Touch Technique Research Articles

O-181 4D ultrasound guided embryo transfers statistically improve live birth rates - A randomised controlled trial

Abstract Study question Does the use of 4D ultrasound to guide embryo transfers improve live birth rates in comparison to the clinical touch technique? Summary answer 4D ultrasound guided embryo transfers (4DUS) result in significantly higher live birth rates (LBR) in comparison to those performed using the clinical touch technique (CTT)(41%vs28%). What is known already A previous Cochrane review showed ultrasound guided embryo transfers (ET) improve pregnancy outcomes in comparison to CTT; however there was a large degree of heterogeneity between the studies and the largest study in the review showed no difference between ultrasound guidance and CTT. A further study demonstrated no difference in ongoing pregnancy rates between 2D vs 3D ultrasound guided embryo transfers, however this study did not use LBR as an endpoint and did not report on procedure duration/difficultly, both of which are known to impact ET success rates. Study design, size, duration This was a prospective, open labelled randomised controlled trial comparing superiority between two techniques for ET (4DUS vs CTT). A total of 320 (n = 160/group) patients were recruited using computer generated randomisation that were centrally distributed in consecutive sealed opaque envelopes between July 2018 to December 2019. Main outcomes were clinical pregnancy rate (CPR) and LBR. Following the procedure, participants completed a survey based on their comfort and satisfaction. Participants/materials, setting, methods Inclusion criteria included single blastocyst transfer and a normal uterine cavity. Participants were recruited and randomized on the day of ET. Those allocated to the CTT group, had their embryo transferred without ultrasound, depositing the embryo 6cm from the external os. Those in the 4DUS group had their ET using transvaginal 4D ultrasonography and had their embryos deposited at the maximal implantation point (MIP). Main results and the role of chance Results were available from a total of 295 women (8% attrition rate, CTT n = 153; 4DUS n = 142)). No demographic differences between the two groups (CTT and 4DUS) were noted including age (p = 0.05), BMI (p = 0.29), duration of infertility (p = 0.94), type of infertility (p = 0.68) or embryo quality (p = 0.89). All the 4DUS and 95% of the CTT group were performed by the same practitioner. The 4DUS resulted in significantly higher CPR (50% vs 36% p = 0.015, OR 1.78 (1.12-2.84)) and LBR (41%vs 28%, p = 0.021, OR 1.77 (1.09-2.87)). There were no statistically significant differences between miscarriage (p = 0.494), pregnancy of unknown location (p = 0.141) or ectopic pregnancy rates (p = 0.958) between the two groups. The 4DUS process took significantly longer time compared with the CTT procedure (15.7 vs 10.2 minutes respectively, p < 0.01). The results of the survey showed no statistical difference between patient comfort (p = 0.17) or satisfaction (p = 0.08) between the groups however there were significantly more positive comments in the 4DUS (p < 0.01). In the 4DUS group there was no difference in mean endometrial thickness (P = 0.186) or endometrial volume (p = 0.836) between pregnant and non-pregnant patients. Limitations, reasons for caution Due to the nature of this trial we were unable to blind the participants due to the obvious differences between the methods. Wallace catheters were used for the CTT and Kitazato catheters for the 4DUS, whilst a methodological weakness; previous meta-analysis has not shown any difference between different soft catheters. Wider implications of the findings LBRs, when utilizing 4DUS, are significantly higher than the current UK average (41%vs22-23%) and significantly higher than CTT. 4DUS allows for superior imaging of the uterine cavity, tailoring the embryo deposition point specifically to the patient. Further RCTs are required to confirm that 4DUS is the superior technique for ET. Trial registration number ISRCTN79955797 ,IRAS 202857

A modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection for upper rectal or lower sigmoid colon cancer: a retrospective study

