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1. J-shaped association of operation duration and blood transfusion risk in patients undergoing primary total knee arthroplasty.

Author

Liu, Bo, Li, Yanyan, and Zhang, Qiang

Subjects
*TOTAL knee replacement, *BLOOD transfusion, *LOGISTIC regression analysis, *SURGICAL complications, *ODDS ratio
Abstract

Purpose: Blood transfusion is a common perioperative complication of primary total knee arthroplasty (TKA) that can lead to adverse outcomes, prolonged hospital stays, and increased medical costs. The purpose of our study was to explore the risk factors for blood transfusion and to establish whether operation duration is independently related to blood transfusion risk in patients undergoing primary TKA after adjusting for other covariates. Methods: This was a secondary analysis of data from a retrospective cohort study involving patients who underwent primary TKA in Singapore. The patients' baseline data, comorbidity, and surgical characteristics were collected. The independent variable was operation duration and the dependent variable was blood transfusion events. Patients were divided into three groups according to operation durations (90 and 120 min). Univariate logistic regression was used to explore the risk factors associated with blood transfusion after primary TKA. Multivariate analysis was used to assess the independent effect of operation duration on blood transfusion risk after adjusting for other covariates. Additionally, we performed subgroup analyses to identify specific groups, test the robustness of the relationships, and explore whether there were interactions between the different variables. Furthermore, restricted cubic splines (RCS) were used to identify the relationship between the two variables. Results: A total of 2,562 patients were included in the study, of whom 136 (5.61%) had a transfusion event. Operation durations were 95.55 ± 36.93 and 83.86 ± 26.29 min for blood transfused and non-transfused patients, respectively. Univariate logistic regression analysis showed that age, BMI, ASA status, Hb level, OSA, CHF, creatinine level > 2 mg/dL, and anaesthesia type were risk factors for blood transfusion. After adjusting for all covariates, multivariate logistic regression models showed that operation duration was positively associated with blood transfusion risk (odds ratio [OR] = 1.87, 95% CI = 1.174–2.933, P = 0.007). Compared to patients with an operation duration of less than 90 min, those with an operation duration of more than 120 min had a 2.141-fold increased risk of blood transfusion (OR = 2.141, 95% CI = 1.035–4.265, P = 0.035). Stratified analysis results showed that the association persisted in patients aged > 50 years, Chinese, BMI > 30 kg/m 2, Hb level > 11 g/dL, ASA status levels 2 and 3, general anaesthesia, and unilateral primary TKA. A non-linear (P-non-linear = 0.30) and J-shaped relationship was identified. The risk of transfusion increased as the operation duration decreased or exceeded the inflection point (73.2 min). Conclusion: Our study demonstrated a non-linear and J-shaped relationship between operation duration and blood transfusion events in patients undergoing primary TKA. Blood transfusion risk was the lowest when the operation duration was 73.2 min. A shorter operation duration implies irregular surgical procedures and incomplete intraoperative haemostasis, leading to increased perioperative blood loss and blood transfusion. These results will be useful for clinical decision-making. [ABSTRACT FROM AUTHOR]

Published
2024
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2. Clinical and economic comparison of laparoscopic versus open hepatectomy for primary hepatolithiasis: a propensity score-matched cohort study.

Author

Xiao-Peng Chen, Wen-Jun Zhang, Bin Cheng, Yuan-Lin Yu, Jun-Lu Peng, Sheng-Hua Bao, Chao-Gang Tong, and Jun Zhao

Abstract

Background: It is unclear whether laparoscopic hepatectomy (LH) for hepatolithiasis confers better clinical benefit and lower hospital costs than open hepatectomy (OH). This study aim to evaluate the clinical and economic value of LH versus OH. Methods: Patients undergoing OH or LH for primary hepatolithiasis at Yijishan Hospital of Wannan Medical College between 2015 and 2022 were divided into OH group and LH group. Propensity score matching (PSM) was used to balance the baseline data. Deviation-based cost modelling and weighted average median cost (WAMC) were used to assess and compare the economic value. Results: A total of 853 patients were identified. After exclusions, 403 patients with primary hepatolithiasis underwent anatomical hepatectomy (OH n= 143; LH n =260). PSM resulted in 2 groups of 100 patients each. Although LH required a longer median operation duration compared with OH (285.0 versus 240.0 min, respectively, P< 0.001), LH patients had fewer wound infections, fewer pre-discharge overall complications (26 versus 43%, respectively, P =0.009), and shorter median postoperative hospital stays (8.0 versus 12.0 days, respectively, P< 0.001). No differences were found in blood loss, major complications, stone clearance, and mortality between the two matched groups. However, the median overall hospital cost of LH was significantly higher than that of OH (CNY¥52,196.1 versus 45,349.5, respectively, P =0.007). Although LH patients had shorter median postoperative hospital stays and fewer complications than OH patients, theWAMCwas still higher for the LH group than for the OH group with an increase of CNY ¥9,755.2 per patient undergoing LH. Conclusion: The overall clinical benefit of LH for hepatolithiasis is comparable or even superior to that of OH, but with an economic disadvantage. There is a need to effectively reduce the hospital costs of LH and the gap between costs and diagnosis-related group reimbursement to promote its adoption. [ABSTRACT FROM AUTHOR]

Published
2024
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3. A meta‐analysis of the risk factors for neurosurgical surgical site infection following craniotomy.

Author

Sun, Dechao, Ma, Zhuang, Geng, Yadong, Kong, Chenxu, and Li, Zhenjiang

Subjects
RISK assessment, MEDICAL information storage & retrieval systems, NEUROSURGERY, CRANIOTOMY, META-analysis, AGE distribution, TREATMENT duration, DESCRIPTIVE statistics, SURGICAL complications, SYSTEMATIC reviews, MEDLINE, ODDS ratio, MEDICAL databases, SURGICAL site infections, ONLINE information services, LENGTH of stay in hospitals, CONFIDENCE intervals, DISEASE risk factors
Abstract

The purpose of the meta‐analysis was to evaluate and compare the risk factors for neurosurgical surgical site infection (SSI) after craniotomy. Using dichotomous or contentious random or fixed effect models, the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were computed based on the examination of the meta‐analysis results. Eighteen analyses, covering 11 068 craniotomies between 2001 and 2023, were included in the current meta‐analysis. Subjects with SSIs had a significantly younger age (MD, −2.49; 95% CI, −2.95 to −2.04, p < 0.001), longer operation duration (MD, 10.21; 95% CI, 6.49–13.94, p < 0.001) and longer length of postoperative hospital stay (MD, 1.52; 95% CI, 0.45–2.60, p = 0.006) compared to subjects with no SSI with craniotomy. However, no significant difference was found between craniotomy subjects with SSIs and with no SSI in gender (OR, 0.90; 95% CI, 0.76–1.07, p = 0.23), and combination with other infection (OR, 3.93; 95% CI, 0.28–56.01, p = 0.31). The data that were looked at showed that younger age, longer operation duration and longer length of postoperative hospital stay can be considered as risk factors of SSI in subjects with craniotomy; however, gender and combination with other infections are not. Nonetheless, consideration should be given to their values because several studies only involved a small number of patients, and there are not many studies available for some comparisons. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Improving preoperative prediction of surgery duration

Author

Vahid Riahi, Hamed Hassanzadeh, Sankalp Khanna, Justin Boyle, Faraz Syed, Barbara Biki, Ellen Borkwood, and Lianne Sweeney

Subjects
Operating room, Operation duration, Prediction models, Individual patient characteristics, Extreme gradient boosting, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Operating rooms (ORs) are one of the costliest units in a hospital, therefore the cumulative consequences of any kind of inefficiency in OR management lead to a significant loss of revenue for the hospital, staff dissatisfaction, and patient care disruption. One of the possible solutions to improving OR efficiency is knowing a reliable estimate of the duration of operations. The literature suggests that the current methods used in hospitals, e.g., a surgeon’s estimate for the given surgery or taking the average of only five previous records of the same procedure, have room for improvement. Methods We used over 4 years of elective surgery records (n = 52,171) from one of the major metropolitan hospitals in Australia. We developed robust Machine Learning (ML) approaches to provide a more accurate prediction of operation duration, especially in the absence of surgeon’s estimation. Individual patient characteristics and historic surgery information attributed to medical records were used to train predictive models. A wide range of algorithms such as Extreme Gradient Boosting (XGBoost) and Random Forest (RF) were tested for predicting operation duration. Results The results show that the XGBoost model provided statistically significantly less error than other compared ML models. The XGBoost model also reduced the total absolute error by 6854 min (i.e., about 114 h) compared to the current hospital methods. Conclusion The results indicate the potential of using ML methods for reaching a more accurate estimation of operation duration compared to current methods used in the hospital. In addition, using a set of realistic features in the ML models that are available at the point of OR scheduling enabled the potential deployment of the proposed approach.

Published
2023
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5. Improving preoperative prediction of surgery duration.

Author

Riahi, Vahid, Hassanzadeh, Hamed, Khanna, Sankalp, Boyle, Justin, Syed, Faraz, Biki, Barbara, Borkwood, Ellen, and Sweeney, Lianne

Subjects
*MACHINE learning, *URBAN hospitals, *OPERATING rooms, *RANDOM forest algorithms, *HOSPITAL utilization
Abstract

Background: Operating rooms (ORs) are one of the costliest units in a hospital, therefore the cumulative consequences of any kind of inefficiency in OR management lead to a significant loss of revenue for the hospital, staff dissatisfaction, and patient care disruption. One of the possible solutions to improving OR efficiency is knowing a reliable estimate of the duration of operations. The literature suggests that the current methods used in hospitals, e.g., a surgeon's estimate for the given surgery or taking the average of only five previous records of the same procedure, have room for improvement. Methods: We used over 4 years of elective surgery records (n = 52,171) from one of the major metropolitan hospitals in Australia. We developed robust Machine Learning (ML) approaches to provide a more accurate prediction of operation duration, especially in the absence of surgeon's estimation. Individual patient characteristics and historic surgery information attributed to medical records were used to train predictive models. A wide range of algorithms such as Extreme Gradient Boosting (XGBoost) and Random Forest (RF) were tested for predicting operation duration. Results: The results show that the XGBoost model provided statistically significantly less error than other compared ML models. The XGBoost model also reduced the total absolute error by 6854 min (i.e., about 114 h) compared to the current hospital methods. Conclusion: The results indicate the potential of using ML methods for reaching a more accurate estimation of operation duration compared to current methods used in the hospital. In addition, using a set of realistic features in the ML models that are available at the point of OR scheduling enabled the potential deployment of the proposed approach. [ABSTRACT FROM AUTHOR]

Published
2023
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6. Learning curve analysis of single-site incision laparoscopic adnexal surgery performed by a single surgeon.

