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1.
Bone Joint J ; 103-B(6): 1078-1087, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34058867

RESUMEN

AIMS: It has been suggested that the direct anterior approach (DAA) should be used for total hip arthroplasty (THA) instead of the posterior approach (PA) for better early functional outcomes. We conducted a value-based analysis of the functional outcome and associated perioperative costs, to determine which surgical approach gives the better short-term outcomes and lower costs. METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and the Cochrane Handbook. Several online databases were searched. Non-stratified and stratified meta-analyses were conducted to test the confounding biases in the studies which were included. The mean cost and probability were used to determine the added costs of perioperative services. RESULTS: The DAA group had significantly longer operating times (p < 0.001), reduced length of hospital stay by a mean of 13.4 hours (95% confidence interval (CI) 9.12 to 18; p < 0.001), and greater blood loss (p = 0.030). The DAA group had significantly better functional outcome at three (p < 0.001) and six weeks (p = 0.006) postoperatively according to the Harris Hip Score (HHS). However, there was no significant difference between the groups for the HHS at six to eight weeks (p = 0.230), 12 weeks (p = 0.470), six months (p = 0.740), and one year (p = 0.610), the 12-Item Short Form Survey (SF-12) physical score at six weeks (p = 0.580) and one year (p = 0.360), SF-12 mental score at six weeks (p = 0.170) and one year (p = 0.960), and University of California and Los Angeles (UCLA) activity scale at 12 weeks (p = 0.250). The mean non-stratified and stratified difference in costs for the operating theatre time and blood transfusion were $587.57 (95% CI 263.83 to 1,010.29) to $887.04 (95% CI 574.20 to 1,298.88) and $248.38 (95% CI 1,003.40 to 1,539.90) to $1,162.41 (95% CI 645.78 to 7,441.30), respectively, more for the DAA group. However, the mean differences in costs for the time in hospital were $218.23 and $192.05, respectively, less for the DAA group. CONCLUSION: The use of the DAA, rather than the PA, in THA has earlier benefits for function and pain. However, these are short-lasting, with no significant differences seen at later intervals. In addition the limited benefits were obtained with higher cumulative costs for DAA. Cite this article: Bone Joint J 2021;103-B(6):1078-1087.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/economía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Tempo Operativo , Recuperación de la Función
2.
Bone Joint J ; 103-B(6): 1009-1020, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34058875

RESUMEN

AIMS: The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted total hip arthroplasty (rTHA), and to compare the accuracy, patient-reported functional outcomes, complications, and survivorship between rTHA and manual total hip arthroplasty (mTHA). METHODS: Searches of PubMed, Medline, and Google Scholar were performed in April 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "hip", and "arthroplasty". The criteria for inclusion were published clinical research articles reporting the learning curve for rTHA (robotic arm-assisted only) and those comparing the implantation accuracy, functional outcomes, survivorship, or complications with mTHA. RESULTS: There were 501 articles initially identified from databases and references. Following full text screening, 17 articles that satisfied the inclusion criteria were included. Four studies reported the learning curve of rTHA, 13 studies reported on implant positioning, five on functional outcomes, ten on complications, and four on survivorship. The meta-analysis showed a significantly greater number of cases of acetabular component placement in the safe zone compared with the mTHA group (95% confidence interval (CI) 4.10 to 7.94; p < 0.001) and that rTHA resulted in a significantly better Harris Hip Score compared to mTHA in the short- to mid-term follow-up (95% CI 0.46 to 5.64; p = 0.020). However, there was no difference in infection rates, dislocation rates, overall complication rates, and survival rates at short-term follow-up. CONCLUSION: The learning curve of rTHA was between 12 and 35 cases, which was dependent on the assessment goal, such as operating time, accuracy, and team working. Robotic arm-assisted total hip arthroplasty was associated with improved accuracy of component positioning and functional outcome, however no difference in complication rates or survival were observed at short- to mid-term follow-up. Overall, there remains an absence of high-quality level I evidence and cost analysis comparing rTHA and mTHA. Cite this article: Bone Joint J 2021;103-B(6):1009-1020.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Curva de Aprendizaje , Tempo Operativo , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias , Supervivencia
3.
Medicine (Baltimore) ; 100(21): e26204, 2021 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-34032781

