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Abstract Mini-endoscopic combined intrarenal surgery (ECIRS) offers improved advantages in the treatment of renal stones. However, the factors influencing the operative time remain poorly understood. This study aimed to identify the factors that enhance treatment planning and minimize complications. Clinical data from consecutive patients who underwent mini-ECIRS for renal stones and achieved a stone-free status between 2015 and 2021 at three high-volume centers in Japan were analyzed. The final treatment outcome was evaluated by computed tomography imaging at postoperative 1 month, and a successful outcome was defined as complete stone-free or residual stone fragments

Previous reports showed that prolonged operative time increases the risk of surgical site infection rates, prolonged hospital stays, and potentially higher rates of revision surgeries. In the context of rhinoplasty, the type of nasal deformity may complicate the surgical procedure and increase the operative time. We aimed to investigate the association between the type of nasal deformity and operative time in rhinoplasty patients. This retrospective chart review studies 349 patients who underwent primary and secondary rhinoplasty procedures due to various nasal deformities in King Saud University-Medical City. The primary outcome of the present study was the association between operative time, defined as the time from the initial incision to the completion of skin closure, and the type of nasal deformity. The association between the type of deformity and operative time was assessed using one-way ANOVA and Bonferroni post hoc analysis. There was a statistically significant association between the type of nasal deformity and operative time (p < 0.001). Patients with dorsal, alar base, and tip deformities had significantly longer operative times than patients with isolated dorsal deformities (208.01 ± 57.73 min) (p < 0.001). The analysis also showed that the presence of crooked nose deformities (p < 0.001), an inverted V deformity (p = 0.01), internal nasal valve collapse (p = 0.025), axis deviation (p = 0.003), over-projection, and under-projection significantly increased surgical duration. The complexity of nasal deformities significantly impacts the operative time in rhinoplasty surgeries; more complex deformities that require extensive surgical procedures are associated with a longer operative time. Further research is warranted to corroborate these findings and investigate other potential influencing factors.

Abstract Background In spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient’s outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery. Methods We retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications. Results A total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value

Abstract Background The adoption of robot-assisted total knee arthroplasty (TKA) aims to enhance the precision of implant positioning and limb alignment. Despite its benefits, the adoption of such technology is often accompanied by an initial learning curve, which may result in increased operative times. This study sought to determine the learning curve for the ROSA (Robotic Surgical Assistant) Knee System (Zimmer Biomet) in performing TKA and to evaluate the accuracy of the system in executing bone cuts and angles as planned. The hypothesis of this study was that cumulative experience with this robotic system would lead to reduced operative times. Additionally, the ROSA system demonstrated reliability in terms of the accuracy and reproducibility of bone cuts. Methods In this retrospective observational study, we examined 110 medical records from 95 patients who underwent ROSA-assisted TKA performed by three surgeons. We employed the cumulative summation methodology to assess the learning curves related to operative time. Furthermore, we evaluated the accuracy of the ROSA Knee System in performing TKA by comparing planned versus validated values for femoral and tibial bone cuts and angles. Results The learning curve for the ROSA Knee System spanned 14, 14, and 6 cases for the respective surgeons, with operative times decreasing by 22 min upon reaching proficiency (70.8 vs. 48.9 min; p

Abstract Background Although percutaneous central venous port (CVP) placement can be quickly performed using minimally invasive surgery, short- and long-term complications can occur. Beginner pediatric surgeons must overcome learning curves influencing operative time and complication rates. However, few studies have been conducted on the learning curve of ultrasound-guided percutaneous CVP placement. This study analyzed the progress, results, complications, and learning curve of ultrasound-guided percutaneous CVP placement in children performed by a single beginner pediatric surgeon. Methods Data from 30 children who underwent ultrasound-guided percutaneous CVP placement were reviewed. The patient characteristics, procedure indications, access veins, operator positions, operative times, and complication rates were analyzed. Results Cumulative sum analysis revealed two stages in the learning curve: stage 1 (initial 15 cases) and stage 2 (subsequent cases). There was a correlation between the number of cases and operative time (Pearson correlation = -0.499, p = 0.005); the operative time was significantly longer in the first than in the second stage (p = 0.007). Although surgical complications occurred more frequently in the early (26.7%) than in the late stage, it was not significantly different between the two stages (p = 0.1). During the study period, the operative time was significantly reduced owing to the change in the operator’s position from the patient’s right side to the patient’s head (p = 0.005). Conclusions Ultrasound-guided percutaneous CVP placement was a safe surgery that allowed a beginner pediatric surgeon to overcome the learning curve after only 15 cases and involved a relatively small number of complications compared with other pediatric surgeries. Additionally, the suitable position of the operator affected the surgical outcomes.

Background: The treatment of lower calyceal calculi with a size

Introduction: Gynaecological procedures may be performed via vaginal, abdominal, or minimally invasive approaches, such as laparoscopy, hysteroscopy, and robotic surgery. Abdominal hysterectomy, a prevalent major surgical intervention, is linked to significant complications, notably bleeding and postoperative pain. The invention of Ligasure represents a pivotal milestone in the field of gynaecology. Aim: To compare the effectiveness of Ligasure and traditional suturing during total abdominal hysterectomy. Materials and Methods: A retrospective observational study was conducted in Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India from March 2022 to September 2023. A total of 34 patients scheduled for elective abdominal hysterectomy were enrolled and divided into two equivalent groups comprising Ligasure (group A) and conventional suturing (group B). Comprehensive preoperative assessments and preparations were done for all participants. Subsequent documentation and comparison of operative and postoperative outcomes, focusing primarily on parameters such as surgical duration, blood loss, and postoperative complications, were done between the two groups. Student’s t-test was used to compare surgical time and blood loss between group A and group B. Results: The mean age of participants in the Ligasure group was 43±4.5 years, and in the suture group was 45±5 years. The difference in BMI between the two groups was not significant. The surgical duration in the Ligasure group was significantly shorter (p-value=0.0002) compared to the conventional suturing group (53.8±6.7 minutes and 64.3±7.62 minutes, respectively). Furthermore, the Ligasure group showed a significant reduction (p-value

Night work is frequently associated with sleep deprivation and is associated with greater surgical and medical complications. Lung transplantation (LT) is carried out both at night and during the day and involves many medical healthcare workers. The goal of the study was to compare morbidity and mortality between LT recipients according to LT operative time. We performed a retrospective, observational, single-center study. When the procedure started between 6 AM and 6 PM, the patient was allocated to the Daytime group. If the procedure started between 6 PM and 6 AM, the patient was allocated to the Nighttime group. Between January 2015 and December 2020, 253 patients were included. A total of 168 (66%) patients were classified into the Day group, and 85 (34%) patients were classified into the Night group. Lung Donors’ general characteristics were similar between the groups. The 90-day and one-year mortality rates were similar between the groups (90-days: n = 13 (15%) vs. n = 26 (15%), p = 0.970; 1 year: n = 18 (21%) vs. n = 42 (25%), p = 0.499). Daytime LT was associated with more one-year airway dehiscence (n = 36 (21%) vs. n = 6 (7.1%), p = 0.004). In conclusion, among patients who underwent LT, there was no significant association between operative time and survival.

