Correlation between BMI, amount of aspirated fat and post-operative complications in VASER liposuction: A single centre experience.

Background: Vibration amplification of sound energy at resonance (VASER) liposuction is an innovative technique that allows surgeons to selectively remove fat and shape desired areas of the body, resulting in more precise and controlled outcomes compared to traditional liposuction techniques. VASER liposuction offers several advantages, including targeted action that reduces trauma to the surrounding tissues, limiting pain, swelling and recovery time. Purpose: This study compared the complication rates among patients who underwent VASER liposuction in relation to their body mass index (BMI) and the amount of fat aspirated. Methods: The authors reviewed the medical records of all patients who underwent VASER liposuction at Scalera Clinic in Naples, dividing them into two groups: the first with BMI < 24.9 kg/m2 and second with BMI >25.0 kg/m2. Results: The authors examined 117 patients who were operated on within a year (2022/2023), with 48 of them having BMIs < 24.9 kg/m2 and 69 showing BMIs >25.0 kg/m2. In patients with a BMI >25 kg/m2, the most common complications were contusion, hematomas and abnormal skin retraction, whereas no complications were observed in the patients with normal-weight. Conclusions: To minimise post-operative complications and maximise results, it is advisable to select patients based on their BMI assessment, the anatomy of the treated body area and the volume of fat to be removed. This approach aims to ensure that the patients are suitable for the procedure and the achieved results align with their aesthetic expectations.

Advancing Precision Rhinoplasty: Preoperative Digital 3D Surgical Planning.

The aim of the study is to assess the efficacy and advantages of utilizing state-of-the-art three-dimensional (3D) reconstruction technology in preoperative planning for rhinoplasty surgery. It is a study of a single rhinoplasty case that was operated at a tertiary hospital. The patient was assessed through a detailed history, blood investigations, radiological investigations and preoperative 3D (three-dimensional) reconstruction of the face and nose. The study utilized high-resolution CT scans and 3D reconstruction software like 3D (three-dimensional) Slicer and Blender 3D (three-dimensional) to analyze nasal anatomy for preoperative planning in rhinoplasty. External and internal nasal measurements were taken, and axial cross-section analysis was conducted to assess nasal structure deviation. The benefits of 3D (three-dimensional) visualization in surgical planning were evaluated, and surgical management was based on preoperative reconstructions. Comprehensive preoperative evaluations were performed, adhering to ethical guidelines. Preoperative 3D (three-dimensional) reconstruction planning methods facilitated precise surgical planning and execution in rhinoplasty with satisfactory outcomes for both the patient and the surgeon. Incorporating 3D (three-dimensional) reconstruction technology in rhinoplasty preoperative planning enhances surgical precision and patient satisfaction, ensuring optimized surgical outcomes while adhering to ethical standards.

Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome.

INTRODUCTION: Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity. This study evaluated the clinical impact of treatment delays on surgical outcomes. METHODS: Overall, 282 patients who underwent nerve decompression surgery at Weill Cornell Medicine and Massachusetts General Hospital between September 2012 and January 2024 were enrolled. Information regarding demographics, onset of symptoms, and headache characteristics was collected using patient surveys. The treatment outcome was evaluated by the percentage of symptom reduction in terms of frequency, duration, and pain intensity. An area under the receiver operating characteristic analysis was performed to determine the optimal timepoint to undergo surgery. RESULTS: Postoperative symptom reduction and time between the onset of symptoms and surgery were negatively correlated (r = -0.22; p < 0.001). The most significant difference in outcome was found at 2.9 years from symptom onset; patients who underwent surgery before this timepoint reported an average improvement of 79 ± 23% versus 67 ± 35% in those who were treated after the timepoint (p = 0.021). CONCLUSION: Our results indicate that delays in undergoing nerve decompression surgery beyond 2.9 years from symptom onset leads to less favorable postoperative outcomes, underscoring the need for timely referral to peripheral nerve surgeons when conservative management fails. Nonetheless, even with delays in surgical intervention, patients continued to experience significant symptom reduction.

ACTH stimulation and oral salt loading tests detect biochemical outcome early after primary aldosteronism surgery.

