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1.
Int J Med Robot ; 17(3): e2218, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34196090

RESUMO

BACKGROUND: Major hepatectomy is still regarded as a technically demanding procedure for which minimally invasive surgery remains limited to selected cases in experienced centres and robotic platforms may provide some advantages over conventional laparoscopy in this setting. We aimed to combine and meta-analyse the available literature upon this topic. METHODS: The PubMed, MEDLINE and Web of Science databases were appraised to find all available studies comparing robotic and laparoscopic major hepatectomies. According to a pre-established pattern preoperative settings, operative and postoperative outcomes were assessed. The meta-analysis was performed by using the Revman 5.3 software. RESULTS: A total of 485 patients from eight studies were included in the analysis. Robotic major hepatectomies showed a significantly lower conversion rate and estimated blood loss as compared to laparoscopic ones. Laparoscopic major hepatectomies patients experienced significant shorter postoperative hospitalisation. CONCLUSIONS: Robotic surgery appears as competent as conventional laparoscopy to perform major hepatectomies, with possible advantages on conversion rate and perioperative blood loss, despite slightly prolonged postoperative hospitalisation.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Perda Sanguínea Cirúrgica , Hepatectomia , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias , Robótica , Resultado do Tratamento
2.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248340

RESUMO

Background: Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS. Objectives: This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures. Method: This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared. Results: All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group. Conclusion: Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.


Assuntos
Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Ovariectomia/métodos , Umbigo/cirurgia , Vagina/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
3.
Bone Joint J ; 103-B(7): 1197-1205, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192922

RESUMO

AIMS: A typical pattern of blood loss associated with total hip arthroplasty (THA) is 200 ml intraoperatively and 1.3 l in the first 48 postoperative hours. Tranexamic acid (TXA) is most commonly given as a single preoperative dose only and is often withheld from patients with a history of thromboembolic disease as they are perceived to be "high-risk" with respect to postoperative venous thromboembolism (VTE). The TRanexamic ACid for 24 hours trial (TRAC-24) aimed to identify if an additional 24-hour postoperative TXA regime could further reduce blood loss beyond a once-only dose at the time of surgery, without excluding these high-risk patients. METHODS: TRAC-24 was a prospective, phase IV, single centre, open label, parallel group, randomized controlled trial (RCT) involving patients undergoing primary unilateral elective THA. The primary outcome measure was the indirect calculated blood loss (IBL) at 48 hours. The patients were randomized into three groups. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional oral regime for 24 hours postoperatively, group 2 only received the intraoperative dose, and group 3 did not receive any TXA. RESULTS: A total of 534 patients were randomized, with 233 in group 1, 235 in group 2, and 66 in group 3; 92 patients (17.2%) were considered high-risk. The mean IBL did not differ significantly between the two intervention groups (848.4 ml (SD 463.8) for group 1, and 843.7 ml (SD 478.7) for group 2; mean difference -4.7 ml (95% confidence interval -82.9 to 92.3); p = 0.916). No differences in mortality or incidence of VTE were observed between any group. CONCLUSION: The addition of oral TXA for 24 hours postoperatively does not reduce blood loss beyond that achieved with a single 1 g IV perioperative dose alone. There may be a clinically relevant difference in patients with a normal BMI, which warrants further investigation. Critically, there were no safety issues in patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease. Cite this article: Bone Joint J 2021;103-B(7):1197-1205.


Assuntos
Antifibrinolíticos/administração & dosagem , Artroplastia de Quadril , Perda Sanguínea Cirúrgica/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Irlanda do Norte , Estudos Prospectivos , Fatores de Tempo , Tromboembolia Venosa/prevenção & controle
4.
Bone Joint J ; 103-B(7): 1309-1316, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192927