Abstract Background Ventricular shunts are one of the most frequent techniques used for the management of hydrocephalus. The ventriculoperitoneal shunt (VPS) is the most commonly performed procedure, and the ventriculoatrial shunt (VAS) is the second option in most medical centers. The main objective of this study is to introduce and describe a surgical approach for VAS outlining our experience and comparing it with traditional shunting techniques. Methods In this retrospective cohort comparison study, we included patients with hydrocephalus treated with a surgical procedure between January 2010 and February 2021 at a single academic institution. We categorized the procedures into two groups: patients with VPS and conventional VAS grouped together into the conventional technique (CT) group, and the second group was patients with whom we performed VAS with complete internal jugular vein occlusion (IJVOT). We compared the surgical time, postoperative complications, and occurrence of shunt failure among the groups by performing univariate analysis using the Fisher exact test. Results Out of the 106 patients included in the analysis, IJVOT was performed in 66 patients, and CT in 40 patients. The median surgical time was 60 min (IQR 60–90) for IJVOT versus 100 min (IQR 60–120) for CT (p

Background/Objectives: Transforaminal endoscopic lumbar discectomy (TELD) under local anesthesia is a promising minimally invasive surgical option for intractable lumbar disc herniation (LDH). However, our understanding of access pain prediction during foraminal pathological procedures is limited. To our knowledge, no predictive rules for access pain have been established during TELD for foraminal or extraforaminal LDH. This study, with its potential for predicting access pain during TELD and discussing strategies for pain prevention and management, could significantly benefit the field of endoscopic spine surgery. Methods: This observational study included 73 consecutive patients who underwent TELD for foraminal or extraforaminal LDH between January 2017 and December 2022. Preoperative clinical and radiographic factors affecting significant access pain and the impact of access pain on clinical outcomes were evaluated. Results: The rate of significant access pain was 13.70% (10 of 73 patients). Extraforaminal LDH tended to cause more severe pain than did foraminal LDH during TELD under local anesthesia (p < 0.05). Although the degree of access pain was not related to global clinical outcomes, increased pain was strongly associated with prolonged operative time and length of hospital stay (p < 0.05). Conclusions: TELD could be an effective surgical option for foraminal or extraforaminal LDH under local anesthesia. More access pain might develop during TELD for extraforaminal LDH. The extraforaminal component of LDH could narrow the safe working zone. Significant access pain might prolong the duration of surgery and hospitalization. Thus, a specialized technique is required for the clinical success of TELD.

ObjectiveThe five-needle pancreato-intestinal anastomosis method is used in laparoscopic pancreaticoduodenectomy (LPD). The aim of this study was to explore the clinical efficacy and adverse reactions of this new surgical method and to provide a scientific reference for promoting this new surgical method in the future.MethodsA single-centre observational study was conducted to evaluate the safety and practicality of the five-needle method for pancreatojejunostomy in LPD surgeries. The clinical data of 78 patients who were diagnosed with periampullary malignancies and underwent LPD were collected from the 1st of August 2020 to the 31st of June 2023 at Lanzhou University First Hospital. Forty-three patients were treated with the ‘Five-Needle’ method (test groups), and 35 patients were treated with the ‘Duct-to-Mucosa’ method (control group) for pancreatojejunostomy. These two methods are the most commonly used and highly preferred pancreatointestinal anastomosis methods worldwide. The primary outcome was pancreatic fistula, and the incidence of which was compared between the two groups.ResultsThe incidence of pancreatic fistula in the five-needle method group and the duct-to-mucosa method group was not significantly different (25.6% vs. 28.6%, p=0.767). Additionally, there were no significant differences between the two groups in terms of intraoperative blood loss (Z=-1.330, p=0.183), postoperative haemorrhage rates (p=0.998), length of postoperative hospital stay (Z=-0.714, p=0.475), bile leakage rate (p=0.745), or perioperative mortality rate (p=0.999). However, the operative time in the ‘Five-Needle’ method group was significantly shorter than that in the ‘Duct-to-Mucosa’ method group (270 ± 170 mins vs. 300 ± 210 mins, Z=-2.336, p=0.019). Further analysis revealed that in patients with pancreatic ducts smaller than 3 mm, the incidence of pancreatic fistula was lower for the ‘Five-Needle’ method than for the ‘Duct-to-Mucosa’ method (12.5% vs. 53.8%, p=0.007).ConclusionThe five-needle method is safe and efficient for pancreatojejunostomy in LPD, and is particularly suitable for anastomosis in nondilated pancreatic ducts. It is a promising, valuable, and recommendable surgical method worthy of wider adoption.

Objectives. Pertrochanteric fractures, commonly incurred by the elderly from low-energy falls, require surgical management. Visible blood loss in the perioperative period is inconsistent with the big drop in hemoglobin seen postoperatively. This discrepancy is attributed to the hidden blood loss (HBL), which must be anticipated in anemia management. This study aimed to determine if the amount of HBL in elderly patients with pertrochanteric femur fractures treated with short proximal femoral anti-rotation nailing (PFNa) is affected by the delay in time to surgery. Methodology. This is a detailed cross-sectional study from a single institution. Two hundred and ten patients admitted and operated on from January 2017 to December 2019 at an orthopedic specialty hospital were included in the study. Patient’s age, sex, AO classification, weight, height, operative time, and hematocrit levels on admission, within 7 days before surgery and immediately postoperatively; visual blood loss and blood transfused were reviewed and retrieved from medical records. Cases were grouped into early (

Abstract Purpose The aim of this study was to analyze the learning curve of total operative time, bone cutting accuracy, and limb alignment in total knee arthroplasty (TKA) using a Chinese image-based knee surgery robot known as HURWA. Additionally, a comparison was conducted with conventional TKA to ascertain the benefits of robotic-assisted TKA. Methods In this retrospective study, we analyzed a series of patients (n = 90) who underwent robotic-assisted total knee arthroplasty using the HURWA robot between December 2021 and October 2022. The procedures were performed by one of three orthopedic surgeons with varying levels of experience. As a control group, we selected the last 30 conventional TKA cases performed by each of these three surgeons. To determine the learning curve, we recorded the operative time, bone cutting error, and pre- and post-surgery radiographs. Results The study found no significant differences in total operative time, bone cutting accuracy, or limb alignment among the three surgeons. Of the three surgeons, surgeon 1, who had the most experience in joint arthroplasty, reached the learning curve in case 8, with the shortest bone cutting time and robot time. Surgeon 2 reached the learning curve in case 16, while surgeon 3 reached the learning curve in case 9. There was no observable learning curve effect for bone cutting accuracy and limb alignment. However, the percentage of cases where limb alignment differed from preoperative planning by 3° or less was higher in robotic-assisted TKA (77.97%) than in conventional TKA (47.19%). Conclusion The study determined that the learning curve for robotic-assisted TKA using the HURWA knee surgery robot ranged from 8 to 20 cases. No observable learning curve effect was detected for bone cutting accuracy or limb alignment. Experienced surgeons using the HURWA robot for bone cutting took less time and reached the learning curve earlier. The HURWA robot achieved better limb alignment without depending on the experience of conventional TKA.

