of use compared to 2D/Ultra HD systems.

The experience of a tertiary referral center with laparoscopic pyelolithotomy for large renal stones during 18 years

This study aimed to evaluate the outcomes of laparoscopic pyelolithotomy, including its efficacy and feasibility in treatment of large renal stones. All patients who underwent laparoscopic pyelolithotomy operations in a referral center were enrolled from 2003 to 2020. The final analysis included 436 patients. The total stone free rate was 88.3% and the stone-free rate for staghorn/multiple stones versus other types of stones was 81% vs. 91% (P = 0.002). Likewise, the total operation duration was 158 ± 50 and the operation duration for staghorn/multiple stones versus other types of stones was 171 ± 51 min vs. 153 ± 49 min (P < 0.001). The operation duration (169 ± 51 vs. 155 ± 58 vs. 155 ± 42 min) and hospitalization (4.5 ± 2.3 vs. 4.0 ± 2.2 vs. 3.6 ± 1.8) decreased with increasing the surgeons' experience over time. The outcomes of laparoscopic pyelolithotomy for children versus adults versus geriatric patients and in patients with normal versus abnormal kidney anatomy did not reveal statistically significant differences. Laparoscopic pyelolithotomy could be employed as an alternative surgical approach for patients with large kidney stones of any age or with kidney abnormalities provided that appropriate expertise is available to carry out the procedure.

Minimally invasive percutaneous screw internal fixation under robot navigation for the treatment of a hamate bone fracture

PurposeHamate fractures are rare fractures of the wrist and there is still no consensus on the optimal treatment for these fractures, especially hook of hamate fractures. Herein, the authors present a case study of a series of patients who were treated with closed reduction and minimally invasive percutaneous fixation under robot navigation.MethodsThis retrospective study reviewed 14 patients who had nondisplaced or minimally displaced hamate fractures on computerized tomography images and were treated using the treatment in our centre from November 1, 2019, to October 31, 2022. At the final follow-up, the flexion-extension and radial-ulnar range of motion of the wrist were measured, and the grip strength and pinch strength were measured. The pain of the wrist was assessed using the visual analogue scale (VAS). The Mayo wrist score reflected the recovery of the wrist.ResultsThe mean total operative duration was 40.1 min. All the fractures showed union at a mean of 3.0 months. At a mean follow-up of 23.3 months (range 6–36 months), the mean VAS score was 0.7, the average Mayo wrist score was 95, and the mean pinch strength and grip strength were 11.3 and 38.7 kg, respectively. The flexion-extension arc was 138.3°, the mean radial and ulnar deviation arc was 63.8°, and the mean pronation-supination arc was 172.3°. And the time of return to the original occupation was mean 4 months (3~6 months). There were no complications, such as infection or nerve paralysis.ConclusionsThis study suggests that nondisplaced or minimally displaced hamate hook fractures can be successfully treated by closed reduction and internal fixation with a headless compression screw with the assistance of robot navigation, and the small fragment of fracture can be accurately fixed with minimal iatrogenic injury.

Rapid artificial ventricular pacing for thoracic endovascular aortic repair

Aim: Rapid artificial ventricular pacing (RAVP) is a reproducible method for rapid and reversible reduction of transvascular flow during endovascular procedures. This method has the potential to increase patient tolerance, reduce operation duration, infection risk, X-ray dose and facilitate early patient mobilisation. The aim of this study to compare the efficacy, safety and impact of RAVP and pharmacological-induced hypotension in patients who underwent thoracic endovascular aortic repair (TEVAR) procedures for aortic dissection and aneurysm. Material and Methods: This retrospective, observational, case-control study was conducted between January 2014 and December 2022. The adult patients who underwent TEVAR procedures for aortic dissection and aneurysm were enrolled in this study. Mean arterial pressure, heart rate, total operation duration, incidence of endoleak, duration of intensive care unit-hospitalization stay, and hospital mortality ratio were compared between nitroglycerin induced hypotension group and RAVP group. Results: A total of 279 patients who underwent TEVAR procedures were included in this study. The mean age of patients in this cohort was 65.6±5.7 years and 158 (56.6%) of the patients were male. Of these 279 patients, hypotension during stent-graft was achieved with nitroglycerin in 155 patients. There were no statistical differences between these two groups in terms of age, gender, body mass index, comorbidities and drugs. The blood pressure lowering effect and the heart rate during the intervention was significantly higher in RAVP. Endoleak and hospital mortality rates were similar in each group. Conclusion: RAVP is a feasible and safe method because it paves the way for agile maneuvers to maintain optimal hemodynamic conditions. Besides this, more meticulous, accurate deployment of endograft can be established with RAVP.