RESUMO

AIMS: To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach. METHODS: Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded. RESULTS: The mean age of the study population was 13.9 years (SD 6.4). The apex of deformity was in thoracic, thoracolumbar, and lumbar spine in five, 14, and eight patients, respectively. The mean operating time was 178.4 minutes (SD 38.5) and the mean operative blood loss was 701.8 ml (SD 194.4). KA (preoperative mean 70.8° (SD 21.6°) vs final follow-up mean 24.7° (SD 18.9°); p < 0.001) and TK (preoperative mean -1.48° (SD 41.23°) vs final follow-up mean 24.28° (SD 17.29°); p = 0.005) underwent a significant change with surgery. Mean Scoliosis Research Society (SRS-22r) score improved after surgical correction (preoperative mean 3.24 (SD 0.37) vs final follow-up mean 4.28 (SD 0.47); p < 0.001) with maximum improvement in self-image and mental health domains. The overall complication rate was 26%, including two neurological and five non-neurological complications. Permanent neurological deficit was noted in one patient. CONCLUSION: Deformity correction employing three-column osteotomies by a single-stage posterior-only approach is safe and effective in treating isolated congenital thoracolumbar kyphosis. Cite this article: Bone Joint J 2021;103-B(7):1309-1316.


Assuntos
Cifose/diagnóstico por imagem , Cifose/cirurgia , Osteotomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(7): 873-877, 2021 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-34308596

RESUMO

Objective: To investigate the safety and effectiveness of low-dose tranexamic acid (TXA) in operation of multi-level continuous thoracic ossification of ligament flavum (TOLF). Methods: A clinical data of 26 patients who underwent operation for multi-level continuous TOLF and met the selection criteria between July 2015 and January 2019 was retrospectively analyzed. Among them, 13 cases (group A) were received intravenous infusion of TXA (10 mg/kg) at 15 minutes before operation, and maintained the infusion at 1 mg/(kg·h) until the end of the operation; 13 cases (group B) were received the same dose of normal saline before and during operation. There was no significant difference in gender, age, body mass index, diseased segment, and preoperative hemoglobin, platelet count, activated partial thromboplastin time, prothrombin time, international normalized ratio (INR) between the two groups ( P>0.05). The hemoglobin, platelet count, activated partial thromboplastin time, prothrombin time, INR, the number of deep vein thrombosis of the lower extremities, operation time, intraoperative blood loss, postoperative drainage volume, total blood loss, and the time of drainage tube extubation in the two groups were recorded and compared. Results: All operations in the two groups were successfully completed. Compared with group B, the operation time and time of drainage tube extubation in group A were shortened, and the intraoperative blood loss, postoperative drainage volume, and total blood loss were reduced. The differences between the two groups were significant ( P<0.05). None of the two groups received blood transfusion, and the hemoglobin level of group A at 24 hours after operation was significantly higher than that of group B ( t=5.062, P=0.000). The incisions in both groups healed and sutures were removed within 2 weeks after operation, and no complications occurred. There was no significant difference between the two groups in activated partial thromboplastin time, prothrombin time, INR, and platelet count at 24 hours after operation ( P>0.05). Conclusion: In multi-level continuous TOLF operation, intravenous administration of low-dose TXA can effectively reduce blood loss, shorten postoperative drainage time, and does not increase the risk of complications.


Assuntos
Antifibrinolíticos , Ácido Tranexâmico , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Ligamentos , Osteogênese , Hemorragia Pós-Operatória , Estudos Retrospectivos
6.
World J Surg Oncol ; 19(1): 198, 2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-34218803

RESUMO

OBJECTIVES: This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng's multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH). METHODS: We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. RESULTS: The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality. CONCLUSIONS: We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.


Assuntos
Laparoscopia , Neoplasias Hepáticas , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Hepatectomia , Humanos , Tempo de Internação , Neoplasias Hepáticas/cirurgia , Duração da Cirurgia , Prognóstico , Resultado do Tratamento
7.
Bone Joint J ; 103-B(6): 1078-1087, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058867

RESUMO

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.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia de Quadril/economia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Duração da Cirurgia , Recuperação de Função Fisiológica
8.
Anticancer Res ; 41(6): 3059-3065, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34083298