Abstract Background Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids. Methods This trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0. Results Findings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p

Abstract Objective To evaluate the risk factors and outcomes in patients surgically treated for subaxial cervical spine injuries with respect of the timing of surgery and preoperative physiological parameters of the patient. Methods 26 patients with sub-axial cervical spine fractures and dislocations were enrolled. Demographic data of patients, appropriate radiological investigation, and physiological parameters like respiratory rate, blood pressure, heart rate, PaO2 and ASIA impairment scale were documented. They were divided pre-operatively into 2 groups. Group U with patients having abnormal physiological parameters and Group S including patients having physiological parameters within normal range. They were further subdivided into early and late groups according to the timing of surgery as Uearly, Ulate, Searly and Slate. All the patients were called for follow-up at 1, 6 and 12 months. Results 56 percent of patients in Group S had neurological improvement by one ASIA grade and a good outcome irrespective of the timing of surgery. Patients in Group U having unstable physiological parameters and undergoing early surgical intervention had poor outcomes. Conclusion This study concludes that early surgical intervention in physiologically unstable patients had a strong association as a risk factor in the final outcome of the patients in terms of mortality and morbidity. Also, no positive association of improvement in physiologically stable patients with respect to the timing of surgery could be established.

Abstract Background The primary objective of this study involves the formulation of a novel variable, derived from initial data related to ischemia duration and operative time in partial nephrectomies. The aim was to determine the proportion of ischemia for the comparison between robotic and open approaches in terms of their relative ischemic requirements. Main body The literature search was conducted from August 2022 to June 2023, primarily encompassing non-randomized comparative studies in the English language. Ultimately, a total of 62 studies involving data from 26,072 patients were included. Following appropriate transformation of the original data under the assumption of normal distribution, the proportion of ischemia (I) was formulated for each study and comparison arm, using estimator functions. Subsequent analysis of the generated data was performed for both the original variables and the I outcome. Statistical significance was only observed regarding the surgical duration, with a mean difference of 19.74 min (CI95% = [11.56; 27.92]) in favor of robotic access. The mean difference in I was estimated on the entire dataset as well as carefully selected subgroups based on publication year, patient matching, the number of referral centers, and risk of bias class. Additionally, meta-regression analysis and four-level sensitivity analysis were conducted. In none of these investigations did statistically significant differences emerge between the two surgical approaches. These findings lead us to hypothesize that the proportion of ischemia in partial nephrectomies may represent an inherent characteristic of the procedure, typically manifesting as baseline ischemia (12–13% of operative time), with fluctuations depending on the chosen strategy or the complexity of the specific intervention. Short conclusion There is no difference in the proportion of ischemia between robotic and open partial nephrectomies. In overall, ischemia time appears to be primarily determined by the overall duration of the procedure and the effectiveness in achieving adequate hemostasis.

Abstract Objective We aimed at evaluating the impact of ultrasound‐guided (US) hookwire localization of nonpalpable cervical lymphadenopathy on operating time. Design and Methods Retrospective case control study (January 2017 and May 2021) of 26 patients with lateral nonpalpable cervical lymphadenopathy undergoing surgery with (H+) and without (H−) per operative US‐guided hook‐wire localization. Operative time (general anesthesiology onset, hookwire placement, end of surgery) and surgery‐related adverse events data were collected. Results Mean operative time was significantly shorter in H+ group versus H− group (26 ± 16 min vs. 43 ± 22 min) (p = 0.02). Histopathological diagnosis accuracy was 100% versus 94% (H+ vs. H−, p = 0.1). No significant between group difference in surgery‐related adverse events was reported (wound healing, p = 0.162; hematomas, p = 0.498; neoplasms removal failure, p = 1). Conclusion US‐guided hookwire localization of lateral nonpalpable cervical lymphadenopathy allowed a significant reduction in operative time, comparable histopathological diagnosis accuracy and adverse events compared with H−.

Purpose Obesity has been known to contribute to technical difficulties in surgery. Until now, body mass index (BMI) has been used to measure obesity. However, there are reports that BMI does not always correspond to the visceral fat. Recently, bioelectrical impedance analysis (BIA) has been used for body composition analysis. This study aimed to evaluate the usefulness of the body composition index obtained using a BIA device in predicting short-term postoperative outcomes. Methods Data of patients who underwent elective major colorectal surgery using minimally invasive techniques were reviewed retrospectively. Body composition status was recorded using a commercial BIA device the day before surgery. The relationship between BMI, body composition index, and short-term postoperative outcomes, including operative time, was analyzed. Results Sixty-six patients were enrolled in this study. In the correlation analysis, positive correlation was observed between BMI and body composition index. BMI and body composition index were not associated with short-term postoperative outcomes. Percent body fat (odds ratio, 4.226; 95% confidence interval [CI], 1.064–16.780; P=0.041) was found to be a statistically significant factor of prolonged operative time in the multivariate analysis. Correlation analysis showed that body fat mass was related to prolonged operative time (correlation coefficients, 0.245; P=0.048). In the area under curve analysis, body fat mass showed a statistically significant predictive probability for prolonged operative time (body fat mass: area, 0.662; 95% CI, 0.531–0.764; P=0.024). Conclusion The body composition index can be used as a predictive marker for prolonged operative time. Further studies are needed to determine its usefulness.

Abstract Objective Rotator cuff repair (RCR) is one of the most common arthroscopic procedures. Our investigation aims to quantify the impact that the COVID-19 pandemic had on RCR, specifically on patients with acute, traumatic injuries. Methods Institutional records were queried to identify patients who underwent arthroscopic RCR between March 1st to October 31st of both 2019 and 2020. Patient demographic, preoperative, perioperative, and postoperative data were collected from electronic medical records. Inferential statistics were used to analyze data. Results Totals of 72 and of 60 patients were identified in 2019 and in 2020, respectively. Patients in 2019 experienced shorter lengths of time from MRI to surgery (62.7 ± 70.5 days versus 115.7 ± 151.0 days; p = 0.01). Magnetic resonance imaging (MRI) scans showed a smaller average degree of retraction in 2019 (2.1 ± 1.3 cm versus 2.6 ± 1.2 cm; p = 0.05) butnodifference in anterior toposterior tear size between years (1.6 ± 1.0 cm versus 1.8 ± 1.0 cm; p = 0.17). Less patients in 2019 had a tele-health postoperative consultation with their operating surgeon compared with 2020 (0.0% versus 10.0%; p = 0.009). No significant changes in complications (0.0% versus 0.0%; p > 0.999), readmission (0.0% versus 0.0%; p > 0.999), or revision rates (5.6% versus 0.0%; p = 0.13) were observed. Conclusion From 2019 to 2020, there were no significant differences in patient demographics or major comorbidities. Our data suggests that even though the time from MRI to surgery was delayed in 2020 and telemedicine appointments were necessary, RCR was still performed in a time in early complications. Level of Evidence III.