P07.14.A OBSERVATIONS FROM THE FIRST 100 CASES OF INTRAOPERATIVE MRI - EXPERIENCES, TRENDS AND SHORT-TERM OUTCOMES IN PEDIATRIC VERSUS ADULT NEUROSURGICAL POPULATION

Abstract BACKGROUND The intraoperative MRI (iMRI) at Sahlgrenska University Hospital installed in 2017 was the first introduced in Sweden. Herein, we present a single center study with our observations from the first 100 patients undergoing neurosurgery in the dedicated iMRI surgical theater. METHODS Patients undergoing surgery in the 3T iMRI hybrid surgical theatre at our neurosurgical department between December 2017 to May 2021 were included after informed consent. Demographic, clinical, surgical, histological, radiological and outcome parameters, as well as variables related to iMRI, were retrospectively collected and analyzed. Patients were subdivided into adult and pediatric cohorts. RESULTS A variety of neurosurgical procedures were performed; resection of tumors and epileptic foci, endoscopic skull base procedures including pituitary lesions, deep brain stimulation (DBS), laser interstitial thermal therapy (LITT) and biopsies. Mean age was 32 years (range 0-81 years), 41 patients were pediatric and 42% were female. An iMRI scan was carried out in 96% of cases and led to continuation of surgery in 50 percent of cases, mainly due to visualized remaining pathological tissue. Median time to iMRI from intubation was 280 minutes and median total duration of surgery was 445 minutes. The majority of patients experienced no postoperative complications (70%), 13 patients suffered permanent postoperative deficits, predominantly visual. CONCLUSION We demonstrate demographics, clinical, surgical and radiological variables from the first 100 patients planned for surgery in the iMRI surgical theatre after INTRODUCTION in 2017. We found that iMRI was performed in almost all cases. In the pediatric cohort, tumors and epileptic focus were main indications for surgery. In adults, indications were intrinsic brain tumors, transsphenoidal pituitary tumor and DBS. Utilization from a resource and patients perspective appears to be most beneficial in tumor surgeries (specially pediatric), epileptic surgery and DBS.

CCA repair or ECA ligation-Which middle cerebral artery occlusion is better in the reperfusion mouse model?

A reliable animal model is essential for ischemic stroke research. The implications of the external carotid artery (ECA) transection or common carotid artery (CCA) ligation have been described. Thus, a modified animal model, the CCA-repair model, has been established, and studies have shown that the CCA-repair model has potential advantages over the CCA-ligation model. However, whether the CCA-repair model is superior to the ECA-ligation model remains unclear. Sixty male C57BL/6 mice were randomly assigned to establish the CCA-repair (n = 34) or ECA-ligation (n = 26) models. Cerebral blood flow before middle cerebral artery occlusion (MCAO), immediately after MCAO and reperfusion were monitored and the operation duration, postoperative body weight, and food intake within 7 days, and the number of intraoperative and postoperative deaths within 7 days were recorded in the two models. Modified neurological severity scores and Bederson (0-5) scores were used to evaluate postoperative neurological function deficits on Days 1/3/5/7. 2,3,5-Triphenyltetrazolium chloride staining was used to quantify lesion volume on Day 7 after the operation. We found the establishment of the CCA-repair model required a longer total operation duration (p = 0.0175), especially the operation duration of reperfusion (p < 0.0001). However, there was no significant difference in body weight and food intake development, lesion volume and intragroup variability, neurological function deficits, mortality, and survival probability between the two groups. The CCA-repair model has no significant advantage over the ECA-ligation model. The ECA-ligation model is still a better choice for focal cerebral ischemia.

A vessel sealing device and an ultrasonic dissector are equally effective and safe for single port laparoscopic ovariectomy in dogs.

To evaluate ovary removal surgery times and intraoperative complication rates between a 5-mm Sonicision cordless ultrasonic dissector (SCUD) and 5-mm vessel sealing device (VSD) for laparoscopic ovariectomy in dogs. Client-owned, intact female dogs (n = 10) presented for elective laparoscopic ovariectomy. In each dog, 1 ovarian pedicle was randomly assigned to the SCUD group and 1 to the VSD group. In the SCUD group (n = 10), the ovariectomy was performed using the SCUD device; the ovariectomy in the VSD group (10) was performed using a VSD. The number of applications of each device during ovariectomy, surgery time required for each ovary removal, total surgery duration, ovarian pedicle fat score, and intraoperative complications were recorded. Both left and right ovaries had median pedicle fat scores of 2 (range, 1 to 3). To complete an ovariectomy, the median number of SCUD applications was 9 (range, 7 to 13) times; the VSD had a median of 10 (range, 5 to 18) times (P = .98). Median surgery times for the removal of 1 ovary with the SCUD and VSD were 96 seconds (range, 45 to 417 seconds) and 110 seconds (range, 42 to 164 seconds), respectively (P = 1). No intraoperative complications were associated with either device. Therefore, the VSD was not required for rescue in the SCUD group, and no conversions to open ovariectomy were necessary. A standard approach laparoscopic ovariectomy performed with the SCUD was successful in our population of dogs, making the 5-mm SCUD safe for laparoscopic ovariectomy in healthy dogs, which provides a more affordable option for practitioners and clients.