Does closure of fascia, type, and location of trocar influence occurrence of port site hernias? A literature review.

BACKGROUND: Since the introduction of laparoscopic surgery, it has become more popular with many advantages over open surgery including faster recovery, shorter hospital stays, and decreased tissue trauma. Despite its benefits, laparoscopic surgery can result in its own unique complications, such as the formation of a trocar site hernia (TSH), which have been reported in approximately 0-1.0% of laparoscopic cases when using non-bladed trocars. METHODS: A literature review was performed from June 1990 to June 2019. PubMed was searched using the keywords "laparoscopic surgery," "trocar site hernia," and "port site hernia." Only articles in English were identified but not limited to the USA. RESULTS: The total number of patients in all articles was 18,533 with a mean follow-up period of 22.50 ± 1.76 months. The overall trocar site hernia rate was 0.104%. When comparing open vs. closed ports, there was no significant difference in the hernia incidence rate for 5-mm and 10-mm ports. When comparing bladed versus non-bladed trocars left open, there was a statistically significant difference with lower hernia incidence rates for non-bladed trocars over bladed trocars for 5-mm, 10-mm, and 12-mm ports. And when comparing trocar location from midline versus off-midline, there was a statistically significant higher TSH incidence in midline trocar locations. CONCLUSION: Results suggest that TSH rate is lower when using non-bladed trocars for any size of trocar. When comparing whether fascial closure had an effect, the 5-mm and 10-mm ports had no difference in incidence rates and leaving the fascia open can reduce operative time, risk of needlestick injuries, and overall procedural cost. In addition, trocars at midline locations resulted in higher TSH incidence rates. Future research is still needed to assess for other factors that may influence hernia formation and how it can be minimized.

Technical feasibility of a newly designed bendable forceps for difficult endoscopic tissue samplings (with video).

BACKGROUND: Biopsies with conventional forceps beyond the operating range are difficult and cumbersome. Thus, we developed a new bendable forceps for improved access to gastrointestinal lesions and evaluated its technical feasibility. METHODS: A bendable forceps was constructed with two channels and a two-stage knob. The bending motion-related structures were designed to improve the range of motion. For the evaluation of the forceps, we used 2 gastrointestinal simulators: an ex vivo porcine model, and an in vivo porcine model with some difficult endoscopic biopsy cases. All evaluations were performed by 5 expert endoscopists and an expert pathologist. RESULTS: Compared with the conventional forceps, the bendable forceps had greater efficacy in the simulator (6.2 ± 0.4 vs. 1.96 ± 0.2, p < 0.001), ex vivo porcine model (6.33 ± 0.52 vs. 4.25 ± 0.89, p < 0.001), and in vivo porcine model (6.33 ± 0.52 vs. 4.25 ± 0.89, p < 0.001); greater safety in the simulator (1.92 ± 0.13 s vs. 4.88 ± 0.50 s, p < 0.001), ex vivo porcine model (2.02 ± 0.15 s vs 4.66 ± 0.27 s, p < 0.001), and in vivo porcine model (2.02 ± 0.15 s vs. 4.08 ± 0.70 s, p = 0.002); and larger specimens in the ex vivo porcine model (3.92 ± 0.03 mm vs. 3.85 ± 0.07 mm, p = 0.020). CONCLUSIONS: This study showed that compared with the conventional forceps, the bendable forceps was effective and safe to use for accessing difficult lesions in the three models. We believe that the bendable forceps serves as a useful supplementary diagnostic tool for accessing difficult lesions. However, further validation of its usefulness in the human body is needed.

Comparison of Carbon Dioxide Absorption Rates in Gynecologic Laparoscopy with a Valveless versus Standard Insufflation System: Randomized Controlled Trial.