Purpose: The goal of this systematic review is to offer a detailed summary of the present status of robotic-assisted surgery for adult spinal deformity. Methods: This review is based on articles systematically searched in PubMed, Medline, and Web of Science Core Collection databases on robotic-assisted surgery for adult spinal deformity. Differences in the precision of pedicle screw placement, duration of surgery, and incidence of complications between robotic-assisted surgery and the conventional open surgery were considered. Results: A total of 172 articles were retrieved from the literature search. A total of 168 articles were excluded. Therefore, this systematic review included the remaining four original articles, including accuracy of pedicle screw placement, operative time, radiation exposure, intraoperative and postoperative complications, respectively. The overall level of evidence in the studies was moderate to low. Conclusion: Robotic-assisted surgery for adult spinal deformity demonstrates the potential to enhance the precision of screw placement, possibly reduce intraoperative and postoperative complications, and decrease radiation exposure. However, the impact on operation duration requires further investigation.

Background: Despite the rising incidence of anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) among surgeons, little is known about the learning curve associated with these procedures. The purpose of this systematic review was to (1) identify the learning curves associated with ATSA and RTSA, (2) evaluate the effect of the learning curves on clinical outcomes, and (3) determine the number of cases needed to achieve proficiency. Methods: Four online databases [PubMed (NLM), MEDLINE (OVID), Cochrane Library (Wiley), and Scopus (Elsevier)] were systematically searched and screened according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The search included results from the inception of each database to May 18, 2022. Data regarding study characteristics, patient demographics, learning curve analyses, patient reported outcome measures, range of motion, complication rates, and reoperation rates were collected. A quality assessment for each article was performed according to the Methodological Index for Nonrandomized Studies criteria. Results: A total of 13 studies of fair to good quality were included for analysis (one of level II evidence, five of level III, and seven of level IV) with the majority originating from the United States [n = 8, 61.5%]. Overall, there were a total of 3381 cases (1861 RTSA and 1520 ATSA), with a mean patient age of 72.6 years [range: 45-92 years]. From the studies analyzed in this systematic review, for RTSA, the approximate average number of cases surgeons need to perform to move to an acceptable position on the RTSA learning curve is 25 cases. For ATSA, a wider range of 16-86 cases was derived as only two studies reported on ATSA. Conclusion: Progression along the learning curve for RTSA and ATSA results in decreased operative times, improved patient-reported outcomes, and fewer complications. However, a true learning curve is difficult to quantify given the heterogeneity of reported outcome measures, individual surgeon experience at the time of data collection, and statistical analyses used across studies.

Abstract Background Robot-assisted total knee arthroplasty (r-TKA) can reportedly achieve more accurate implant positioning than conventional total knee arthroplasty (c-TKA), although its learning curve is controversial. Moreover, few studies have investigated r-TKA in Asians, who have different anatomical characteristics. This study aimed to determine the learning curve for r-TKA and compare implant positions between r-TKA and c-TKA according to the learning curve in Asian patients. Methods This prospective study included 50 consecutive c-TKAs (group C), followed by 50 consecutive r-TKAs conducted using the MAKO robotic system (Stryker, USA). Cumulative summation analyses were performed to assess the learning curve for operative time in r-TKA. Accordingly, the r-TKA cases were divided into the initial (group I) and proficiency cases (group P). The femoral and tibial component positions in the coronal, sagittal, and axial planes and lower limb alignment were compared among the three groups. Results r-TKA was associated with a learning curve for operative time in 18 cases. The operative time was significantly shorter in groups C and P than that in group I, with no significant difference between groups C and P. Groups I and P demonstrated fewer outliers with respect to lower limb alignment, femoral component coronal position, axial position, and tibial component sagittal position than those in group C, with no significant difference between groups I and P. Conclusion The operative time did not differ significantly between r-TKA and c-TKA after the learning curve. Surgeons could expect more accurate and reproducible lower limb alignment and implant positioning with r-TKA in Asian patients, irrespective of the learning curve.

This study aimed to identify early postoperative complications after carotid endarterectomy and the factors that may influence their occurrence.

Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time. Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg/kg, followed by 0.2 mcg/kg/h, and to group II at the same loading dose, followed by 0.5 mcg/kg/h. Comparative analyses were performed using the Student's t-test, repeated-measures analysis of variance, and Mann–Whitney U test; p-values

Background and Aims: Pancreaticoduodenectomy (PD) is a complex and high-skill demanding procedure often associated with significant morbidity and mortality. However, the results have improved over the past two decades. However, there is a paucity of research concerning the learning curve for PD. Our aim was to report the outcomes of 100 consecutive PDs representing a single surgeon’s learning curve and to depict the factors that influenced the learning process. Methods: We reviewed the first 121 PDs performed at our academic center (2013–2019) by a single surgeon; 110 were PDs (5 laparoscopic and 105 open) and 11 were total PDs (1 laparoscopic and 10 open). Subsequent statistics was performed on the first 100 PDs, with attention paid to the learning curve and survival rate at 5 years. The data were analyzed comparing the first 50 cases (Group 1) to the last 50 cases (Group 2). Results: The most frequent histopathological tumor type was pancreatic ductal adenocarcinoma (50%). A total of 39% of patients had preoperative biliary drainage and 45% presented with positive biliary cultures. The preferred reconstruction technique included pancreaticogastrostomy (99%), in situ hepaticojejunostomy (70%), and precolic gastro-jejunal anastomosis (88%). Postoperative complications included biliary fistula (1%), pancreatic fistula (8%), pancreatic stump bleeding (4%), and delayed gastric emptying (13%). The mean operative time decreased after the first 50 cases (p < 0.001) and blood loss after 60 cases (p = 0.046). R1 resections lowered after 25 cases (p = 0.025). Vascular resections (17%) did not influence the rate of complications (p = 0.8). The survival rate at 5 years for pancreatic adenocarcinoma was 32.93%. Conclusions: Outcomes improve as surgeon experience increases, with proper training being the most important factor for minimizing the impact of the learning curve over the postoperative complications. Analyzing the learning curve from the perspective of a single surgeon is mandatory for accurate statistical results and interpretation.