BackgroundIn recent years, natural orifice specimen extraction surgery (NOSES) has become a field of special interest for colorectal surgeons. Some researchers have reported transanal specimen extraction in the laparoscopic anterior rectal resection, including intersphincteric resection (ISR) and rectal eversion-resection. However, these surgical procedures have certain limitations. Based on the proven expertise in laparoscopic surgery, our center has developed a modified technique of transanal specimen extraction. The aim of this study was to investigate the safety and feasibility of a modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection.MethodsFrom January 2011 to January 2014, the patients with upper rectal or lower sigmoid colon cancer who had undergone laparoscopic anterior rectal resection with specimen extraction by a modified transanal technique were enrolled in the observation group, and the patients who had undergone laparoscopic anterior rectal resection with specimen extraction via an abdominal incision by the same surgeons during the same period were enrolled in the control group.ResultsA total of 36 patients were included in the observation group and 128 patients were included in the control group. There were no significant differences (P > 0.05) between the two groups in terms of the mean operative time [144 ± 10 min vs. 141 ± 11 min], mean intraoperative blood loss [63 ± 6 ml vs. 61 ± 7 ml], and the mean time to anal exhaust [67 ± 7 h vs. 65 ± 8 h]. However, there were significant differences (P < 0.05) between the two groups in terms of the mean postoperative Visual Analogue Scale (VAS) pain scores [3.4 ± 1.1 vs. 4.5 ± 1.2], mean postoperative hospital stay [6.0 ± 1.1 days ± vs. 7.2 ± 1.2 days], and incidence of postoperative complications (4/36 vs. 15/128). Long-term follow-up results showed that there was no significant difference (P > 0.05) between the two groups in terms of the 3- or 5-year overall survival.ConclusionsThe modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection fulfilled the principle of no-neoplasm touch technique, with advantages, such as minimal trauma, rapid recovery, and fewer complications. Long-term follow-up results also showed satisfactory oncological outcomes.

Best practice skin antisepsis for insertion of peripheral catheters.

This article discusses the importance of effective skin antisepsis prior to the insertion of peripheral intravenous catheters (PIVCs) and how best clinical practice is promoted by application of an appropriate method of skin disinfection integrated effectively with a proprietary aseptic non touch technique, or other standard aseptic technique. Historically under-reported, incidence of infection and risk to patients from PIVCs is now increasingly being recognised, with new research and evidence raising concern and helping to drive new clinical guidance and improvement. The risks posed by PIVCs are particularly significant given increasing PIVC dwell times, due to cannula removal now being determined by new guidance for clinical indication, rather than predefined time frames. Clinical 'best practice' is considered in context of the evidence base, importantly including availability and access to appropriate skin antisepsis products. In the UK, and other countries, ChloraPrep is the only skin antisepsis applicator licensed as a drug to disinfect skin and help prevent infections before invasive medical procedures, such as injections, blood sampling, insertion of PIVCs and minor or major surgery.

Initial Experience with the New Super Thin Single-use Pusen Flexible Ureteroscope 7.5 Fr in Renal Stones Endoscopic Treatment.

Introduction: Single-use flexible ureteroscopes (SU-fURS) seems to overcome the main limitations of conventional reusable ureteroscopes in terms of acquisition and maintenance costs and breakages. Our aim was to analyz the efficiency and safety of the thinnest single use flexible scope from Pusen: Uscope Pusen, PU 3033A (Tip = 7.5 Fr.). Material and Methods: We analyzed data from 24 patients with pyelocaliceal stones from January to March 2021. The mean age of the patients was 49 years (range 27 to 71 years). There were unique stones, 7 pyelic, 10 in inferior calyx, 4 in the middle calyx and 3 in superior calyx. The average stone size (larger diameter) was 18 mm (12-26 mm). We used Uscope Pusen 7.5 Fr. (PU 3033A) and Dornier Medilas H Solvo laser. In all cases we applied no touch technique (NTT). We did't used CArm for progression control of the ureteroscope. We evaluated the patients for stone-free rate (SFR), mean operation time and complication rate. Results: The average operative time was 72 +- 21 minutes, range 66-131 min. For all 24 patients we didn't use wires or ureteral access sheath (NTT). Concerning the laser settings for dusting we used low energy: 0.5J, high frequency: 50 Hz, for pop-corning we used high energy: 1 J, medium frequency: 10-50 Hz, and for fragmenting high energy: 1 J, low frequency: 10 Hz. The stone-free status (residual fragments under 3 mm.) after one month was 91,7%. In 2 patients we need the second session with completely dusting of the residual stones. The visibility was optimal and we didn't describe any mucosal lesions of the ureter when we retired the scope. The intrarenal maneuverability was very good. Clavien I and II occurred in 6 patients. Conclusions: This new SU-fURS (7.5 Fr.) seems to be very effective and safe offering us an easy NTT. No ureteral damage and one day surgery are the main real minimally invasive characteristics of this ureteroscope.