RESUMO

BACKGROUND: Peri-operative variables associated with prolonged Intensive Care Unit (ICU) admission following cytoreductive surgery for ovarian cancer were investigated. PATIENTS AND METHODS: A retrospective review was carried out of patients admitted to the ICU following cytoreductive surgery for ovarian cancer in a single tertiary referral centre from 2015-2019. Patients were categorized according to length of ICU stay (<48 h and ≥48 h), and peri-operative variables were compared across the two groups. RESULTS: A total of 56 patients were admitted to the ICU post-operatively, 37 for <48 h and 19 for ≥48 h (range=3-11 days). Greater duration of procedure and estimated blood loss, bowel resection, higher post-operative lactate level, lower post-operative albumin level and requirement for post-operative blood products were associated with prolonged ICU stay. Increased intraoperative fluid requirement was an independent predictor of extended ICU stay. CONCLUSION: Utilizing identified intra-operative risk factors to perform individualized risk assessments might improve planning of ICU resources. Optimizing intraoperative fluid management may improve short-term patient outcomes.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Unidades de Terapia Intensiva , Tempo de Internação , Neoplasias Ovarianas/cirurgia , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Feminino , Humanos , Intestinos/cirurgia , Pessoa de Meia-Idade , Período Perioperatório , Fatores de Tempo
9.
Medicine (Baltimore) ; 100(23): e25754, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114982

RESUMO

ABSTRACT: Our objective was to identify independent risk factors for predicting which patients in the Chinese population would likely develop respiratory failure.A descriptive analysis was conducted of demographic and clinical data of patients with tuberculous empyema (TE) admitted to the Beijing Chest Hospital, Capital Medical University between January 2001 and January 2020. Risk factors associated with postsurgical respiratory failure in TE patients were identified based on results of analyses based on univariable and multivariable logistic regression models.A total of 139 TE patients who underwent surgical treatment in the Beijing Chest Hospital, Capital Medical University from January 2001 to January 2020 were enrolled in this study. Cases included 109 male and 30 female patients, with an overall mean age (range 17-73) of 39.3 years. Of 139 TE patients, 26 (18.7%) experienced respiratory failure after surgery. Among significant risk factors for postsurgical respiratory failure, intraoperative blood loss volume greater than 1000 mL had the highest odds ratio value of 6.452. In addition, a pathologic preoperative pulmonary function test result showing a high partial pressure of carbon dioxide level was an independent risk factor for respiratory failure. Moreover, the presence of tuberculosis lesions in the contralateral lung was another significant risk factor for respiratory failure, as determined using multivariate analysis.Respiratory failure is a predominant complication experienced by TE patients undergoing surgery. High intraoperative blood loss, high preoperative high partial pressure of carbon dioxide level, and tuberculosis lesion(s) in the contralateral lung of TE patients were associated with increased risk of postoperative respiratory failure.


Assuntos
Perda Sanguínea Cirúrgica , Empiema Tuberculoso/cirurgia , Complicações Pós-Operatórias , Insuficiência Respiratória , Medição de Risco , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Tuberculose Pulmonar , Adulto , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Dióxido de Carbono/análise , China/epidemiologia , Empiema Tuberculoso/sangue , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/epidemiologia , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Procedimentos Cirúrgicos Torácicos/métodos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/cirurgia
10.
Medicine (Baltimore) ; 100(23): e26074, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114991

RESUMO

ABSTRACT: To compare the clinical effect of Bulldog clamps with traditional Pringle for vascular occlusion during laparoscopic hepatectomy.One hundred ten patients were retrospectively investigated in this research from December 2014 to January 2019 in the second hospital of Anhui Medical University, who underwent laparoscopic liver resection using Bulldog (modified group, n = 54) and cotton tourniquet (traditional group, n = 56) for blocking the liver inflow-blood. Intraoperative blood loss, duration of the operation time, clamping time, postoperative outcomes were analyzed.All the operations were accomplished successfully without conversion to laparotomy, perioperative period clinical date was calculated. Intraoperative operative time, blood loss and resection sections had no statistical significance, but the clamping time (36.2 ±â€Š5.6 vs 277.3 ±â€Š88.4 s, P < .001) was significantly shorter in the bulldog group. Albumin, alanine aminotransferase, aspartate aminotransferase and serum total bilirubin had no statistical differences in postoperative day (POD) 1and 3, but POD 5 alanine aminotransferase (71.0 ±â€Š46.8vs 105.8 ±â€Š61.7IU/L P = .018) and aspartate aminotransferase (72.8 ±â€Š39.7 vs 100.2 ±â€Š16.7 IU/L P = .028). The postoperative hospital stays (7.02 ±â€Š1.56 vs 8.50 ±â€Š2.35 days P = .026) in bulldog group were lower than cotton group and differences had statistical significance. The C-reactive protein levels were significantly higher in the traditional group than in the modified group on POD 3 (46.3 ±â€Š19.2 vs 57.7 ±â€Š23.9 mg/L P = .019), and POD5 (13.3 ±â€Š4.2 vs 17.5 ±â€Š7.3 mg/L P = .001). There were 8 postoperative complications occurred in cotton group, while there was 5 in Bulldog group, all patients with complications were discharged after adequate drainage and symptomatic treatment.Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle maneuver.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Carcinoma Hepatocelular , Hepatectomia , Laparoscopia , Neoplasias Hepáticas , Complicações Pós-Operatórias , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , China/epidemiologia , Constrição , Drenagem/métodos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Hepatectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Testes de Função Hepática/métodos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Torniquetes
11.
Spine (Phila Pa 1976) ; 46(13): 845-851, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34100838