BACKGROUND: In primary aldosteronism (PA), the biochemical outcomes of the Primary Aldosteronism Surgical Outcome study are used to assess aldosterone hypersecretion 6-12 months after surgery. However, few studies have investigated whether the outcomes can be predicted in the early postoperative period. In this retrospective study, we evaluated whether the adrenocorticotropin stimulation test (AST) and oral salt loading test (OST) performed immediately after surgery could predict biochemical outcomes 1 year after surgery. METHODS: We assessed 268 patients with PA who underwent adrenalectomy at our hospital between 2008 and 2020, underwent AST and OST within 15 days of surgery, and were assessed for biochemical outcomes 1 year after surgery. Patients were divided into two groups: biochemical complete success (B-com; n = 219) and incomplete success (B-inc; n = 49). Patients were divided into clinical complete and partial success and absent success groups. The relationships between various AST and OST values and outcomes were analyzed. RESULTS: The B-inc group had significantly higher plasma aldosterone concentration (PAC) and PAC/serum cortisol ratio (PAC/Cort) at baseline and after ACTH loading in AST and 24-hour urine aldosterone in OST than the B-com group. PAC/Cort at 30 min after ACTH loading (area under the curve (AUC) = 0.76) and 24-hour urine aldosterone (AUC = 0.77) were relatively superior predictors of the outcome. Parameters after ACTH loading were better predictors of biochemical and clinical outcomes than baseline. CONCLUSIONS: AST and OST immediately after surgery can predict biochemical and clinical outcomes 1 year after surgery in patients with PA.

Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated. We aimed to determine if robotic assisted surgery and Pfannenstiel extraction decreased the rate of radiologically detected incisional hernias compared to standard laparoscopy with extra-corporeal anastomosis. The secondary outcomes aimed to evaluate incidence of port site hernias in 8 mm robotic ports for which routine closure is not followed. Our single centre retrospective cohort study included patients who had minimally invasive right hemicolectomy and had cross-sectional imaging at least 1-year later. Patient demographics, body mass index, history of smoking or previous surgery was recorded. At imaging, evidence of new extraction site or port site-site hernia, contents and clinical impact was noted. A total of 100 patients (50 robotic and 50 laparoscopic) were included. Baseline characteristics appeared equally distributed. 16% (8 patients) who had laparoscopic surgery developed midline extraction site hernias which was significantly higher to RAS group (0 patients). 3 patients developed hernias at the site of robotic ports and this was more commonly at the right iliac fossa port. RAS, by simplifying intra-corporeal anastomosis has potential to eliminate incisional hernias, particularly when Pfannenstiel extraction is used. The potential for 8 mm robotic ports to develop clinically significant hernias cannot be ignored and meticulous closure can prevent patient harm.

Worse cholecystectomy outcomes during the COVID-19 pandemic: were staff shortages or a change in patient case-mix the culprit?

BACKGROUND: The COVID-19 pandemic has profoundly impacted the field of surgery, mostly through infectious risks, staff shortages, reduced hospital capacities, and changed patient pathways. Prompted by an increase in wound complications, we performed an in-depth analysis of an example surgical procedure. METHODS: A consecutive cohort of 195 patients undergoing laparoscopic cholecystectomy was studied retrospectively. Data of patients receiving cholecystectomy before, during, and after the peak of the pandemic were compared. The potential influence of patient characteristics, pandemic phase, and staffing level (surgeons and nurse assistants) was analyzed statistically. In the primary analyses, the composite measure of a 'textbook outcome' was examined, which was defined as no relevant complication, hospital stay < 5 days, and no readmission. RESULTS: During the COVID-19 phase, acute biliary disease was more common than in the pre-COVID-19 phase (62% vs. 30%). In 35% of cases, no qualified operating room nurse was available. Intraoperative features and postoperative complication rates were increased (bile spillage in 46%, wound complications in 24%). A 59-year-old male admitted with acute cholecystitis during COVID-19 died of wound-related septic shock. Multivariate analysis confirmed the acuity of gallbladder inflammation (odds ratio 5.3) and old age (2.6) as risk factors for a non-textbook outcome. The absence of qualified nursing staff was clearly associated with a non-textbook outcome (odds ratio 3.3). CONCLUSIONS: The fact that laparoscopic cholecystectomy outcomes were worse during COVID-19 can be partly attributed to a change in patient case-mix, but the shortage of qualified nursing staff in the operating room also had a strong negative influence.

