Air Embolism-Induced Ischemic Stroke Following Orthognathic Surgery in a Patient With Goldenhar Syndrome.

Goldenhar syndrome, a rare congenital anomaly, manifests as craniofacial malformations often necessitating intricate surgical interventions. These procedures, though crucial, can expose patients to diverse postoperative complications, including hemorrhage or infection. A noteworthy complication is stroke, potentially linked to air embolism or local surgical trauma. We highlight a case of a male patient, aged 20 years, who experienced a significant postoperative complication of an ischemic stroke, theorized to be due to an air embolism, after undergoing orthognathic procedures for Goldenhar syndrome. The patient was subjected to LeFort I maxillary osteotomy, bilateral sagittal split ramus osteotomy of the mandible, and anterior iliac crest bone grafting to the right maxilla. He suffered an acute ischemic stroke in the left thalamus post-surgery, theorized to stem from an air embolism. Advanced imaging demonstrated air pockets within the cavernous sinus, a rare and concerning finding suggestive of potential air embolism. This case underscores the intricate challenges in treating Goldenhar syndrome patients and the rare but significant risk of stroke due to air embolism or surgical trauma. Limited literature on managing air embolism complications specific to Goldenhar syndrome surgeries exists. Generally, management includes immediate recognition, positional adjustments, air aspiration via central venous catheters, hyperbaric oxygen therapy, hemodynamic support, and high-flow oxygen administration to expedite air resorption. Our patient was conservatively managed post-surgery, and at a 3-month neurology follow-up, he showed significant improvement with only residual right arm weakness. It emphasizes the imperative of a comprehensive, multidisciplinary approach.

Epidemiological Predictors of Financial Toxicity in Surgical Burn Injuries: A Multicenter, Longitudinal, Cohort Study.

BACKGROUND: Burns constitute a major global health challenge, causing over 11 million injuries and 300,000 deaths annually and surpassing the economic burden of cervical cancer and HIV combined. Despite this, patient-level financial consequences of burn injuries remain poorly quantified, with a significant gap in data from low- and middle-income countries. In this study, we evaluate financial toxicity in burn patients. METHODS: A prospective, multicenter cohort study was conducted across two tertiary care hospitals in India, assessing 123 adult surgical in-patients undergoing operative interventions for burn injuries. Patient sociodemographic, clinical, and financial data were collected through surveys and electronic records during hospitalization and at 1, 3, and 6 months postoperatively. Out-of-pocket costs (OOPCs) for surgical burn treatment were evaluated during hospitalization. Longitudinal changes in income, employment status, and affordability of basic subsistence needs were assessed at the 1-, 3-, and 6-month postoperative time point. Degree of financial toxicity was calculated using a combination of the metrics catastrophic health expenditure and financial hardship. Development of financial toxicity was compared by sociodemographic and clinical characteristics using logistic regression models. RESULTS: Of the cohort, 60% experienced financial toxicity. Median OOPCs was US$555.32 with the majority of OOPCs stemming from direct nonmedical costs (US$318.45). Cost of initial hospitalization exceeded monthly annual income by 80%. Following surgical burn care, income decreased by US$318.18 within 6 months, accompanied by a 53% increase in unemployment rates. At least 40% of the cohort consistently reported inability to afford basic subsistence needs within the 6-month perioperative period. Significant predictors of developing financial toxicity included male gender (odds ratio, 4.17; 95% confidence interval, 1.25-14.29; P = 0.02) and hospital stays exceeding 20 days (odds ratio, 11.17; 95% confidence interval, 2.11-59.22; P ≤ 0.01). CONCLUSIONS: Surgical treatment for burn injuries is associated with substantial financial toxicity. National and local policies must expand their scope beyond direct medical costs to address direct nonmedical and indirect costs. These include burn care insurance, teleconsultation follow-ups, hospital-affiliated subsidized lodging, and resources for occupational support and rehabilitation. These measures are crucial to alleviate the financial burden of burn care, particularly during the perioperative period.