Efficacy of Yakson touch and kinesthetic stimulation on the behavioral development, pain and vitals of pre-term neonates during critical care stay: A randomized controlled trial.

Background: Premature infants are susceptible to various sources of stress that is compounded by stays in critical care units. The evidence to recommend stimulation to reduce such stress in neonates is limited. Purpose: Determine effects of intervention. Methods: 64 pre-term neonates were randomized into two groups. One group received kinesthetic stimulation including the Yakson touch technique in addition to standard care while the other received only standard care. Primary outcome measures were the differences in the sleep-wake pattern and vital parameters and the secondary outcome measures pain response of preterm. ABSS and PIPP are between baselines and immediately after an invasive procedure. Analysis was per protocol. Result:58 neonates completed the trials and were analyzed. In the intervention group, ABS score change from 54.8% (pre-test) to 64.4% (post-test) for sleep and 45.2% (pre) to 35.5% (post) for awake in experimental group. 70.4% (pre) to 11.1% (post) for sleep and 29.6% (pre) to 88.9% (post) in control group. In PIPP the p=0.73 for control group and p=0.001 for the experimental group. The behavioral status in experimental group with the p-value=0.001(<0.05). The heart rate p-value of 0.001(<0.05), the respiratory rate the p-value=0.005(<0.05); in oxygen saturation p-value 0.02(<0.05) Conclusion: The intervention has significant effect on management of sleep-wake pattern, stabilization of the vitals (heart-rate, respiratory-rate and oxygen saturation) and minimization of pain during the heel-prick. Implications for Practice: Neonatal nurses can Practice for early improvement in different aspects of pre-terms. Implications for Research: Studies can be conducted for neuro-behavioral improvement by using this therapy.

How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland?

To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.

Harvesting internal mammary artery: a narrative review.

Scientific literature has highlighted the development of surgical procedures with studies investigating optimal selection of arterial conduit, ideal harvesting method and type of graft. There have also been studies on the utility and efficiency of harvesting the internal mammary artery (IMA) through minimally invasive techniques such as endoscopic and robotic assisted methods. In the pursuit of a more total and complete revascularization of the coronary arteries, surgeons have also explored more extensive anastomosis techniques, i.e. sequential and no-touch. This review analyzes the literature in order to better understand the various methods for harvesting and using the IMA in coronary artery bypass graft (CABG) through outlining the pros and cons of each methodology. Literature search on PubMed and Google Scholar was performed using search terms such as "CABG," "IMA," "internal thoracic artery," "harvesting," "technique," and "approach." Manuscripts in languages other than English were not considered. Manuscripts that assess outcomes of IMA harvesting are reviewed and included. A review of 48 studies, narrowed down from 150 articles that were retrieved, were used to evaluate current evidence for different IMA harvesting techniques. This includes evidence comparing various techniques: skeletonized and pedicled harvesting, minimally invasive techniques for harvesting; free arterial and in-situ grafts; no-aortic touch technique sequential grafting. Each technique and harvesting method is associate with various advantages and disadvantages. Common patterns in patient outcomes were identified for many of the techniques. This review provides a summary and overview of the current evidence base for CAGB surgery and identifies gaps in the evidence base to direct future research.