RESUMEN

ABSTRACT: Laparoscopic pancreaticoduodenectomy (LPD) is widely used as a treatment for periampullary tumors and pancreatic head tumors. However, postoperative pancreatic fistula (POPF), which significantly affects mortality and length of hospital stay of patients, remains one of the most common and serious complications following LPD. Though numerous technical modifications for pancreaticojejunostomy (PJ) have been proposed, POPF is still the "Achilles heel" of LPD.To reduce POPF rate and other postoperative complications following LPD by exploring the best approach to manage with the pancreatic remnant, a novel duct-to-mucosa anastomosis technique named Double Layer Running Suture (Double R) for the PJ was established. During 2018 and 2020, a totally 35 patients who underwent LPD with Double R were included, data on the total operative time, PJ duration, estimated blood loss, recovery of bowel function, postoperative complications, and length of hospital stay were collected and analyzed.The average duration of surgery was (380 ±â€Š69) minutes. The mean time for performing PJ was (34 ±â€Š5) minutes. The average estimated blood loss was (180 ±â€Š155) mL. The overall POPF rate was 8.6% (3/35), including 8.6% (3/35) for the biochemical leak, 0% (0/35) for Grade B, and 0% (0/35) for Grade C. No patient suffered from biliary fistula, post-pancreatectomy hemorrhage, and intra-abdominal infection, the 30-day mortality was 0%.Double R anastomosis is potentially a safe, reliable, and rapid anastomosis with a low rate of POPF and post-pancreatectomy hemorrhage. It provides surgeons more options when performing LPD. However, its safety and effectiveness should be verified further by a larger prospective multicenter study.


Asunto(s)
Laparoscopía/métodos , Pancreaticoduodenectomía/métodos , Pancreatoyeyunostomía/métodos , Técnicas de Sutura , Adulto , Anciano , Neoplasias del Sistema Biliar/cirugía , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Intestinos/fisiología , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Fístula Pancreática/prevención & control , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Pancreatoyeyunostomía/efectos adversos , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/prevención & control , Recuperación de la Función , Estudios Retrospectivos , Técnicas de Sutura/efectos adversos
4.
Bone Joint J ; 103-B(6 Supple A): 131-136, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34053278

RESUMEN

AIMS: It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons. METHODS: This retrospective study involved patients who underwent aseptic unilateral rTKA between January 2016 and March 2019, using the database of a large urban academic medical centre. Surgeons who performed ≥ 19 aseptic rTKAs per year during the study period were considered HV and those who performed < 19 per year were considered LV. Demographic characteristics, surgical factors, and postoperative outcomes were compared between the two groups. RESULTS: A total of 308 rTKAs were identified, 132 performed by HV surgeons and 176 by 22 LV surgeons. The LV group had a significantly greater proportion of non-smokers (59.8% vs 49.2%; p = 0.029). For all types of revision, HV surgeons had significantly shorter mean operating times by 17.75 minutes (p = 0.007). For the 169 full revisions (85 HV, 84 LV), HV surgeons had significantly shorter operating times (131.12 (SD 33.78) vs 171.65 (SD 49.88) minutes; p < 0.001), significantly lower re-revision rates (7.1% vs 19.0%; p = 0.023) and significantly fewer re-revisions (0.07 (SD 0.26) vs 0.29 (SD 0.74); p = 0.017). CONCLUSION: Patients of HV rTKA surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centres of excellence to offer patients the best possible outcomes following rTKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):131-136.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Competencia Clínica , Hospitales de Alto Volumen , Reoperación/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos
5.
Ann R Coll Surg Engl ; 103(6): 444-451, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34058117

RESUMEN

INTRODUCTION: Despite early enthusiasm, minimally invasive cardiac surgery has had a low uptake compared with novel techniques in interventional cardiology. Steep learning curves from high-volume centres have deterred smaller units from engaging, even though low-volume centres undertake a large proportion of surgical interventions worldwide. We sought to identify the safety and experience of learning minimally invasive cardiac surgery after undertaking a structured fellowship at Blackpool Victoria Hospital, a low-volume centre. MATERIALS AND METHODS: A retrospective analysis of outcomes for all consecutive minimally invasive cardiac surgery procedures performed via a right mini-thoracotomy at our institution between 2007 and 2017 was undertaken. Clinical outcomes included death, conversion to sternotomy, stroke, renal failure and other organ support. Cardiopulmonary bypass, aortic cross-clamp times and learning cumulative sum sequential probability method curves were also assessed to determine how safely the procedure was adopted. RESULTS: A total of 316 patients were operated on for mitral, tricuspid, atrial fibrillation, septal defects or other conditions. The mean logistic European System for Cardiac Operative Risk Evaluation score was 7.0 (± 8.5). Conversion to sternotomy occurred in 12 patients (3.8%) and in-hospital mortality was 7 (2.2%). None of the converted patients died. The learning curves showed an accelerated process of adoption, similar to reference figures from a high-volume German centre. DISCUSSION: It is possible for low-volume cardiac surgical centres to undertake minimally invasive surgical programmes with good outcomes and short learning curves. Despite technical complexities, with a team approach, the learning curve can be navigated safely.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Cardiopatías/cirugía , Hospitales de Bajo Volumen/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/cirugía , Puente Cardiopulmonar , Femenino , Defectos de los Tabiques Cardíacos/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Mortalidad Hospitalaria , Hospitales de Bajo Volumen/organización & administración , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Tempo Operativo , Estudios Retrospectivos , Esternotomía , Toracotomía/métodos , Adulto Joven
6.
Acta Cir Bras ; 36(3): e360308, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33978064