Complicaciones tras retirada de barra de Nussen pectus excavatum. Análisis y propuesta de unprotocolo de seguridad / Complications after Nuss bar removal procedure for pectus excavatum. Analysis and proposal of a safety protocol

Objetivo: La retirada de la barra de Nuss puede provocar diversascomplicaciones, algunas leves y otras potencialmente mortales. Su incidencia puede verse reducida con una preparación quirúrgica adecuaday siguiendo ciertos pasos de seguridad. El presente estudio tiene porobjeto analizar nuestra experiencia con las complicaciones acontecidasdurante la retirada de la barra, así como nuestro protocolo de seguridadpara la prevención y el manejo de dichas complicaciones.Material y métodos:Estudio de cohortes observacional llevado acabo a partir del análisis retrospectivo de todos los pacientes sometidos acirugía de retirada de barra de Nuss entre noviembre de 2013 y marzo de2022 en un hospital universitario. Se analizaron las siguientes variables:demografía de los pacientes, presencia de comorbilidades, tiempo desdela colocación de la barra hasta su retirada, y complicaciones operatoriasy postoperatorias. El estudio se realizó conforme a las directrices de laPROCESS Guideline. Resultados: Se incluyó a 40 pacientes, 37 de ellos varones. En 17pacientes se retiró una barra, y en 22, dos. La edad media en el momento de la cirugía fue de 17,5 años (percentil 25-75%: 16,75 - 19,25).El tiempo transcurrido desde la colocación hasta la retirada fue de 26meses (percentil 25-75%: 23,75 - 30,25). Se registraron 10 complicaciones en 9 pacientes (22,5%), 6 de clase I según la clasificación deClavien-Dindo (67%), 2 de clase II (22%), 1 de clase IIIb y 1 de claseIV. La complicación hemorrágica motivó la creación de un protocolo deseguridad para disminuir la incidencia de las complicaciones. Conclusión: La retirada de la barra de Nuss es un procedimientoseguro, habitualmente con escasas complicaciones, aunque en ocasionespueden ser graves. Para evitarlas, es importante contar con un protocoloque garantice la seguridad.(AU)

Objective: The Nuss bar removal procedure may bring about different complications. Some are mild while others can be life-threatening.An adequate surgery setup and the fulfilment of some security stepsmay reduce their incidence. This study aims to analyze our experiencewith the complications that occurred during bar removal and our safetyprotocol for the prevention and management of these complications.Materials and methods: Observational cohort study from a retrospective chart review of all patients who underwent Nuss bar removalfrom November 2013 to March 2022 at a University hospital. Variablesanalyzed include patients’ demographics; presence of comorbidities;time elapsed from bar placement to removal, and the occurrence ofoperative and postoperative complications. Study written under the´PROCESS Guideline’. Results: Fourty (40) patients were included in the study; 37 weremale. One bar was removed in 17 patients and two in 22 patients. Medianage at surgery: 17.5 years (Percentile 25-75%: 16.75 - 19.25). Timeelapsed from placement to removal: 26 months (Percentile 25 - 75%:23.75 - 30.25). Complications: 10 in 9 patients (22.5%); 6 Clavien-Dindoclass I (67%); 2 class II (22%); 1 class IIIb, 1 class IV. The hemorrhagiccomplication motivated the development of a safety protocol to reduceincidence of complications. Conclusion: Nuss bar removal is a safe procedure with usuallyscant complications. Nonetheless, these may be serious sometimes. Toprevent them, a protocol for a safe procedure is important.(AU)

Study protocol for the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) global cross-specialty surveys and consensus.

Annually, about 300 million surgeries lead to significant intraoperative adverse events (iAEs), impacting patients and surgeons. Their full extent is underestimated due to flawed assessment and reporting methods. Inconsistent adoption of new grading systems and a lack of standardization, along with litigation concerns, contribute to underreporting. Only half of relevant journals provide guidelines on reporting these events, with a lack of standards in surgical literature. To address these issues, the Intraoperative Complications Assessment and Reporting with Universal Standard (ICARUS) Global Surgical Collaboration was established in 2022. The initiative involves conducting global surveys and a Delphi consensus to understand the barriers for poor reporting of iAEs, validate shared criteria for reporting, define iAEs according to surgical procedures, evaluate the existing grading systems' reliability, and identify strategies for enhancing the collection, reporting, and management of iAEs. Invitation to participate are extended to all the surgical specialties, interventional cardiology, interventional radiology, OR Staffs and anesthesiology. This effort represents an essential step towards improved patient safety and the well-being of healthcare professionals in the surgical field.