STUDY OBJECTIVE: The primary objective was to compare carbon dioxide (CO2) absorption rates in patients undergoing gynecologic laparoscopy with a standard versus valveless insufflation system (AirSeal; ConMed, Utica, NY) at intra-abdominal pressures (IAPs) of 10 and 15 mm Hg. Secondary objectives were assessment of surgeons' visualization of the operative field, anesthesiologists' ability to maintain adequate end-tidal CO2 (etCO2), and patients' report of postoperative shoulder pain. DESIGN: A randomized controlled trial using an equal allocation ratio into 4 arms: standard insufflation/IAP 10 mm Hg, standard insufflation/IAP 15 mm Hg, valveless insufflation/IAP 10 mm Hg, and valveless insufflation/IAP 15 mm Hg. SETTING: Single tertiary care academic institution. PATIENTS: Women ≥ 18 years old undergoing nonemergent conventional or robotic gynecologic laparoscopic surgery. INTERVENTIONS: A standard or valveless insufflation system at IAPs of 10 or 15 mm Hg. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-two patients were enrolled and randomized with 33 patients per group. There were 84 robotic cases and 47 conventional laparoscopic cases. CO2 absorption rates (mL/kg*min) did not differ across groups with mean rates of 4.00 ± 1.3 in the valveless insufflation groups and 4.00 ± 1.1 in the standard insufflation groups. The surgeons' rating of overall visualization of the operative field on a 10-point Likert scale favored the valveless insufflation system (median visualization, 9.0 ± 2.0 cm and 9.5 ± 1.8 cm at 10 and 15 mm Hg, respectively) over standard insufflation (7.0 ± 3.0 cm and 7.0 ± 2.0 cm at 10 and 15 mm Hg, respectively; p <.001). The anesthesiologists' ability to maintain adequate etCO2 was similar across groups (p = .417). Postoperative shoulder pain scores were low overall with no significant difference across groups (p >.05). CONCLUSION: CO2 absorption rates, anesthesiologists' ability to maintain adequate etCO2, and postoperative shoulder pain did not differ based on insufflation system type or IAP. Surgeons' rating of visualization of the operative field was significantly improved when using the valveless over the standard insufflation system.

Feasibility of the new sutureless excimer laser-assisted non-occlusive anastomosis clip in a rabbit model.

BACKGROUND: The excimer laser-assisted non-occlusive anastomosis (ELANA) technique facilitates the construction of anastomoses without temporary occlusion of the recipient artery. Experiments aimed at simplifying the technique eventually resulted in a sutureless ELANA slide (SEsl) anastomosis. After the first clinical use, new insights lead to the application of a clip at the back of the device, the SELANA clip (SEcl). The SEcl offers a distinct advantage over the SEsl since no sealant is necessary. In this study, we determine the feasibility of the SEcl anastomosis in an in vivo rabbit model. METHODS: 15 SEcl anastomoses and 15 conventional ELANA anastomoses were created on the abdominal aorta in 5 rabbits. Mean application times, flap retrieval rates, hemostasis, and burst pressures were assessed. RESULTS: The mean application time of the SEcl anastomoses was 11.4 min versus 39.0 min for the ELANA anastomoses (mean difference, 27.6 min; 95% CI, 20.6-34.7). The flap retrieval rate of the SEcl anastomoses (14/15) was not inferior to the flap retrieval rate of the ELANA anastomoses (13/15). Direct hemostasis was achieved in 13/15 (87%) SEcl anastomoses and in 14/15 (94%) ELANA anastomoses. All SEcl anastomoses were resistant to provoked pressures until 250 mmHg. CONCLUSION: The SEcl anastomosis is technically feasible in in vivo experiments. Mean application time, flap retrieval rate, hemostasis, and burst pressure are not inferior to the conventional ELANA anastomosis. Further long term experiments should be performed to assess safety, patency, and reendothelialization.

Customized disposable kit versus a conventional stainless steel instrument for an intravitreal injection: A comparison.

Comparison of a customized disposable kit with a conventional stainless steel instrument was performed for an intravitreal injection. A total of 2700 eyes of 2250 patients were enrolled in two groups. Comfort level of the patients was assessed using a 'Pain Scale' and any post intravitreal injection complications were examined clinically by a slit lamp biomicroscopy. Surgeon's ease was assessed by a questionnaire. In group A, no pain was recorded in 1231(82.06%) eyes, mild pain was d escribed in 184(12.27%), moderate pain was documented in 78 (5.2%) while, severe pain was noticed in 7(0.47%). In group B, no pain was seen in 1014(84.5%), mild pain was present in 123(10.25%), moderate pain was perceived in 58 (4.83%) while, severe pain was recorded in 5 (0.42%). With respect to surgeon's ease, 6 out of the 7 surgeons found the kit to be more convenient and cost effective as compared to the conventional instruments. Disposable intravitreal kit is beneficial for both the patients as well as the surgeons.