RESUMEN

PURPOSE: To evaluate hemostasis of the ovarian arteriovenous complex (OAVC) in relation to surgical time, practicality and feasibility in three ovariohysterectomy (OH) techniques for queens. METHODS: The experiment was performed on 21 female cats aged between six months and seven years, randomly arranged into three groups in a completely randomized design. Group one was spayed using the conventional three-clamp technique, group two using the OAVC knotting technique, and group three using the ovarian pedicle rotation technique. The student's t-test and Tukey's test were used to compare the mean surgical times. RESULTS: The conventional technique, which uses thread wires, was more laborious and required longer execution time compared to the other two techniques. The OAVC knotting technique was the fastest and had the least blood loss. CONCLUSIONS: The use of techniques that do not use synthetic materials for OAVC hemostasis was proven to be appropriate in castration projects, provided that the surgical team has sufficient training.


Asunto(s)
Histerectomía , Ovario , Animales , Gatos , Femenino , Hemostasis , Humanos , Histerectomía/veterinaria , Tempo Operativo , Ovariectomía , Ovario/cirugía
7.
BMC Surg ; 21(1): 264, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34044817

RESUMEN

BACKGROUND: This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility. METHODS: This retrospective case-control study was performed on 236 robotic myomectomies at a university medical center. After 1:1 propensity score matching for the total myoma number, total myoma diameter, and patient age, 90 patients in each group (RSS: n = 90; RMP: n = 90) were evaluated. Patient demographics, preoperative parameters, intraoperative characteristics, and postoperative outcome measures were analyzed. RESULTS: The body mass index, parity, preoperative hemoglobin levels, mean maximal myoma diameter, and anatomical type of myoma showed no mean differences between RSS and RMP myomectomies. The RSS group was younger, had lesser number of myomas removed, and had a smaller sum of the maximal diameter of total myomas removed than the RMP group. After propensity score matching, the total operative time (RSS: 150.9 ± 57.1 min vs. RMP: 170 ± 74.5 min, p = 0.0296) was significantly shorter in the RSS group. The RSS group tended to have a longer docking time (RSS: 9.8 ± 6.5 min vs. RMP: 8 ± 6.2 min, p = 0.0527), shorter console time (RSS: 111.1 ± 52.3 min vs. RMP: 125.8 ± 65.1 min, p = 0.0665), and shorter time required for in-bag morcellation (RSS: 30.1 ± 17.2 min vs. RMP: 36.2 ± 25.7 min, p = 0.0684). The visual analog scale pain score 1 day postoperatively was significantly lower in the RSS group (RSS: 2.4 ± 0.8 days vs. RMP: 2.7 ± 0.8 days, p = 0.0149), with similar consumption of analgesic drugs. The rate of transfusion, estimated blood loss during the operation, and length of hospital stay were not different between the two modalities. No other noticeable complications were observed in either group. CONCLUSIONS: Da Vinci RSS myomectomy is a compatible option with regard to reproducibility and safety, without significantly compromising the number and sum of the maximal diameter of myomas removed. The advantage of shorter total operative time and less pain with the same amount of analgesic drugs in RSS myomectomy will contribute to improving patient satisfaction.


Asunto(s)
Laparoscopía , Leiomioma , Procedimientos Quirúrgicos Robotizados , Miomectomía Uterina , Neoplasias Uterinas , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Leiomioma/cirugía , Tempo Operativo , Embarazo , Reproducibilidad de los Resultados , Estudios Retrospectivos , Miomectomía Uterina/efectos adversos , Neoplasias Uterinas/cirugía
8.
Bone Joint J ; 103-B(5): 976-983, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934644

RESUMEN

AIMS: To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. METHODS: In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae. RESULTS: Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors. CONCLUSION: The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: Bone Joint J 2021;103-B(5):976-983.