Author

Sang Wook Yi

Subjects
LAPAROSCOPIC surgery, TREATMENT effectiveness, ADNEXAL diseases, ABDOMINAL surgery, SURGICAL complications
Abstract

Objectives: Due to the development of laparoscopy techniques, single-site incision laparoscopic surgery (SILS) has recently been performed at many institutes using only a single-incision transumbilical port. We aimed to carry out a learning curve analysis for SILS for adnexal surgery and validate the short-term surgical outcomes. Material and methods: In total, 214 patients were enrolled in this study. The medical records of patients who underwent SILS for adnexal surgery by an expert surgeon from October 2008 to September 2018 were reviewed and analyzed. Results: The mean age and parity were 33.9 ± 11.5 years and 1.0 ± 1.1, respectively. The mean operation duration was 77.5 ± 22.3 min. In the analysis of the learning curve for single-site incision laparoscopic adnexal surgery, surgical proficiency was defined as the point at which the slope of the learning curve became less steep, which was evident after the 24th operation. No operative complications, conversions to laparotomy or additional trocar insertions were observed. Conclusions: Single-site incision laparoscopic surgery (SILS) for adnexal surgery is a safe technique and does not increase the risk of peri- or postoperative complications. For safe performance of SILS, a certain training period for learning the technique should be required. [ABSTRACT FROM AUTHOR]

Published
2023
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7. A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients.

Author

Chan, Chris Yin Wei, Gani, Siti Mariam Abd, Chung, Weng Hong, Chiu, Chee Kidd, Hasan, Mohd Shahnaz, and Kwan, Mun Keong

Subjects
PERIOPERATIVE care, ADOLESCENT idiopathic scoliosis, SPINAL fusion, OPERATIVE blood salvage, SCOLIOSIS
Abstract

Study Design: Retrospective propensity score matching (PSM) study. Objective: To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). Methods: 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. Results: Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients (P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) (P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable (P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. Conclusion: Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy. [ABSTRACT FROM AUTHOR]

Published
2023
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8. The effectiveness of the dacryocystorhinostomy operation with physiodispenser in nasolacrimal duct obstruction.

Author

Ucar, Fikret, Cetinkaya, Servet, and Seyrek, Lutfi

Subjects
*LACRIMAL apparatus, *DACRYOCYSTORHINOSTOMY, *AGE groups
Abstract

To evaluate the effectiveness of the dacryocystorhinostomy (DCR) operation with physiodispenser in nasolacrimal duct obstruction. Two hundred and twelve eyes from 150 patients with chronic dacryocystitis who had undergone external DCR operation with Kerrison punch were included in Group 1. Two hundred and fourteen eyes from 150 patients with chronic dacryocystitis who had undergone external DCR operation with physiodispenser were included in Group 2. There were no significant differences between the two groups in terms of age and sex (p >.05). Excessive bleeding requiring cauterization was observed in 41 (19%) patients in Group 1 and 8 (3%) patients in Group 2 (p <.05) during surgery. The mean operation duration was 32.36 ± 5.46 (26–42) minutes in the first group and 20.41 ± 4.98 (15–28) minutes in the second group (p <.05). Functional success rate at the end of the second postoperative year was 90.2% in the first group and 92.4% in the second (p >.05). Anatomical success rate at the end of second postoperative year was 95.8% in the first group and 98.1% in the second (p >.05). DCR operation with physiodispenser shortens the operation duration, reduces excessive bleeding, and has high functional and anatomical success rates. [ABSTRACT FROM AUTHOR]

Published
2022
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10. Laparoscopy in surgical treatment of acute cholecystitis

Author

Kaljević Goran, Olujić Branislav, Micić Dušan, and Stoimirov Ivan

Subjects
laparoscopy, acute cholecystitis, complications, operation duration, Medicine (General), R5-920
Abstract

In the presented randomized study, laparoscopic cholecystectomy has been performed on 50 patients with acute cholecystitis (experimental group) and 50 patients undergoing laparoscopic cholecystectomy as an elective procedure (control group). There were 35 male and 65 female patients. The average age of the patients was 59 years (56-68 years). In the experimental group, the laparoscopic cholecystectomy was performed within 72 hours from the moment of admission. Both groups were observed and data recorded as regards to demographic data, body mass index, presence or absence of fever, white blood cell count, CRP and ultrasound findings. The operation lasted 35 versus 50 minutes. In the experimental group 6% of the patients developed local complications, while the same happened to only 4% of the patients in the control group. There was a significant difference in the length of time spent at the hospital after the operation (5 days for the experimental group and only 2 for the control group). None of the patients died during this study. Laparoscopic cholecystectomy for treating acute cholecystitis in a carefully selected group of patients, performed during the initial hospital admission, is a safe method associated with acceptable morbidity. It should be performed as soon as possible, preferably within the first 72 hours after admission.

Published
2019

11. Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate.

Author

Yu-Cheng Ma, Zhong-Yu Jian, Chi Yuan, Hong Li, Kun-Jie Wang, Ma, Yu-Cheng, Jian, Zhong-Yu, Yuan, Chi, Li, Hong, and Wang, Kun-Jie

Subjects
*URETEROSCOPY, *OPERATIVE surgery, *REGRESSION analysis, *FORECASTING, *DIABETES, *ESTIMATES, *RESEARCH, *FERRANS & Powers Quality of Life Index, *URETERS, *META-analysis, *RESEARCH methodology, *SURGICAL stents, *EVALUATION research, *TREATMENT effectiveness, *COMPARATIVE studies, *LITHOTRIPSY
Abstract

Background: Multiple studies have reported that gender, pre-operative stent insertion, positive pre-operative urine culture results, and diabetes mellitus are associated with infectious complication after ureteroscopy. A previous meta-analysis focused on this topic is based, however, on crude estimate. Further analysis based on adjusted estimates is needed. Methods: PubMed, Web of Science, Embase, and the Cochrane Library database were searched with ureteroscopy, ureteroscopies, ureteroscopic surgical procedures, ureteroscopic surgery, ureteroscopic lithotripsy, flexible ureteroscopic lithotripsy, ureteroscopy (URS), flexible ureterorenoscopy, risk factor, predictor, predicting model, and nomogram until December 15, 2019. The quality of research was evaluated by Newcastle-Ottawa Scale system. Odds ratio (OR) and 95% confidence intervals (CI) of each risk factor were extracted. Meta-analysis was performed with Stata 15.0 software. Heterogeneity was assessed by I2. Publication bias was tested by the Egger test, and funnel plot. Meta-regressions and subgroup analysis were further performed. Results: There were 16 studies; 12,357 patients finally were included in this meta-analysis. The association between gender (OR = 1.82, 95% CI: 1.48-2.23, I2 = 0%, p = 0.701), pre-operative ureteric stent insertion (OR = 1.91, 95% CI: 1.26-2.91, I2 = 40.4%, p = 0.109), diabetes mellitus (OR: 1.40, 95% CI: 1.07-1.85, I2 = 34.1%, p = 0.168), positive urine culture before URS (OR: 2.18, 95% CI: 1.34-3.57, I2 = 47.2%, p = 0.092), operation duration (OR: 1.03, 95% CI: 1.01-1.04, I2 = 70.6%, p = 0.001) and infectious complications was positively significant. All four pooled results were different from results of meta-analysis based on crude estimate. Conclusion: Female gender, pre-operative ureteric stent insertion, diabetes mellitus, positive urine culture results before URS, and operation duration are risk factors for infectious complications after URS. Meta-analysis based on adjusted estimates may be more convincing. [ABSTRACT FROM AUTHOR]

Published
2020
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12. The Effect of Uterine Manipulator Use in Laparoscopic Tubal Ligation on Operation Duration and Anesthesia Drug Quantity.