RESUMO

STUDY DESIGN: Randomized Clinical Trial. OBJECTIVE: The aim of this study was to compare the efficacy of USBS with standard-of-care surgical instruments during posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) by evaluating the difference in estimated blood loss per level fused (EBL/level). SUMMARY OF BACKGROUND DATA: PSF surgery for AIS is often associated with high blood loss. Use of an ultrasonic bone scalpel (USBS) has been proposed to reduce blood loss during scoliosis surgery. METHODS: This was a single-blinded (patient-blinded), randomized, controlled superiority trial. We randomized 66 patients with AIS undergoing PSF to the control group (osteotome) or the experimental group (USBS). The primary outcome was intraoperative EBL/level obtained from red blood cell salvage reports. One-year follow-up was available for 57 of 62 (92%) of patients. RESULTS: EBL/level averaged 35 and 39 mL/level in the experimental and control groups, respectively [adjusted mean difference USBS - osteotome -8 mL/level, 95% CI: -16.4 to 0.3 mL/level, P = 0.0575]. There was no difference in curve correction [adjusted mean difference: -1.7%, 95% CI: -7.0 to 3.6%, P = 0.5321] or operative time [adjusted mean difference: -3.55 minutes, 95% CI: -22.45 to 15.46 min, P = 0.7089] between groups. Complications requiring change in routine postoperative care were noted in eight patients: two occurred in patients assigned to the experimental group and six occurred in patients assigned to the control group. CONCLUSION: There was no clinically significant difference in total blood loss, EBL/level, or complications between the two groups. In contrast to reports from other centers, at our high-volume spine center, USBS did not lead to reduced blood loss during PSF for AIS. These results may not be generalizable to centers with longer baseline operative times or higher baseline average blood loss during PSF for AIS.Level of Evidence: 1.


Assuntos
Perda Sanguínea Cirúrgica , Escoliose/cirurgia , Fusão Vertebral , Terapia por Ultrassom , Adolescente , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Terapia por Ultrassom/efeitos adversos , Terapia por Ultrassom/métodos
12.
Artigo em Russo | MEDLINE | ID: mdl-34156209

RESUMO

The authors report resection of anaplastic convexital meningioma in a middle-aged woman complicated by expected massive blood loss. The most intense bleeding occurred at the final stage of resection and it was impossible to stop it with traditional approaches. The surgeon pressed a standard tachocomb plate moistened with a diluted solution of recombinant activated factor VII (coagil, Russia) to the most bleeding area for 5 minutes. Subsequently, surgeon replaced finger pressure with a permanent napkin. Hemostatic effect of recombinant activated factor VII following its systemic administration is well known and convincingly proven in many surgical areas including neurosurgery. However, we do not know any descriptions of its local application in neurosurgical patients.