Asunto(s)
Laminectomía/métodos , Osteotomía/métodos , Complicaciones Posoperatorias , Neoplasias de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/diagnóstico por imagen
9.
Khirurgiia (Mosk) ; (5): 63-71, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33977700

RESUMEN

OBJECTIVE: To evaluate an effectiveness of minilaparotomy in the treatment of choledochal malformation (CM) in children. MATERIAL AND METHODS: The study included children with CM who underwent surgery from January 2010 to May 2020. All patients were divided into 3 groups depending on surgical approach: minilaparotomy (ML), laparoscopy (LS) and laparotomy (LT). We analyzed surgery time, early postoperative outcomes and cosmetic results. RESULTS: There were 99 patients with CM for 10 years. ML was performed in 39 patients, LS - in 51 patients, and LT - in 9 patients. Significantly (p-value <0.001, Kruskal-Wallis test with Dunn paired comparison test, p<0.05) less surgery time was observed in ML group. According to Clavien-Dindo classification of surgical complications, we found a significant prevalence of complications in the LS group (p - 0.018, Kruskal-Wallis test). Moreover, LS was characterized by insignificant (p>0.05) predominance of the most severe complications requiring multiple redo surgeries. CONCLUSION: Currently, open surgery is a "gold standard" in the treatment of children with CM. LS is not preferred in children with CM. ML ensures favorable early outcomes in children with CM.


Asunto(s)
Quiste del Colédoco , Laparoscopía , Niño , Quiste del Colédoco/cirugía , Conducto Colédoco , Humanos , Laparoscopía/efectos adversos , Laparotomía/efectos adversos , Tempo Operativo , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento
10.
Medicine (Baltimore) ; 100(21): e26076, 2021 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-34032738

RESUMEN

ABSTRACT: There has been no ideal surgical approach for lumbar brucella spondylitis (LBS). This study aims to compare clinical efficacy and safety of posterior versus anterior approaches for the treatment of LBS.From April 2005 to January 2015, a total of 27 adult patients with lumbar brucella spondylitis were recruited in this study. The patients were divided into 2 groups according to surgical approaches. Thirteen cases in group A underwent 1-stage anterior debridement, fusion, and fixation, and 14 cases in group B underwent posterior debridement, bone graft, and fixation. The clinical and surgical outcomes were compared in terms of operative time, intraoperative blood loss, hospitalizations, bony fusion time, complications, visual analog scale score, recovery of neurological function, deformity correction.Lumbar brucella spondylitis was cured, and the grafted bones were fused within 11 months in all cases. It was obviously that the operative time and intraoperative blood loss of group A were more than those of group B (P = .045, P = .009, respectively). Kyphotic deformity was signifcantly corrected in both groups after surgery; however, the correction rate was higher in group B than in group A (P = .043). There were no significant differences between the two groups in hospitalizations, bony fusion time, and visual analog scale score in the last follow-up (P = .055, P = .364, P = .125, respectively).Our results suggested that both anterior and posterior approaches can effectively cure lumbar brucella spondylitis. Nevertheless, posterior approach gives better kyphotic deformity correction, less surgical invasiveness, and less complications.


Asunto(s)
Trasplante Óseo/métodos , Brucelosis/cirugía , Vértebras Lumbares/cirugía , Dolor Postoperatorio/diagnóstico , Espondilitis/cirugía , Adulto , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Trasplante Óseo/efectos adversos , Brucella/aislamiento & purificación , Brucelosis/diagnóstico , Brucelosis/microbiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Dimensión del Dolor/estadística & datos numéricos , Dolor Postoperatorio/etiología , Espondilitis/diagnóstico , Espondilitis/microbiología , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 100(20): e25879, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011054

RESUMEN

ABSTRACT: There might be a thick "protrusion" in the visceral surface of hepatic quadrate lobe during the laparoscopic cholecystectomy (LC), which affects the surgical fields and consequently triggers high risks of biliary tract injury. Although n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery for liver retraction, there is still no consensus on its safety and feasibility in LC. In this study, we investigated the safety, feasibility, and effectiveness of liver retraction using NBCA glue for these patients which have the thick "protrusion" on the square leaf surface of the liver during LC.Fifty-seven patients presenting thick "protrusion" hepatic quadrate lobe were included in our retrospective study. We performed LC in the presence of NBCA glue (n = 30, NBCA group) and absence of NBCA glue (n = 27, non-NBCA group), respectively. NBCA was used to fix the thick "protrusion" of the liver leaves to the hepatic viscera surface, which contributed to the revelation of the gallbladder triangle. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the 2 groups.Both the groups' patients accomplished the operation in the laparoscopy. There was no mortality and no additional incision during operation. No severe complications including bile duct injury were available after surgery and no postoperative NBCA-related complications occurred after 9- to 30 months' follow-up. The time of operation in NBCA group showed significant decrease compared with that of non-NBCA group (48.33 ±â€Š16.15 vs 65.00 ±â€Š22.15 minutes, P < .01). There were no significant differences in blood loss, postoperative hospital stays, and the preoperative and postoperative liver function between the two groups (P > .05). Besides, no significant differences were noticed in major clinical characteristics between the 2 groups (P > .05).Liver retraction using NBCA during LC for thick "protrusion" hepatic quadrate lobe patients is safe, effective, and feasible.


