Low Transverse versus Midline Abdominal Skin Incisions for in utero Spina Bifida Repair

2021 ◽  
pp. 1-9
Author(s):  
Michal Fishel Bartal ◽  
Eric P. Bergh ◽  
Kuojen Tsao ◽  
Mary T. Austin ◽  
Kenneth J. Moise ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Pain Score ◽  
Operative Time ◽  
In Utero ◽  
Wound Complications ◽  
Total Operative Time ◽  
Postoperative Stay ◽  
Validated Questionnaire ◽  
Scar Assessment

<b><i>Objective:</i></b> The 2 types of maternal skin incisions for in utero spina bifida repair are low transverse (LT) incision perceived to be cosmetic benefit and midline longitudinal (ML) incision, typically associated with a reduction in surgical time and lower blood loss. Our objective was to compare short- and long-term outcomes associated with these 2 types of skin incisions following in utero spina bifida repair. <b><i>Methods:</i></b> Prospective observational cohort of 72 patients undergoing fetal spina bifida repair at a single institution between September 2011 and August 2018. The decision for the type of incision was at the discretion of the surgeons. The primary outcome was total operative time. Secondary outcomes included an analog scale of wound pain score on postoperative day 3, duration of postoperative stay, and postoperative wound complications within the first 4 weeks. The Patient Scar Assessment Questionnaire, a validated questionnaire, was obtained for all patients (≥6 months from delivery) using 4 categories (appearance, consciousness, satisfaction with appearance and with symptoms), with higher scores reflecting a poorer perception of the scar. <b><i>Results:</i></b> There were 43 women (59.7%) in the LT group and 29 (40.3%) in the ML group. In all patients, the same incision was used during cesarean delivery. The total operative time was higher in the LT group by 33 min (<i>p</i> &#x3c; 0.001), primarily due to abdominal wall incision time (open and closure). No significant differences were found between the groups in pain score, length of postoperative stay, or the rate of wound complications. Fifty-three patients (73.6%) responded to the questionnaire, 36/43 from the LT group and 17/29 from the ML group. There was no difference in the scores of appearance, consciousness, and satisfaction with appearance and symptoms between the groups. <b><i>Conclusion:</i></b> ML incisions shorten operative times without altering long-term incision-related satisfaction when compared to LT incisions.

scholarly journals Canada’s First Robotic Assisted Totally Intracorporeal Orthotopic Ileal Neobladder

2013 ◽  
Vol 7 (7-8) ◽  
pp. 537 ◽  
Author(s):  
Richard L. Haddad ◽  
Patrick Richard ◽  
Franck Bladou
Keyword(s):  
Operative Time ◽  
Technical Difficulty ◽  
Outcome Data ◽  
Ileal Neobladder ◽  
Total Operative Time ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Timely Completion ◽  
Muscle Invasive

Despite robotic-assisted radical cysto-prostatectomy being performed in several centres, the urinary diversion is most often performed extra-corporeal. A robotic intra-corporeal ileal neobladder is technically demanding and long-term functional outcome data is lacking. We performed a robotic intra-corporeal ileal neobladder in a 73-year-old man for muscle invasive non-metastatic bladder cancer. The total operative time was 6 hours 8 minutes. The estimated blood loss was 900 mL. There were no complications and he was discharged on day 12. The principles of open neobladder surgery were maintained, however key modifications were used to reduce technical difficulty and enable timely completion. We found that robotic intracorporeal ileal neobladder can be safely performed with an experienced robotic unit.

scholarly journals Predictors of short-term and long-term incontinence after robot-assisted radical prostatectomy

2017 ◽  
Vol 46 (1) ◽  
pp. 421-429 ◽  
Author(s):  
I-Hung Shao ◽  
Ying-Hsu Chang ◽  
Chun-Ming Hou ◽  
Zheng-Feng Lin ◽  
Chun-Te Wu
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Operative Time ◽  
Univariate Analysis ◽  
Albumin Level ◽  
Robot Assisted ◽  
Laboratory Findings ◽  
Total Operative Time ◽  
Preoperative Serum