A Novel Surgical Indication for Scheuermann's Kyphosis.

Scheuermann kyphosis can be treated surgically to restore proper sagittal alignment. Thoracic curves >70° are typically indicated for surgical intervention. However, patients who have reached their natural limit of compensatory lumbar hyperlordosis are at risk of accelerated degeneration. This can be determined by comparing lumbar lordosis on standing neutral radiographs and supine extension radiographs. Minimal additional lordosis in extension compared with neutral, abutment of the spinous processes, or greater lumbar lordosis standing than with attempted extension suggest the patient is maximally compensated. We present a case of an adolescent boy with Scheuermann kyphosis who had reached the limit of his hyperlordosis compensation reserve. He subsequently underwent a T4 to L2 posterior spinal fusion with T7 to T11 Ponte Smith-Petersen grade two osteotomies. He tolerated the procedure well with no intraoperative complications or neuromonitoring changes. The patient has continued to do well and progressed to normal activity at 5-month follow-up.

Reparación laparoscópica de las lesiones quirúrgicas de la vía biliar: factibilidad y evaluación de resultados / Laparoscopic repair of bile duct injuries: Feasibility and outcomes

Introducción: Las lesiones quirúrgicas de la vía biliar (LQVB) posteriores a la colecistectomía videolaparoscópica tienen una incidencia de 0,6% aproximadamente, siendo por lo general más graves y complejas. La hepaticoyeyunoanastomosis (HYA) en Y de Roux es la mejor opción terapéutica (tasas de éxito entre 75-98%). Algunas series demostraron factible el abordaje laparoscópico en la resolución de esta patología. El objetivo es describir nuestra experiencia en la reparación laparoscópica de las LQVB. Métodos: Estudio retrospectivo y descriptivo. Se incluyeron pacientes sometidos a reparación laparoscópica posterior a LQVB. Se analizaron variables demográficas, clínicas, quirúrgicas y posoperatorias. Se aplicaron análisis estadísticos descriptivos. Resultados: Se evaluaron 92 pacientes con LQVB; 81 se sometieron a reparación quirúrgica, ocho fueron candidatos a HYA laparoscópica (aplicabilidad 9,88%). En 75% (seis) se logró una reparación laparoscópica completa. La mayoría eran mujeres (75%). Edad promedio de 40,8 ± 16,61 años (rango 19-65). Las lesiones Strasberg-Bismuth ≥ E3 afectaron a 25% (dos). En la mitad se realizó una HYA laterolateral según la técnica de Hepp-Couinaud; tres usuarios recibieron una HYA terminolateral y otro una bi-HYA terminolateral en Y de Roux. El tiempo operatorio promedio fue de 260 min (rango 120-360). La morbilidad global fue de 37,5% (tres casos): dos complicaciones menores (bilirragia grado A y hemorragia por drenajes) y una mayor (bilirragia grado C). No se registró mortalidad. El seguimiento máximo fue de 26 meses (rango 6-26). Conclusiones: Nuestro estudio muestra que, en un grupo seleccionado de pacientes, la HYA laparoscópica es factible, con los beneficios de un abordaje miniinvasivo.(AU)