Abstract Background Patients with a high body-mass index (BMI) are at increased risk for significant complications after total knee arthroplasty (TKA). We explored whether operative time is a modifiable risk factor for infectious and thromboembolic complications. Methods A retrospective observational cohort study of the ACS-NSQIP registry, including all patients who underwent primary TKA (2015–2018), and were morbidly obese (BMI 40 kg/m2 or greater) was performed. We created four categories of operative time in minutes: less than 60, 60–90, 91–120, and greater than 120. The association of prolonged operative time with superficial/deep surgical site infection (SSI), DVT and PE within 30 days postoperatively was evaluated using multivariate logistic regression. Results 34,190 patients were included (median age 63 [IQR 57–68], mean BMI of 44.6 kg/m2 [SD 4.4]). The majority of patients had an operative time between 60–90 mins (n = 13,640, 39.9%) or 91–120 mins (n = 9908, 29.0%). There was no significant association between longer operative time and superficial/deep/organ-space SSI or PE. DVT risk was significantly increased. Patients with time exceeding 120 mins had nearly 2.5 greater odds of DVT compared to less than 60 minutes (OR 2.47, 95% CI: 1.39–4.39, P = 0.002). Odds of DVT were 1.73 times greater in those with time of 91–120 mins (OR 1.73, 95%CI: 0.98–3.05, P = 0.06). Conclusion Early infection and thromboembolic complications with prolonged operative time in morbidly obese patients remain low. We did not identify a significant association with increased operative time and superficial/deep SSI, or PE. There was a significantly increased risk for deep vein thrombosis with prolonged operative time.

Background: Transurethral resection of the prostate (TURP) is one of the best available treatments for benign hypertrophy of the prostate. Many of the complications in TURP are associated with the absorption of irrigation fluid. In BIPOLAR TURP, normal saline is used as an irrigant which is more physiological. Aims and Objectives: Our aim of the study is to evaluate the correlation between post-operative electrolyte changes to perioperative factors in bipolar TURP. Materials and Methods: One hundred and ten patients enrolled in this study who were admitted to Meenakshi Mission Hospital, Madurai, Tamil Nadu, India. Results: Mean age of the participants was 65.68 (±8.50) years with a median of 66 years. mean hemoglobin drop was 1.21 (±1.36) g/dl. The mean serum sodium drop was 1.55 (±3.01) mEq/L. The mean serum potassium change was 0.06 (±0.74) mEq/L. There was a significant positive association between operative time and serum sodium drop (P

Objectives: Laparoscopic hepatectomy (LH) is still technically challenging for patients with previous nonhepatectomy abdominal surgery (AS). Therefore, this study aimed to assess the difficulty of performing LH for patients with hepatocellular carcinoma (HCC) and a history of nonhepatectomy AS during the initial developing period of LH. Materials and Methods: The retrospective study enrolled patients who were newly diagnosed with HCC receiving LH from January 2013 to June 2021. Demographic characteristics, perioperative variables, and surgical complications were prospectively collected. Results: One hundred patients were reviewed consecutively, comprising 23 in the AS group and 77 in the non-AS group. No significant differences were observed in median IWATE score (5 vs. 5, P = 0.194), operative time (219 vs. 200 min, P = 0.609), blood loss (100.0 vs. 200.0 mL, P = 0.734), transfusion rate (4.3% vs. 10.4%, P = 0.374), duration of parenchyma transection (90.0 vs. 72.4 min, P = 0.673), and mean nonparenchymal transection time (191.0 vs. 125.0 min, P = 0.228), without increasing the conversion rate (0.0% vs. 3.9%, P = 0.336), postoperative complications (30.3% vs. 33.8%, P = 0.488), and postoperative hospital stay (6 vs. 7 days, P = 0.060) in AS group and non-AS groups. Conclusion: History of previous nonhepatectomy AS can lead to longer nonparenchymal transection time instead of conversion and did not increase the difficulty. Prolonged nonparenchymal transection time did not increase the surgical complications, prolong the postoperative hospital stay, and compromise the survival outcomes.

Abstract Background In rectal cancer surgery, recent studies have found associations between clinical factors, especially pelvic parameters, and surgical difficulty; however, their findings are inconsistent because the studies use different criteria. This study aimed to evaluate common clinical factors that influence the operative time for the laparoscopic anterior resection of low and middle rectal cancer. Methods Patients who underwent laparoscopic radical resection of low and middle rectal cancer from January 2018 to December 2020 were retrospectively analyzed and classified according to the operative time. Preoperative clinical and magnetic resonance imaging (MRI)-related parameters were collected. Logistic regression analysis was used to identify factors for predicting the operative time. Results In total, 214 patients with a mean age of 60.3 ± 8.9 years were divided into two groups: the long operative time group (n = 105) and the short operative time group (n = 109). Univariate analysis revealed that the male sex, a higher body mass index (BMI, ≥ 24.0 kg/m2), preoperative treatment, a smaller pelvic inlet (

Objective:Holmium lasers are an effective endoscopic treatment for renal stones. Although laboratory studies have demonstrated reduced destruction times for high-power lasers, clinical evidence is lacking. Operative times for ureterorenoscopy (URS) were investigated by comparing high- and low power lasers in a general hospital setting.Materials and Methods:An audited review was conducted of 354 patients who underwent URS over a two-year period at two hospital sites using high- or low power laser. Operative time, stone characteristics, disposable equipment, s use of dusting, complications and stone-free rates were recorded. Linear regression was used to model the relationship between laser type and theater time. Univariate analysis was performed to determine other factors associated with increased operative time.Results:Mean operative time was 61.9 minutes. No significant difference between sites [0.40, p=0.88, confidence interval (CI) -4.9-5.8] was found, including following the exclusion of large stones (>20 mm). Stone size categories analyzed separately showed reduced operative times for larger stones when using high-power laser. Basket use (8.4, p=0.002, CI 3.06-13.65) and increasing stone size (6.9, p

IntroductionUterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss.Materials and methodsThis single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: “LM + TOHA” group (29 patients), and “LM” group (31 patients). The study’s main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb).ResultsDelta Hb was statistically lower in the “LM + TOHA” group compared to “LM” group, with mean ± standard (min–max): 1.68 ± 0.67 (0.39–3.99) vs. 2.63 ± 1.06 (0.83–4.92) g/dL, respectively (p

Objective: Lipomas are common, benign tumors usually located in the subcutaneous tissue. The “one-inch method” is a minimally invasive technique for resecting large subcutaneous lipomas through a one-inch incision after blunt dissection of the lipoma from its peripheral retaining ligaments. The limitations of this method are currently unclear.Materials and methods: We assessed twenty-five patients with large lipomas, defined as a tumor diameter greater than 5 cm. The location of the lipoma was at the shoulder in fifteen patients, the extremity in six patients, and the torso in four patients. Results: The mean operative time for all lesions was 28.3 minutes, with a mean time of 25.9 minutes for lipomas at the shoulder, 21.8 minutes for the extremities, and 47.0 minutes for the torso. We classified patients into three groups according to operative time: the short group (10–2in), middle group (30–49 min), and long group (50–70 min). For lipomas of the shoulder, there were eleven patients (73%) in the short group, three patients (20%) in the middle group, and one patient (7%) in the long group. For lipomas of the extremity, the groups contained five patients (83%), one patient (17%), and no patients (0%), respectively. For lipomas of the torso, the groups contained one patient (25%), no patients (0%), and three patients (75%), respectively. Conclusions: Lipomas of the torso require a longer operative time than those of the shoulder or extremity; this difference could be due to the number of retaining ligaments present, which is reportedly higher in the back than in the anterior or side body. Lipomas of the back are less amenable to the one-inch method, and posterior shoulder lipomas may take more time than those at other parts of the shoulder or at the extremities.