Author

BIYIK, İsmail, ALBAYRAK, Mustafa, KESKİN, Fatih, and MUT, Ayşe Nur

Subjects
*TUBAL sterilization, *SEVOFLURANE, *ANALGESICS, *OPERATING rooms, *LAPAROSCOPY
Abstract

Objective: The aim of this study is to compare the duration of surgery and anesthesia, complication rates and the amount of anesthetic drugs used and the cost in laparoscopic tubal ligation cases with and without the use of manipulator. This retrospective case control study included the women who underwent elective interval laparoscopic tubal ligation. Material and Methods: The time between intubation and the onset of surgery, duration of surgery (main operation time) and intubation-extubation (total operation time-duration of anesthesia) were recorded in the operating room. Results: Demographic datas were similar between the patients with and without manipulators (p> 0.05). In the non-manipulator group, intubation to beginning of surgery time, main operation time, total anesthesia time were found to be shorter (p <0.001, p <0.001, p <0.001, respectively). Postoperative hospital stay, the amount of parenteral anesthetic drug used, the need for postoperative parenteral analgesics, the number of laparoscopic ports used and the complication rates were similar between the two groups (p> 0.05). Sevoflurane use was found to be less in the non-manipulator group (p <0.001). Conclusions: In laparoscopic tubal ligation operation where no uterine manipulator is used, anesthesia and total surgery times are approximately 8 minutes shorter. The use of uterine manipulator increases the duration of surgery and the amount of sevoflurane used. Laparoscopic tubal ligation without uterine manipulator may be considered in cases where severe adhesions are not anticipated and no additional intervention is planned. Besides, avoidance of manipulator use may have the advantage of time and cost savings. [ABSTRACT FROM AUTHOR]

Published
2020
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13. Laparoskopik histerektominin klinik sonuçları: tek merkez deneyimi

Author

Zeynep ÖZTURK İNAL and Hasan Ali İNAL

Subjects
laparoskopik histerektomi, ameliyat süresi, hastanede kalış süresi, komplikasyonlar, laparoscopic hysterectomy, operation duration, duration of hospitalization, complications, Medicine (General), R5-920
Abstract

Amaç: Bu çalışmanın amacı laparoskopik histerektominin (LH) klinik sonuçlarını değerlendirmektir.Gereç ve Yöntem: Bu retrospektif çalışmada, Ocak 2010 ile Aralık 2016 arasında LH uygulanan 511 hastanın orijinal dosyaları incelendi. Yaş ortalamaları, vücut kütle indeksi (VKİ), doğum sayısı, ameliyat endikasyonları, uterus ağırlığı, operasyon süresi, kan kaybı, hastanede kalma süresi, analjezik ihtiyaçları, intraoperatif veya postoperatif komplikasyonlar kaydedildi ve yıllara göre değerlendirildi.Bulgular: En düşük LH oranı %10.14 ile 2012 yılında, en yüksek oran % 47.73 ile 2016 yılında idi. Medikal tedaviye dirençli uterin myom (%31.51) ve menometroraji (%25.63) en sık görülen endikasyonlardı. Değerlendirilen süre içerisinde yaş, VKİ, doğum sayısı, kan kaybı, analjezik gereksinimi, uterus ağırlığı, önceden karın içi cerrahi operasyon geçirme oranı, laparoskopiden laparatomiye dönüşüm oranı, intraoperatif veya postoperatif komplikasyonlar açısından fark yoktu. Ancak ameliyat süresi ve hastanede kalış süresi ilk 3 yıldan sonra önemli ölçüde azalmıştı.Sonuç: Jinekolojik cerrahlar için endoskopi eğitimine, teknolojik gelişmelere ve cerrahi tekniklerin kullanımına verilen önem LH sonrası iyileşmeyi geliştirmiş ve hastanede kalış süresini kısaltmıştır. LH hasta için etkin ve güvenli olduğundan histerektomi endikasyonlarında tercih edilen cerrahi seçenek olmalıdır.

Published
2017
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15. The effect of surgeon's fatigue on early term patency and complications of arteriovenous fistulas: A prospective cohort study.

Author

Yabanoglu, Hakan, Bali, Cagla, Avci, Tevfik, Arer, İlker Murat, and Yildirim, Sedat

Subjects
*FATIGUE (Physiology), *ARTERIOVENOUS fistula, *HEMODIALYSIS
Abstract

Aim: Examining the effect of surgeon's fatigue on early term patency and complications of arteriovenous fistula (AVF). Material and Methods: AVFs created for hemodialysis in patients with end-stage renal failure were included in the study. The patients were divided into 2 groups as those operated in the first operation of that day (Group 1) and those operated after the first or second operations (Group 2). The patients were compared with respect to clinical, demographics, postoperative, surgical variables, and operation duration. Results: A total of 100 patients underwent AVF operation. No statistically significant differences were found between the groups with respect to clinical, demographic, surgical, and postoperative variables. Efficiency of dialysis was found to be higher and complication rate lower in Group 1. But no statistical significance was obtained in terms of early dialysis efficiency and complication rates in between the groups (p>0.05). Complication rate was higher in Group 2 when compared according to operation time as 120, 120-240, and 240< minutes. But no statistical significance was obtained in this manner (p>0.05). Conclusions: Although not statistically significant, surgical fatigue factor and long operation time increase the rate of early complications and reduce early dialysis efficiency. We think that early term patency of AVF can also be affected by the complication rate. The effect of this variable can be statistically significant with studies having larger sample size. [ABSTRACT FROM AUTHOR]

Published
2018
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16. Clinical results of laparoscopic hysterectomies: single center experience.

Author

İnal, Zeynep Özturk and İnal, Hasan Ali

Subjects
*HYSTERECTOMY, *UTERINE tumors, *BODY mass index, *TUMOR treatment
Abstract

Purpose: The aim of this study was to evaluate the clinical results of laparoscopic hysterectomy (LH). Materials and Methods: In this retrospective study, the original files of 511 patients who underwent LH between January 2010 and December 2016 were analyzed. The following parameters were recorded and assessed according to the years studied: mean age, body mass index (BMI), parity, indications for surgery, uterine weight, operation duration, blood loss, duration of hospitalization, analgesic needs, and intra- and post-operative complications. Results: The lowest LH rate was 10.14% in 2012, and the highest rate was 47.73% in 2016. Uterine myoma (31.51%) and menometrorrhagia (25.63%) resistant to medical treatment were the most common indications. There were no differences in terms of age, BMI, parity, blood loss, analgesic requirements, uterus weight, previous intra-abdominal surgery rate, laparoscopy to laparatomy conversion rate, and intra- or post-operative complications during the period assessed. However, operation time and hospital stay durations were significantly reduced after the first 3 years. Conclusion: An emphasis on endoscopy training for gynecological surgeons, along with technological advances and the use of surgical techniques, has improved postoperative LH recovery, and the length of the required hospital stay has become shorter. LH should be the preferred surgical option in hysterectomy indications, as it is effective and safe for the patient. [ABSTRACT FROM AUTHOR]

Published
2017
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17. Single center experience with laparoscopic adrenalectomy on a large clinical series: Lessons learned from 273 cases: A retrospective cohort study

Author

Çelen, S., Gunseren, K.O., Vuruşkan, H., Acimis, N.M., Kordan, Y., and Yavascaoglu, I.

Subjects
adrenal tumor, retrospective study, laparoscopy, adrenal cortex adenoma, morbidity, Article, length of stay, male, Cushing syndrome, human, nodular hyperplasia, adult, adrenalectomy, operation duration, cohort analysis, major clinical study, pheochromocytoma, body mass, aged, learning curve, female, adrenal, tumor volume, oncology, hyperaldosteronism, laparoscopic adrenalectomy, hospitalization
Abstract

Objectives: We aim to evaluate the risk of laparoscopic adrenalectomy (LA) for large adrenal tumors and the risk of learning curve. Design: Single centre, retrospective study Setting: Uludag University, Bursa, Turkey Subjects: A study in a large patient population (N=273) who underwent LA between 2006 and 2017. Interventions: The patients were divided into two study groups according to tumour size as estimated by pathologic specimen maximum diameter, Group A (less than 5cm) and group B (larger than 5cm). In addition, to evaluate learning curve of LA, the patients were divided into two groups according to time interval: the first period was 2006 to 2011, and the second period 2012-2017. Main outcome measures: To evaluate the risk of learning curve and tumour size Results: There was no statistical difference between the two groups for per-operative and postoperative complications according to tumour size

Published
2022

18. The effects of stone density on surgical outcomes of retrograde intrarenal stone surgery

Author

Suleyman Hilmi Aksoy, Basri Cakiroglu, Tuncay Tas, Isil Yurdaisik, İstinye Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Işıl Yurdaışık / 0000-0001-8316-1229, Yurdaışık, Işıl, Işıl Yurdaışık / GDD-1849-2022, Işıl Yurdaışık / 57211471093, and Aksoy, Süleyman Hilmi

Subjects
Operative Time, General Medicine, Nephrolithiasis, Kidney, Retrospective studies, Retrospective study, Kidney Calculi, Treatment Outcome, Operation duration, Operative time, Kidney calculi, Diagnostic imaging, Humans, Radiology, Nuclear Medicine and imaging, Treatment outcome, Retrospective Studies
Abstract

Objective: Several pre-operative parameters have been studied to estimate stone-free rate (SFR) following retrograde intrarenal surgery (RIRS) procedures. The objective of this study was to evaluate the effects of stone density on surgical outcomes of RIRS. Methods: This retrospective study included 30 stone-free patients (Group SF) and 30 patients with residual fragments (Group RF). Patients’ age and gender, laterality, non-contrast CT findings, including size and density of the kidney stones, infundibular pelvic angle (IPA), operational time, and post-operative pain were recorded and compared between the two groups. The stone density was measured by free hand region of interest (ROI) determination coincident with the stone borders and expressed as Hounsfield units (HUs). Results: The rate of single stones was significantly higher in Group SF compared to Group RF (p < 0.001). The mean stone size was found as 11.93 ± 7.81 mm in Group SF and 16.27 ± 7.29 mm in Group RF with the difference being statistically significant (p < 0.001). The mean IPA was 53.87 degrees in Group SF and 50.33 degrees in Group RF. The mean density was measured as 748.17 ± 318.14 HU in Group SF and 945.90 ± 345.30 HU in Group RF. The mean stone density was statistically significantly higher in patients with residual fragments compared to the stone-free patients (p < 0.001). Conclusion: This study revealed that stone density as measured as HU affects the treatment outcomes with RIRS procedure and the mean density is significantly higher in patients with residual stone fragments. Advances in knowledge: Studies about the effects of HUs on stone-free rate are limited in the literature. Stone density affects the treatment outcomes with RIRS procedure and the mean density is significantly higher in patients with residual stone fragments.

Published
2022

19. Psychophysical workload in the operating room: primary surgeon versus assistant.

Author

Rieger, Annika, Fenger, Sebastian, Neubert, Sebastian, Weippert, Matthias, Kreuzfeld, Steffi, and Stoll, Regina

Subjects
*EMPLOYEES' workload, *SURGEONS, *OPERATING rooms, *HEART beat, *RESPIRATION
Abstract

Background: Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. Methods: Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. Results: Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands ( p < 0.05; η = 0.283), temporal demands ( p < 0.05; η = 0.260), effort ( p < 0.05; η = 0.287), and NASA-TLX sum score ( p < 0.01; η = 0.287). Conclusions: Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown. [ABSTRACT FROM AUTHOR]

Published
2015
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20. Minimally invasive plate osteosynthesis for short oblique diaphyseal tibia fractures: does fracture site affect the outcomes?