Introduction: Bile duct injuries (BDI) following laparoscopic cholecystectomy occurs in approximately 0.6% of the cases, often being more severe and complex. Roux-en-Y hepaticojejunostomy (RYHJ) is considered the optimal therapeutic option, with success rates ranging from 75% to 98%. Several series have demonstrated the advancements of the laparoscopic approach for resolving this condition. The objective of this study is to describe our experience in the laparoscopic repair of BDI. Methods: A retrospective, descriptive study was conducted, including patients who underwent laparoscopic repair after BDI. Demographic, clinical, surgical, and postoperative variables were analyzed using descriptive statistical analyses. Results: Eight patients with BDI underwent laparoscopic repair (out of 81 surgically repaired patients). Women comprised 75% of the sample. A complete laparoscopic repair was achieved in 75% (6) of cases. The mean age was 40.8 ± 16.61 years (range 19–65). Injuries at or above the confluence (Strasberg–Bismuth ≥ E3) occurred in 25% of cases (2). Primary repair was performed in two cases. Half of the cases underwent a Hepp-Couinaud laterolateral RYHJ, while three patients received a terminolateral RYHJ, and one underwent a bi-terminolateral RYH. The mean operative time was 260 min (range 120–360). Overall morbidity was 37.5% (three cases): two minor complications (bile leak grade A and drainage-related bleeding) and one major complication (bile leak grade C). No mortality was recorded. The maximum follow-up period reached 26 months (range 6–26). Conclusions: Our study demonstrates the feasibility of laparoscopic RYHJ in a selected group of patients, offering the benefits of a minimally invasive approach.(AU)

Factors Influencing the Occurrence of Intraoperative Hypothermia in Patients Undergoing General Anesthesia Intervention: A Study in a Tertiary Care Hospital.

BACKGROUND Intraoperative and postoperative hypothermia of patients can be caused by the use of anesthetic drugs and the complicated and time-consuming procedures of interventional surgery. This retrospective study included 184 patients to investigate the incidence and factors associated with hypothermia during intraoperative anesthesia in a single center in China between January and October 2023. MATERIAL AND METHODS A convenient sampling method was used to select 184 patients who underwent general anesthesia intervention in a tertiary hospital in Sichuan Province from January to October 2023 as the study population. The independent factors influencing the occurrence of intraoperative hypothermia were analyzed. A survey was conducted to collect 5 demographic factors, 4 preoperative-related factors, and 10 surgically related factors. According to the occurrence of intraoperative hypothermia, the independent influencing factors of unplanned hypothermia during perioperative period were further analyzed. RESULTS Among 184 patients, 64 (34.78%) experienced perioperative unplanned hypothermia, of which 5 (7.81%) cases occurred before the start of surgery, 7 (10.94%) occurred before the start of surgery after anesthesia, and 52 (81.25%) occurred during surgery. Logistic regression analysis showed that body temperature at the beginning of surgery (P<0.001), set operating room temperature (P<0.001), duration of anesthesia (P=0.006), and age (P=0.001) were independent influencing factors for unplanned hypothermia during perioperative period. CONCLUSIONS The incidence of intraoperative hypothermia is high in patients undergoing general anesthesia interventions. Age, duration of anesthesia, set operating room temperature, and body temperature at the beginning of the operation were independent influencing factors for the occurrence of unplanned hypothermia during the perioperative period.

Operative efficiency: a comparative analysis of Versius and da Vinci robotic systems in abdominal surgery.

Robotic-assisted surgery has gained momentum in the pursuit of improved minimally invasive procedures. The adoption of new robotic platforms, such as the Versius, raises concerns about safety, efficacy, and learning curves. This study compares the Versius to the well-established da Vinci in terms of operative time and patient population. Retrospective data collection was conducted on patient data from inguinal hernia surgery, ventral hernia surgery, and cholecystectomies performed between February 2022 and March 2023 at the American Hospital of Dubai. Only experienced cases were included, ensuring proficiency with robotic technology. Versius had longer procedure times in inguinal and ventral hernia surgeries but not in cholecystectomy. No intraoperative complications were observed in either system. This study demonstrates that Versius can provide comparable outcomes to the da Vinci in abdominal surgery, with no observed intraoperative complications.

The practical and educational value of scleral buckling with chandelier illumination.