Unsupervised Clustering of Adult Spinal Deformity Patterns Predicts Surgical and Patient-Reported Outcomes.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes. METHODS: Patients were classified based on the results of a previously conducted analysis that examined clusters of deformity, including Moderate Sagittal (Mod Sag), Severe Sagittal (Sev Sag), Coronal, and Hyper-Thoracic Kyphosis (Hyper-TK). The surgical data, HRQOL, and complication outcomes of these clusters were then compared. RESULTS: The final analysis included 1062 patients. Similar to published results on a different patient sample, Mod Sag and Sev Sag patients were older, more likely to have a history of previous spine surgery, and more disabled. By 2-year, all clusters improved in HRQOL and reached a similar rate of minimal clinically important difference (MCID).The Sev Sag cluster had the highest rate major complications (53% vs 34-40%), and complications leading to reoperation (29% vs 17-23%), implant failures (20% vs 8-11%), and operative complications (27% vs 10-17%). Coronal patients had the highest rate of pulmonary complications (9% vs 3-6%) but the lowest rate of X-ray imbalance (10% vs 19-21%). No significant differences were found in neurological complications, infection rate, gastrointestinal, or cardiac events (all P > .1). Kaplan-Meier survival curves demonstrated a lower time to first complications for the Sev Sag cluster. CONCLUSIONS: All clusters of adult spinal deformity benefit similarly from surgery as they all achieved similar rates of MCID. Although the rates of complications varied among the clusters, the types of complications were not significantly different.

Predictive Factors for Structural and Functional Outcomes of 25-Gauge Pars Plana Vitrectomy (PPV) for the Removal of Posterior Intraocular Foreign Bodies (IOFBs): A Retrospective Data Analysis From North India.

PURPOSE: To identify predictive factors for structural and functional outcomes of 25-gauge pars plana vitrectomy (25G PPV) for removal of posterior segment intra-ocular foreign body (IOFB). METHODOLOGY: A retrospective data analysis was performed for patients undergoing 25G PPV for removal of posterior segment IOFB between August 2019 to June 2021. Necessary demographic details and data regarding pre-operative ophthalmic examination were recorded. Similarly, intraoperative surgical details were recorded. Postoperative outcome measures included final best corrected visual acuity (BCVA), retinal status, and epiretinal membrane formation at the last follow-up visit. A univariate analysis was applied to find the association of various independent variables with functional and structural outcomes. RESULTS: Thirty-nine patients were included in the study, with 37 males and two females. The mean age of the study group was 30.5+10.8 years. The most common zone of open globe injury was zone 1. Most of the impactions of IOFB were seen outside the macular area. Preoperative BCVA was 2.23+0.58 logarithm of the Minimum Angle of Resolution (logMAR), which improved significantly to 1.01+0.53 in the postoperative period (p-value <0.001). Anatomical success was achieved in 92.3% of patients at one year follow-up. The presence of impacted IOFB, associated endophthalmitis and IOFB >4mm were associated with poor visual outcomes (univariate analysis; p-value <0.05). None of the factors affected the anatomical success rates. CONCLUSION: The presence of impacted IOFB, associated endophthalmitis, and large IOFB (>4mm) were associated with poor visual outcomes with 25G PPV for removal of IOFB.

A Morphometric Study of the Adult Distal Femur in the South Indian Population.

Introduction The most vital joint for locomotion is the knee joint, which is a condylar, modified hinge joint. Osteoarthritis is a degenerative disease commonly affecting the knee joint, which can be successfully treated by joint replacement surgeries wherein the condyles of the affected knee joints are replaced based on the measurement of the condyles for which the accurate morphometric values of the tibia and femur play an important role thereby decreasing the complications post-surgery and improving the mobility and quality of life of patients. Aim The present study aims to evaluate the morphometric data of femoral condyles and compare the morphometric data of the left and right femurs using the direct method. Materials and methods One hundred femoral condyles of unidentified sex were used for the measurement in the study. Medial condylar anteroposterior distance (MCAPD), lateral condylar anteroposterior distance (LCAP), bicondylar width (BCW), medial condylar transverse distance (MCTD), lateral condylar transverse distance (LCTD), and intercondylar notch width (ICNW) were measured by Vernier Calliper and the values between the left and right femurs were compared. Results The mean MCAPD is 56.88 mm, the mean LCAP is 57.72 mm, the mean BCW is 72.22 mm, the mean MCTD is 22.88 mm, the mean LCTD is 22.99 mm, and the mean ICNW is 21.58 mm, respectively. Conclusion The morphometric data obtained by direct measurement using Vernier Callipers is more accurate than indirect measurements which in turn aid biomedical engineers in designing more accurate and apt prostheses for knee replacement surgeries which in turn decrease the post-surgical complications and result in better outcomes due to surgery.