Prediction of the service life of surgical instruments from the surgical instrument management system log using radio frequency identification.

BACKGROUND: Bar code- or radio frequency identification (RFID)-based medical instrument management systems have gradually been introduced in the field of surgical medicine for the individual management and identification of instruments. We hypothesized that individual management of instruments using RFID tags can provide previously unavailable information, particularly the precise service life of an instrument. Such information can be used to prevent medical accidents caused by surgical instrument failure. This study aimed to predict the precise service life of instruments by analyzing the data available in instrument management systems. METHODS: We evaluated the repair history of instruments and the usage count until failure and then analyzed the data by the following three methods: the distribution of the instrument usage count was determined, an instrument failure probability model was generated through logistic regression analysis, and survival analysis was performed to predict instrument failure. RESULTS: The usage count followed a normal distribution. Analysis showed that instruments were not used uniformly during surgery. In addition, the Kaplan-Meier curves plotted for five types of instruments showed significant differences in the cumulative survival rate of different instruments. CONCLUSIONS: The usage history of instruments obtained with RFID tags or bar codes can be used to predict the probability of instrument failure. This prediction is significant for determining the service life of an instrument. Implementation of the developed model in instrument management systems can help prevent accidents due to instrument failure. Knowledge of the instrument service life will also help in developing a purchase plan for instruments to minimize wastage.

How I do it? Endoscopic discectomy using a new trocar "Endospine Plus" for lumbar prolapsed intervertebral disc.

BACKGROUND: Endoscopic spine surgery is a promising minimally invasive technique and use of trocars like Metrx (Neurosurgery 51(5):S129-36, 2002), Destandau (Neurol Res 21:39-42, 1999), and Easy go (Acta Neurochir (Wien) 151:1027­33, 2009) has revolutionized this field. However, the steep learning curve makes this procedure elusive to many parts of the world. METHODS: The authors describe the technique of pure endoscopic discectomy using a specialized trocar devised by the senior author "Endospine Plus" which makes the technique easy to learn along with the advantages and complications of the procedure. CONCLUSIONS: Endoscopic lumbar discectomy is a safe and effective technique for the treatment of prolapsed intervertebral disc.

Minimally invasive surgical clip closure of anorectal fistulas: current status of OTSC Proctology.

OTSC Proctology is a minimally invasive sphincter-preserving technique for the surgical treatment of anorectal fistulas. It is based on a super-elastic Nitinol clip which closes the internal fistula opening to allow healing of the fistula tract. A systematic search of the literature was undertaken to identify publications about OTSC Proctology. All studies and reports identified were reviewed and evaluated to determine the feasibility, efficacy and safety of clip surgery. The assessment of all available studies with a total of more than 200 surgical cases strongly suggests that the clip procedure is safe and effective with a low rate of complications. The technique rendered convincing short and long term results with an overall healing rate of approximately 63%. Best results were achieved when OTSC Proctology was used as first-line treatment (healing rate 74%) and for cryptoglandular fistulas (healing rate 64%). However, its future clinical role for IBD-associated recurrent and anorecto-vaginal fistulas remains to be determined, due to a relatively low number of these patients in the evaluated studies. OTSC Proctology is part of the novel armamentarium for the treatment for anorectal fistulas, which is based on high-technology devices. They can be repeatedly used and even combined without causing irreversible sphincter damage.

Comparison of two methods for endoscopic full-thickness resection of gastrointestinal lesions using OTSC.