PURPOSE: To compare the surgical results in cases of primary rhegmatogenous retinal detachments between standard scleral buckling (SSB) and scleral buckling with chandelier illumination (SBC) and to analyse the differences in SBC surgical results between an experienced ophthalmologist and inexperienced ophthalmologists. METHODS: Consecutive surgical case series of 155 eyes that underwent scleral buckling were retrospectively reviewed and divided into four groups: SSB performed by an experienced ophthalmologist (n = 54), SBC performed by an experienced ophthalmologist (n = 52), SBC performed by inexperienced ophthalmologists (n = 40) and SSB performed by inexperienced ophthalmologists (n = 9). Then, these four groups were compared. RESULTS: No significant differences were observed between SSB and SBC procedures both performed by the experienced ophthalmologist with regard to demographics, preoperative findings, contents of the surgery, intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SBC performed by the experienced ophthalmologist and SBC performed by the inexperienced ophthalmologists, no significant differences were found regarding intraoperative complications, retinal reattachment, postoperative findings and postoperative complications. Between SSB and SBC procedures both performed by the inexperienced ophthalmologist, a significant difference was found regarding intraoperative complications. CONCLUSION: There were no significant differences in surgical results between SSB and SBC when both were performed by the experienced ophthalmologist. In addition, the surgical results were equal between the experienced ophthalmologist and the inexperienced ophthalmologist as far as SBC was concerned. Learning scleral buckling skills by using SBC is a reasonable course of action for inexperienced ophthalmologists.

Gasless transvaginal natural orifice transluminal endoscopic surgery for hysterectomy and salpingectomy on a robot platform with flexible devices in a porcine model.

In this report, we described a new technique of gasless V-NOTES for hysterectomy and salpingectomy on a robotic platform with flexible devices in a porcine model. As a result, the gynecological procedures were successfully completed. The total operative time was 110 min, while the docking time was 10 min. The estimated blood loss was estimated to be 10 mL with no intraoperative complications. It revealed that gasless V-NOTES for hysterectomy and salpingectomy on a robotic platform with flexible devices appeared to be feasible and safe in the porcine model and has the potential for clinical use in human beings.

Comparison of perioperative outcomes between robot-assisted adrenalectomy and laparoscopic adrenalectomy: a propensity score matching analysis.

This study aimed to evaluate and compare the perioperative outcomes of robot-assisted adrenalectomy (RAA) and laparoscopic adrenalectomy (LA) using propensity score matching. This retrospective study included 395 patients who underwent minimally invasive adrenalectomy: 354 who underwent LA and 41 who underwent RAA between February 2015 and March 2023. To mitigate potential confounding factors, 2:1 propensity score matching was conducted based on age, sex, body mass index, American Society of Anesthesiologists score, tumor laterality, and tumor size. Perioperative outcomes and complications were compared between the two groups, and prognostic factors for complications were analyzed. Propensity score matching analysis identified 123 patients, with 82 and 41 in the LA and RAA groups, respectively. Operative time (81.4 ± 26.6 min vs. 83.5 ± 25.9 min, P = 0.675), estimated blood loss (77.7 ± 68.3 mL vs. 83.2 ± 73.9 mL, P = 0.683), and post-operative stay (3.8 ± 1.0 days vs. 4.0 ± 0.9 days, P = 0.211) showed no significant differences between two groups. Intraoperative complications occurred in 8 patients (9.8%) in the LA group, while no patients (0%) experienced intraoperative complications in the RAA group (P = 0.051). In both groups, post-operative complications occurred in 2.4% (P = 1). The only factor contributing to complications after adrenalectomy was tumor size (OR 1.026, 95% CI 1.001-1.051, P = 0.042). RAA exhibited comparable perioperative outcomes and presented an improved intraoperative complication rate compared with LA. Tumor size was the only factor that contributed to complications after adrenalectomy.

[Intraoperative Complications in Cataract Surgery]. / Intraoperative Komplikationen der Kataraktchirurgie.

Cataract surgery is frequently and successfully performed in the developed world. The indications for the operation have shifted on one hand towards healthier patients seeking freedom from glasses and on the other hand towards more complex cases. How should the patient be informed? What complications can occur intraoperatively, and what treatment options are available for these complications?This article offers a focus on conditions such as zonulopathy and pseudoexfoliation that can pose challenges to cataract surgery. It discusses the use of specialized tools such as capsular tension rings and capsular hooks and precise maneuvers to minimize stress on weakened zonules in order to ensure in-the-bag fixation of the IOL.Furthermore, the article addresses appropriate actions towards intraoperative complications such as anterior or posterior capsule ruptures and loss of nuclear fragments into the vitreous cavity.Exploring innovative advancements, this article presents the latest alternatives for intracapsular lens fixation, such as sutureless scleral fixation and emerging lens designs in cases where there is insufficient capsular support.Ultimately, the primary objective remains delivering optimal outcomes even for complex cases, and minimizing post-surgical issues. Numerous tools and techniques are available.