Asunto(s)
Colecistectomía Laparoscópica/métodos , Enbucrilato/administración & dosificación , Complicaciones Intraoperatorias/prevención & control , Adhesivos Tisulares/administración & dosificación , Adulto , Anciano , Conductos Biliares/lesiones , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Colecistectomía Laparoscópica/efectos adversos , Enbucrilato/efectos adversos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias/etiología , Tiempo de Internación/estadística & datos numéricos , Hígado , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Adhesivos Tisulares/efectos adversos , Resultado del Tratamiento
12.
West Afr J Med ; 38(5): 498-501, 2021 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-34051724

RESUMEN

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common cause of bladder outlet obstruction in men worldwide. African men are known to have larger mean prostate volumes than other races. Giant benign prostatic hyperplasia (GBPH) is defined as prostate size greater than 200 grams. Management of GBPH is associated with several challenges which have been under-reported from the African sub-region. OBJECTIVE: To highlight the peculiarities of clinical presentation, surgical management and outcome of GBPH. PATIENTS AND METHODS: Men with BPH and trans-rectal ultrasound estimated prostate volume > 200 grams who were scheduled for open simple prostatectomy between January and December 2016 in our hospital were prospectively studied. RESULTS: Four patients with GBPH had simple prostatectomy during the period under review. Their ages ranged from 68 to 78 years with a mean age of 73.7 years.Three patients (75.0%) had transvesical prostatectomy while one (25.0%) had retropubic prostatectomy. The enucleated prostate specimen were found to weigh 312.1g, 396.4g, 420.8g and 450.0g respectively with mean weight of 394.8 ±50.2g and mean operation time of 111.7 ±19.7 minutes. They all had blood transfusion post-operatively with mean transfusion of 3±1.5 pints of blood per patient with relatively longer hospital stay (mean 10 days). CONCLUSION: The surgical management of GBPH can be quite challenging. Recalcitrant gross haematuria, chronic urinary retention and renal impairment are possible modes of presentation. Open simple prostatectomy is the best option for treatment in our environment. It is associated with improved quality of life and minimal morbidity in expert hands.


Asunto(s)
Hiperplasia Prostática , África del Sur del Sahara/epidemiología , Anciano , Humanos , Masculino , Tempo Operativo , Prostatectomía , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/cirugía , Calidad de Vida
13.
Medicine (Baltimore) ; 100(20): e25745, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011033

RESUMEN

ABSTRACT: To analyze the efficacy and safety between bipolar transurethral enucleation of the prostate (BipoLEP) and bipolar transurethral resection of the prostate (B-TURP).One hundred twenty eight patients with benign prostatic hyperplasia were recruited and divided into group 1 (BipoLEP group, n = 72) and group 2 (B-TURP group, n = 56). The study period was from October 2016 to February 2019. All data parameters were prospectively collected and analyzed.In these 2 groups, there were no significant differences of the mean ages (71.88 ±â€Š6.54 years vs 73.05 ±â€Š7.05 years, P = .407), prostate volumes (99.14 ±â€Š9.5 mL vs 95.08 ±â€Š10.93 mL, P = .302) and the mean operation times (93.7 ±â€Š27.5 minutes vs 89.8 ±â€Š22.4 minutes, P = .065). In BipoLEP group, it had more prostate tissue resected (64.2 ±â€Š22.1 g vs 52.7 ±â€Š28.6 g, P = .018), less duration of continuous bladder irrigation (20.7 ±â€Š6.5 hours vs 29.6 ±â€Š8.3 hours, P = .044), shorter catheterization time (4.3 ±â€Š1.5 days vs 5.6 ±â€Š2.1 days, P = .032), shorter hospitalization stay (5.2 ±â€Š1.4 days vs 6.5 ±â€Š1.9 days, P = .031) and less complications (3 cases vs 9 cases, P = .021). There were significant improvements in 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life in each group (p < 0.01). However, there were no significant differences of preoperative and 3-month postoperative parameters, including: post void residual urine, maximum flow rate, International Prostatic Symptoms Scale, and quality of life between these 2 groups (P > .05).BipoLEP can produce a more radical prostatic resection with better safety profile and faster postoperative recovery. It may become a more favorable surgical alternative to the B-TURP, especially for the prostate larger than 80 g.