Background and aims: The aim of this study was to compare and analyze the feasibility and safety of two methods of endoscopic full-thickness resection (EFTR) for the management of challenging epithelial and subepithelial neoplasms that are not amenable to resection techniques.Material and methods: This was a retrospective case series study of patients who underwent one of two methods of EFTR, resection using ESD knives and post-resection closure with OTSC (Group 1), or closure with OTSC and secondary EFTR with snare (Group 2).Results: Of 11 patients, six were in Group 1 and five in Group 2. The mean time of the EFTR procedure was 76.83 ± 34.97 min in Group 1 which is significantly longer than that of Group 2 (p = .0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rates of Group 1 and Group 2 were 83.3% and 100% (p = .338), respectively. VAS scores of Group 1 immediately after the operation and after 24 h are significantly higher than those of Group 2 (p = .047 and p = .009, respectively). In Group 1, one patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain. No complications associated with the endoscopic procedure were observed in Group 2.Conclusion: EFTR of pre-resection closure are potentially faster compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.

[Subcontracting a steam sterilization activity: Impact on surgical instruments]. / Externalisation de l'activité de stérilisation : impact sur l'état des instruments chirurgicaux.

Subcontracting our institution's sterilization activity induced the implementation of an automated cleaning facility. Following this development, some of the resterilizable stainless steel needle holders started to show abnormal corrosion. Our study goal was to investigate the causes of this corrosion in order to optimize the sterilization circuit. A full sterilization process mapping and Ishikawa diagram enabled us to identify potential causes of corrosion. The needle holders' intrinsic characteristics, like steel quality and manufacturing, were analyzed as well as extrinsic factors such as the influence of preprocessing soaking conditions, steel passivation, water quality and the impact of corrosion inhibitors. Each potential factor of corrosion was tested in real conditions on needle holders' kits. The needle holders steel grade complies with medical standards and the tests showed that passivation and pre-processing conditions were not involved in the occurrence of corrosion, contrary to soaking length and use of softened rinsing water, containing more chloride than reverse osmosis water, and, thus conducive to rust formation. Moreover, corrosion inhibitors were deemed ineffective or incompatible. Due to this analysis, the incidence of corrosion was reduced by switching softened water to osmosis water and by introducing dynamic drying in the automated cleaning process. In addition, this work stresses the importance of minimizing waiting times and auditing the sterilization circuit before any subcontracting. Management Guidelines related to sterilization's outsourcing would probably have helped to limit this episode.

Rotational component alignment in patient-specific total knee arthroplasty compared with conventional cutting instrument.

BACKGROUND: Although many studies investigated the accuracy of customized cutting block (CCB), the data on rotational alignment are still lacking. The study aimed to assess whether CCB improved the component rotational position compared with conventional cutting instrument (CCI) using computed tomography scanning. METHODS: Eighty-six of 102 total knee arthroplasties from the previous randomized study were analyzed. The outcomes were rotational position of the femoral and tibial components, frequency of outliers and intra-class correlation coefficient. RESULTS: The mean femoral component rotation was not different between CCB versus CCI: 0.9° ± 0.8° versus 1.1° ± 1.1° (P = 0.29). Both groups had similar outlier frequencies: 2% (CCB) versus 2% (CCI) (P = 0.74). CCB had nearly 1° less mean tibial component deviation compared with CCI (P < 0.001): (1) dorsal tangent reference (DTR): 0.7° ± 0.8° versus 1.5° ± 1.0°, and (2) tibial trans-epicondylar reference (TTR): 0.5° ± 0.9° versus 1.4° ± 1.1°. Outlier frequencies were similar: (1) DTR: 0% CCB versus 5% CCI (P = 0.24), and (2) TTR: 5% in CCB versus 12% CCI (P = 0.20). Measurements based on tibial tubercle showed that CCB had ~ 1.4° less mean tibial component deviation compared with CCI: 0.3° ± 1.4° versus 1.7° ± 1.6° (P < 0.001) with a corresponding, less frequency of outliers: 0% versus 19% (P = 0.002). However, there was poor intra-observer reproducibility (0.61). CONCLUSIONS: CCB did not improve femoral component rotational alignment compared with CCI nor affect outlier frequency, but it marginally improved the accuracy of tibial rotational alignment. The tibial tubercle reference point had poor intra-observer reproducibility.

Application of a sub-specialties management model improves quality control in a central sterile supply department.