Diagnosis and Therapy of Benign and Malignant Tumors of the Conjunctiva

The aim of this paper is to give an overview of different benign and malignant epibulbar tumors. Categories can be made of the age of manifestation (paediatric tumors versus tumors of adults), the originating cell types (squamous cell tumors, melanocytic tumors, lymphomas or germ cell tumors) or genesis (proliferative, infectious or degenerating tumors). Most epibulbar tumors show lesions on the conjunctiva or the cornea. These can be flesh coloured or pigmented efflorescences with leucoplakias or hyperkeratosis. Especially malignant tumors show atypical growth of blood vessels, are often prominent and can have ulcerations or bleeding. In case of tumor growth, change in pigmentations or atypical bleedings a malign tumor can be suspected. The diagnosis should be confirmed using histopathological evaluation after an incisional or excisional biopsy. Molecular pathologic techniques extend the diagnostic tools and have an implication on the therapy of metastatic tumors. Therapeutic options of the malignant tumors (apart from lymphomas) are chirurgical excision preferably with a no touch technique and afterwards an adjuvant therapy consisting of radiation or cryotherapy. A topical chemotherapy with Mitomycin C, 5-Fluorouracil or Interferon α2b can be effective to reduce persisting precancerosis and reduce recurrences. In case of a suspected malignant tumor it is advisable to refer the patient to an ophthalmo-oncologic center to plan and ensure interdisciplinary therapy.

Minimally Invasive No Touch Technique for Subinguinal Orchiectomy and Testicular Prosthesis Insertion

Abstract Introduction: Minimally invasive no touch (MINT) technique approach aims to minimize infection and features the use of wound retractors and drapes to all but eliminate exposure to skin flo...

Early experience with laparoscopic treatment of liver tumors using a separable cluster electrode with a no-touch technique.

IntroductionRadiofrequency ablation (RFA) is one of the best curative treatments for hepatocellular carcinoma in selected patients, and this procedure can be applied either percutaneously or laparoscopically. Laparoscopic RFA has the benefit of direct visual control of the RFA procedure. Cluster electrodes (Octopus RF electrodes) can create a common ablation zone.AimUsing these two methods (laparoscopic approach and no touch technique), this present study evaluated the technical and clinical outcomes of early experience with laparoscopic RFA and a no-touch technique.Material and methodsBetween November 2015 and November 2018, 21 patients underwent laparoscopic RFA for hepatocellular carcinoma with a no-touch technique using cluster electrodes. Laparoscopic RFA is recommended for patients with a contraindication for surgical resection, patients wants and a relative contraindication for conventional percutaneous RFA, such as lesions adjacent to the gastrointestinal tract, gallbladder, bile duct, or heart.ResultsIn the 21 tumors, 2 were treated with a single electrode, 12 with 2 electrodes, and 7 tumors with 3 electrodes. The mean time of ablation per lesion was 20.43 ±8.77 min. There was no mortality, local tumor progression, delayed destructive biliary damage, or liver abscess at the follow-up computed tomography. No technical failures occurred.ConclusionsLaparoscopic RFA can access lesions for which percutaneous RFA is contraindicated or risky. Cluster electrodes can create sufficient ablation zones without contact and can achieve a sufficient margin with a low complication rate and no tumor dissemination. Therefore, laparoscopic RFA with a no-touch technique might be a safe and feasible treatment for HCC tumor in selected patients.

Ultrastructural examination of left internal mammary artery under electron microscopy in patients with chronic kidney disease who underwent coronary bypass surgery

Aim: To investigate the vascular damage of internal mammary artery graft with electron microscope secondary to chronic renal failure transmission in patients who underwent coronary artery bypass grafting surgery. Method: A total of 30 patients (10 patients with chronic renal failure and 20 patients without chronic renal failure) who underwent coronary artery bypass graft surgery were included in this prospective study. Left internal mammary artery graft was harvested as conventional fashion with no touch technique. Samples were prepared and then examined with the transmission electron microscope. Every arterial sample was individually examined ultrastructurally, and the changes were recorded. Then the samples of the control group and chronic renal failure group were compared. Results: There were no significant differences between chronic renal failure group and the control group in terms of demographics, comorbidities, intraoperative data and postoperative outcomes, and the groups were statistically similar (p<0.05). Moreover, no statistically significance was detected in terms of structure and ultrastructure between the groups. Conclusion: The results of our study revealed that no ultrastructural changes were observed in the structure of IMA, suggesting that this graft would provide a good graft patency.