Asunto(s)
Complicaciones Posoperatorias/epidemiología , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Retención Urinaria/epidemiología , Anciano , Anciano de 80 o más Años , Cateterismo/estadística & datos numéricos , Estudios de Seguimiento , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Próstata/cirugía , Calidad de Vida , Irrigación Terapéutica/estadística & datos numéricos , Resección Transuretral de la Próstata/efectos adversos , Resultado del Tratamiento , Retención Urinaria/diagnóstico , Retención Urinaria/etiología , Retención Urinaria/prevención & control , Urodinámica
14.
Medicine (Baltimore) ; 100(20): e25926, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011064

RESUMEN

BACKGROUND: Several studies have reported that medical robot-assisted method (RA) might be superior to conventional freehand method (FH) in orthopedic surgery. Yet the results are still controversial, especially in terms of femoral neck fractures surgery. Here, 2 methods were assessed based on current evidence. METHODS: Electronic databases including Cochrane Library, PubMed, Web of Science. and EMBASE were selected to retrieved to identify eligible studies between freehand and RAs in femoral neck fractures, with 2 reviewers independently reviewing included studies as well as collecting data. RESULTS: A total of 5 studies with 331 patients were included. Results indicated that 2 surgical methods were equivalent in terms of surgical duration, Harris score, fracture healing time, fracture healing proportion and complications, while RA showed clinical benefits in radiation exposure, intraoperative bleeding, total drilling times, and screw parallelism. CONCLUSIONS: Current literature revealed significantly difference between 2 techniques and suggested that RA might be beneficial for patients than freehand method.


Asunto(s)
Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas/efectos adversos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Robotizados/efectos adversos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/lesiones , Cabeza Femoral/cirugía , Fluoroscopía/efectos adversos , Fluoroscopía/estadística & datos numéricos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Curación de Fractura , Humanos , Tempo Operativo , Tornillos Pediculares , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Robotizados/instrumentación , Factores de Tiempo , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 100(17): e25567, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907106

RESUMEN

ABSTRACT: Surgical site infections (SSIs) are common complications after spinal surgery that result in increased morbidity, mortality, and healthcare costs. It was estimated that SSIs after spinal surgery resulted in a 4-fold increase in health care costs. The reported SSI rate following spinal surgery remains highly variable between approximately 0.5% and 18%. In this study, we aimed to estimate the SSI rate and identify possible risk factors for SSI after spinal surgery in our Saudi patient population.We conducted a single-center, retrospective case-control study in Saudi Arabia that included patients who developed SSIs, while the controls were all consecutive patients who underwent spinal surgery between January 2014 and December 2016. We extracted data on patient characteristics, anthropometric measurements, preoperative laboratory investigations, preoperative infection prevention measures, intraoperative measures, comorbidities, and postoperative care.We included 201 consecutive patients in our study; their median age was 56.9 years, and 51.2% were men. Only 4% (n = 8) of these patients developed SSIs postoperatively. Postoperative SSIs were significantly associated with longer postoperative hospital stays, hypertension, higher American Society of Anesthesia (ASA) scores, longer procedure durations, and the use of a greater number of blood transfusion units.This study revealed a low SSI rate following spinal surgery. We identified a history of hypertension, prolonged hospitalization, longer operative time, blood transfusion, and higher ASA score as risk factors for SSI in spine surgery in our population. As our findings are from a single institute, we believe that a national research collaboration among multiple disciplines should be performed to provide better estimates of SSI risk factors in our patient population.


Asunto(s)
Procedimientos Neuroquirúrgicos/efectos adversos , Columna Vertebral/cirugía , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Anciano , Anestesia/efectos adversos , Anestesia/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Estudios de Casos y Controles , Femenino , Humanos , Hipertensión/complicaciones , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Factores de Riesgo , Arabia Saudita/epidemiología , Reacción a la Transfusión/etiología
16.
Medicine (Baltimore) ; 100(17): e25648, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907124