Purpose To determine retrospectively the prognostic factors for urinary incontinence following robot-assisted radical prostatectomy (RARP). Methods Altogether, 180 patients with localized prostate cancer underwent RARP (same surgeon). Preoperative physical status, disease characteristics, laboratory findings, and surgical technique were recorded and the patients checked 1, 6, 12, and 24 months after RARP regarding their contribution to predicting post-prostatectomy urinary incontinence (PPI). Results Overall, 114 (63.3%) patients had PPI 1 month after RARP and 19 patients (16.0%) at 24 months. Univariate analysis showed that age was a significant factor for predicting PPI at 1 month. PPI predictors at 24 months were age, body mass index, preoperative serum albumin level, previous transurethral resection of the prostate, total operative time, and bladder neck sparing. Multivariate analysis indicated that age and total operative time were significant predictors. Conclusion Older age and longer operative time were highly relevant to short- and long-term PPI occurrence after RARP.

scholarly journals One surgeon’s experience with r-TAPP: a retrospective analysis of 150 consecutive robotic inguinal hernia cases

2022 ◽  
Author(s):  
Jorge L. Florin ◽  
Valeria Bianchi ◽  
Daniel D. Wiggan
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Open Surgery ◽  
Operative Time ◽  
Total Operative Time ◽  
Age Range

AbstractThere is a tremendous paucity of literatures regarding the long-term surgical outcomes of the r-TAPP procedure for inguinal hernia repair. Additionally, much of the existing literatures regarding this procedure have limited follow-up of to 12 months. This article presents the outcomes of 150 consecutive r-TAPP inguinal hernia repairs performed on 111 patients using Progrip mesh without fixation, with up to 24 months of follow-up. The initial 150 consecutive r-TAPP inguinal hernia repairs were performed from February 2017 to April 2018 using Progrip without fixation. All patients were seen at 2 weeks, followed by phone follow-up at 6 months, 1 year, and 2 years. Of the 111 patients, 39 had bilateral hernias (35%) and 72 had unilateral hernias (65%). The age range was 18–93 years. The BMI range was 20.7–50.2, with a mean of 26.4 and median of 25.8. Total operative time ranged from 28 to 138 min with a mean of 62.4 min and median of 56 min. ASA classification ranged from 1 to 4, with a mean of 2.1. No significant blood loss was observed in any of the cases. There were no conversions to open surgery. All patients were discharged the same day of the operation. We were able to follow up with 100% of the hernias at 2 weeks, 88% at 6 months, 87% at 1 year, and 80% at 2 years. No recurrences were recorded at 2 weeks, 3 months, 6 months, 1 year, or 2 years. There were no reports of chronic pain up to 2 years in any of the patients. These results indicate that r-TAPP inguinal hernia repair using Progrip without further fixation is safe, effective, and can be performed with minimal recurrences or chronic pain.

scholarly journals Long-Term Results of a Standard Algorithm for Intravenous Port Implantation

2021 ◽  
Vol 11 (5) ◽  
pp. 344
Author(s):  
Ching-Feng Wu ◽  
Jui-Ying Fu ◽  
Chi-Tsung Wen ◽  
Chien-Hung Chiu ◽  
Ming-Ju Hsieh ◽  
...  
Keyword(s):  
Operative Time ◽  
Functional Results ◽  
Long Term Results ◽  
Related Complication ◽  
Standard Algorithm ◽  
Port Implantation ◽  
Male Patients ◽  
Catheter Fracture ◽  
Guided Puncture

Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.

scholarly journals Association between confirmed congenital Zika infection at birth and outcomes up to 3 years of life

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Najeh Hcini ◽  
Yaovi Kugbe ◽  
Zo Hasina Linah Rafalimanana ◽  
Véronique Lambert ◽  
Meredith Mathieu ◽  
...  
Keyword(s):  
Neurological Impairment ◽  
In Utero ◽  
In Utero Exposure ◽  
Zikv Infection ◽  
Neurodevelopmental Delay ◽  
Systematic Testing ◽  
Brain Anomalies ◽  
Increased Risk ◽  
Structural Brain

AbstractLittle is known about the long-term neurological development of children diagnosed with congenital Zika infection at birth. Here, we report the imaging and clinical outcomes up to three years of life of a cohort of 129 children exposed to Zika virus in utero. Eighteen of them (14%) had a laboratory confirmed congenital Zika infection at birth. Infected neonates have a higher risk of adverse neonatal and early infantile outcomes (death, structural brain anomalies or neurologic symptoms) than those who tested negative: 8/18 (44%) vs 4/111 (4%), aRR 10.1 [3.5–29.0]. Neurological impairment, neurosensory alterations or delays in motor acquisition are more common in infants with a congenital Zika infection at birth: 6/15 (40%) vs 5/96 (5%), aRR 6.7 [2.2–20.0]. Finally, infected children also have an increased risk of subspecialty referral for suspected neurodevelopmental delay by three years of life: 7/11 (64%) vs 7/51 (14%), aRR 4.4 [1.9–10.1]. Infected infants without structural brain anomalies also appear to have an increased risk, although to a lesser extent, of neurological abnormalities. It seems paramount to offer systematic testing for congenital ZIKV infection in cases of in utero exposure and adapt counseling based on these results.

