[Time management in operating rooms-a cross-sectional study to evaluate estimated and objective durations of otorhinolaryngologic surgical procedures]. / Zeitmanagement im OP ­ eine Querschnittstudie zur Bewertung der subjektiven und objektiven Dauer chirurgischer Prozeduren im HNO-Bereich.

BACKGROUND: Accurate planning of operating times in surgical clinics is essential. Moreover, high-capacity utilization of operating rooms (ORs) is necessary for economic efficiency. OBJECTIVE: Most planning of operating times is performed by surgeons. Herein, surgeons' estimated times and the objective times for performing surgical procedures were compared to detect sources of error. MATERIALS AND METHODS: In a retrospective analysis, the durations of 1809 operations using general anesthesia (22 types of surgery) by 31 surgeons (12 specialists and 19 residents) were compared. Comparisons were analyzed by Mann-Whitney U­tests. RESULTS: The comparison of objective times of surgical action showed significant differences between specialists and residents in 6 of 15 types of surgeries. The post-processing times estimated by specialists deviated from the objective times in 2 out of 22 surgery types, while the post-processing times estimated by residents deviated in 7 of 15 types. Specialists misjudged the incision-to-suture times in 7 of 22 surgery types, and residents misjudged these times in 3 of 15 types. The preparation times estimated by specialists deviated from the objective times in 16 of 22 types of surgeries and in 7 of 15 types estimated by residents. CONCLUSION: A surgeon's routine must be carefully considered in order to estimate operating times. Specialists generally underestimated preparation and post-processing times and overestimated incision-to-suture times, whereas residents underestimated all three. Preparation and post-processing times must be considered in planning and, ideally, determined together with anesthesiologists and surgical assistants.

Navigation-guided biopsy of retropharyngeal lymph nodes.

The impact of metastasis to the retropharyngeal lymph node group is poorly understood because of the difficult access to the retropharyngeal space (RPS). In 20%-50% of surgically treated oropharyngeal, hypopharyngeal, and cervical oesophageal carcinomas, we can find metastases to the retropharyngeal lymph nodes (RPLNs). 1 The use of a three-dimensional (3D)-imaging-guided navigation system to perform a biopsy for a suspicion of metastasis in an RPLN can provide advantages in terms of better precision and 3D orientation with protection of the surrounding critical structures. We report two cases of an open biopsy by transoral and transnasal approaches for a suspicion of metastasis in a retropharyngeal lymph node in two patients with oropharyngeal and pulmonary cancer, respectively, by using the 3D imaging-guided navigation system. In the both cases, the biopsies performed were very accurate and allowed to get a full histological analysis and diagnosis. The use of the navigation system as a means to perform biopsies in the soft tissue of the neck is rarely reported and up to date few reports can be found in the literature. This technique can provide multiple advantages when compared with other conventional methods. The procedure is simple, safe and minimally invasive.

Repair of displaced thyroid cartilage fracture using miniplate osteosynthesis.

Acute laryngeal trauma is estimated to occur in approximately one patient per 14 500 to 42 500 emergency room admissions. If the larynx is injured, its vital functions are affected and can be threatened in case of severe injury. Soft cartilage offers no protective advantage, which is the reason why young as well as older individuals are at risk of thyroid cartilage fracture. Experimentation on cadaver larynx has demonstrated that virtually all laryngeal fractures are longitudinally oriented. Furthermore, muscular pull can contribute to a misalignment of the fractures. As stated by Bent and Porubsky, a fracture is considered severely rather than moderately displaced, if it is freely mobile on physical examination, has more than two fracture lines or demonstrates a displacement greater than the width of the thyroid cartilage on CT imaging. We present two cases of severely displaced thyroid cartilage fracture treated in our department by open reduction and internal fixation using miniplates. Functional and radiological outcomes were excellent.