Evaluation of the accuracy of fully guided implant placement by undergraduate students and postgraduate dentists: a comparative prospective clinical study.

PURPOSE: This study aimed to assess the accuracy of implant placement through three-dimensional planning and fully guided insertion, comparing outcomes between undergraduate and postgraduate surgeons. METHODS: Thirty-eight patients requiring 42 implants in posterior single-tooth gaps were enrolled from the University Clinic for Prosthodontics at the Martin Luther University Halle Wittenberg and the Department of Prosthodontics, Geriatric Dentistry, and Craniomandibular Disorders of Charité University Medicine, Berlin. Twenty-two implants were placed by undergraduate students (n = 18), while 20 implants were placed by trainee postgraduate dentists (n = 5). Pre-operative intraoral scans and cone beam computed tomography images were performed for implant planning and surgical template fabrication. Postoperative intraoral scans were superimposed onto the original scans to analyze implant accuracy in terms of apical, coronal, and angular deviations, as well as vertical discrepancies. RESULTS: In the student group, two implant insertions were performed by the assistant dentist because of intraoperative complications and, thus, were excluded from further analysis. For the remaining implants, no statistically significant differences were observed between the dentist and student groups in terms of apical (p = 0.245), coronal (p = 0.745), or angular (p = 0.185) implant deviations, as well as vertical discrepancies (p = 0.433). CONCLUSIONS: This study confirms the viability of fully guided implant placement by undergraduate students, with comparable accuracy to postgraduate dentists. Integration into dental education can prepare students for implant procedures, expanding access and potentially reducing costs in clinical practice. Collaboration is essential for safe implementation, and future research should explore long-term outcomes and patient perspectives, contributing to the advancement of dental education and practice. TRIAL REGISTRATION: DRKS, DRKS00023024, Registered 8 September 2020-Retrospectively registered, https://drks.de/search/de/trial/DRKS00023024 .

Intraoperative vascular air embolism and intracardiac thrombosis complicating liver transplantation: a case report.

BACKGROUND: Intracardiac thrombus and vascular air embolism represent rare complications in the context of orthotopic liver transplantation. While isolated reports exist for intracardiac thrombus and vascular air embolism during orthotopic liver transplantation, this report presents the first documentation of their simultaneous occurrence in this surgical setting. CASE PRESENTATION: This case report outlines the clinical course of a 60-year-old white female patient with end-stage liver disease complicated by portal hypertension, ascites, and hepatocellular carcinoma. The patient underwent orthotopic liver transplantation and encountered concurrent intraoperative complications involving intracardiac thrombus and vascular air embolism. Transesophageal echocardiography revealed the presence of air in the left ventricle and a thrombus in the right atrium and ventricle. Successful management ensued, incorporating hemodynamic support, anticoagulation, and thrombolytic therapy, culminating in the patient's discharge after a week. CONCLUSIONS: This report highlights the potential for simultaneous intraoperative complications during orthotopic liver transplantation, manifesting at any phase of the surgery. It underscores the critical importance of vigilant monitoring throughout orthotopic liver transplantation to promptly identify and effectively address these rare yet potentially catastrophic complications.

Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience.

Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.

The da Vinci robotic surgery system for the management of endometrial cancer: a single-center experience.