Assuntos
Fator VIIa/uso terapêutico , Hemostáticos , Neoplasias Meníngeas , Perda Sanguínea Cirúrgica , Feminino , Humanos , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Proteínas Recombinantes/uso terapêutico , Federação Russa
13.
Medicine (Baltimore) ; 100(19): e25847, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106626

RESUMO

BACKGROUND: In facial contour surgery, due to the narrow field of vision in the oral approach and the abundant blood supply to the maxillofacial area, hemostasis is not easy. The purpose of this study was to evaluate the hemostatic effect of soluble hemostatic gauze. METHODS: We organized a prospective randomized study of 282 patients receiving facial contouring surgery (4 types of procedures in total) during 2016.1.1 to 2018.12.30. For each type of procedure, patients were randomly divided into study group (received hemostatic gauze) and control group (received sterile gauze). Two groups were compared for each type of procedure regarding 5 major perioperative variables: intraoperative blood loss, operation time, 24-hour postoperative drainage volume, total postoperative drainage volume, and postoperative drainage time. Correlation between variables was analyzed. RESULTS: Compared with control group, the study group had higher amount of intraoperative blood loss in mandibular angle ostectomy (MAO) (P < .01) and mandibular angle-body-chin curved ostectomy procedures (P < .05), less total postoperative drainage volume in MAO (P < .01) but not in malarplasty with MAO and partial masseter muscle resection along with MAO procedures. No significant difference was observed between respective study and control groups regarding operation time, 24-hour postoperative drainage volume, and postoperative drainage time in any of the 4 types of surgery. In all 4 types of procedures, a strongly positive correlation was observed between total drainage volume and 24-hour drainage volume in both the study and control groups (r: 0.88-0.97, P < .01). CONCLUSION: The effect of hydroxyethyl cellulose soluble hemostatic gauze on hemostasis in facial contouring surgery is associated with the type of surgery, which can reduce the risk of postoperative bleeding in MAO. However, for surgery with relatively large amount of intraoperative and postoperative bleeding, the hemostatic gauze had a limited postoperative hemostasis efficacy, which needs further evaluation.


Assuntos
Bandagens , Perda Sanguínea Cirúrgica/prevenção & controle , Celulose/análogos & derivados , Hemostasia Cirúrgica/métodos , Hemostáticos/administração & dosagem , Adulto , Celulose/administração & dosagem , Face/cirurgia , Feminino , Humanos , Masculino , Duração da Cirurgia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Método Simples-Cego
14.
Orthop Clin North Am ; 52(3): 201-208, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053565

RESUMO

Based on a series of 407 outpatient total hip arthroplasties performed by a single surgeon, a standardized protocol for blood loss management in outpatient arthroplasty was developed consisting of a presurgical hematocrit of greater than 36%, administration of tranexamic acid, prophylactic introduction of albumin, hypotensive epidural anesthesia, monopolar electrocautery, and bipolar sealer. This protocol uses techniques that alone are not novel but together create a standardized and reproducible pathway that when implemented can increase the safety of outpatient hip arthroplasty.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Artroplastia de Quadril/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/normas , Antifibrinolíticos/uso terapêutico , Artroplastia de Quadril/normas , Eletrocoagulação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Tranexâmico/uso terapêutico , Adulto Jovem
15.
Medicine (Baltimore) ; 100(20): e25879, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011054

RESUMO

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.


Assuntos
Colecistectomia Laparoscópica/métodos , Embucrilato/administração & dosagem , Complicações Intraoperatórias/prevenção & controle , Adesivos Teciduais/administração & dosagem , Adulto , Idoso , Ductos Biliares/lesões , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Colecistectomia Laparoscópica/efeitos adversos , Embucrilato/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Fígado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(20): e25926, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011064

RESUMO

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.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/lesões , Cabeça do Fêmur/cirurgia , Fluoroscopia/efeitos adversos , Fluoroscopia/estatística & dados numéricos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Duração da Cirurgia , Parafusos Pediculares , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Robóticos/instrumentação , Fatores de Tempo , Resultado do Tratamento
17.
Can J Anaesth ; 68(6): 894-917, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33993459