Extracapsular Dissection Versus Traditional Parotid Surgery: A Comprehensive Review of Techniques and Outcomes.

Parotid tumours, encompassing both benign and malignant forms, present significant challenges in surgical management. Traditional parotid surgery, including various forms of parotidectomy, has long been the standard approach, aiming for complete tumour removal while addressing potential complications such as facial nerve injury. However, extracapsular dissection (ECD) has emerged as an alternative technique, focusing on excising the tumour along with a thin layer of surrounding tissue, which may offer benefits in preserving healthy glandular tissue and reducing postoperative complications. This review comprehensively compares ECD and traditional parotid surgery techniques, evaluating their efficacy, outcomes, and associated complications. We analyse clinical studies and evidence to assess differences in tumour recurrence rates, facial nerve function preservation, and overall patient recovery. Additionally, the review explores the indications for each surgical approach, considering tumour characteristics and patient-specific factors. The findings suggest that while ECD may offer advantages in terms of reduced postoperative complications and improved preservation of glandular tissue, traditional parotidectomy remains a robust method for managing complex cases. This review aims to inform clinical decision-making by presenting a detailed comparison of both techniques, ultimately guiding surgeons in selecting the most appropriate approach for individual patients.

Comparison of Clinical Outcomes of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in Bilateral Inguinal Hernia Repair: A Retrospective Study.

OBJECTIVE: This study compared the clinical outcomes of two commonly used laparoscopic techniques, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair, in the treatment of bilateral inguinal hernias. MATERIALS AND METHODS: This retrospective cohort study included 250 patients who underwent laparoscopic bilateral inguinal hernia repair using either the TEP or TAPP technique between May 2009 and May 2024. The patients were divided into two groups: 50 patients in the TEP group and 200 in the TAPP group. Data were collected from patient records, including demographics, type of hernia, surgical details, intraoperative and postoperative complications, conversion rates, and early hernia recurrence. Statistical analysis was performed to compare outcomes between the two groups. RESULTS: Among the 250 patients included in the study, the mean age was 51.62 ± 8.79 years, and 94% (n=235) were male. The mean operative time was significantly longer in the TEP group (93.2 ± 13.0 minutes) than in the TAPP group (57.95 ± 7.5 minutes) (p <.001). The mean hospital stay was also longer in the TEP group (1.36 ± 0.48 days) compared to the TAPP group (1.07 ± 0.25 days) (p <.001). The TEP group had a higher rate of conversion to open surgery 18%(n=9) and conversion to TAPP 10% (5) than the TAPP group, which had no conversions (p <.0001). Postoperative complications were more frequent in the TEP group, with urinary retention being significantly higher at 16%(n=8) than in the TAPP group at 2% (n=4) (p <.0004). Additionally, the TAPP group experienced two (1%) notable intraoperative complications that required reoperation: arterial injury and small bowel injury. CONCLUSION: The findings suggest that, while both TEP and TAPP effectively repair bilateral inguinal hernia, TAPP is associated with shorter operative times, shorter hospital stays, and fewer postoperative complications. However, the TAPP technique also presented notable intraoperative risks, including arterial and bowel injury. The choice between TEP and TAPP should be based on the surgeon's experience, patient characteristics, and the specific clinical context.

Health care disparities in complication and mortality rates following surgical management of cauda equina syndrome in New York State.