Author

Cenk Ermutlu, Teoman Atici, Adnan Cakar, Kemal Durak, Bartu Sarisozen, Gokay Eken, Bursa Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı., Ermutlu, Cenk, Durak, Kemal, Atıcı, Teoman, Sarısözen, Bartu, Çakar, Adnan, ABI-7283-2020, AAB-2795-2021, and A-5095-2018

Subjects
Male, Medicine (General), Clinical assessment, Fracture site, Tibia Fracture, minimally invasive percutaneous osteosynthesis, Fracture nonunion, Biochemistry, Fracture Fixation, Internal, Tibia fracture, 0302 clinical medicine, Postoperative infection, 030212 general & internal medicine, Malunion, Range of motion, Fracture Healing, Orthodontics, 030222 orthopedics, Clinical outcome, Osteosynthesis, bone union, General Medicine, Retrospective study, Distal meta, Treatment Outcome, Plate osteosynthesis, Operation duration, nonunion, Diagnostic imaging, Intramedullary Nailing, Tibial Fractures, Female, Bone Plates, plate osteosynthesis, malunion, Age distribution, Human, Adult, Clinical article, Bone plate, Nonunion, Research & experimental medicine, Metaphyseal, Article, Tibia shaft fracture, 03 medical and health sciences, R5-920, Minimally invasive surgery, medicine, Humans, Minimally Invasive Surgical Procedures, Clinical evaluation, Tibia, Medicine, research & experimental, Retrospective Studies, Pharmacology & pharmacy, Bone union, business.industry, Biochemistry (medical), Oblique case, Surgical technique, Follow up, Cell Biology, Plate fixation, Surgical infection, Sex difference, medicine.disease, Clinical effectiveness, Clinical feature, Single-center, business, Controlled study, Retrospective Clinical Research Report
Abstract

Objective To report the results of patients with short oblique diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO). The secondary aim was to understand the effect of fracture location (midshaft or distal 1/3) on outcomes. Methods Twenty-eight patients with short oblique (>30°) tibial shaft fractures (AO/OTA 42A2) treated with plate and MIPO technique between 2015 and 2019 were retrospectively assessed. Age, gender, follow-up time, fracture type (open or closed), operation time, postoperative infection rate, union time, ankle joint range of motion, and complications were analyzed. Patients’ radiographs at a minimum 1-year follow-up were evaluated for malunion, nonunion, and implant-related complications. Results Mean age and follow-up time were 47.0 ± 15.7 years and 18.3 ± 12.1 months, respectively. Mean bone union time was 3.66 ± 1.04 months in middle 1/3 diaphysis and 4.23 ± 1.48 months in distal 1/3 tibia fractures. Seven (25%) patients developed superficial infections. Mean union time, malunion rate, coronal and sagittal angulation, operation length, and infection rate were similar between the groups. Conclusion MIPO is an effective method for treatment of short oblique diaphyseal tibia fractures, and results in few complications. Both distal and midshaft fractures have similar union and malunion rates.

Published
2020

21. Predictors for Anastomotic Leak, Postoperative Complications, and Mortality After Right Colectomy for Cancer: Results From an International Snapshot Audit