RESUMEN

BACKGROUND: Robot-assisted and laparoscopic surgery are the most minimally invasive surgical approaches for the removal of liver lesions. Minor hepatectomy is a common surgical procedure. In this study, we evaluated the advantages and disadvantages of robot-assisted vs laparoscopic minor hepatectomy (LMH). METHODS: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify comparative studies on robot-assisted vs. laparoscopicminor hepatectomy up to February, 2020. The odds ratios (OR) and mean differences with 95% confidence intervals were calculated using the fixed-effects model or random-effects model. RESULTS: A total of 12 studies involving 751 patients were included in the meta-analysis. Among them, 297 patients were in the robot-assisted minor hepatectomy (RMH) group and 454 patients were in the LMH group. There were no significant differences in intraoperative blood loss (P = .43), transfusion rates (P = .14), length of hospital stay (P > .64), conversion rate (P = .62), R0 resection rate (P = .56), complications (P = .92), or mortaliy (P = .37) between the 2 groups. However, the RMH group was associated with a longer operative time (P = .0003), and higher cost (P < .00001) compared to the LMH group. No significant differences in overall survival or disease free survival between the 2 groups were observed. In the subgroup analysis of left lateral sectionectomies, RMH was still associated with a longer operative time, but no other differences in clinical outcomes were observed. CONCLUSIONS: Although RMH is associated with longer operation times and higher costs, it exhibits the same safety and effectiveness as LMH. Prospective randomized controlled clinical trials should now be considered to obtain better evidence for clinical consensus.


Asunto(s)
Hepatectomía/métodos , Laparoscopía/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Tempo Operativo , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento
17.
Medicine (Baltimore) ; 100(17): e25676, 2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33907137

RESUMEN

BACKGROUND: Intrauterine adhesion seriously affects reproductive health in women. Hysteroscopic adhesiolysis using cold scissors or electrosurgery is the main treatment, although there is no consensus on the preferable method. This review aimed to compare the efficacy and safety of these methods for treating moderate to severe intrauterine adhesion. METHODS: PubMed, EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure were searched on April 30, 2020. Randomized controlled trials and observational studies that were published in all languages (must contain English abstracts) and compared hysteroscopic cold scissors with electrosurgery for the treatment of intrauterine adhesion were included. Mean differences, odds ratios, and 95% confidence intervals (CIs) were reported. Bias was evaluated using the Cochrane Risk of Bias assessment tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Data were analyzed using RevMan software (Review Manager version 5.3, The Cochrane Collaboration, 2014). Two researchers independently extracted data and assessed the quality of the included studies. If a consensus was not reached, a third researcher was consulted. RESULTS: Nine studies (n = 761; 6 randomized controlled trials and 3 retrospective studies) were included. The intrauterine adhesion recurrence rate with second look hysteroscopy was significantly lower (odds ratio = 0.30, 95% CI = 0.16-0.56; P = .0002) with hysteroscopic cold scissors than with electrosurgery. The total operation time was significantly shorter (mean difference = -7.78, 95% confidence interval = -8.50 to -7.07; P < .00001), intraoperative blood loss was significantly lower (mean difference = -9.88, 95% CI = -11.25 to -8.51; P < .00001), and the menstrual flow rate was significantly higher (odds ratio = 4.36, 95% confidence interval = 2.56-7.43; P < .00001) with hysteroscopic cold scissors than with electrosurgery. There were no significant differences in the pregnancy rate. One complication (1 perforation case, hysteroscopic cold scissors group) was reported. CONCLUSIONS: Hysteroscopic cold scissors is more efficient in preventing intrauterine adhesion recurrence, increasing the menstrual flow, reducing intraoperative blood loss, and shortening the operation time.


Asunto(s)
Electrocirugia/métodos , Histeroscopía/instrumentación , Complicaciones Posoperatorias/prevención & control , Instrumentos Quirúrgicos , Enfermedades Uterinas/cirugía , Adulto , Pérdida de Sangre Quirúrgica , Frío , Femenino , Humanos , Histeroscopía/efectos adversos , Menstruación , Estudios Observacionales como Asunto , Tempo Operativo , Complicaciones Posoperatorias/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Adherencias Tisulares/patología , Adherencias Tisulares/cirugía , Resultado del Tratamiento , Enfermedades Uterinas/patología
18.
Biomed Res Int ; 2021: 6676999, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33791373

RESUMEN

Background: The technical challenge of pancreatojejunostomy (PJ) is the greatest barrier for surgeons to complete pancreatoduodenectomy (PD). The authors present an easy-to-master PJ anastomosis technique with limited technical requirements. This technique uses two layers of sutures and double purse-string sutures to complete the entire anastomosis. This anastomosis technique has achieved good results in laparoscopic surgery (LS) and small size main pancreatic duct (MPD). Methods: From February 2015 to August 2020, 63 patients who met the surgical indications underwent a modified double purse-string continuous suture pancreaticojejunostomy technique in our center. We collected patient demographic characteristics and perioperative outcomes and analyzed these data. Results: A total of 63 patients underwent PD using our new anastomosis technique. Thirty-eight patients underwent LS, and 26 patients had a small MPD (<3 mm). The median operative time (OT) was 270 min, and the median estimated blood loss (EBL) was 200 ml. Ten patients had grade B postoperative pancreatic fistula (POPF), while no patients had grade C POPF. No 90-day mortality was observed. There were significant differences in the OT and postoperative hospital stay (PHS) among groups with different surgical procedures, while there were no significant differences among groups with different MPD sizes. Neither the surgical procedure nor the MPD size affected early postoperative complications. Conclusion: This new technique can not only reduce the incidence of POPF but also is reliable for LS and surgeries with small size MPD. Therefore, this technique is worthy of clinical promotion and application in the future.