Objective: To compare Dynamic Hip Screw with Proximal Femoral Nail in unstable Inter Trochanteric femur fractures. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Malir Pakistan, from Dec 2020 to Aug 2021. Methodology: This study comprised patients aged 40 to 80 years with unstable inter Trochanteric proximal femoral fractures (AO Classification 31A2, 31A3). These patients were randomised into two Groups. Group-A patients underwent Dynamic hip screw fixation, and Group-B patients were subjected to Proximal Femoral Nailing. Follow-up was done at 2,6,12 weeks postoperatively. Two variables, namely operative time and blood loss, were evaluated. Result: Thirty patients were recruited in this study, with 18 patients in each Group. The average blood loss for Group-A Dynamic Hip Screw was measured to be 193.3±29.10 ml, and for Group-B Proximal Femoral Nail was 79.44±17.98 ml (p< 0.001). Group-A (DHS) scored an average operative time of 51.56±7.76 min, and Group-B Proximal Femoral Nail was 36.89±3.66 min (p

Chest wall osteoradionecrosis, one of the most serious complications of radiation therapy for breast cancer treatment, is usually treated by wide debridement followed by coverage with a well-vascularized flap. However, the extent of radiation-induced injury and limits in performing wide resection of the injured bones often present challenges in treatment. Herein, we present our experience treating chest wall osteoradionecrosis with a contralateral breast Y-V flap in an 81-year-old woman. She was diagnosed with chest wall osteoradionecrosis and had grade 3 ptotic breasts. Redundant contralateral breast tissue was used for reconstruction to cover the wound. The flap was elevated in the subfascial plane after an inverted-T incision was made in the lower pole and inframammary fold of the contralateral breast, while preserving the perforators of the left lateral thoracic artery. The flap was spread using the Y-V advancement fashion to cover the wound. The patient was discharged 2 weeks after surgery. At 19 months postoperation, there were no complications or recurrence. The patient was satisfied with the short recovery time and surgical results. The contralateral breast Y-V flap allows simple and quick reconstruction, potentially expanding the available treatment options and therefore increasing flexibility in choosing a treatment plan for patients.

INTRODUCTION: In this study, the authors aimed to compare the results of one-shot dilation (OD) and sequential dilation (SD) techniques which are used to access in patients who had undergone percutaneous nephrolithotomy (PCNL). METHODS: The authors retrospectively evaluated the data of 159 patients who had undergone PCNL between July 2017 and December 2020 in our clinic. The dilation methods were compared concerning demographic characteristics, operation time, fluoroscopy time, hemoglobin decrease, creatinine increase, complication rate, length of hospital stay, and operation success rate. RESULTS: While OD was applied to 79 patients, SD was applied to 80 patients. The mean length of operation time and fluoroscopy time were shorter in the OD group than SD group (51.14+-22.33 vs. 60.19+-18.91 min, 119.70+-51.03 vs. 136.54+-44.24 s, p0.01). No differences were found between OD and SD groups in terms of success and complication rate (91% vs. 85.0% and 11.3% vs. 15%) p≥0.05 (p>0.01). DISCUSSION AND CONCLUSION: The OD technique is a successful access method that can be utilized safely in patients considered for PCNL operation, contributing directly to the reduction of entry, operation, and fluoroscopy times without increasing complication rates.

Background: Appendectomy is most common surgical procedure done for treatment of acute appendicitis. Both laparoscopic and open techniques are used for its removal. The aim of this study is to compare the outcome of laparoscopic appendectomy with open appendectomy. Materials and Methods: A retrospective study was conducted in Nobel Medical College And Teaching Hospital, Biratnagar, Nepal from April 2019 to February 2021.Total 90 patients were enrolled in the study of which 44 in laparoscopic appendectomy group and 46 in open appendectomy group. These two groups were compared for demographic profiles, operative time, postoperative pain, length of hospital stay and surgical site infections. Results: Ninety patients underwent appendectomy of which 44 were in Laparoscopic group and 46 in Open group with similar demographic profiles. The mean operative time in Laparoscopic group was 42.95±2.46 minutes where as in Open group it was 35.25±1.87 minutes [p

AIM: To compare and observe the efficacy of 25G+ and 27G+ minimally invasive vitrectomy(MIVS)in the treatment of vitreoretinal diseases.METHODS: A retrospective case-control study, 76 patients(76 eyes)with various vitreoretinal diseases treated in our hospital from December 2018 to January 2020 were selected and randomly divided into 25G+ group and 27G+ group underwent vitrectomy, and the operation time of the two groups of patients, as well as the changes of ETDRS visual acuity, intraocular pressure, and conjunctival edema 1d before surgery, 1d after surgery, and 1, 4, 12, and 24wk after surgery were compared and analyzed.RESULTS: Compared with the 25G+ group, the 27G+ group had a longer vitrectomy time(27.17±5.95 vs 26.71±5.93min)and the total operation time was shorter than that of the 25G+ group(28.26±6.88 vs 30.37±6.68 min), but there was no significant difference between the two groups(t=0.322, P=0.748; t=-1.353, P=0.180). After vitrectomy, the visual acuity of the two groups was significantly improved compared with that before operation, but there was no significant difference between the two groups(P>0.05). Compared with the 25G+ group, the intraocular pressure fluctuation range of the 27G+ group at 1d(12.58±2.44 vs 10.56±3.21mmHg, t=2.943, P=0.004)and 1wk(13.48±2.85 vs 12.89±2.01mmHg, t=1.460, P=0.031)after the operation was low. Within 1wk after the operation, 7 eyes of transient hypotony occurred in the 25G+ group, but no hypotony occurred in the 27G+ group, indicating that the 27G+ MIVS can better stabilize postoperative intraocular pressure.CONCLUSION: 27G+ MIVS and 25G+ MIVS are safe and effective in the treatment of vitreoretinal diseases. Compared with 25G+ MIVS, 27G+ MIVS can better stabilize intraocular pressure and reduce the occurrence of complications caused by postoperative hypotony.