BACKGROUND: The management of medical devices is crucial to safe, high-quality surgical care, but has received little attention in the medical literature. This study explored the effect of a sub-specialties management model in the Central Sterile Supply Department (CSSD). METHODS: A traditional routine management model (control) was applied from September 2015 through April 2016, and a newly developed sub-specialties management model (observation) was applied from July 2016 through February 2017. Health personnel from various clinical departments were randomly selected to participate as the control (n = 86) and observation (n = 90) groups, respectively. The groups were compared for rates of personnel satisfaction, complaints regarding device errors, and damage of medical devices. RESULTS: The satisfaction score of the observation group (95.8 ± 1.2) was significantly higher than that of the control (90.2 ± 2.3; P = 0.000). The rate of complaints of the observation group (3.3%) was significantly lower than that of the control (11.6%; P = 0.035). The quality control regarding recycle and packing was significantly higher during the observation period than the control period, which favorably influenced the scores for satisfaction. The rate of damage to specialist medical devices during the observation period (0.40%) was lower than during the control period (0.61%; P = 0.003). The theoretical knowledge and practical skills of the CSSD professionals improved after application of the sub-specialties management model. CONCLUSIONS: A management model that considers the requirements of specialist medical devices can improve quality control in the CSSD.

Sterility of Selected Operative Sites During Total Laparoscopic Hysterectomy.

STUDY OBJECTIVE: To describe the type and quantity of bacteria found intraoperatively on the abdomen, vagina, surgical gloves, instrument tips, and uterus at distinct time points during total laparoscopic hysterectomy (TLH). DESIGN: Observational study (Canadian Task Force classification III). SETTING: Academic affiliated hospital. PATIENTS: Thirty-one women undergoing TLH for benign indications in 2016. INTERVENTIONS: After antibiotic prophylaxis and chlorhexidine preparation, swabs were collected from the vaginal fornices and abdomen. During subsequent TLH, additional swabs were collected from the following sites: surgeon's gloves after placement of the uterine manipulator, tips of instruments used to close the vaginal cuff, uterine fundus after extraction, and surgeon's gloves after removal of the uterus. A calibrated loop was used to inoculate each specimen onto 5% blood and chocolate agars for growth of aerobes and onto Brucella blood, phenylethyl alcohol, kanamycin vancomycin, and Bacteroides bile esculin agars for growth of anaerobes. Manual colony counts were tabulated for all positive cultures and reported in colony-forming units per milliliter (CFU/mL). MEASUREMENTS AND MAIN RESULTS: Anaerobic growth was not seen on the instrument tips, in the vagina, or on the abdomen of any patient. Aerobic bacterial growth was not seen in the vagina of any patient. On the surgeon's gloves after uterine manipulator placement, no patients demonstrated sufficient bacterial growth to potentially cause surgical site infection (≥5000 CFU/mL). On the surgeon's gloves following uterine extraction, 1 patient demonstrated sufficient growth to potentially cause infection. None of the patients developed surgical site infections postoperatively. CONCLUSION: Cultures from multiple operative sites yielded bacterial growth, but the bacterial concentrations did not exceed the threshold for infection in 98.9% of cultures. Given absent growth from vaginal cultures and rare growth from abdominal cultures, chlorhexidine gluconate 4% is considered an appropriate surgical preparation for use in laparoscopic hysterectomy.

Mechanical evaluation of cerebral aneurysm clip scissoring phenomenon: comparison of titanium alloy and cobalt alloy.

Cerebral aneurysm clip blades crossing during surgery is well known as scissoring. Scissoring might cause rupture of the aneurysm due to laceration of its neck. Although aneurysm clip scissoring is well known, there have been few reports describing the details of this phenomenon. Quasi-scissoring phenomenon was introduced mechanically by rotating the clip head attached to a silicone sheet. The anti-scissoring torque during the twist of the blades was measured by changing the depth and the opening width. The closing force was also evaluated. Sugita straight clips of titanium alloy and cobalt alloy were used in the present study. In both materials, the anti-scissoring torque and the closing force were bigger 3 mm in thickness than 1 mm. The initial closing forces and the anti-scissoring torque values at each rotation angles were increased in proportion to depth. Closing forces of titanium alloy clip were slightly higher than those of cobalt alloy clip. By contrast, anti-scissoring torque values of cobalt alloy clip were bigger than those of titanium alloy clip in all conditions. In condition of 3 mm in thickness and 3 mm in depth, anti-scissoring torque vales of titanium alloy clip decreased suddenly when an angle surpassed 70 degrees. Aneurysm clip scissoring phenomenon tends to occur when clipping the aneurysm neck only with blade tips. Based on the results of this experiment, titanium alloy clip is more prone to scissoring than cobalt alloy clip under the condition that the wide blade separation distance and the shallow blade length.