scholarly journals AB0423 NEUROPSYCHIATRIC OUTCOME OF CHILDREN BORN TO WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) WOMEN AND EXPOSED IN UTERO TO AZATHIOPRINE: A CASE-CONTROL STUDY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1511.2-1511
Author(s):  
M. G. Lazzaroni ◽  
F. Crisafulli ◽  
I. Debeni ◽  
C. Nalli ◽  
L. Andreoli ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Renal Involvement ◽  
In Utero ◽  
Learning Disorders ◽  
Control Group ◽  
In Utero Exposure ◽  
Term Outcome ◽  
Similar Frequency ◽  
Long Term Outcome

Background:A possible increase in neurodevelopmental (ND) and learning disorders (LD) in the offspring of mothers affected by SLE have been suggested in some studies, along with the identification of different possible risk factors. Azathioprine (AZA) is commonly used during pregnancy, based on its non-teratogenicity and extended experience in women with different diseases. However, a few small studies suggested an association between in utero exposure to AZA and possible increased frequency of ND/LD in children, indirectly derived from increased request of supportive educational services.Objectives:To evaluate the medium-long term outcome in terms of ND/LD in children of school age (≥6 years) born to SLE women treated with AZA during pregnancy, as compared to that of children born to SLE mothers not treated with AZA during pregnancy.Methods:Data from our Pregnancy Clinic registry were collected for prospectively followed pregnancies of SLE women treated with AZA (cases) and compared to pregnancies of SLE women not treated with AZA (controls), that were matched for age at pregnancy, presence of renal involvement and aPL positivity. SLE patients (cases and controls) were interviewed by phone to collect data about their children, focusing on the presence of ND/LD certified by Neuropsychiatrists.Results:Data were collected for 14 SLE mothers in the AZA group and 31 in the control group, with similar age at pregnancy (30.3±5.21 vs 31.4±4.70 years, p:0.45) and frequency of renal involvement (50.0% vs 44.1%, p:0.77), aPL positivity (33.3% vs 29.4%, p:0.76) and anti-Ro/SSA positivity (27.8% vs. 26.5%, p:0.55). A SLE flare during pregnancy was more frequently recorded in the AZA group (27.8% vs. 2.94%, p:0.02). Other medications included HCQ (55.6% vs. 70.6%, p:0.36) and corticosteroids (100% vs 79.4%, p:0.08).We collected data for 18 children in the AZA group and 34 children in the control group, that had a similar mean age at the time of the interview (12.7±4.80 vs. 12.9±5.61 years, p:0.91). The two groups had also similar gestational age (37.4±2.20 weeks vs. 38.0±1.29 weeks, p:0.23), birth weight (3003±433 g vs 3011±453 g, p:0.95) and rate of male sex (61.1% vs 44.1%, p:0.38).We recorded similar frequency of ND/LD in the two groups. In particular, a ND was present in 2/18 (11.1%) of children exposed to AZA vs. 2/34 (5.88%) in the control group (p:0.60). A LD was present in 1/18 cases (5.56%) and 6/34 controls (17.6%) (p:0.40).Conclusion:The medium-long term outcome of children born to SLE mothers in the whole cohort was characterized by the presence of ND in 4/54 (7.69%) and LD in 7/52 (13.5%). ND/LD do not seem to be related to in utero exposure to AZA.Disclosure of Interests:None declared

scholarly journals 81 A three-layer fetoscopic spina bifida closure has fewer neonatal complications than open in-utero closure

2021 ◽  
Vol 224 (2) ◽  
pp. S56-S57
Author(s):  
Jimmy Espinoza ◽  
Michael A. Belfort ◽  
William Whitehead ◽  
Magdalena Sanz-Cortes ◽  
Ahmed A. Nassr ◽  
...  
Keyword(s):  
Spina Bifida ◽  
In Utero ◽  
Neonatal Complications
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