scholarly journals Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Melina Shoni ◽  
Taymaa May ◽  
Allison F. Vitonis ◽  
Anjelica Garza ◽  
Michael G. Muto ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Admission Rate ◽  
Safe Procedure ◽  
Short Term ◽  
Surgical Morbidity ◽  
Hospital Admission Rate ◽  
Estimated Blood Loss ◽  
Risk Reducing

Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6, 26.0–197.0), significantly affected by BMI greater than 30 (P<0.0001) and status of adhesions (P=0.001). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery.

scholarly journals Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kun-peng Li ◽  
Xian-zhong Deng ◽  
Tao Wu
Keyword(s):  
Surgical Outcomes ◽  
Operative Time ◽  
Meta Analysis ◽  
Intraoperative Complications ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Gynecologic Cancers ◽  
Estimated Blood Loss ◽  
Clavien Grade

Purpose: The optimal surgical approach for para-aortic lymphadenectomy (PALND) in gynecologic cancers using minimally invasive surgery (laparoscopy or robotic-assisted) is controversial. This study summarizes the current evidence on the extraperitoneal (EP) approach and compares its perioperative, surgical outcomes, and complications to the transperitoneal (TP) approach in an updated meta-analysis.Methods: We performed a systematic search in PubMed, Embase, Web of Science, Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs that compare EP to TP for PALND. The main outcomes included surgical, perioperative outcomes, and complications. The weighted mean difference (WMD) and odds ratio (OR) were applied for the comparison of continuous and dichotomous variables with 95% CIs. Three RCTs and 10 non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis.Results: A total of three RCTs and ten non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. We reported similar results for EP and TP in terms of the hospital stay, estimated blood loss, blood transfusion, conversion to laparotomy, total operative time, and postoperative complications (Clavien grade ≥ 1 and Clavien grade ≥ 3). However, the PALND operative time (WMD −10.46 min, 95% CI −19.04, −1.88; p = 0.02) and intraoperative complications (OR 0.40, 95% CI 0.23, 0.69; p = 0.001) were less with EP. Also, more nodes were removed in EP compared with the TP (WMD 1.45, 95% CI 0.05, 2.86; p = 0.04).Conclusions: The EP approach did not show differences regarding surgical and perioperative parameters compared with the TP approach. However, the number of aortic nodes retrieved was higher. Furthermore, The PALND operative time and intraoperative complications were less in EP.

Antegrade Transsphenoidal Vidian Neurectomy: Short-Term Surgical Outcome Analysis

2011 ◽  
Vol 25 (6) ◽  
pp. e217-e220 ◽  
Author(s):  
Wan-Fu Su ◽  
Shao-Cheng Liu ◽  
Feng-Shiang Chiu ◽  
Chia-Hsuan Lee
Keyword(s):  
Allergic Rhinitis ◽  
Surgical Outcomes ◽  
Transsphenoidal Approach ◽  
Type I ◽  
Type Ii ◽  
Short Term ◽  
Surgical Morbidity ◽  
Simple Method ◽  
Vidian Neurectomy

Background Vidian neurectomy was an option for treating allergic rhinitis in the past but outcomes varied. A modified transsphenoidal approach is proposed to simplify endoscopic vidian neurectomy. The postoperative evaluation of rhinorrhea, sneezing, and recurrence was investigated. Methods A total of 317 patients with refractory allergic rhinitis underwent 414 transsphenoidal vidian neurectomies from September 2006 to December 2010. A rigid nasal endoscope was used through a transsphenoidal approach to reach the vidian canal inside the sphenoid sinus (type I) or through its anterior opening into the pterygopalatine fossa (type II) and to cut or cauterize the vidian nerve. The surgical outcomes were analyzed for patients with at least 6 months of follow-up. Results Our approach was successful in 90.3% of the 414 vidian neurectomies. Vidian neurectomy was successful via the type I approach in 27 sides and type II approach in 347 sides. The short-term surgical outcomes of 163 patients who underwent a total of 236 vidian neurectomies with at least 6 months of follow-up were analyzed. Immediate, complete cessation of sneezing and rhinorrhea occurred uniformly. Three recurrences were detected during the 1–2 years of follow-up. The symptom of dry eye was reported for 172 surgical sides, but only 6 had persistent symptoms for > 6 months. Conclusion The transsphenoidal approach in a vidian neurectomy is a simple method that removes the need for sphenopalatine artery ligation and causes less surgical morbidity. However, the possibility of recurrence of this condition in the long term needs further investigation.