Comparison of Keyes Punch Biopsy Instrument with Cervical Punch Biopsy Forceps for Diagnosing Cervical Lesions.

OBJECTIVE: To assess the feasibility and efficacy of Keyes punch biopsy instrument (KP) in diagnosing cervical lesions and compare it with cervical punch biopsy forceps (CP). METHODS: 75 women having satisfactory colposcopy with abnormal transformation zone were included and paired colposcopic directed biopsies were taken using KP followed by CP from the same target area. RESULTS: It was feasible in all cases to take cervical biopsy with KP after increasing its effective length. The volume of gross specimen obtained by KP was less than CP (0.076 ± 0.097 vs. 0.101 ± 0.156 cm3, p = 0.061), however on microscopic examination, mean length and mean depth of tissue in KP was greater than CP by 0.06 mm (p = 0.810) and 0.14 mm (p = 0.634) respectively. Exact agreement was found with the final surgical specimen in 42% of cases in both the biopsy forceps. CONCLUSION: KP is almost at par with CP for diagnosing preinvasive cervical lesions and is a useful adjunct to the existing armamentarium of biopsy forceps.

Vascular control during laparoscopic kidney donation.

SUMMARY: Laparoscopic donor nephrectomy (LDN) is the gold standard for kidney donation. Recent literature has led to considerable debate regarding the safest route to provide vascular control during this procedure. The most common devices used for vascular control during LDN are staplers and surgical clips. Opinions regarding the safety of these devices vary, as both are prone to dysfunction. Certain clips have already been contraindicated for use on the donor artery owing to reports of catastrophic complications of falling off. Donor safety is paramount to the continued success of renal transplantation in Canada. A review of existing practice at each institution may be called for to ensure the safest standards possible are in place. An appendix to this commentary is available at canjsurg.ca.

[Prevention of the wound infection: little changes, huge results]. / Resultados de la modificación de la actitud ante la asepsia en cirugía neonatal: pequeños cambios, grandes resultados.

INTRODUCTION: Neonatal surgical wound infection occurs in almost 50% of neonatal procedures. It increases the rates of morbimortality in neonatal units. There is no guidelines about prevention of wound infection in neonatal surgery. We present our results after changing our behaviour in neonatal surgery. MATERIALS AND METHODS: Comparative study between 2 groups. In order to decrease wound infection at the end of the procedure gloves, covertures and surgical instruments were changed and saline and antiseptic solutions were used during laparotomy closing. Group P included procedures with these recommendations and Group NP without them. Age, weight, surgery, infection, length of stay, and mortality were analized between groups through a logistic regression model. RESULTS: Group P included 55 procedures in 32 patients, median weight 1,300 g (1,000-2,100), 19 median days of life (6-40), 5 postoperative wound problems (9%). Group NP included 26 procedures in 14 neonates, median weight 1,700 g (700-2,500), 20 median days of life (3-33), 14 wound problems (53.8%). We decrease the wound problems in our patients in 44.8% (p < 0.0001). Additionally, the protection provided by our recommendations was maintained after adjustment by weight, age and type of pathology (0.07) p= 0.000. CONCLUSIONS: Simple changes in during the procedures in neonatal surgery can reduce the appearance of wound infection and morbidity.

