Clinical study of Evaluation of the Effect of Tranexamic Acid in Primary Cleft Palate Surgery in Children

Aim : To evaluate tranexamic acid effect on quality of surgery. Design: Double-blind study, Prospective and randomized Place & time of study: June 2020 to may 2021Allama iqbal memorial trust hospital Gujranwala. Methods: Two groups of candidates were made. The saline was administered to the control group whereas tranexamic acid was administered as 0.01g/kg in a bolus form, before surgical incision to tranexamic acid group. On a 10-point scale, grading of surgical field, primary hemorrhage and satisfaction of surgeon Results: As far as operating surgeon satisfaction is concerned, noteworthy improvement was witnessed and evaluation of surgery in case of control individuals group as compared to in case of test individual group in the tranexamic acid individuals group was estimated against the control members of group. Conclusion: tranexamic acid was given in dosage of 0.01g/kg of before surgical incision showed improved in a great way in surgical field during repairing of cleft palate operation. Keywords: tranexamic acid surgical field, pediatric, palatoplasty satisfaction, cleft palate

Marginal mandibular nerve — a wandering enigma and ways to tackle it

Background This study aims to propose surgical approaches intended to localize and preserve the marginal mandibular nerve (MMN) during routinely performed head and neck surgical procedures. Main body of abstract Preservation of the functional integrity of the MMN is a critical measure in the success of orofacial surgeries involving the submandibular triangle. This study systematically reviews the anatomical description of the nerve including origin, course relative to fascial planes, relation to the parotid gland and facial pedicle, branching pattern and anastomosis of nerve and consolidate the findings of several significant studies to determine the “surgically safe” approaches to avoid iatrogenic injury to MMN. Short conclusion The systematic approaches described in this study have helped the authors precisely determine which particular MMN preserving approach to be adopted for each aspect of head and neck surgery. This has definitely enhanced the quality of surgery performed and the postoperative satisfaction of the patients.

377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer

Introduction Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes. Method RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Results As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power. Conclusions RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.

The opinions of specialists and students regarding the use of visual and written expression forms in rhinoplasty education

This research was conducted to investigate the contribution of visual and written expression to nasal surgery education and the preferences of usage. The research was conducted with the observation of cases in the Ear, Nose and Throat (ENT) Surgery Department of Ondokuz Mayıs University Medical Faculty. During the study, the processes of the ‘closed dorsum rhinoplasty’ cases were observed. The case illustrations made as a result of the observations were presented to the study population comprising 36 medical students from 3 different universities (Ondokuz Mayıs University, Hitit University, İstanbul Medeniyet University). Data were obtained concerning the sampling of the research, the specialization areas of the participants, title groups, number of participants, and the information from the Likert type responses and the non-parametric statistical findings. The results showed that although the use of illustrations was seen to be more important according to the opinion of specialists and non-specialists in the area, sole use was concluded to be insufficient. A total of 43 of 60 ENT specialists and 9 of 11 Plastic Surgery specialists preferred the use of illustrations, photographs and written expression together. Non-specialists were seen to be undecided about their responses while no significant difference was found between specialists. The preferences of the participants were determined to be illustration, photography and written expression, respectively. The results of this study indicate that the use of visual and written expression forms together when they are available is related to the quality of surgery education at a semantic level.

The surgical treatment of non-metastatic melanoma in a Clinical National Melanoma Registry Study Group (CNMR): a retrospective cohort quality improvement study to reduce the morbidity rates

Background Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. Methods Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. Results Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. Conclusions Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management.

Does Circular Stapler Size in Surgical Management of Esophageal Cancer Affect Anastomotic Leak Rate? 4-Year Experience of a European High-Volume Center

Anastomotic leak is one of the most severe postoperative complications and is therefore considered a benchmark for the quality of surgery for esophageal cancer. There is substantial debate on which anastomotic technique is the best for patients undergoing Ivor Lewis esophagectomy. Our standardized technique is a circular stapled anastomosis with either a 25 or 28 mm anvil. The aim of this study was to retrospectively analyze whether the stapler diameter had an impact on postoperative anastomotic leak rates during a 4-year time frame from 2016 to 2020. A total of 632 patients (open, hybrid, and totally minimally invasive esophagectomy) met the inclusion criteria. A total of 214 patients underwent an anastomosis with a 25 mm stapler vs. 418 patients with a 28 mm stapler. Anastomotic leak rates were 15.4% vs. 10.8%, respectively (p = 0.0925). Stapler size should be chosen according to the individual anatomical situation of the patient. Stapler size may be of higher relevance in patients undergoing totally minimally invasive reconstruction.

The surgical treatment of non-metastatic melanoma in a Clinical National Melanoma Registry Study Group (CNMR): a retrospective cohort quality improvement study to reduce the morbidity rates

Background: Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry.Methods: Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (>80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated.Results: Wound infection rate was 1.1% (0.4% to 2.7%) in WE, 1.3% (0.7% to 2.5%) in SLNB and 4.1% (2.1% to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8% to 5.1%) in WE, 0.9% (0.2% to 3.0%) in SLNB and 2.8% (0.9% to 8.6%) in LFND. Seroma rate was 4.2% (1.5% to 11.1%) in SLNB and 15.1% (4.6% to 39.9%) in LFND. Unreliable information was found on skin graft failure.Conclusions: Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management.