Author

Gallo, G., Pata, F., Vennix, S., Laurberg, S., Morton, D., Rubbini, M., Vaizey, C., Magill, L., Perry, R., Sheward, N., Hervas, D., Cillo, M., Estefania, D., Uriburu, J.P., Ruiz, H., Solomon, M., Makhmudov, A., Selnyahina, L., Varabei, A., Vizhynis, Y., Claeys, D., Defoort, B., Muysoms, F., Pletinckx, P., Vergucht, V., Debergh, I., Feryn, T., Reusens, H., Nachtergaele, M., Francart, D., Jehaes, C., Markiewicz, S., Monami, B., Weerts, J., Houben, B., Haeck, L., Lange, C., Sommeling, C., Vindevoghel, K., Castro, S., De Bruyn, H., Huyghe, M., De Wolf, E., Reynders, D., D'Hoore, A., De Buck Van Overstraeten, A., Wolthuis, A., Delibegovic, S., Christiani, A., Marchiori, M., Jr., De Moraes, C.R., Tercioti, V., Jr., Arabadjieva, E., Bulanov, D., Dardanov, D., Stoyanov, V., Yonkov, A., Angelov, K., Maslyankov, S., Sokolov, M., Todorov, G., Toshev, S., Georgiev, Y., Karashmalakov, A., Zafirov, G., Wang, X., Condic, D., Kraljik, D., Mrkovic, H., Pavkovic, V., Raguž, K., Bencurik, V., Holášková, E., Skrovina, M., Farkašová, M., Grolich, T., Kala, Z., Antos, F., Pruchova, V., Sotona, O., Chobola, M., Dusek, T., Ferko, A., Örhalmi, J., Hoch, J., Kocian, P., Martinek, L., Bernstein, I., Sunesen, K.G., Leunbach, J., Thorlacius-Ussing, O., Oveson, A.U., Christensen, P., Chirstensen, S.D., Gamez, V., Oeting, M., Loeve, U.S., Ugianskis, A., Jessen, M., Krarup, P., Linde, K., Mirza, Q., Stovring, J.O., Erritzøe, L., Jakobsen, H.L., Lykke, J., Colov, E.P., Madsen, A.H., Friis, T.L., Funder, J.A., Dich, R., Kjar, S., Rasmussen, S., Schlesinger, N., Kjaer, M.D., Qvist, N., Khalid, A., Ali, G., El-Hussuna, A., Hadi, S., Walker, L.R., Kivelä, A., Lehtonen, T., Lepistö, A., Scheinin, T., Siironen, P., Kössi, J., Kuusanmäki, P., Tomminen, T., Turunen, A., Rautio, T., Vierimaa, M., Huhtinen, H., Karvonen, J., Lavonius, M., Rantala, A., Varpe, P., Cotte, E., Francois, Y., Glehen, O., Kepenekian, V., Passot, G., Maggiori, L., Manceau, G., Panis, Y., Gout, M., Rullier, E., Van Geluwe, B., Chafai, N., Lefevre, J., Parc, Y., Tire, E., Couette, C., Duchalais, E., Agha, A., Hornberger, M., Hungbauer, A., Iesalnieks, I., Weindl, I., Crescenti, F., Keller, M., Kolodziejski, N., Scherer, R., Sterzing, D., Bock, B., Boehm, G., El-Magd, M., Krones, C., Niewiera, M., Buhr, J., Cordesmeyer, S., Hoffmann, M., Krückemeier, K., Vogel, T., Schön, M., Baral, J., Lukoschek, T., Münch, S., Pullig, F., Horisberger, K., Kienle, P., Magdeburg, J., Post, S., Batzalexis, K., Germanos, S., Agalianos, C., Dervenis, C., Gouvas, N., Kanavidis, P., Kottikias, A., Katsoulis, I., Korkolis, D., Plataniotis, G., Sakorafas, G., Akrida, I., Argentou, M., Kollatos, C., Lampropoulos, C., Tsochatzis, S., Besznyák, I., Bursics, A., Egyed, T., Papp, G., Svastics, I., Atladottir, J., Möller, P., Sigurdsson, H., Stefánsson, T., Valsdottir, E., Andrews, E., Foley, N., Hechtl, D., Majeed, M., McCourt, M., Hanly, A., Hyland, J., Martin, S., O'Connell, R., Winter, D., Connelly, T., Joyce, W., Wrafter, P., Berkovitz, R., Avital, S., Yahia, I.H., Herman, N., Shpitz, B., White, I., Lishtzinsky, Y., Tsherniak, A., Wasserberg, N., Horesh, N., Keler, U., Pery, R., Shapiro, R., Zmora, O., Tulchinsky, H., Badran, B., Dayan, K., Iskhakov, A., Lecaros, J., Nabih, N., Angrima, I., Bardini, R., Pizzolato, E., Tonello, M., Arces, F., Balestri, R., Ceccarelli, C., Prosperi, V., Rossi, E., Giannini, I., Vincenti, L., Di Candido, F., Di Iena, M., Guglielmi, A., Iambrenghi, O., Marsanic, P., Mellano, A., Muratore, A., Annecchiarico, M., Bencini, L., Bonapasta, S., Coratti, A., Guerra, F., Asteria, C., Boccia, L., Gerard, L., Pascariello, A., Manca, G., Marino, F., Casaril, A., Inama, M., Moretto, G., Bacchelli, C., Carvello, M., Mariani, N., Montorsi, M., Spinelli, A., Romairone, E., Scabini, S., Belli, A., Bianco, F., De Franciscis, S., Romano, G.M., Delrio, P., Pace, U., Rega, D., Sassaroli, C., Scala, D., De Luca, R., Ruggieri, E., Elbetti, C., Garzi, A., Romoli, L., Scatizzi, M., Vannucchi, A., Curletti, G., Durante, V., Galleano, R., Mariani, F., Reggiani, L., Bellomo, R., Infantino, A., Franceschilli, L., Sileri, P., Clementi, I., Coletta, D., La Torre, F., Mingoli, A., Velluti, F., Di Giacomo, A., Fiorot, A., Massani, M., Padoan, L., Ruffolo, C., Caruso, S., Franceschini, F., Laessig, R., Monaci, I., Rontini, M., De Nardi, P., Lemma, M., Rosati, R., Tamburini, A., De Luca, M., Sartori, A., Benevento, A., Bottini, C., Ferrari, C., Tessera, G., Pellino, G., Selvaggi, F., Lanzani, A., Romano, F., Sgroi, G., Steccanella, F., Turati, L., Yamamoto, T., Ancans, G., Gerkis, S., Leja, M., Pcolkins, A., Sivins, A., Latkauskas, T., Lizdenis, P., Saladžinskas, Ž., Švagždys, S., Tamelis, A., Razbadauskas, A., Sokolovas, M., Dulskas, A., Samalavicius, N., Jotautas, V., Mikalauskas, S., Poskus, E., Poskus, T., Strupas, K., Camenzuli, C., Cini, C., Predrag, A., Psaila, J., Spiteri, N., Bemelman, W., Buskens, C., De Groof, J., Gooszen, J., Tanis, P., Belgers, E., Davids, P., Furnee, E., Postma, E., Pronk, A., Smakman, N., Clermonts, S., Zimmerman, D., Omloo, J., Van Der Zaag, E., Van Duijvendijk, P., Wassenaar, E., Bruijninckx, M., De Graff, E., Doornebosch, P., Tetteroo, G., Vermaas, M., Iordens, G., Knops, S., Toorenvliet, B., Van Westereenen, E., Boerma, E., Coene, P., Van Der Harst, E., Van Der Pool, A., Raber, M., Melenhorst, J., De Castro, S., Gerhards, M., Arron, M., Bremers, A., De Wilt, H., Ferenschild, F., Yauw, S., Cense, H., Demirkiran, A., Hunfeld, M., Mulder, I., Nonner, J., Swank, H., Van Wagensveld, B., Bolmers, M., Briel, J., Van Geloven, N., Van Rossem, C., Klemann, V., Konsten, J., Leenders, B., Schok, T., Bleeker, W., Gidwani, A., Lawther, R., Loughlin, P., Skelly, B., Spence, R., Brun, M., Helgeland, M., Ignjatovic, D., Øresland, T., Peyman, Y., Backe, I.F., Sjo, O.H., Nesbakken, A., Tandberg-Eriksen, M., Cais, A., Traland, J.H., Herikstad, R., Kørner, H., Lauvland, N., Jajtner, D., Kabiesz, W., Rak, M., Gmerek, L., Horbacka, K., Horst, N., Krokowicz, P., Kwiatkowski, A., Pasnik, K., Karcz, P., Romaniszyn, M., Rusek, T., Walega, P., Czarencki, R., Obuszko, Z., Sitarska, M., Wojciech, W., Zawadzki, M., Amado, S., Clara, P., Couceiro, A., Malaquias, R., Rama, N., Almeida, A., Barbosa, E., Cernadas, E., Duarte, A., Silva, P., Costa, S., Insua, C.M., Pereira, J., Pereira, C., Sacchetti, M., Ferreira, R.A.M., Pinto, B.C., Sousa, P.J.V., Oliveira, A., Cardoso, R., Carlos, S., Corte-Real, J., Pereira, P.M., Souto, R., Carneiro, C., Marinho, R., Nunes, V., Rocha, R., Sousa, M., Leite, J., Melo, F., Pimentel, J., Ventura, L., Nova, C.V., Copǎescu, C., Bintintan, V., Ciuce, C., Dindelegan, G., Scurtu, R., Seicean, R., Domansky, N., Karachun, A., Moiseenko, A., Pelipas, Y., Petrov, A., Pravosudov, I., Aiupov, R., Akmalov, Y., Parfenov, A., Suleymanov, N., Tarasov, N., Jumabaev, H., Mamedli, Z., Rasulov, A., Aliev, I., Chernikovskiy, I., Kochnev, V., Komyak, K., Smirnov, A., Achkasov, S., Bolikhov, K., Shelygin, Y., Sushkov, O., Zapolskiy, A., Gvozdenovic, M., Jovanovic, D., Lausevic, Z., Cvetković, D., Maravić, M., Milovanovic, B., Stojakovic, N., Tripković, I., Mihajlovic, D., Nestorovic, M., Pecic, V., Petrovic, D., Stanojevic, G., Barisic, G., Dimitrijevic, I., Krivokapic, Z., Markovic, V., Popovic, M., Aleksic, A., Dabic, D., Kostic, I., Milojkovic, A., Perunicic, V., Dragana, R., Lukic, D., Petrovic, T., Radovanovic, Z., Cuk, V., Kenic, M., Kovacevic, B., Krdzic, I., Korcek, J., Rems, M., Toplak, J., Escarrâ, J., Barrionuevo, M.G., Golda, T., Moreno, E.K., Martin, C.Z., Laso, C.A., Cumplido, P., Padin, H., Fons, J.B., Hernández-Lizoain, J., Martinez-Ortega, P., Molina-Fernández, M., Sánchez-Justicia, C., Solanas, J.A.G., De Laspra, E.C.D., Elia-Guedea, M., Gallego, E., Ramirez, J., Chaves, J.A., González, P.D., Elosua, T., Sahagún, J., Frade, A.T., Conde, J.A., Castrillo, E., Maag, R.D., Maderuelo, V., Saldarriaga, L., Cao, I.A., Varela, X.F., Fernández, S.N., Calvo, A.P., Álvarez, S.V., Sierra, I.B., Lozano, R., Márquez, M., Porcel, O., Menendez, P., Hevia, M.F., Sigüenzo, L.F., Toscano, M.J., Fortuny, A.L., Trujillo, J.O., Espi, A., Garcia-Botello, S., Martín-Arévalo, J., Moro-Valdezate, D., Pla-Martí, V., Blanco-Antona, F., Abrisqueta, J., Canovas, N.I., Mompean, J.L., Ripoll, D.E., Gonzalez, S.M., Parodi, J., López, A.F., Fernández, M.R., Valls, J.C., De Zarate, L.O., Ribas, R., Sabia, D., Viso, L., Gonçalves, S.A., Egea, M.J.G., Damieta, M.P., Pera, M., Ruiz, S.S., Bernal, J., Landete, F., Ais, G., Alonso, E., Lucia, J.A., Boscá, A., Deusa, S., Del Caño, J.G., Viciano, V., García-Armengol, J., Roig, J., Blas, J., Escartin, J., Fatás, J., Fernando, J., Ferrer, R., Pacheco, R.A., Flórez, L.G., Gijón, M.M., Díez, J.O., Garcia, L.S., Teixido, F.A., Ojo, C.B., Berzosa, J.B., Moure, S.L., Sierra, J.E., Fermiñán, A., Herrerias, F., Rufas, M., Viñas, J., Codina-Cazador, A., Farrés, R., Gómez, N., Julià, D., Planellas, P., López, J., Luna, A., Maristany, C., Duyos, A.M., Puértolas, N., Moral, M.A., Serra-Aracil, X., Coello, P.C., Gómez, D., Carton, C., Miguel, A., Pascual, F.R., Cerrato, X.V., Muñoz, R.Z., Cervera-Aldama, J., González, J.G., Ramos-Prada, J., Santamaría-Olabarrieta, M., Urigüen-Echeverría, A., Alcover, R.C., Soria, J.E., Rodriguez, E.F., Hernandis, J., Ibañez, V.M., De La Torre Gonzalez, F., Huerga, D., Viejo, E.P., Rivera, A., Ucar, E.R., Garcia-Septiem, J., Jiménez, V., Miramón, J.J., Rodriquez, J.R., Alvarez, V.R., Garcea, A., Ponchietti, L., Borda, N., Enriquez-Navascues, J., Saralegui, Y., Molina, G.F., Nogues, E., Méndez, A.R., Castellano, C.R., Quesada, Y.S., Gallego, M., Pascual, I., Perez, I., San Andrés, B., Villanueva, F., Alonso, J., Cagigas, C., Castillo, J., Gómez, M., Martín-Parra, J., Ballester, M.M., Franco, E.P., Aledo, V.S., Navarro, G.V., Rodriquez, E.C., De Chaves, P.G., Hernandez, G., Alvarez, A.P., Sanchez, A.S., Garcia, F.C.B., Roque, J.G.A., Aria, F.L.R., Del Valle Ruiz, S.R., De La Villa, G.S., Compañ, A., Marín, A.G., Nofuentes, C., Micó, F.O., Auladell, V.P., Carrasco, M., Perez, C.D., Gálvez-Pastor, S., Garcia, I.N., Perez, A.S., Enjuto, D., Bujalance, F.M., Marcelin, N., Pérez, M., García, R.S., Cabrera, A., De La Portilla, F., Diaz-Pavon, J., Jimenez-Rodriguez, R., Vazquez-Monchul, J., González, J.D., Pérez, R.G., Castellano, J.R., De La Rua, J.R., Toral, B.C., Alustiza, J.E., Fernández, L., Ramirez, J.R., Ramos, J.S., Alias, D., Garcia-Olmo, D., Guadalajara, H., Herreros, M., Pacheco, P., Del Castillo Díez, F., Pinto, F.L., Alegre, J.M., Ortega, I., Antonio, A.P.N., Caro, A., Escuder, J., Feliu, F., Millan, M., Company, R.A., Caregnato, A.F., Trujillo, R.L., Carrillo, R.R., Carmona, M.R., Alonso, N., Zafra, D.A., Candia, B.A.A., Pascual, J.B., Flores, C.P., Montero, J.A., Clavijo, M.A., Garcia, J., Tocino, J.S., Alcazar, C., Navarro, D.C., Romero, J.F., Riveiro, M.R., Romero, M., Arencibia, B., Esclapez, P., Frasson, M., García-Granero, E., Granero, P., Herrera, A.B.G., Diaz, L., Tordera, E.M.T., Fernandez, F.M., Rodriguez, E.N., Arenal, J., Citores, M., Marcos, J., Sánchez, J., Tinoco, C., Espin, E., Granero, A.G., Gomez, L.J., Garcia, J.S., Vallribera, F., Folkesson, J., Sköldberg, F., Bergman, K., Borgström, E., Frey, J., Silfverberg, A., Söderholm, M., Nygren, J., Segelman, J., Gustafsson, D., Lagerqvist, A., Papp, A., Pelczar, M., Abraham-Nordling, M., Ahlberg, M., Sjovall, A., Tengstrom, J., Hagman, K., Chabok, A., Ezra, E., Nikberg, M., Smedh, K., Tiselius, C., Al-Naimi, N., Dao Duc, M., Meyer, J., Mormont, M., Ris, F., Prevost, G., Villiger, P., Hoffmann, H., Kettelhack, C., Kirchhoff, P., Oertli, D., Weixler, B., Aytac, B., Leventoglu, S., Mentes, B., Yuksel, O., Demirbas, S., Ozkan, B.B., Özbalci, G.S., Sungurtekin, Uğur, Gülcü, B., Ozturk, E., Yilmazlar, T., Challand, C., Fearnhead, N., Hubbard, R., Kumar, S., Arthur, J., Barben, C., Skaife, P., Slawik, S., Williams, M., Zammit, M., Barker, J., French, J., Sarantitis, I., Slawinski, C., Clifford, R., Eardley, N., Johnson, M., McFaul, C., Vimalachandran, D., Allan, S., Bell, A., Oates, E., Shanmugam, V., Brigic, A., Halls, M., Pucher, P., Stubbs, B., Agarwal, T., Chopada, A., Mallappa, S., Pathmarajah, M., Sugden, C., Brown, C., Macdonald, E., Mckay, A., Richards, J., Robertson, A., Kaushal, M., Patel, P., Tezas, S., Touqan, N., Ayaani, S., Marimuthu, K., Piramanayagam, B., Vourvachis, M., Iqbal, N., Korsgen, S., Seretis, C., Shariff, U., Arnold, S., Battersby, N.J., Chan, H., Clark, E., Fernandes, R., Moran, S., Bajwa, A., McArthur, D., Cao, K., Cunha, P., Pardoe, H., Quddus, A., Theodoropoulou, K., Bolln, C., Denys, G., Gillespie, M., Manimaran, N., Reidy, J., Malik, A., Pitt, J., Aryal, K., El-Hadi, A., Lal, R., Pal, A., Velchuru, V., Chaudhri, S., Cunha, M.O., Singh, B., Thomas, M., Bains, S., Boyle, K., Miller, A., Norwood, M., Yeung, J., Goian, L., Gurjar, S., Saghir, W., Sengupta, N., Stewart-Parker, E., Bailey, S., Khalil, T., Lawes, D., Nikolaou, S., Omar, G., Church, R., Muthiah, B., Garrett, W., Marsh, P., Obeid, N., Chandler, S., Coyne, P., Evans, M., Hunt, L., Lim, J., Oliphant, Z., Papworth, E., Weaver, H., Leon, K.C., Williams, G., Hernon, J., Kapur, S., Moosvi, R., Shaikh, I., Swafe, L., Aslam, M., Evans, J., Ihedioha, U., Kang, P., Merchant, J., Hompes, R., Middleton, R., Broomfield, A., Crutten-Wood, D., Foster, J., Nash, G., Akhtar, M., Boshnaq, M., Eldesouky, S., Mangam, S., Rabie, M., Ahmed, J., Khan, J., Goh, N.M., Shamali, A., Stefan, S., Nepogodiev, D., Pinkney, T.D., Thompson, C., Amin, A., Docherty, J., Lim, M., Walker, K., Watson, A., Hossack, M., Mackenzie, N., Paraoan, M., Alam, N., Daniels, I., Narang, S., Pathak, S., Smart, N., Al-Qaddo, A., Codd, R., Rutka, O., Bronder, C., Crighton, I., Davies, E., Raymond, T., Bookless, L., Griffiths, B., Plusa, S., Carlson, G., Harrison, R., Lees, N., Mason, C., Quayle, J., Branagan, G., Broadhurst, J., Chave, H., Sleight, S., Awad, F., Bhangu, A., Cruickshank, N., Joy, H., Boereboom, C., Daliya, P., Dhillon, A., Watson, N., Watson, R., Artioukh, D., Gokul, K., Javed, M., Kong, R., Sutton, J., Faiz, O., Jenkins, I., Leo, C., Samaranayake, F., Warusavitarne, J., Arya, S., Bhan, C., Mukhtar, H., Oshowo, A., Wilson, J., Duff, S., Fatayer, T., Mbuvi, J., Sharma, A., Cornish, J., Davies, L., Harries, R., Morris, C., Torkington, J., Knight, J., Lai, C., Shihab, O., Tzivanakis, A., Hussain, A., Luke, D., Padwick, R., Torrance, A., Tsiamis, A., Dawson, P., Balfour, A., Brady, R., Mander, J., Paterson, H., Chandratreya, N., Chu, H., Cutting, J., Vernon, S., Ho, C.W., Andreani, S., Patel, H., Warner, M., Tan, J.Y.Q., Iqbal, A., Khan, A., Perrin, K., Raza, A., Tan, S., European Society of Coloproctology Collaborating Group Collaborators, Group, ESCP Cohort Studies Sub-Committee, ESCP Research Committee, Logistical Support and Data Collection, Analysis, Investigators, Radiology and nuclear medicine, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, MUMC+: MA Heelkunde (9), Graduate School, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Neurology, and Center for Evidence Based Education