CONTEXT: While healthcare disparities related to race and ethnicity are well reported for non-emergent conditions, the literature on disparities in outcomes of emergent spinal conditions such as cauda equina syndrome (CES) remains sparse. OBJECTIVE: To evaluate racial disparities in complication, mortality, and readmission rates following surgical intervention for CES. METHODS: This retrospective analysis of The Statewide Planning and Research Cooperative System (SPARCS) database demonstrates that among patients surgically treated for CES in New York between 2015 and 2020. Bivariate and multivariate logistic regression analysis was performed to analyze the association of race and outcome variables after controlling for age, sex, comorbidities, length of stay, insurance, and hospital characteristics. RESULTS: Overall, 2,114 patients who underwent lumbar surgery for CES were identified. The study population was comprised of Black patients (177, 8%), White patients (79%, 1680), and Asian patients (257, 12%). Options for surgery included lumbar decompression (821, 38.8%), fusion (746, 35.3%), or both (547, 25.9%). On multivariate analysis, the odds of 30-day mortality were 2.98-fold greater in Black patients than in other patients (P = 0.029). By 180 and 360 days, the odds of mortality were 4.27 and 3.05-fold greater in Black patients than in other patients, respectively (P < 0.001 each). Thirty-day readmissions were 1.87-fold greater in Black patients than others (P = 0.004). No difference in overall complication rate was found between Black patients and all other race groups (P = 0.306). CONCLUSIONS: Black patients surgically treated for CES face significantly higher rates of mortality and readmission than their non-Black counterparts.

Progress in surgical approaches and outcomes of patients with pheochromocytoma and paraganglioma.

Significant advances have been made in the past few decades in surgical management and outcomes of patients with pheochromocytoma and paraganglioma. Improvements in preoperative hypertensive control with the implementation of alpha- and beta-adrenergic blockade has resulted in better intra-operative blood pressure control and less incidence of hypertensive crises, which had been a large source of morbidity in the past. Emphasis on anesthesia and surgical team communication has also assisted in minimizing intraoperative hypertensive events at critical points of the operation. Shifting away from open resection, the now standard-of-care laparoscopic and minimally invasive adrenalectomy offers less pain, shorter hospitalizations, and quicker recoveries. Patient underlying germline mutations can guide the timing, approach, and extent of surgery. Postoperative outcomes have significantly improved with recent advancements in perioperative care in addition to regimented biochemical and radiographic surveillance. Here, we highlight the recent advancements in surgical approaches and outcomes for patients with pheochromocytoma and paraganglioma.

Retrograde transurethral injection of indocyanine green better assists complete transperitoneal nephroureterectomy in a single-position.

Background: Complete transperitoneal nephroureterectomy (CTNU) in a single-position is an advanced surgical technique for the treatment of upper urinary tract urothelial carcinoma (UTUC), performed entirely through a transperitoneal approach without the need for patient repositioning. Indocyanine green (ICG) has been extensively studied in urologic surgery, with applications ranging from sentinel lymph node mapping to tumor localization. This study aimed to evaluate the performance of retrograde ureteral fluorescence imaging in CTNU. Methods: This retrospective cohort enrolled 81 patients diagnosed with UTUC and underwent single-position CTNU. Cohorts were divided into two groups according to whether the ICG was applied. Perioperative data and oncology outcomes were recorded and analyzed. Results: In total, 81 eligible participants were finally included, with 40 in the ICG group and 41 in the non-ICG group. The ICG group presented significantly shorter ureter identification time (8.5±3.3 vs. 17.3±4.2 min, P<0.001) and duration of surgery (132±40 vs. 162±49 min, P=0.003), as well as lower estimated blood loss (EBL) (108±94 vs. 183±126 mL, P=0.003) compared to the non-ICG group. The rates of intravesical and extravesical carcinoma recurrence were comparable between the two groups. At a median follow-up of 16.7 months, there were no significant differences in terms of the recurrence-free survival (RFS) and overall survival (OS) between groups. Conclusions: ICG guided ureteral fluorescence imaging in single-position CTNU showed significant advantages in precisely and effectively locating the ureter, with improved surgical outcomes. Meanwhile, the enhanced visualization of the ureteral intramural segment and bladder cuff facilitated the complete removal of the specimen en bloc and the watertight closure of the bladder.

Rectal Prolapse Surgery: Balancing Effectiveness and Safety in Abdominal and Perineal Approaches.