OBJETIVOS: La infección de herida quirúrgica neonatal tiene una incidencia de hasta el 50% y produce un aumento de morbimortalidad. No existen recomendaciones preventivas consensuadas en la literatura. Presentamos los resultados tras la implantación de un protocolo creado en nuestro Servicio para cierre de laparotomía en cirugía neonatal contaminada y sucia. MATERIAL Y METODOS: Estudio ambispectivo de las laparotomías neonatales realizadas durante 32 meses comparando los resultados con un grupo de pacientes intervenidos durante un período previo similar. El protocolo incluye cambio de guantes, de campo y material quirúrgico, lavado por planos con antiséptico y sutura antibacteriana en el cierre. Se analizan edad, peso, tipo de intervención, infección, estancia hospitalaria y mortalidad y se compara con un grupo similar de pacientes intervenidos de forma previa a la creación del protocolo (NP) y se analiza la influencia del protocolo en la aparición de infección mediante regresión logística. RESULTADOS: El grupo P incluye 55 laparotomías en 32 neonatos con mediana de peso 1.300 g (1.000-2.100), mediana de edad 19 días (6-40) con 3 infecciones de herida (2 cultivos positivos) y 2 dehiscencias leves (9%). El grupo NP incluyó 26 intervenciones en 14 neonatos, mediana de peso 1.700 g (700-2.500), mediana de edad 20 días (3-33), 14 infecciones (53,8%), 8 cultivos positivos y 2 muertes. Se redujo un 44,8% la aparición de infección (p < 0,0001) y el efecto protector del protocolo se mantuvo después del ajuste por peso, edad y tipo de patología (0,07) p= 0,000. CONCLUSIONES: La sencilla modificación de la asepsia y técnica de cierre ha contribuido a disminuir considerablemente la tasa de infección y morbimortalidad en nuestros pacientes y consideramos que es necesario hacer conciencia de ello.

Code Grey: Stained Surgical Instruments and Their Impact on One Canadian Health Authority.

In 2016, NL's largest RHA was faced with serious challenges stemming from the discovery of stained surgical instruments at its two largest hospitals. This discovery prompted a series of postponed surgeries, an extensive internal mobilization of labour and the purchase of millions of dollars of new equipment. In tackling these challenges, the organization not only acquired a better understanding of its surgical tools, but it also gained renewed appreciation for the resilience of its human resources. By describing this incident and the lessons learned, we hope to offer insight to providers in similar circumstances.

Validation of Reverse-Engineered and Additive-Manufactured Microsurgical Instrument Prototype.

With advancements in imaging techniques, neurosurgical procedures are becoming highly precise and minimally invasive, thus demanding development of new ergonomically aesthetic instruments. Conventionally, neurosurgical instruments are manufactured using subtractive manufacturing methods. Such a process is complex, time-consuming, and impractical for prototype development and validation of new designs. Therefore, an alternative design process has been used utilizing blue light scanning, computer-aided designing, and additive manufacturing direct metal laser sintering (DMLS) for microsurgical instrument prototype development. Deviations of DMLS-fabricated instrument were studied by superimposing scan data of fabricated instrument with the computer-aided designing model. Content and concurrent validity of the fabricated prototypes was done by a group of 15 neurosurgeons by performing sciatic nerve anastomosis in small laboratory animals. Comparative scoring was obtained for the control and study instrument. T test was applied to the individual parameters and P values for force (P < .0001) and surface roughness (P < .01) were found to be statistically significant. These 2 parameters were further analyzed using objective measures. Results depicts that additive manufacturing by DMLS provides an effective method for prototype development. However, direct application of these additive-manufactured instruments in the operating room requires further validation.

Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces.

Increasing drying time adversely affects attachment of tissue proteins and prion-associated amyloid to surgical stainless steel, and reduces the efficacy of commercial cleaning chemistries. This study tested the efficacy of commercial humidity retention bags to reduce biofouling on surgical stainless steel and to improve subsequent cleaning. Surgical stainless steel surfaces were contaminated with ME7-infected brain homogenates and left to dry for 15 to 1,440 min either in air, in dry polythene bags or within humidity retention bags. Residual contamination pre/post cleaning was analysed using Thioflavin T/SYPRO Ruby dual staining and microscope analysis. An increase in biofouling was observed with increased drying time in air or in sealed dry bags. Humidity retention bags kept both protein and prion-associated amyloid minimal across the drying times both pre- and post-cleaning. Therefore, humidity bags demonstrate a cheap, easy to implement solution to improve surgical instrument reprocessing and to potentially reduce associated hospital acquired infections.