Subjects
Male, Leak, Conference Paper, adverse event, ileostomy, non-smoker, 0302 clinical medicine, middle aged, antibiotic therapy, 80 and over, antibiotic agent, postoperative complication, emergency surgery, Colectomy, cecum, Aged, 80 and over, OUTCOMES, adult, COLON-CANCER, Gastroenterology, operation duration, clinical trial, General Medicine, cohort analysis, laparoscopic surgery, ureter injury, Survival Rate, aged, risk factor, 030220 oncology & carcinogenesis, Cohort, kidney injury, 030211 gastroenterology & hepatology, Colonic Neoplasms/mortality, anastomosis leakage, liver injury, prospective study, medicine.medical_specialty, SURGICAL STRESS, ELECTIVE RIGHT, surgical infection, 03 medical and health sciences, Humans, human, Aged, clinical audit, sex ratio, major clinical study, mortality, hemicolectomy, multicenter study, RISK-FACTORS, observational study, Complication, Anastomotic leak, Colon cancer, Postoperative outcome, Right colectomy, general surgery, surgical mortality, SURGERY, very elderly, morbidity, Anastomotic Leak, mortality rate, open surgery, Cohort Studies, Postoperative Complications, gallbladder disease, LAPAROSCOPY, Risk Factors, Neoplasms, cancer mortality, Laparoscopy, Prospective cohort study, colon resection, Medical Audit, medicine.diagnostic_test, Mortality rate, colon tumor, Middle Aged, female, colon cancer, Right Colectomy, Colonic Neoplasms, ileum, surgical stapling, Female, cancer surgery, Colectomy/adverse effects, duodenum injury, small intestine resection, RESECTION, reoperation, Anastomosis, NO, MORBIDITY, medicine, operative blood loss, LS7_4, percutaneous drainage, business.industry, suture technique, Surgery, blood vessel injury, peroperative complication, elective surgery, Anastomotic Leak/epidemiology, pathology, business
Abstract

A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking.This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy.This was a snapshot observational prospective study.The study was conducted as a multicenter international study.The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients.Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method.Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041).This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors.Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery. See Video Abstract at http://links.lww.com/DCR/B165. PREDICTORES DE FUGA ANASTOMóTICA, COMPLICACIONES POSTOPERATORIAS Y MORTALIDAD DESPUéS DE LA COLECTOMíA DERECHA POR CáNCER: RESULTADOS DE UNA AUDITORíA INTERNACIONAL DE CORTO PLAZO: La hemicolectomía derecha se encuentra entre las operaciones más frecuentemente realizadas para cáncer de colon, pero faltan datos modernos multinacionales de alta calidad, que aborden las tasas de morbilidad y mortalidad.Reportar la tasa de morbilidad y mortalidad para cáncer de colon del lado derecho, e identificar predictores de resultados desfavorables a corto plazo, después de la hemicolectomía derecha.Estudio prospectivo observacional de corto plazo.Estudio multicéntrico internacional.El estudio de corto plazo de la Sociedad Europea de Coloproctología de 2015, fue una serie prospectiva multicéntrica internacional, que incluyó a todos los pacientes sometidos a hemicolectomía derecha electiva, de emergencia o resección ileocecal, por un período de dos meses y a principios de 2015. Este es un subanálisis, cohorte de pacientes con cáncer de colon.Los predictores de fuga anastomótica, morbilidad y mortalidad postoperatorias a los 30 días, se evaluaron usando modelos de regresión logística de efectos multivariables mixtos, después de la selección de variables con el método Lasso.De los 2,515 pacientes incluidos, se realizó una anastomosis en el 97,2% (n = 2,444); sutura manual en 38.5% (n = 940) y por engrapadora en 61.5% (n = 1504) casos. La tasa global de fuga anastomótica fue del 7,4% (180/2,444), morbilidad a los 30 días fue del 38,0% (n = 956) y la mortalidad fue del 2,6% (n = 66). Los pacientes con fuga anastomótica tuvieron una tasa de mortalidad significativamente mayor (10,6% frente al 1,6% de pacientes sin fuga, p0,001). En el análisis multivariable, las siguientes variables se asociaron con la fuga anastomótica: mayor duración de la cirugía (OR 1.007 por minuto, p = 0.0037), abordaje abierto (OR 1.9, p = 0.0037) y anastomosis por engrapadora (OR 1.5, p = 0.041).Este es un estudio observacional y por lo tanto podría estar presente el sesgo de selección. Por esta razón, se realizó un modelo de regresión logística multivariable, tratando de corregir posibles factores de confusión.La fuga anastomótica después de la hemicolectomía derecha oncológica, es una complicación frecuente y asociada a mayor mortalidad. Los factores quirúrgicos clave que contribuyeron a la fuga anastomótica, fueron la técnica anastomótica, abordaje quirúrgico y duración de la cirugía. Consulte Video Resumen en http://links.lww.com/DCR/B165. (Traducción-Dr. Fidel Ruiz Healy).