scholarly journals Attaining Proficiency in Robotic-Assisted Minimally Invasive Esophagectomy While Maximizing Safety during Procedure Development

2016 ◽  
Vol 11 (4) ◽  
pp. 268-273 ◽  
Author(s):  
Inderpal S. Sarkaria ◽  
Nabil P. Rizk ◽  
Rachel Grosser ◽  
Debra Goldman ◽  
David J. Finley ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Intraoperative Complications ◽  
Team Approach ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Estimated Blood Loss ◽  
Dedicated Team ◽  
Median Operative Time

Objective Robotic-assisted minimally invasive esophagectomy (RAMIE) is an emerging complex operation with limited reports detailing morbidity, mortality, and requirements for attaining proficiency. Our objective was to develop a standardized RAMIE technique, evaluate procedure safety, and assess outcomes using a dedicated operative team and 2-surgeon approach. Methods We conducted a study of sequential patients undergoing RAMIE from January 25, 2011, to May 5, 2014. Intermedian demographics and perioperative data were compared between sequential halves of the experience using the Wilcoxon rank sum test and the Fischer exact test. Median operative time was tracked over successive 15-patient cohorts. Results One hundred of 313 esophageal resections performed at our institution underwent RAMIE during the study period. A dedicated team including 2 attending surgeons and uniform anesthesia and OR staff was established. There were no significant differences in age, sex, histology, stage, induction therapy, or risk class between the 2 halves of the study. Estimated blood loss, conversions, operative times, and overall complications significantly decreased. The median resected lymph nodes increased but was not statistically significant. Median operative time decreased to approximately 370 minutes between the 30th and the 45th cases. There were no emergent intraoperative complications, and the anastomotic leak rate was 6% (6/100). The 30-day mortality was 0% (0/100), and the 90-day mortality was 1% (1/100). Conclusions Excellent perioperative and short-term patient outcomes with minimal mortality can be achieved using a standardized RAMIE procedure and a dedicated team approach. The structured process described may serve as a model to maximize patients’ safety during development and assessment of complex novel procedures.

scholarly journals The Shortest Distance from the Skin to Pancreas and the Lower Sternum Angle can Influence Short-Term Surgical Outcomes of Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

2020 ◽  
Author(s):  
Dong Peng ◽  
Wei Tao ◽  
Yuxi Cheng ◽  
Ying-Ying Zou ◽  
Kun Qian ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Subcutaneous Fat ◽  
Short Term ◽  
Xiphoid Process ◽  
Female Patients ◽  
Shortest Distance ◽  
Estimated Blood Loss ◽  
Male Patients

Abstract Background The surgery of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG) is widely used in patients with gastric cancer, the purpose of the study is to explore the effect of abdominal shape on short-term surgical outcomes.Methods This was a retrospective study which included 316 patients undergoing LADG from January 2013 to June 2019 at a single clinical center. The abdominal parameters including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and left-right diameters(LRD) at the navel level, the distance from xiphoid process to the navel (XND), and the distance from xiphoid process to the pubis (XBD) were calculated by preoperative abdominal computed tomography (CT) image. The parameters and short-term surgical outcomes were analyzed.Results In males, the number of retrieved lymph nodes was significantly higher in patients with BMI <25kg/m2 (p=0.023) and APD <176.2mm (p=0.004). The time of operation was significantly shorter in male patients with BMI <25kg/m2(p=0.001), PAAD <64.6mm(p=0.000), SFT <14.9mm(p=0.017), APD <176.2mm(p=0.002) and LRD <290.0mm(p=0.036), and in female patients with XBD >370.0mm(p=0.042). The estimated blood loss was significantly lower in male patients with LSA <83.8° (p=0.009), PAAD <64.6mm(p=0.001), SFT <14.9mm(p=0.001), APD <176.2mm(p=0.009) and LRD <290.0mm(p=0.011). The complications were fewer in male patients with PAAD <64.6mm(p=0.045) and APD <176.2mm(p=0.011), and in female patients with LRD <288.5mm(p=0.047).Conclusion Various abdominal shapes can influence the difficulty of LADG. Lower LSA and PAAD can reduce the difficulty of LADG in male patients.