Management of Dietary Services in Secondary Level Hospitals

Hospital diet is an essential part of modern therapy in all medical departments. It comprises both the so-called normal diets which are prepared according to modern nutrition knowledge, dietetic foods and the various forms of artificial nutrition. The dietary department provides food and nutrition services that consistently promote adequate nutritional intake, improve health and enhance the quality of life. This study was cross-sectional from January 2016 to December 2016. The nonprobability purposive sampling method was used for data collection. Total 164 samples were collected purposively within the data collection period. There were 150 hospital patients and 14 dietary staff who collected the data secondary level hospitals by using semi-structured questionnaire. The data was analyzed by using SPSS. Among 150 patients 92% of the patients ate hospital diet and only 8% of the patients did not eat hospital diet. Among them 6.7 % of the patients said that the hospital supply foods were unhygienic and 93.3% say the hospital food was healthily. There was 8% patients complains that the supply food was not neat and 13% of the patient says that they did not use the spoon. There were 64.3% of the dietary staff did not use non touch technique during food distribution. Majority of the patients 79.3% said they have no training about food hygiene. The satisfaction level of the dietary staff, there was 57.1% staff were satisfied and there was 21.4% dietary staff were very satisfied following 21.4% was dissatisfied. The satisfaction among the patient 75.8% patient was satisfied 9.8% of the patient were dissatisfied. Dietary department improved the food quality and supplied adequate quantity of food among the patients. Dietary department needs to clean regularly and training should be implemented among the nutrition personnel. The sufficient lighting facility may improve for the patient’s satisfaction.

Infrared dermal thermometry is highly reliable in the assessment of patients with Charcot neuroarthropathy

BackgroundCharcot neuroarthropathy (Charcot foot) is a serious limb-threatening complication most commonly seen in individuals with diabetic peripheral neuropathy. Although dermal thermometry is widely used by clinicians to assist in the diagnosis, monitoring, and management of the disease, there is limited high-quality evidence to support its reliability. Therefore, this study investigated the intra-rater and inter-rater reliability of infrared dermal thermometry in patients with Charcot neuroarthropathy.MethodsWe collected clinical, demographic, health status, and foot examination information on 32 adults with Charcot neuroarthropathy from a metropolitan high-risk foot service in Melbourne, Australia. Infrared dermal thermometry assessments were conducted by two independent raters at 10 anatomical sites of the Charcot foot using both a (i) touch and (ii) non-touch technique. Intra-rater and inter-rater reliability of the two assessment techniques were evaluated using intra-class correlation coefficients (ICCs), limits of agreement, standard error of measurement, and minimal detectable change statistics.ResultsMean age was 59.9 (standard deviation [SD], 10.5) years, 68.8% were male, average duration of diabetes was 20.6 (SD, 15.1) years, 71.9% had type 2 diabetes, 93.8% had peripheral neuropathy, 43.8% had peripheral arterial disease, and 50% had previous foot ulceration. Charcot foot most commonly affected the tarsometatarsal joints (38.9%), had a median duration of 2.8 (interquartile range [IQR], 1.3 to 5.9) months, and a large proportion were being treated with total contact casting (69.4%). Overall, there was good to excellent intra-rater and inter-rater relative reliability for the ‘touch’ technique (ICC, 0.87 to 0.99; ICC, 0.83 to 0.98, respectively), and excellent intra-rater and inter-rater relative reliability for the ‘non-touch’ technique (ICC, 0.93 to 0.99; ICC, 0.91 to 0.99, respectively). In addition, measurement error was found to be relatively low across the 10 anatomical sites.ConclusionsInfrared dermal thermometry can now be used with confidence in clinical and research settings to provide a reliable assessment of skin temperature in patients with Charcot neuroarthropathy, using either a touch or non-touch technique at 10 commonly used testing sites. A non-touch technique, however, was observed to have slightly higher reliability indicating it may be associated with less measurement error than the touch technique.

Standardizing the Critical Clinical Competency of Aseptic, Sterile, and Clean Techniques with a Single International Standard: Aseptic Non Touch Technique (ANTT®)

Standardizing the Critical Clinical Competency of Aseptic, Sterile, and Clean Techniques with a Single International Standard: Aseptic Non Touch Technique (ANTT^®)

Standardizing the Critical Clinical Competency of Aseptic, Sterile, and Clean Techniques with a Single International Standard: Aseptic Non Touch Technique (ANTT®)

Standardizing the Critical Clinical Competency of Aseptic, Sterile, and Clean Techniques with a Single International Standard: Aseptic Non Touch Technique (ANTT®)

Wire-guided biliary cannulation: a comprehensive approach to a set of techniques.