Published
2020

23. Laparoskopik histerektominin klinik sonuçları: tek merkez deneyimi

Author

Hasan Ali Inal and Zeynep Ozturk Inal

Subjects
Gynecology, medicine.medical_specialty, lcsh:R5-920, complications, business.industry, komplikasyonlar, operation duration, duration of hospitalization, General Medicine, ameliyat süresi, Single Center, hastanede kalış süresi, Medicine, laparoscopic hysterectomy, business, laparoskopik histerektomi, lcsh:Medicine (General)
Abstract

Amac: Bu calismanin amaci laparoskopik histerektominin (LH) klinik sonuclarini degerlendirmektir. Gerec ve Yontem: Bu retrospektif calismada, Ocak 2010 ile Aralik 2016 arasinda LH uygulanan 511 hastanin orijinal dosyalari incelendi. Yas ortalamalari, vucut kutle indeksi (VKI), dogum sayisi, ameliyat endikasyonlari, uterus agirligi, operasyon suresi, kan kaybi, hastanede kalma suresi, analjezik ihtiyaclari, intraoperatif veya postoperatif komplikasyonlar kaydedildi ve yillara gore degerlendirildi. Bulgular: En dusuk LH orani %10.14 ile 2012 yilinda, en yuksek oran % 47.73 ile 2016 yilinda idi. Medikal tedaviye direncli uterin myom (%31.51) ve menometroraji (%25.63) en sik gorulen endikasyonlardi. Degerlendirilen sure icerisinde yas, VKI, dogum sayisi, kan kaybi, analjezik gereksinimi, uterus agirligi, onceden karin ici cerrahi operasyon gecirme orani, laparoskopiden laparatomiye donusum orani, intraoperatif veya postoperatif komplikasyonlar acisindan fark yoktu. Ancak ameliyat suresi ve hastanede kalis suresi ilk 3 yildan sonra onemli olcude azalmisti. Sonuc: Jinekolojik cerrahlar icin endoskopi egitimine, teknolojik gelismelere ve cerrahi tekniklerin kullanimina verilen onem LH sonrasi iyilesmeyi gelistirmis ve hastanede kalis suresini kisaltmistir. LH hasta icin etkin ve guvenli oldugundan histerektomi endikasyonlarinda tercih edilen cerrahi secenek olmalidir.

Published
2017

24. Learning curve analysis of single-site incision laparoscopic adnexal surgery performed by a single surgeon.

Author

Yi SW

Abstract

Objectives: Due to the development of laparoscopy techniques, single-site incision laparoscopic surgery (SILS) has recently been performed at many institutes using only a single-incision transumbilical port. We aimed to carry out a learning curve analysis for SILS for adnexal surgery and validate the short-term surgical outcomes., Material: AND METHODS: In total, 214 patients were enrolled in this study. The medical records of patients who underwent SILS for adnexal surgery by an expert surgeon from October 2008 to September 2018 were reviewed and analyzed., Results: The mean age and parity were 33.9 ± 11.5 years and 1.0 ± 1.1, respectively. The mean operation duration was 77.5 ± 22.3 min. In the analysis of the learning curve for single-site incision laparoscopic adnexal surgery, surgical proficiency was defined as the point at which the slope of the learning curve became less steep, which was evident after the 24th operation. No operative complications, conversions to laparotomy or additional trocar insertions were observed., Conclusions: Single-site incision laparoscopic surgery (SILS) for adnexal surgery is a safe technique and does not increase the risk of peri- or postoperative complications. For safe performance of SILS, a certain training period for learning the technique should be required.

Published
2022
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25. Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: a prospective controlled study in patients with skull base tumors

Author

Yang, De L., Xu, Qi W., Che, Xiao M., Wu, Jin S., and Sun, Bin

Subjects
*HOLOGRAPHY in medicine, *SKULL base, *TUMORS, *QUALITY of life, *LONGITUDINAL method, *FOLLOW-up studies (Medicine), *HEALTH outcome assessment, *VIRTUAL reality in medicine, *PATIENTS
Abstract

Abstract: Background: Patient-specific approach design, comprehensive evaluation on perioperative data, and follow-up of postoperative life quality (KPS) were carried out to evaluate the application of VR technology of Dextroscope in procedures of patients with skull base tumors. Methods: Eighty-four patients with skull base tumors involved in this research were randomized into 2 groups (test group and control group), each with 42 patients. Before operation, image data such as MR, MRA, or CTA of head were collected and imported into the Dextroscope workstation. The detailed preoperative plans were made in the test group, but no Dextroscope plans in control group. The resection rate of tumors, preoperative evaluation including the duration of operation, total blood loss, the postoperative LOS, the number of cases with cerebrovascular injury complications in operation, and postoperative KPS of patients on discharge and the sixth month follow-up in the 2 groups were recorded and compared. Results: The total resection rate of tumors was 83.33% in test group and 71.42% in the control group (P > .05). The total resection rate of meningioma was 86.67% in test group and 76.47% in control group. The total resection rates of trigeminal Schwannoma in the 2 groups were all 100% (P > .05). The duration of operation and the postoperative LOS of each patient were 5.25 ± 0.64 hours and 8.50 ± 1.10 days in the test group and 7.36 ± 0.87 hours and 12.50 ± 1.52 days in the control group, respectively (P < .05). Total blood loss of each patient was 456.75 ± 55.76 mL in the test group and 523.85 ± 66.78 mL in the control group (P > 05). There were 3 cases with complications of cerebral vessels injury in the test group and 7 cases in the control group (P < .05). During follow-up, KPS of patients in the test group on discharge (85.75 ± 9.68) was significantly superior to that in the control group (81.66 ± 9.24; P < .05). The KPS of patients on the sixth-month follow-up in the test group was 92.35 ± 9.95, which was significantly superior to that in the control group (85.6 ± 9.34; P < .05). Karnofsky performance scores of patients in the test group improved significantly from discharge to the sixth month after procedure (P < .05), whereas there were adverse results in the test group (P < .05). The 2 cases with CSF leakage were cured completely. Conclusion: The preoperative plans with VR technology in patients with skull base tumor or CSF leakage operations can help certain the diagnosis, individually locate the position of skull base lesions, and design patient-specific approach, which also facilitate to shorten operation duration and the postoperative LOS, reduce total blood loss and injury of vessels in operation, and improve the postoperative KPS. [Copyright &y& Elsevier]

Published
2009
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26. Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals

Author

Félix R. Montes, Paula A. Alvarado, Juan Carlos Villar, Lina Góez-Mogollón, Skarlet Marcell Vásquez, Claudia Marcela Camargo-Rojas, Myriam V. Rueda, and Danny J. Novoa

Subjects
Male, Hospital mortality, Epidemiology, Comorbidity, Hospitals, University, 0302 clinical medicine, Risk Factors, Orthopedic Procedures, 030212 general & internal medicine, Hospital Mortality, hospital, Middle aged, Digestive System Surgical Procedures, Outcome, Orthopedic surgery, education.field_of_study, Perioperative period, lcsh:RC952-1245, Incidence, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Orthopedic procedures, Preoperative period, Hospital emergency service, Middle Aged, Cardiovascular disease, Hospitals, Retrospective study, Operation duration, Emergency Medicine, Emergency surgery, Female, Cohort analysis, Infection, Emergency Service, Hospital, Emergency service, Cohort study, Human, Research Article, Adult, medicine.medical_specialty, lcsh:Special situations and conditions, Population, Abdominal surgery, Emergency ward, Kidney failure, Major clinical study, Emergency treatment, Colombia, Article, Adverse outcome, 03 medical and health sciences, Age, Digestive system surgical procedures, university, medicine, Humans, Adverse effect, education, Perioperative Period, Emergency Treatment, Aged, Retrospective Studies, University hospital, business.industry, Emergency department, Bleeding, 030208 emergency & critical care medicine, Retrospective cohort study, lcsh:RC86-88.9, Perioperative, Length of Stay, Retrospective studies, Risk factors, Emergency medicine, Length of stay, Risk factor, business, Controlled study
Abstract

Background: In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient's risk categories. Methods: A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. Results: Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5-53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1-2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p less than 0.001 for the interaction). Conclusion: Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases. © 2019 The Author(s).

Published
2019

27. Comparison of two prototypes of a magnetically adjustable glaucoma implant in rabbits

Author

Birthe Schwerk, Lisa Harder, Claudia Windhövel, Marion Hewicker-Trautwein, Anna Wagner, Jan-Peter Bach, Lena Carolin Voigt, Ulf Hinze, Boris Chichkov, Heinz Haferkamp, Holger Lubatschowski, Stephan Nikolic, and Ingo Nolte

Subjects
geometry, genetic structures, Ocular Hypotension, Pilot Projects, animal cell, Eye, iris disease, Postoperative Complications, implantation, Glaucoma Drainage Implants, Dewey Decimal Classification::500 | Naturwissenschaften, meloxicam, tonometry, pilot study, operation duration, eye swelling, female, Models, Animal, Medicine, Female, disease severity, Rabbits, ddc:500, intraocular hypotension, magnetically adjustable glaucoma implant, Science, animal experiment, iris hyperemia, Leporidae, blepharospasm, intraocular hemorrhage, dexamethasone, macrophage, lymphocyte, Prosthesis Design, ocular fibrosis, Article, Aqueous Humor, foreign body reaction, histology, in vivo study, Magnetics, Tonometry, Ocular, biocompatibility, slit lamp microscopy, Animals, Humans, controlled study, ddc:610, ophthalmoscopy, Intraocular Pressure, nonhuman, animal model, polymyxin, neomycin, Glaucoma, Fibrosis, eye diseases, thickness, eye inflammation, New Zealand White (rabbit), Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit, hyperemia, erythema, intraocular pressure
Abstract

Glaucoma drainage devices are used in surgical glaucoma therapy. Success of controlling the intraocular pressure is limited due to fibrous implant encapsulation and fibrin coating on the implant which lead to drainage obstructions. An innovative implant with a magnetically adjustable valve was developed. The valve opening of the implant should eliminate inflammatory products from the outflow area and affect fibrous tissue formation to achieve a sufficient long-term aqueous humour outflow. Lifting of this valve should disturb cell adhesion by exerting mechanical forces. Before testing this hypothesis, the flow characteristics of glaucoma drainage devices, especially the outflow resistance by regular IOP, should be considered in a pilot study, as they are important in preventing too low postoperative intraocular pressure known as ocular hypotony. Therefore, two prototypes of the innovative implant differing in their valve area design were examined regarding their flow characteristics in a limited animal experiment lasting two weeks. Ten healthy New Zealand White rabbits were divided into two groups (A & B) with different implanted prototypes. Daily, tonometry and direct ophthalmoscopy were performed to assess the intraocular pressure and the inflammatory reaction of the eye. After two weeks, the rabbits were euthanised to evaluate the initially histological inflammatory reaction to the implant. In group A, one case of hypotony emerged. When considering the entire observation period, a highly statistically significant difference between the intraocular pressure in the operated eye and that in the control eye was detected in group A (p < 0.0001) in contrast to group B (p = 0.0063). The postoperative inflammatory signs decreased within two weeks. Histologically, a typical but low level foreign body reaction with macrophages and lymphocytes as well as mild to moderate fibrosis was seen after the short experimental period. Based on our tonometric results, prototype B seems to be the system of choice for further research assessing its long-term function and biocompatibility.

