The association of frailty, age, and ASA classification with postoperative outcomes in minimally invasive pituitary surgery

2021 ◽  
Author(s):  
Elaine C. Martin ◽  
Khodayar Goshtasbi ◽  
Jack L. Birkenbeuel ◽  
Arash Abiri ◽  
Brandon M. Lehrich ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pituitary Surgery ◽  
Postoperative Outcomes ◽  
Asa Classification

PREDICTORS AND INCIDENCE OF CENTRAL DIABETES INSIPIDUS AFTER ENDOSCOPIC PITUITARY SURGERY

Neurosurgery ◽  
2008 ◽  
Vol 62 (1) ◽  
pp. 71-79 ◽  
Author(s):  
Dimitri G. Sigounas ◽  
Julie L. Sharpless ◽  
D. Ming L. Cheng ◽  
Tiffany G. Johnson ◽  
Brent A. Senior ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Diabetes Insipidus ◽  
Serum Sodium ◽  
Elevated Serum ◽  
High Sensitivity ◽  
Cerebrospinal Fluid Leak ◽  
Pituitary Surgery ◽  
Minimal Risk ◽  
Low Incidence ◽  
Traditional Approaches

Abstract OBJECTIVE With the advent of minimally invasive endoscopic pituitary surgery, there has been concern that the technique may be associated with higher rates of complications such as diabetes insipidus (DI) than traditional approaches, particularly early in a center's experience. We report the incidence and predictors of diabetes insipidus in patients after endoscopic transnasal resection (minimally invasive pituitary surgery) of pituitary lesions. METHODS Data were collected from hospital and clinic records on the first 119 consecutive patients undergoing endoscopic pituitary surgery at our center. RESULTS The rate of postoperative diabetes insipidus is low in patients undergoing minimally invasive pituitary surgery (permanent, 2.7%; transient, 13.6%). Factors associated with development of DI after minimally invasive pituitary surgery include Rathke's cleft cyst histology, intraoperative cerebrospinal fluid leak, and previous nonendoscopic lesion resection. Elevated serum sodium (>145 mmol/L) within the first 5 days postoperatively has a high sensitivity (87.5%), specificity (83.5%), and negative predictive value (99.5%) for permanent postoperative DI development. CONCLUSION Transitioning from microscopic to endoscopic pituitary surgery can be achieved with a low incidence of DI. An elevated serum sodium level in the first 5 postoperative days using standard monitoring can predict the chance of developing permanent DI. Patients having no elevated serum sodium measurements, defined as >145 mmol/L, in the first 5 days postoperatively will rarely, if ever, develop permanent DI, thereby validating short postoperative inpatient stays with minimal risk of readmission for DI management. Those with a single serum sodium measurement greater than 145 mmol/L have a 15% risk of developing permanent DI.

Evaluation of Minimally Invasive Surgical Therapies for Ulcerative Colitis

2020 ◽  
Vol 86 (7) ◽  
pp. 782-786 ◽  
Author(s):  
Salini Hota ◽  
Salvatore Parascandola ◽  
Richard Amdur ◽  
Vincent Obias
Keyword(s):  
Ulcerative Colitis ◽  
Minimally Invasive ◽  
Postoperative Outcomes ◽  
Open Group ◽  
Open Approach ◽  
Cardiac Events ◽  
Improvement Program ◽  
Robotic Assisted ◽  
Confounding Variables ◽  
Significant Difference

Introduction Ulcerative colitis (UC) is a chronic inflammatory intestinal disorder that can be managed surgically with a proctocolectomy. Minimally invasive techniques such as laparoscopic or robotic-assisted surgery are available based on the surgeon’s preference and familiarity. To date, there is a paucity of literature evaluating the safety of these techniques in comparison to the open approach in patients with UC. Methods We surveyed the National Surgical Quality Improvement Program (NSQIP) database to select patients with the diagnosis of UC who underwent either robotic, laparoscopic, or open proctocolectomy between 2012 and 2017. A total of 2129 patients were included in the study. The 30-day postoperative outcomes were compared using multivariable logistic regression models after adjusting for confounding variables. The confounding variables were defined as any preoperative variable that was associated with the type of procedure. Results The 30-day postoperative outcomes reported in the NSQIP database were reviewed for each of the treatment groups (open, laparoscopic, and robotic). The anastomotic leak rate was significantly higher in the open group ( P = .022). The robotic and laparoscopic groups had significantly fewer occurrences of postoperative ileus ( P = .0006) and wound infections ( P < .0001). There were significantly more strokes, cardiac events, and pulmonary events in the open surgical group. Operative time was significantly shorter in the open group ( P < .0001). Reintervention rates were not significantly different among the groups. Conclusions Minimally invasive proctocolectomy has significantly fewer postoperative complications compared with open proctocolectomy for UC. There is no significant difference in the postoperative outcomes between robotic-assisted and laparoscopic proctocolectomy.

scholarly journals Roboscopic minimally invasive pancreaticoduodenectomy: mixing laparoscopic and robotic approach in order to achieve better postoperative outcomes

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S1013
Author(s):  
M. Abu Hilal ◽  
A. Manzoni ◽  
L. Jones ◽  
G. Zimmitti ◽  
M. Garatti ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Postoperative Outcomes ◽  
Robotic Approach

scholarly journals PRIMARY ABANDON-OF-THE-SAC (PAS) TECHNIQUE: PRELIMINARY RESULTS OF A NOVEL MINIMALLY INVASIVE APPROACH FOR INGUINOSCROTAL HERNIA REPAIR

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Alexander Charles MORRELL ◽  
Andre Luiz Gioia MORRELL ◽  
Flavio MALCHER ◽  
Allan Gioia MORRELL ◽  
Alexander Charles MORRELL-JUNIOR
Keyword(s):  
Minimally Invasive ◽  
Average Length ◽  
Intraoperative Complications ◽  
Case Series ◽  
Surgical Site Infections ◽  
Postoperative Outcomes ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Preliminary Results ◽  
Average Length Of Stay

ABSTRACT Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia. Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure. Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the “primary abandon-of-the-sac” (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed. Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up. Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.

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