The event in which the entire thickness of the rectum protrudes through the anal canal is called rectal prolapse. This ailment is common in the elderly population and especially in females. It causes some disastrous symptoms, including incontinence to feces and flatus, constipation, and discomfort, because of the weakness in the anorectal junction, making it mandatory for surgical correction. Over time, several surgical techniques have been developed; these are broadly classified into two categories: abdominal and perineal techniques. However, the best approach for surgery that minimizes recurrence while maximizing patient quality of life is still up for debate. A comprehensive review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; a systematic search of the PubMed Database was performed to identify studies published between 2000 and 2024 with the keywords ((Rectal Prolapse) AND ("Perineal" OR "Laparotomy")). The inclusion criteria were focused on studies comparing the outcomes between surgical approaches at the abdominal and perineal locations, particularly on the recurrence rate, postoperative complications, and functional outcomes. In total, 21 studies were included in the review: these ranged from retrospective analysis and prospective studies to a multicentric randomized trial. In this review, abdominal approaches, particularly in the form of laparoscopic rectopexy, consistently demonstrated improved results compared to perineal techniques, with a much lower recurrence rate. The rates of mortality and morbidity were also remarkably lower in laparoscopic operations, which were advocated for suitable patients. However, perineal approaches, while still producing higher rates of recurrence, are a valuable alternative for elderly and high-risk patients due to their being relatively less invasive. Laparoscopic rectopexy can be considered a better surgical method for rectal prolapse, as it has a lower recurrence rate and better functional outcomes. In contrast, perineal approaches will have their place in the management of rectal prolapse, given patient selection for patients at high risk with regard to surgery. Future research should be directed toward multicenter trials with long-term outcomes in order further to fine-tune surgery strategy and criteria for patient selection.

Exploring the Potential of Robotic Single-Port Surgery for Gallbladder Cancer: Initial Insights and Future Prospects.

BACKGROUND: Robotic surgery has demonstrated outcomes comparable or superior to open and laparoscopic surgeries for extended cholecystectomy.1-8 Despite its advantages, the minimally invasive robotic single-port (SP) system remains underutilized in complex hepatobiliary pancreatic surgery due to instrument limitations and retraction issues.9,10 This study evaluated the feasibility, safety, and effectiveness of the da Vinci SP system in gallbladder cancer surgery. The study was approved by the Ethics Committee of OOO University Hospital (IRB no. DAUH IRB-24-081) and conducted in accordance with the principles of the Declaration of Helsinki. The requirement for informed consent was waived due to the study's retrospective design. METHODS: A 62-year-old woman with a diagnosis of gallbladder cancer was referred for surgery. Preoperative computed tomography (CT) scans showed no evidence of metastasis (T2N0). Therefore, a robotic SP extended cholecystectomy was planned. Figure 1 shows a 30-mm SP port and a 1-mm assistant port inserted for the procedure. Due to the absence of an energy device for the liver wedge resection, Maryland bipolar forceps were used, mimicking the Kelly clamp crushing technique. A monopolar cautery hook was used for lymph node resection of stations 7, 8, 12, and 13 (Fig. 2). Fig. 1 Port placement for robotic extended cholecystectomy using the da Vinci Xi system Fig. 2 Demonstration of full lymph node dissection RESULTS: The total duration of the operation was 226 min, with an estimated blood loss of 200 ml. The CT scan on day 5 showed no abnormalities, and the patient was discharged routinely on day 7 (Fig. 3). The pathologic examination confirmed adenocarcinoma (T2a) with clear resection, and all six lymph nodes tested negative for malignancy. Fig. 3 The wound 2 weeks after surgery CONCLUSIONS: This study underscores the adequacy of robotic surgeries and emphasizes the potential of the da Vinci SP system in hepatobiliary surgery. Despite current challenges related to instrument limitations, the authors are confident that the SP system will evolve into a crucial asset for hepatobiliary surgical practices in the foreseeable future.

Pre-operative clinical deterioration and long-term surgical outcomes in 41 patients with split cord malformation type 1.