INTRODUCTION: The delay in surgical intervention for open fractures can have severe negative consequences. However, the delay for patients with open fractures presenting at Centre Hospitalier Universitaire de Kigali (CHUK), one of the largest public hospitals in Kigali, Rwanda, had not been studied. This study assessed the waiting time for surgery and compared it against the 6-hour (ideal time) and 24-hours (acceptable time) standards. METHODS: A review of the postoperative register and patients’ records was conducted. All medical charts of open fracture cases between April and September 2018 were audited. A surgical case was considered significantly delayed if the time interval from patient arrival at the emergency room to the operation theater was longer than 24 hours. The demographics, acuity level, insurance status and work shifts, were assessed using bi- and multivariate analysis. RESULTS: A total of 115 open fracture case files were audited. From arrival at the emergency room to surgery, the median time was 41 hours (IQR 21, 93). Only 3 (2.6%) were operated within 6 hours and 38 (33%) within 6 to 24 hours. The main factor contributing to the delay was obtaining orthopedic consultation note and documenting the decision to operate (median 10 hours, IQR 4 to 17). Meanwhile, the designated emergency theater was not utilized for a total of 18 hours per day, especially during night shifts. CONCLUSION: There was a significant delay in obtaining emergency orthopedic consultation and, thus, the timing of the surgical treatment. Examining the patient flow system in orthopedic surgical care delivery is needed in order to maximize theater utilization at this urban university hospital.

Abstract Background In Sweden, the incidence of a prosthetic joint infection (PJI) after a planned Total Hip Arthroplasty (THA) is 1.3%, but the worldwide incidence of PJI after THA is unknown. This study explores associations between reoperation due to PJI and potential risk factors. Methods Primary elective THA surgery registered in both the Swedish Hip Arthroplasty Registry (SHAR) and the Swedish Perioperative Registry (SPOR) between 1 January 2015 and 31 December 2019 were included in this registry study, resulting in a total study population of 35,056 cases. The outcome variable was reoperation as the result of PJI within a year after surgery. Data were analysed using a multivariable Cox regression model. Results Reoperation due to PJI occurred in 460 cases (i.e., 1.3% of the study population). Each year of age increased the risk with 2% (HR 1.02 Cl 1.01, 1.03 P = 30), the risk increased considerably compared to underweight, normal weight, or overweight patients (HR 1.89 Cl 1.43, 2.51 P =

Objective: This study assessed the results of robotic thyroidectomy for differentiated thyroid cancer in early stage, to identify the predictive factors of operative time and complication rate. Methods: A patient cohort of 359 cases in total was involved in this retrospective study. The data of clinical characteristics and follow-up results were collected. Results: The cohort of patients involved was composed of 285 female patients and 74 male ones. The mean age was 34.91 ± 7.93 years old. The mean Body Mass Index (BMI) was 22.43 ± 3.47. The mean tumor size was 0.75 ± 0.56 cm, and the mean gland size was 4.68 ± 0.83 cm. Among all the specimen, the ratio of tumor invasion of gland capsule was 63/296, and the ratio of chronic thyroiditis was 110/249. 75 patients underwent total thyroidectomy + central compartment node dissection (CCND). 284 patients underwent Lobectomy + CCND. The ratio of central lymph node metastasis was 144/215 (40.1%). The mean number of lymph node dissected was 5.26 ± 4.09. The mean operative time was 96.53 ± 25.69 min. 21(5.8%) patients had hoarseness after operation. 22(29.3%) patients had hypocalcemia after total thyroidectomy. The inadvertent parathyroidectomy was found in 66(18.4%) cases. The surgical extent (unilateral/bilateral resection), BMI and gland size were found to have a significantly correlation with the operative time (p

Abstract Background The primary aim of this study was to identify if there is an association between the operative time of the initial debridement for necrotizing soft tissue infections (NSTIs) and the mortality corrected for disease severity. Methods A retrospective multicenter study was conducted of all patients with NSTIs undergoing surgical debridement. The primary outcome was the 30-day mortality. The secondary outcomes were days until death, length of intensive care unit (ICU) stay, length of hospital stay, number of surgeries within first 30 days, amputations and days until definitive wound closure. Results A total of 160 patients underwent surgery for NSTIs and were eligible for inclusion. Twenty-two patients (14%) died within 30 days and 21 patients (13%) underwent an amputation. The median operative time of the initial debridement was 59 min (IQR 35–90). In a multivariable analyses, corrected for sepsis just prior to the initial surgery, estimated total body surface (TBSA) area affected and the American Society for Anesthesiologists (ASA) classification, a prolonged operative time (per 20 min) was associated with a prolonged ICU (β 1.43, 95% CI 0.46–2.40; p = 0.004) and hospital stay (β 3.25, 95% CI 0.23–6.27; p = 0.035), but not with 30-day mortality. Operative times were significantly prolonged in case of NSTIs of the trunk (p = 0.044), in case of greater estimated TBSA affected (p = 0.006) or if frozen sections and/or Gram stains were assessed intra-operatively (p

Purpose: Stereotactic navigation is being increasingly used for orbital decompression (OD). Recent studies have cited clinical benefits of navigation including greater proptosis reduction but have differed regarding effects on operative time. This study aimed to evaluate navigated vs. non-navigated OD with respect to operative time and proptosis reduction. Materials and Methods: Retrospective nonrandomized comparative trial of navigated vs. nonnavigated OD. Operative time and proptosis reduction were recorded and analyzed for all patients. Results: A total of 30 orbital decompressions were included; 14 were performed with stereotactic navigation (SN), and 16 were performed without SN. On average, the SN group took 19 minutes longer for 3-wall decompressions (p = 0.185), 25 minutes shorter for balanced decompressions (p = 0.025), and 18 minutes longer (p = 0.067) for lateral wall decompressions. Mean proptosis reduction (PR) in 3-wall decompressions was greater in the SN group (p = 0.02). Among balanced wall decompressions, mean PR was 4.25 mm and 3.67 mm for the SN and non-SN groups (p = 0.30), respectively. For lateral wall decompressions, mean PR was 2.63 mm with SN and 2.50 mm without SN (p = 0.45). Conclusions: This study showed no difference in operative times between navigated and non-navigated OD, although empirical experience showed variable times required for registration and intraoperative troubleshooting of the navigation system. This study also found that navigation increased proptosis reduction for all types of OD. Further randomized controlled trials are needed to better understand the impact of navigation technology on operative times and surgical outcomes.

Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those “fragile” patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those “fragile” patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection.

Introduction: Laparoscopic Cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis. During this procedure, sometimes abdominal drain is placed in the right sub-hepatic space. The main objectives of this study were to assess the indications for the use of intra-abdominal drains (IADs) in elective LCs and its outcomes following LCs. Methods: This is a prospective descriptive cross-sectional study conducted between November 2017 and December 2018 in the Department of Surgery of a tertiary level teaching hospital in Kathmandu, Nepal. Sixty patients who underwent elective LC with the placement of intra-abdominal drain were selected for the study. The data were recorded in a preformed proforma and analyzed using MS Excel and Statistical Package for Social Sciences Version 16.0. Results: The total LCs performed during this period was 536. The overall prevalence of IAD placement in LC was 11.19% (n=60), with drains placed more frequently among males than females (27.4% v/s 6.3%). Cholelithiasis with cholecystitis (35%, n=21) was the most common indication for elective IAD placement while adhesions (56%, n=34) was the most common intraoperative indication for IAD in LC. Surgical site infection (SSI) and fever were encountered in 15% (n=9) and 5% (n=3) of the patients respectively. SSI was found to have a positive correlation with the operative time (p=0.01), post-operative hospital stay (p=0.003) and age of the patient (p=0.021). Conclusion: The prevalence of IAD placement in LC in our study was almost double as compared to that of studies in other countries and predominantly more among males than females. Cholelithiasis with cholecystitis and adhesions were the most common indications for IAD placement. SSI in IAD placement was found to be positively correlated with the operative time, post-operative hospital-stay and age of the patient.