The aim of this study was to report our single-center experience of the da Vinci robotic surgery system in the management of endometrial cancer (EC) patients during 2019-2023. We descriptively summarized the preoperative, intraoperative, and postoperative outcomes. Moreover, we conducted subgroup analyses based on obesity (BMI ≥ 30 kg/m2) and the intraoperative use of indocyanine green dye (ICG). Overall, 100 patients were analyzed. Eighty-five patients (85%) were obese. The mean operative time and estimated blood loss (EBL) were 240.84 ± 70.08 min (range: 110-720) and 104.2 ± 80.3 ml (range: 20-500), respectively. The mean number of retrieved pelvic LNs was 3.01 ± 3.06 (range: 0-15). The use of ICG was employed in 58 (58%). Only a single patient (1%) underwent conversion to laparotomy. Besides, only three (3%) patients experienced vaginal laceration intraoperatively, respectively. The mean hospital stay was 1.34 ± 0.69 days (range: 1-5). No patient experienced postoperative complications. Most tumors had endometrioid histology (82%), grade-1 tumor (49%), and stage-1A disease (67%). At 3-year follow-up, only two patients (2%) developed recurrence. Patients who received the ICG had significantly lower operative time (225.86 vs. 261.52 min, p = 0.011), estimated blood loss (90 vs. 123.81 ml, p = 0.037), and hospital stay (1.12 vs. 1.64 days, p < 0.001) compared with patients who did not receive it. However, there was no significant difference between both groups regarding the number of retrieved pelvic LNs. Obesity had no significant impact on the rates of intraoperative complications, postoperative complications, and 3-year recurrence incidence. In conclusion, robotic surgery was technically feasible and safe. The use of ICG was statistically linked to favorable outcomes, in terms of decreased operative time, EBL, and hospital stay. Obesity did not impact the perioperative surgical outcomes.

Hypotension prediction index for the prevention of hypotension during surgery and critical care: A narrative review.

Surgeons and anesthesia clinicians commonly face a hemodynamic disturbance known as intraoperative hypotension (IOH), which has been linked to more severe postoperative outcomes and increases mortality rates. Increased occurrence of IOH has been positively associated with mortality and incidence of myocardial infarction, stroke, and organ dysfunction hypertension. Hence, early detection and recognition of IOH is meaningful for perioperative management. Currently, when hypotension occurs, clinicians use vasopressor or fluid therapy to intervene as IOH develops but interventions should be taken before hypotension occurs; therefore, the Hypotension Prediction Index (HPI) method can be used to help clinicians further react to the IOH process. This literature review evaluates the HPI method, which can reliably predict hypotension several minutes before a hypotensive event and is beneficial for patients' outcomes.

Intraoperative Blood Pressure Management and Its Effects on Postoperative Delirium After Cardiac Surgery: A Single-Center Retrospective Cohort Study.

OBJECTIVES: There is accumulating evidence that blood pressure management might be associated with end-organ dysfunction after cardiac surgery. This study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurologic outcomes and mortality. DESIGN: A single-center retrospective cohort study. SETTING: The Heart and Diabetes Centre Bad Oeynhausen NRW, Ruhr-University Bochum. PARTICIPANTS: This retrospective cohort study included 31,315 adult patients who underwent elective cardiac surgery at the authors' institution between January 2009 and December 2018. INTERVENTIONS: All cardiac surgery procedures except assist device implantation, organ transplantation, and emergency surgery. MEASUREMENTS AND MAIN RESULTS: Adverse neurologic outcomes were defined as postoperative delirium and stroke. IOH was defined as mean arterial pressure below 60 mmHg for >2 minutes. The frequency of IOH episodes and the cumulative IOH duration were recorded. The association between IOH and adverse neurologic outcomes was examined with unadjusted statistical analysis and multiple logistic regression analysis. Eight hundred forty-nine (2.9%) patients developed postoperative stroke, and 2,401 (7.7%) patients developed postoperative delirium. The frequency of IOH episodes was independently associated with postoperative delirium in the multiple logistic regression analysis (odds ratio 1.02, 95% CI 1.003-1.03, p < 0.001), whereas there was no association between it and stroke. CONCLUSION: This large retrospective monocentric cohort study revealed that increased episodes of IOH were associated with the risk of developing postoperative delirium after cardiac surgery. This might have important clinical implications with respect to careful and precise hemodynamic monitoring and proactive treatment, especially in patients with increased risk for postoperative delirium.