PURPOSE: To document the pre-operative rate of clinical deterioration in a cohort of patients with split cord malformation type 1 (SCM 1) and the early- and long-term surgical outcome in these patients. METHODS: Data from 41 patients with SCM 1 operated upon by the same surgeon (VR) between January 2008 to June 2023 were retrospectively reviewed with respect to history of clinical deterioration prior to surgery and early and long-term surgical outcomes. RESULTS: The mean age of the patients at presentation was 79.3 months and the male to female ratio was 1:1.93. Twelve (29%) patients had congenital deficits whereas 4 (10%) patients had no neurological deficits. Twenty-six (63%) patients had kyphoscoliosis and 25 (61%) patients had motor dysfunction. Thirty-three (81%) patients (8/12 (67%) with congenital deficits) had clinical deterioration prior to surgery. By the age of 2 years, 56% of patients had clinical deterioration. After surgery, 18 (55%) patients with progressive symptoms had improvement in one or more of their symptoms on long-term follow-up (mean, 63.4 months). There were no predictors of surgical outcome. CONCLUSIONS: Since over half of our patients with SCM 1 developed progression of congenital deficits or developed deficits by the age of 2 years, surgery should be performed as soon as possible in these children. On long-term follow-up after surgery, improvement can be expected in over half the patients.

Assessment of Complications and Length of Hospital Stay Associated With Surgical Emergencies in Patients With Concurrent COVID-19 Infection.

The delivery of surgical services was profoundly affected by the COVID-19 pandemic, resulting in the postponement of elective surgeries and a shift in focus to essential emergency procedures. Our study aimed to assess the impact of concurrent COVID-19 infection on complications, hospital stay, and recovery following emergency surgery. A retrospective matched cohort study was conducted between July 2020 and February 2022 at a tertiary care hospital in India. Data from 48 patients with COVID-19 infection in the immediate preoperative period was compared with 48 matched controls not infected with the virus. The data collected included patient demographics, surgical procedures, duration of hospital stay, and postoperative complications. Patients with concurrent COVID-19 infection had notably longer mean hospital stays (13.44 days) than the controls (6.63 days) (P = 0.002). An elevated proportion of COVID-19-positive patients experienced discharge delays (36 out of 48, 75%), compared to just six of the 48 non-COVID-19 patients (12.5%) (P ≤ 0.001). Postoperative findings in the COVID-positive cohort revealed elevated rates of pulmonary complications (5/48, 10.4%), higher rates of postoperative ICU admissions (8/48, 16.7%), and persistently elevated D-dimer levels extending beyond postoperative day seven (18/48, 37.5%). This suggests that emergency surgery in patients with COVID-19 is linked to significantly lengthier hospital stays, increased discharge delays, and a greater prevalence of adverse events in the postoperative period when compared to controls. These findings underscore the need for enhanced perioperative strategies and preparedness for potential future pandemics.

Short term outcomes of minimally invasive total versus supracervical hysterectomy for uterine fibroids: a NSQIP study.

BACKGROUND: Uterine fibroids are the most common indication for benign hysterectomy in the United States, but data regarding the association of hysterectomy type and outcomes for this indication are lacking. OBJECTIVE: We aimed to describe the rate and odds of short-term (30 days) postoperative complications among patients undergoing minimally invasive total (TLH) compared to supracervical (LSCH) hysterectomy for uterine fibroids. STUDY DESIGN: We conducted a cohort study of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020. We compared characteristics of women who underwent TLH and LSCH for uterine fibroids and identified risk factors associated with the occurrence of 30-days postoperative complications defined according to the Clavien-Dindo classification. Multivariable regression analysis including age, BMI, race, comorbidities, ASA classification, uterine weight and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The co-primary outcomes were the risk of (1) a composite of any postoperative complications and of (2) major postoperative complications according to surgical type. RESULTS: A total of 44,413 and 6,383 patients underwent minimally invasive TLH and LSCH respectively. Operative time was shorter (143.0 vs. 150.6 minutes, p<.001), and the proportion of uterine weight >250 g was lower (39.4% vs. 45.1%, p<.001) in the TLH group. The rates of any (6.6% vs. 5.3%, p<.001), and major (2.7% vs. 1.6%, p<.001) complications were higher in the TLH group, while minor complications rate was comparable (4.4% vs. 4.1%, p=.309). In multivariable regression analysis, LSCH was independently associated with lower risk of any [aOR 95% CI 0.79 (0.70-0.88)], and major [aOR 95% CI 0.55 (0.44-0.69)] complications compared to TLH. CONCLUSION: Compared with TLH, LSCH is associated with a lower risk of short-term postoperative complications among patients with uterine fibroids. The current study findings can aid in shared decision-making prior to minimally invasive hysterectomy for uterine fibroids.