Asunto(s)
Laparoscopía , Conductos Pancreáticos/cirugía , Pancreatoyeyunostomía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo
19.
Med Sci Monit ; 27: e928965, 2021 Apr 26.
Artículo en Inglés | MEDLINE | ID: mdl-33901163

RESUMEN

BACKGROUND Nonintubated video-assisted thoracic surgery (NIVATS) has been demonstrated to be safe and effective in patients. However, the risk factors for intraoperative hypoxia are unclear. This retrospective study aimed to identify the risk factors for the development of intraoperative hypoxia in patients undergoing NIVATS. MATERIAL AND METHODS The study included patients who underwent NIVATS between January 2011 and December 2018. Intraoperative hypoxia was defined as SpO2 ≤93%. Risk factors for hypoxia were identified by binary logistic regression analysis, and the characteristic distribution of patients with and without hypoxia was elaborated. RESULTS Of 2742 included patients, age, anesthesia method, the technical level of surgeons, stair-climbing ability, and type of thoracic procedure were associated with intraoperative hypoxia (P<0.05). The characteristics of patients with hypoxia were older age (P=0.011), higher body mass index and revised cardiac risk index level (P=0.033 and P=0.031), and lower composition of stair-climbing ≥22 m (P<0.001). These patients also had more anatomical lung surgery and mediastinal mass resection (P=0.033) and more epidural anesthesia (P=0.005). The surgeries were more likely to be performed by surgeons with less than 10 years of VATS training (P=0.009) and to have increased intraoperative maximum end-expiratory carbon dioxide partial pressure (P<0.001). These patients had a longer Intensive Care Unit stay (P<0.001), duration of chest-tube drainage (P=0.019), and postoperative hospitalization (P=0.003). CONCLUSIONS The current study suggests that old age and stair-climbing ability of patients, anesthesia method, thoracic procedures, and surgeon experience are risk factors for intraoperative hypoxia in patients undergoing NIVATS.


Asunto(s)
Hipoxia/etiología , Complicaciones Intraoperatorias/etiología , Cirugía Torácica Asistida por Video/efectos adversos , Adolescente , Adulto , Anciano , Anestesia Epidural/métodos , Tubos Torácicos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
20.
BMC Pregnancy Childbirth ; 21(1): 321, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33892651

RESUMEN

BACKGROUND: A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a metreurynter with the success rate of the procedure and a comparison of surgical results and pregnancy outcomes between the successful and unsuccessful cases. METHODS: Between August 2003 and February 2020, 11 pregnant patients with a tumor found sunk in the Cul-de-sac underwent laparoscopic cystectomy for a benign ovarian cyst with a metreurynter. The surgical results, success and failure of the elevation by a metreurynter, pregnancy outcomes, and fetal status at delivery were evaluated. RESULTS: Elevation of ovarian tumors with a metreurynter was successful in nine cases. However, it was unsuccessful in the remaining two cases wherein the ovary was lifted with forceps while the uterus was in a compressed state. The operative time was also longer in these cases. The pregnancy prognosis, however, was good for both, successful and unsuccessful cases. CONCLUSIONS: The metreurynter is an inexpensive and practical obstetric device, and its optimal use allows the performance of a procedure with minimal burden on a pregnant uterus. Therefore, we recommend the appropriate use of this method to enable effective laparoscopic cystectomy of ovarian tumors during pregnancy.


Asunto(s)
Fondo de Saco Recto-Uterino/cirugía , Complicaciones Intraoperatorias , Laparoscopía , Quistes Ováricos , Ovariectomía , Complicaciones del Embarazo , Instrumentos Quirúrgicos , Adulto , Femenino , Humanos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Laparoscopía/efectos adversos , Laparoscopía/instrumentación , Laparoscopía/métodos , Elevación/efectos adversos , Tempo Operativo , Quistes Ováricos/patología , Quistes Ováricos/cirugía , Ovariectomía/efectos adversos , Ovariectomía/métodos , Neumoperitoneo Artificial/métodos , Embarazo , Complicaciones del Embarazo/patología , Complicaciones del Embarazo/cirugía , Resultado del Embarazo , Instrumentos Quirúrgicos/efectos adversos , Instrumentos Quirúrgicos/clasificación , Útero/lesiones
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