Introduction: Laparoscopic Cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis. During this procedure, sometimes abdominal drain is placed in the right sub-hepatic space. The main objectives of this study were to assess the indications for the use of intra-abdominal drains (IADs) in elective LCs and its outcomes following LCs. Methods: This is a prospective descriptive cross-sectional study conducted between November 2017 and December 2018 in the Department of Surgery of a tertiary level teaching hospital in Kathmandu, Nepal. Sixty patients who underwent elective LC with the placement of intra-abdominal drain were selected for the study. The data were recorded in a preformed proforma and analyzed using MS Excel and Statistical Package for Social Sciences Version 16.0. Results: The total LCs performed during this period was 536. The overall prevalence of IAD placement in LC was 11.19% (n=60), with drains placed more frequently among males than females (27.4% v/s 6.3%). Cholelithiasis with cholecystitis (35%, n=21) was the most common indication for elective IAD placement while adhesions (56%, n=34) was the most common intraoperative indication for IAD in LC. Surgical site infection (SSI) and fever were encountered in 15% (n=9) and 5% (n=3) of the patients respectively. SSI was found to have a positive correlation with the operative time (p=0.01), post-operative hospital stay (p=0.003) and age of the patient (p=0.021). Conclusion: The prevalence of IAD placement in LC in our study was almost double as compared to that of studies in other countries and predominantly more among males than females. Cholelithiasis with cholecystitis and adhesions were the most common indications for IAD placement. SSI in IAD placement was found to be positively correlated with the operative time, post-operative hospital-stay and age of the patient.

Abstract Introduction: Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up. Methods: This is a retrospective review of the medical records of 152 patients undergoing elective CABG with the use of BITA and cardiopulmonary bypass (CPB). These patients were divided into two groups, diabetics and non-diabetics. Patients with acute myocardial infarction and concomitant valvular disease were not included in the sample. Results: Preoperative characteristics did not show significant differences between the groups, which allowed a comparative analysis. The variables electrocardiography time and aortic clamping time were higher in the diabetic group, with a significant statistical difference (P

Sagol Tangjanyatam Department of Ophthalmology, Hua Hin Hospital, Prachuap Khiri Khan, ThailandCorrespondence: Sagol Tangjanyatam Email golno1@gmail.comPurpose: The objective was to compare the operative time, ultrasound time, efficacy and safety of phacoemulsification with IOL insertion between using halogen and light-emitting diode (LED) illuminated microscope.Patients and Methods: Two hundred and twenty-seven surgical charts of cataract patients who underwent phacoemulsification with IOL insertion between June 2018 and October 2020 were reviewed. There were 113 cases operated on under halogen-illuminated microscope (Carl Zeiss OPMI LUMERA S7®) and 114 cases operated on under light-emitting diode (LED)-illuminated microscope (Leica PROVEO 8®). All cases were operated on by the same surgeon (S.T.). The difference in operative time and ultrasound time between two groups was compared by independent samples t-test. The proportion of cases with 3-months BCVA that was better than 20/30 and the proportion of cases with intraoperative complications from the operation between two groups were compared by Pearson’s Chi-squared test.Results: The mean ultrasound time was 121.29± 53.60 seconds in halogen group and 123.98± 61.53 seconds in LED group. The mean difference was − 2.69± 8.44 seconds which was not statistically significant (95% CI, − 19.35 to 13.97; p=0.573). The mean operative time was 19.83± 4.77 minutes in the halogen group and 17.20± 3.02 minutes in the LED group. The mean difference was 2.63± 0.53 minutes (95% CI, 1.59 to 3.67; p < 0.001). The cases with BCVA better than 20/30 was 93.69% in halogen group and 95.49% in LED group. The proportion of cases with intraoperative complications was 3.53% in halogen group and 2.63% in LED group. The difference of both proportions was not statistically significant (p=0.553 and p=0.692, respectively).Conclusion: This study shows statistically significant operative time reduction with LED microscope. This evidence could be used for making the decision to switch from halogen microscope to LED microscope. Upgrading to LED-illuminated microscope might be beneficial for productivity improvement if there were at least six to seven cases operated on per day. The ultrasound time, efficacy, and safety showed no significant difference.Keywords: operative time, ultrasound time, light source, operative microscope

ObjectiveTo determine the optimal timing of thoracic endovascular aortic repair (TEVAR) for patients with uncomplicated type B dissections who have a smoking history.MethodsData from 308 consecutive patients with uncomplicated type B dissections, who have a smoking history and onset-to-TEVAR time within 90 days, were analyzed. The patients were divided into two groups: Acute and subacute phases. Univariate and multivariate regression analyses were performed. Smooth curve fitting and threshold analysis were performed to characterize the relationship between the onset-to-TEVAR time and follow-up deaths.ResultsThere were no significant differences between the two groups. Smooth curve fitting and threshold effect analysis showed that if early TEVAR was performed within 9.4 days from onset, there was better long-term survival and there was no significant difference after 9.4 days.ConclusionBy studying the relationship between onset-to-TEVAR time and all-cause mortality, we found that early TEVAR may have a lower all-cause mortality rate during follow-up in uncomplicated type B dissection patients who have a smoking history and within 90 days from onset.

ObjectiveTo compare the clinical outcomes of unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS) via the posterior approach with those of interlaminar endoscopic lumbar discectomy (IELD) for the treatment of L5/S1 lumbar disc herniation.MethodsWe collected the clinical data of patients with L5/S1 lumbar disc herniation who had undergone endoscopic surgery at our center from January 2020 to July 2021, and 92 patients were included. They were divided into UBE/BESS (n = 42) and IELD (n = 50) groups. The incision length, operative time (overall operative, extracanal operative, and intracanal decompression times), intraoperative radiation exposure dose, changes in hemoglobin before and after surgery, postoperative hospital stay, visual analog scale (VAS) score for low back pain and leg, and Oswestry disability index (ODI) were statistically analyzed.ResultsOne case incurred dural tear in the UBE/BESS group, and one case developed recurrence in the IELD group. Postoperatively, the VAS score and ODI index decreased significantly in both groups (P 0.05). No statistical difference in intraoperative radiation exposure dose was noted between the two groups (P > 0.05). The surgical incision length was greater in the UBE/BESS group (P