Short-term Results Of Sclerotherapy With 3% Polidocanol Foam For Symptomatic Second- And Third-degree Haemorrhoidal Disease

2019 ◽  
Author(s):  
Pierluigi Lobascio ◽  
Rita Laforgia ◽  
Eugenio Novelli Novelli ◽  
Fabrizio Perrone ◽  
Maria Di Salvo ◽  
...  
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Cost Effective ◽  
Daily Activities ◽  
Anal Continence ◽  
Short Term ◽  
Haemorrhoidal Disease ◽  
Post Operative Pain ◽  
Symptom Scores ◽  
The Mean

Abstract Background.Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most common proctological diseases. Sclerotherapy (ST) with 3% polidocanol foam induces an inflammatory reaction with sclerosis of the submucosal tissue and consequent suspension of the haemorrhoidal tissue. The aim of this study was to evaluate the short-term effectiveness and safety of ST with 3% polidocanol foam for the treatment of symptomatic second- and third-degree HD. Methods.A total of 66 patients with symptomatic second- and third-degree HD underwent a single ST session between March 2017 and July 2018. A visual analogue scale score was used to assess post-operative pain and patient satisfaction. The symptoms severity and anal continence were investigated through a self-reported questionnaire and Vaizey score, respectively, at baseline, at 4 weeks and after 1 year. Results. Fifty-seven out of 66 patients were male (86.3%), and the mean age was 52 (29-75; SD ± 12) years. The mean operative time was 4.5 (2-6; SD ± 1.23) minutes. No intraoperative complications and no drug-related side effects occurred. The overall success rate was 78.8% (52/66 patients) after a single ST session and 86% after two ST sessions (57/66 patients). The mean treatment effect, obtained comparing preoperative and T5 symptom scores in each patient, showed a mean change of 7.88 (p<0.001). All patients resumed their normal daily activities the day after the procedures. Conclusions.ST with 3% polidocanol foam is a safe, cost-effective and repeatable conservative treatment.

scholarly journals Single-institution case series of pituitary biopsy for suspected germinoma in the pediatric population: diagnostic utility, operative risks, and biopsy approaches

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Emily L. Day ◽  
Edward R. Smith ◽  
Katie P. Fehnel
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Pediatric Population ◽  
Intraoperative Complications ◽  
Pituitary Stalk ◽  
Diagnostic Utility ◽  
Surgical Morbidity ◽  
Icu Stay ◽  
Estimated Blood Loss ◽  
Pituitary Stalk Thickening

Abstract Little has been reported on the safety and efficacy of pituitary biopsy in the pediatric population for suspected germinoma. An updated review is needed. Patients who underwent biopsy (endoscopic endonasal vs. open craniotomy) for isolated pituitary stalk thickening were identified. Age, pre- and post-operative endocrine status, surgical approach, length of surgery, estimated blood loss, surgical morbidity, length of ICU stay, total length of stay, and pathology reports were reviewed. Nine patients met inclusion criteria. Germinoma diagnosis was rendered in 7 of 9 patients; 1 patient required two biopsy attempts. Two-patients had histology consistent with inflammation and a subsequently self-limited disease course. Average operative time, blood loss, ICU stay and overall length of stay was just over 2 h, 28 mL, 1.6 days and 3.7 days respectively. There were no intraoperative complications and all patients were discharged home. One patient developed new diabetes insipidus post-operatively. Patients who underwent endoscopic biopsy had decreased operative times and shorter hospitalizations. Biopsy for isolated pituitary stalk thickening for suspected germinoma is generally safe with high diagnostic utility. Importantly, 22% of presumed germinomas on imaging yielded alternative diagnoses on biopsy, adding support for pathology-proven data to guide treatment in relevant cases.