Biliary cannulation represent a challenge for the endoscopists that approach to endoscopic retrograde cholangiopancreatography, with non-negligible rate of failure even in expert hands. In order to achieve the biliary tree, two main technique are nowadays mainly used, namely the contrast-assisted cannulation and the wire-guided cannulation (WGC) techniques. The WGC technique is widely used because it seems to be related to higher success rate of cannulation of the common bile duct and, at the same time, to lower rates of complications. Particularly, this approach is associated with lower risk of post endoscopic retrograde cholangiopancreatography pancreatitis, although the pathogenesis of this adverse event is still not completely understood. The outspread of this technique among endoscopists promoted the development of different methods of performing WGC-assisted endoscopic retrograde cholangiopancreatography, such as the touch technique, the no-touch technique and the double guide-wire cannulation. Furthermore, the variety of guide wires and accessories, with their different characteristics, contribute to make the scenario extremely heterogeneous. To date, the published studies did not highlight which is the best strategy that maximizes the rate of success and minimizes the percentage of complications, even because the experience of the operator represents an important variable that conditions the outcomes. The aim of this review is to define state of the art in WGC technique, in order to better understand the possible advantages in using this approach and to bring to light the possible area that may be object of further studies.

The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting: A randomized trial

BackgroundIn 2004, a prospective randomized trial demonstrated that after 3 years, saphenous veins (SVs) harvested with a no touch (NT) technique had a greater patency than radial grafts for coronary bypass surgery. Here we report the 8-year follow-up data of this trial. MethodsThe trial included 108 patients undergoing coronary artery bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1 radial artery (RA) graft to either the left or right coronary territory to complement the left internal thoracic artery (LITA). Sequential grafting was common, so overall graft patency as well as the patency of each anastomosis were assessed. ResultsAngiography was performed in 84 patients (78%) at mean of 97 months postoperatively. Graft patency were high and similar for both NT and RA: 86% for NT versus 79% for RA (P = .22). The patency of coronary anastomoses was significantly higher with the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent patency in coronary arteries with <90% stenosis (93% patency) and in coronary arteries of small diameter (87% patency) or with mild calcification (88% patency). Patency for the LITA was 92%. ConclusionsNT SV grafts have excellent patency similar to that of RA grafts after 8 years. In addition, NT SV grafts can be used in situations that are not ideal for RA grafts.

The application of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract

Objective To investigate the value of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract. Methods A retrospective analysis was made in consecutive 140 cases, including 94 males and 46 females, who are considered for hematuria from unilateral upper urinary tract in Renmin hospital of Wuhan University from January 2014 to February 2019.Their age ranged from 22 to 89 years, with mean of 62.3 years. The mean BMI was 24.6 kg/m2(ranging 22.1-28.2 kg/m2). All patients complained about the continuously or intermittently gross hematuria. 29 cases (20.7%) complained about the flank pain, as well. All cases were examined by urinary sonography, CTU and voided urine cytology preoperatively. Occupying lesion was found in 47 case by sonography including suspected diagnosis. Upper tract urothelial carcinoma(UTUC) was diagnosed in 63 cases by CTU including suspected diagnosis.Voided cytology was positive in 17 cases. Concomitant bladder or urethral lesions were excluded by cystoscopy. Hematuria was confirmed from left side in 82 cases(58.6%) and from right side in 58 cases(41.4%). Diagnostic digital flexible ureteroscopy were performed under general anethesia strictly according to 'No touch technique’. Biopsy for suspicious lesions as well as selective in situ cytology were acquired during ureteroscopy. Results All patients accepted the examination successfully. The duration of follow-up ranged from 3 to 37 months, with mean of 13 month. Benign lesions were found in 71 cases(50.7%) while malignant lesions were identified in 69 cases(49.3%). Benign lesions included 39(54.9%)minute venous rupture, 12 (16.9%)hemangioma, 3 (4.2%)varix and 11 (15.5%)no obvious lesion. The overall success rate of ureteroscopic treatment was 66(93.0%) whereas recurrence rate after treatment was 8(11.3%). Malignant lesions including 67(97.1%) cases with UTUC and 2 cases with squamous carcinoma. The radical nephroureterectomy(RNU)and bladder sleeve resection was performed in all cases. To 67 cases with UTUC, the overall identification rate of urinary sonography, CTU, voided urine cytology, selective in situ cytology and diagnostic digital flexible ureteroscopy was 41(61.2%), 61(91.0%), 13(19.4%), 38(56.7%) and 63(94.0%) respectively. Identification rate of selective in situ cytology was superior to voided cytology(P<0.01) while diagnostic digital flexible ureteroscopy was no significant difference compared with CTU. The concordance of pathological grade between biopsy and final resection specimen was 73.1%.The concordance of low grade was 93.3% whereas high grade was 56.8%. Up-grading was found in 16(23.9%) cases while down-grading was found in 2(3.0%) cases. Intravesical recurrence was affirmed in 11(16.4%) cases during follow-up. Conclusions Diagnostic digital flexible ureteroscopy may not only present qualitative as well as localized evidence for etiological diagnosis of hematuria from unilateral upper urinary tract, but also provides strategy choice for treatment. Key words: Ureteroscopy; Flexible ureteroscope; Hematuria; Upper urinary tract; Upper tract urothelial carcinoma; Laser ablation