RESUMO

PURPOSE: In this Continuing Professional Development module, we review the practical pharmacology of tranexamic acid and its clinical use in trauma, obstetrics, and major orthopedic surgery. PRINCIPAL FINDINGS: Tranexamic acid is a synthetic drug that inhibits fibrinolysis. Multiple clinical trials in various clinical settings have shown that it can reduce blood loss, transfusion rates, and bleeding-associated mortality. In trauma and obstetrical bleeding, early tranexamic acid administration (< three hours) may have greater clinical benefits. Overall, tranexamic acid use appears safe with no significant increase of thromboembolic or seizure events. Nevertheless, current evidence has limitations related to wide heterogeneity in dose, route, and timing of drug administration, as well as generalizability of the large-scale trial findings to higher income nations. CONCLUSIONS: Tranexamic acid is an efficacious and safe pharmacological-based blood conservation technique in the management of clinically significant hemorrhage. All anesthesiologists should have a good understanding of the pharmacotherapeutic properties and perioperative role of tranexamic acid therapy both inside and outside of the operating room. The use of tranexamic acid is likely to continue to rise with endorsement by various clinical guidelines and healthcare organizations. Further quantitative research is needed to evaluate optimal dosing and drug efficacy in these clinical scenarios.


Assuntos
Antifibrinolíticos , Obstetrícia , Ácido Tranexâmico , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Hemorragia , Humanos , Ácido Tranexâmico/uso terapêutico
18.
BMC Pregnancy Childbirth ; 21(1): 367, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971838

RESUMO

BACKGROUND: Prophylactic uterine artery embolization (UAE) combined with subsequent curettage is suggested as an effective and minimally invasive treatment strategy for cesarean scar pregnancy (CSP) with a high bleeding risk. However, the timing of curettage after UAE remains to be studied. Thus, we aimed to identify the optimal time interval to perform curettage after UAE in patients with CSP. METHODS: We conducted a retrospective cohort study in a large medical center for women and children in Southwest China. CSP patients treated by UAE combined with subsequent curettage were included and grouped by the treatment time interval between these two procedures. The clinical outcomes among arms were compared by univariate and multivariable analysis. RESULTS: Our study included 314 CSP patients who received this combination treatment in our department from January 2014 to December 2019. The median time interval between UAE and curettage was 48 h, with a range of 12-168 h among all participants. Thirty-two patients (10.2%) experienced intraoperative hemorrhage (blood loss ≥200 mL). Intrauterine balloon tamponade was used in 17 cases (5.4%). In 14 cases (4.5%), the procedure was converted to laparoscopy (or laparotomy). In the cohort study, patients with longer treatment intervals had more intraoperative blood loss and a higher incidence of complications than those with shorter intervals (P < 0.05). The rates of intraoperative bleeding were 5.0% for patients who received curettage within 24 h after UAE (Arm 1) and 19.4% for those who had a treatment interval longer than 72 h (Arm 4). In the multivariable logistic regression model of bleeding, a treatment interval > 72 h had an adjusted odds ratio of 3.37 (95% confidence interval: 1.40-8.09). CONCLUSION: We suggest that curettage not be delayed longer than 72 h after UAE in this combined treatment of CSP.


Assuntos
Cesárea/efeitos adversos , Cicatriz , Curetagem , Embolização Terapêutica , Gravidez Ectópica/cirurgia , Adulto , Perda Sanguínea Cirúrgica , China , Cicatriz/etiologia , Terapia Combinada , Curetagem/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Gravidez , Estudos Retrospectivos , Tempo para o Tratamento , Artéria Uterina , Embolização da Artéria Uterina
19.
Bone Joint J ; 103-B(5): 809-812, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934656

RESUMO

The use of tourniquets in lower limb trauma surgery to control bleeding and improve the surgical field is a long established practice. In this article, we review the evidence relating to harms and benefits of tourniquet use in lower limb fracture fixation surgery and report the results of a survey on current tourniquet practice among trauma surgeons in the UK.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Fixação Interna de Fraturas/métodos , Traumatismos da Perna/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Torniquetes , Medicina Baseada em Evidências , Humanos , Medição da Dor , Complicações Pós-Operatórias , Inquéritos e Questionários , Reino Unido
20.
Medicine (Baltimore) ; 100(18): e25704, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950952

RESUMO

RATIONALE: Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery. PATIENT CONCERNS: A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass. DIAGNOSES: The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery. INTERVENTIONS: The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion. OUTCOMES: The postoperative course was uneventful. LESSONS: Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Laparoscopia/métodos , Pâncreas/irrigação sanguínea , Pancreatectomia/métodos , Artéria Esplênica/anormalidades , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Laparoscopia/efeitos adversos , Artéria Mesentérica Superior/anormalidades , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/lesões , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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