Laparoscopic single port radical prostatectomy in the 2020: Why not? Our experience

2021 ◽  
pp. 039156032199355
Author(s):  
Giuseppe Sortino ◽  
Willy Giannubilo ◽  
Manuel Di Biase ◽  
Andrea Marconi ◽  
Maurizio Diambrini ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Personal Experience ◽  
Functional Outcomes ◽  
Operative Time ◽  
Safe Procedure ◽  
Estimated Blood Loss ◽  
High Risk Disease ◽  
Oncological Results ◽  
The Mean

Objectives: To analyze the feasibility, safety and advantages of Laparo-Endoscopic Single-site Surgery radical prostatectomy (LESS-RP) based on our personal experience. Patients and methods: Details of 520 patients were retrospectively analyzed, from 2009 to 2019. Extraperitoneal approach, with only two accesses (2.5 cm and 5 mm respectively) was used to perform radical prostatectomy. Perioperative characteristics and postoperative oncologic and functional outcomes are reported. Results: The mean age was 66.6 ± 5.6 years. Mean PSA level was 9 ± 3.5 ng/ml. According to D’Amico classification, the percentage of patients with low-, intermediate-, and high-risk disease cases were 116 (22.4%), 275 (52.8%), and 129 (24.8%) respectively. Mean operative time was 156 ± 43 min. Mean estimated blood loss was 214 ± 93 ml. Positive surgical margins (PSMs) were detected in 110 (21.2%) patients. PSM rates in pT2 and pT3 stages were 20.1% and 22.9%, respectively. The overall complication rate was 9.2%, based on the modified Clavien classification. The 12 months continence and potency rates were 90.9% and 49.1%, respectively. The biochemical recurrence rate was 6.8%, at the median follow-up time of 26.7 months (IQR 12–32). Conclusions: Our analyses show that LESS-RP is a safe procedure, if performed by surgeons with adequate experience and skills. Unlike the classic laparoscopic prostatectomy, this technique allows better aesthetic and psychological results, reduced postoperative pain, and a faster return to normal daily activity with the same functional and oncological results.

A Simple Predictive Index of the Abdominal Shape for Postoperative Complications After Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

2021 ◽  
Author(s):  
Wei Tao ◽  
Yuxi Cheng ◽  
Xiao-Yu Liu ◽  
Bin Zhang ◽  
Chao Yuan ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Subcutaneous Fat ◽  
Operation Time ◽  
Short Term ◽  
Predictive Index ◽  
Xiphoid Process ◽  
Estimated Blood Loss ◽  
Abdominal Shape

Abstract Purpose The purpose of this study was to explore the effect of abdominal shape on the short-term surgical outcomes of laparoscopic distal gastrectomy + D2 lymph node dissection (LADG). Methods This was a retrospective study that included 425 patients undergoing LADG from January 2013 to January 2021 at a single clinical center. The abdominal parameters, including the shortest distance of the pancreas from the anterior abdominal skin (PAAD), the lower sternum angle (LSA), the thickness of the subcutaneous fat at the navel level (SFT), the anteroposterior diameters (APD) and the left-right diameters (LRD) at the navel level, the distance from the xiphoid process to the navel (XND) and the distance from the xiphoid process to the pubis (XBD), were calculated by preoperative abdominal computed tomography (CT) imaging. The abdominal parameters and short-term surgical outcomes were analyzed. Results In males, the number of retrieved lymph nodes was significantly higher in patients with a lower APD group (p=0.031). The operation time was significantly shorter in the lower body mass index (BMI) (p=0.007), lower LSA (p=0.035), lower PAAD (p=0.000), lower SFT (p=0.004), lower APD (p=0.000) and lower LRD (p=0.014) groups. The estimated blood loss was significantly less in the lower BMI (p=0.035), lower LSA (p=0.001), lower PAAD (p=0.012), lower SFT (p=0.003), lower APD (p=0.000) and lower LRD (p=0.005) groups. The complications were fewer in the lower LSA (p=0.012), lower APD (p=0.043) and lower LRD (p=0.023) groups. In females, the postoperative hospital stay was shorter in the lower PAAD (p=0.027) and lower SFT (p=0.004) groups, and the lower SFT group had fewer complications (p=0.020). Furthermore, in multivariate analysis, higher PAAD (p=0.029, odds ratio=1.030, 95% CI=1.003-1.058) was an independent factor for predicting postoperative complications in males. Conclusion Various abdominal shapes can affect the difficulty of LADG. Higher PAAD is a simple independent index for predicting postoperative complications in males.