Comparison of recovery in pediatric patients: a retrospective study.

The recovery after general anesthesia is influenced by the choice of inhalational agent. Stimulations might make patient's agitate. However, the recovery using no touch technique might be safer. In this study, we compared the recovery time, awakening end-tidal concentration, and respiratory complications among inhalational anesthetics in pediatric patients using no touch technique, retrospectively. The subjects were pediatric patients aged 3months to 11years under general anesthesia using sevoflurane, isoflurane, or desflurane. Background, awakening end-tidal concentration, respiratory complications, the time of eye open, body movement, and extubation were recorded. A total of 170 patients were included in the study. There were no respiratory complications during emergence. Awakening end-tidal concentration in desflurane was 0.98%, sevoflurane (0.39%), and isoflurane (0.25%). In patients received desflurane, the time of body movement, eye open, and extubation were significantly shorter than patients who received other anesthetics (p < 0.05). The recovery from desflurane was significantly shorter among three inhalational anesthetics with no touch technique. In addition, no airway-related complication occurred. The recovery from desflurane might be useful to predict emergence by end-tidal inhalational concentration.

Vaginoscopy “No Touch” Technique: A Feasible Alternative to Paracervical Block for in Office Hysteroscopy [34E

INTRODUCTION: Hysteroscopy allows direct visualization of the uterine cavity. Traditionally, in office hysteroscopy is performed using a speculum and tenaculum to hold the cervix. However, the emergence of smaller diameter hysteroscopes along with the vaginoscopy no touch technique without the need of speculum or tenaculum has contributed for the procedure to be done in the office setting without the use of analgesia. This study reviews our experience of in office hysteroscopy using the vaginoscopy "no touch" approach. METHODS: Retrospective chart review of 22 in office hysteroscopies performed without analgesia using the vaginoscopy “No touch” technique from June 1, 2017 to January 31, 2018. Patients received 200 mcg of oral Misoprostol 30 minutes before the procedure. Data gathered included age, body mass index, prior vaginal deliveries, and pain during the procedure. Success was measured as the ability to enter the endometrial cavity and perform the expected procedure. RESULTS: The median age 45 SD ±10.0 and BMI of 26.9 SD ±4.4. Hysteroscopic indications were: 2 (9.1%) postmenopausal bleeding, 5 (22.7%) retained IUD, 7 (31.8%) for suspected polyp, 8 (36.4%) for abnormal uterine bleeding. Of the 22 procedures, 18 were successful completed (80%). The median pain on VAS scale reported immediately after the procedure was 3.8 SD ±0.8 All four of the unsuccessful procedures were in postmenopausal females, two of which due to severe cervical stenosis. There were no complications. CONCLUSION: In office hysteroscopies using the vaginoscopy “no touch” technique is a feasible and safe procedure. We recommend adopting this innovative, painless technique.