Short-term surgical outcomes after Monopolar- versus Bipolar Transurethral Resection of the Prostate

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Ramadan ◽  
mohammed shoeb ◽  
Mohamed Shabayek
Keyword(s):  
Transurethral Resection ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Perioperative Complications ◽  
Controlled Study ◽  
Transurethral Resection Of Prostate ◽  
Short Term ◽  
Intraoperative Bleeding ◽  
Significant Difference

Abstract Background Transurethral resection of prostate (TURP) is currently the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), as this procedure results in the best improvement in symptoms and urine flow rate (1). Aim of the Work to compare between the two techniques used for transurethral resection of the prostate; Monopolar versus Bipolar resection as regards short term surgical outcomes, perioperative complications and early changes in quality of life.. Patients and Methods Randomized controlled study with simple randomization (1:1) of 80 patients with BPH candidate for transurethral resection of the prostate, 40 patients underwent M-TURP, and other 40 patients underwent B-TURP, their age mean age of paients included in our study 57-61 years old, mean prostate size 68-71 gm. Results Comparing intra-operative data in monopolar and bipolar TURP groups, our study reported that there was statistically significant decrease in volume of irrigation and operative time in B-TURP group in comparison to M-TURP group. although intra-operative complications; bleeding, electrolytes disturbance, fever and LUTS were lower in BTURP group; however, did not reach statistically significant. In M-TURP group ,there was statistically significance increase in change Hb, and time of post-oprative irrigation, IPSS in compared to B-TURP group. While in respect to PVR, time of catheterization and hospital stay, there was no statistically significant difference data among the two studied groups. Conclusion Bipolar TURP represents a promising endoscopic treatment for patients with BPH with decrease in volume of irrigation and reduced operative time, and less incidence of TUR syndrome, intraoperative bleeding, and postoperative complications .However, further investigations are needed with larger, preferably randomized multicentric controlled trials to confirm the results of this study in the future.

Trunk Fat Volume Can Be a Predictor of Short-Term Surgical Outcomes After Gastrectomy: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Shinichiro Shiomi ◽  
Tetsuro Toriumi ◽  
Koichi Yagi ◽  
Raito Asaoka ◽  
Yasuhiro Okumura ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Visceral Fat ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Proximal Gastrectomy ◽  
Short Term ◽  
Visceral Fat Area ◽  
Fat Volume

Abstract Background Obesity can affect postoperative outcomes of gastrectomy. Visceral fat area is superior to body mass index in predicting postoperative complications. However, visceral fat area measurement is time-consuming and is not optimum for clinical use. Meanwhile, trunk fat volume (TFV) can be easily measured via bioelectrical impedance analysis. Hence, this current study aimed to determine the association of trunk fat volume in predicting the occurrence of complications after gastrectomy. Methods We retrospectively reviewed patients who underwent curative gastrectomy for gastric cancer between November 2016 and November 2019. The trunk fat volume-to-the ideal amount (%TFV) ratio was obtained using InBody 770 before surgery. The patients were classified into the obese and nonobese groups according to %TFV (TFV-H group, ≥ 150 %; TFV-L group, < 150 %) and body mass index (BMI-H group, ≥ 25 kg/m2; BMI-L group, < 25 kg/m2). We compared the short-term postoperative outcomes (e.g., operative time, blood loss volume, number of resected lymph nodes, and duration of hospital stay) between the obese and nonobese patients. Risk factors for complications were assessed using logistic regression analysis. Results In total, 232 patients were included in this study. The TFV-H and BMI-H groups had a significantly longer operative time than the TFV-L (p = 0.022) and BMI-L groups (p = 0.006). Moreover, the TFV-H group had a significantly higher complication rate (p = 0.004) and a lower number of resected lymph nodes (p < 0.001) than the TFV-L group. In univariate analysis, %TFV ≥ 150, total or proximal gastrectomy, and open gastrectomy were found to be potentially associated with higher complication rates with p values < 0.1. Meanwhile, multivariate analysis revealed that %TFV ≥ 150 (OR: 2.73; 95%CI: 1.37–5.46; p = 0.005) and total or proximal gastrectomy (OR: 3.57; 95%CI: 1.79–7.12; p < 0.001) were independently correlated with postoperative morbidity. Conclusions %TFV independently affected postoperative complications. Hence, it may be a useful parameter for the evaluation of obesity and a predictor of short-term surgical outcomes after gastrectomy.

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