Published
2019

28. Impact of previous SWL on ureterorenoscopy outcomes and optimal timing for ureterorenoscopy after SWL failure in proximal ureteral stones

Author

Irer B., Sahin M.O., Erbatu O., Yildiz A., Ongun S., Cinar O., Cihan A., Sahin M., Sen V., Ucer O., Kizilay F., Bozkurt O., Aegean Study Group of the Society of Urological Surgery, Zonguldak Bülent Ecevit Üniversitesi, Ege Üniversitesi, Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey, Department of Urology, Manisa State Hospital, Manisa, Turkey, Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey, Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey, Department of Urology, Balikesir University School of Medicine, Balıkesir, Turkey, Department of Urology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey, Department of Urology, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey, Department of Urology, Ege University School of Medicine, Izmir, Turkey, Irer, B., Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey -- Sahin, M.O., Department of Urology, Manisa State Hospital, Manisa, Turkey -- Erbatu, O., Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey -- Yildiz, A., Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey -- Ongun, S., Department of Urology, Balikesir University School of Medicine, Balıkesir, Turkey -- Cinar, O., Department of Urology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey -- Cihan, A., Department of Urology, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey -- Sahin, M., Department of Urology, Ege University School of Medicine, Izmir, Turkey -- Sen, V., Department of Urology, Manisa State Hospital, Manisa, Turkey -- Ucer, O., Department of Urology, Celal Bayar University School of Medicine, Manisa, Turkey -- Kizilay, F., Department of Urology, Ege University School of Medicine, Izmir, Turkey -- Bozkurt, O., Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey -- Aegean Study Group of the Society of Urological Surgery, and 0-Belirlenecek

Subjects
Nephrology, Male, Time Factors, 030232 urology & nephrology, Shock wave lithotripsy, lithotripsy, Ureterorenoscopy, 0302 clinical medicine, Postoperative Complications, Urolithiasis, time factor, middle aged, postoperative complication, Treatment Failure, operation duration, female, Treatment Outcome, 030220 oncology & carcinogenesis, Stents, Adult, medicine.medical_specialty, kidney, Ureteral Calculi, Demographics, Urology, Stone free, Operative Time, 03 medical and health sciences, length of stay, Internal medicine, medicine, Ureteroscopy, Humans, In patient, human, procedures, endoscopy, ureter stone, business.industry, Curve analysis, Stone, Proximal ureteral stone, Lithotripsy, Laser, Surgery, stent, laser lithotripsy, business, Complication
Abstract

Purpose: We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any optimal timing for safe URS after SWL. Methods: The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone [SWL (-)] and group 2 consisted of patients with a previous SWL for the stone [SWL (+)]. Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis. Results: Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5 days (AUC = 0.657, p = 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5 days (27.7% vs 6.5%, p < 0.001). Conclusions: The optimal timing; 2–3 weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.

Published
2019

29. Thromboprophylaxis for Hip Revision Arthroplasty: Can We Use the Recommendations for Primary Hip Surgery? A Cohort Study

Author

Daniel Monsalvo, Adolfo Llinás, Maria Bautista, Meilyn Muskus, Daniela Tafur, and Guillermo Bonilla

Subjects
Male, lcsh:Diseases of the circulatory (Cardiovascular) system, hip, medicine.medical_treatment, Arthroplasty, Replacement, Hip, Thrombosis prevention, Replacement, 030204 cardiovascular system & hematology, replacement, Procedures, Cohort Studies, 0302 clinical medicine, Rivaroxaban, Deep vein thrombosis, Prevalence, Apixaban, Middle aged, Priority journal, Aged, 80 and over, 030222 orthopedics, Blood transfusion, Hematology, General Medicine, Middle Aged, Dabigatran, Hospitalization, Retrospective study, Body mass, Doppler flowmetry, Operation duration, Cohort, Hip arthroplasty, Cohort studies, Original Article, Female, Lung embolism, Cohort analysis, medicine.drug, Cohort study, Anticoagulant agent, Human, Venous thromboembolism, musculoskeletal diseases, Adult, Reoperation, medicine.medical_specialty, Joint replacement, venous thromboembolism, prevention & control, reoperation, Major clinical study, blood transfusion, Hip replacement (animal), Article, Arthroplasty, 03 medical and health sciences, Hip surgery, Osteoarthritis, medicine, Lung ventilation, Humans, Enoxaparin, Retrospective Studies, Aged, Hip revision arthroplasty, business.industry, Computed tomographic angiography, Very elderly, Anticoagulants, Retrospective cohort study, Hip replacement, Surgery, Retrospective studies, Prevention and control, Fondaparinux, lcsh:RC666-701, arthroplasty, Comparative study, business, Controlled study
Abstract

The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively (P =.801). The 38.4% of hip revision patients and 20.3% of primary hip patients presented major bleeding events. Thromboembolic disease outcomes with the use of a standardized thromboprophylaxis regimen were similar in both cohorts, regardless of the high variability of hip revision surgery and the increased risk of complications. Implementation of this regimen is recommended in patients requiring joint replacement revision surgery. © The Author(s) 2019.

Published
2019

30. Comparison of the effects of isoflurane and sevoflurane general anaesthesia after induction by propofol on clinical and physiological measurements in calves

Author

Selvinaz Yakan, Özgür Aksoy, and Belirlenecek

Subjects
leukocyte count, systolic blood pressure, Hemodynamics, Calves, hemodynamics, newborn, time factor, heart rate, Medicine, General anaesthesia, Propofol, atrol r, endotracheal intubation, sevoflurane likit, Inhalation, operation duration, General Medicine, female, respiratory tract parameters, Anesthesia, erythrocyte count, Premedication, blood sampling, medicine.drug, electrocardiography, hematocrit, atropine, animal experiment, sevoflurane, Sevoflurane, Article, rectal temperature, isoflurane, male, controlled study, unspecified side effect, nonhuman, business.industry, clinical effectiveness, diastolic blood pressure, hemoglobin, platelet count, general anesthesia, breathing rate, pulse rate, Blood pressure, Isoflurane, calf (bovine), business
Abstract

Background: In veterinary surgical operations for cats and dogs, inhalation anaesthesia is known to be a good option for general anaesthesia in long operations or emergency cases. Studies have revealed that during inhalation anaesthesia, the heart and respiratory functions of the animals are more stable compared to injectable anaesthesia. However, there are few studies performed with the use of inhalation anaesthesia in ruminants. In this research, the goal is to evaluate the effects of isoflurane and sevoflurane after induction with propofol in calves based on clinical and physiological parameters and to find a more reliable strategy for general anaesthesia in ruminants. Materials, Methods & Results: The research was carried out on 30 calves, from new-born up to 3-month-old, undergoing surgery operation. Each group consisted of 15 animals that were divided as isoflurane and sevoflurane. For premedication, atropine was administered at a dose of 0.04 mg/kg via subcutaneous injection in calves. For induction, 15 min after atropine application, propofol was given at 5-6 mg/kg via intravenous infusion. Then, endotracheal intubation was performed and inhalation anaesthesia began at 5 min after induction. In the isoflurane group, the onset of anaesthesia concentration was set to 3-5% and the maintenance was set to a concentration of 1.5-3%. In the sevoflurane group, the onset of anaesthesia concentration was set to 5-7% and the maintenance was set to a concentration of 2.5-4%. To monitor the calves, the heart rate (HR), the pulse rate (PR), the systolic blood pressure (SBP), the diastolic blood pressure (DBP), the respiratory rate (RR), the rectal temperature (RT) and the electrocardiogram (ECG) measurements were recorded before anaesthesia, the premedication, the induction periods, at 5, 15, 30, 45, 60, and 75 min after the onset of inhalation anaesthesia during the operation period. Blood samples were taken before anaesthesia, premedication, induction periods, at 30 and 75 min during the operation and the red blood cell (RBC) count, white blood cell (WBC) count, the amount of haemoglobin (HGB), the haematocrit concentration (HCT), and the platelet (PLT) count were evaluated. Based on the findings, isoflurane and sevoflurane suppressed the cardiovascular system minimally. Both anaesthetic agents caused decreases that did not exceed the physiological limits compared to the measurements taken before the initiation of anaesthesia. Although no significant differences were detected between the groups (P > 0.05) at clinical parameters, the RT differences were regarded as statistically significant according to the measurements that were taken before anaesthesia at all measurement times (P < 0.05). In both groups, the changes that occurred in the P wave, the PR interval, and in the QRS, R and T waves remained within the reference values given in the literature. Both anaesthetic agents have similar effects on the ECG. The dramatic no changes throughout anaesthesia in terms of the amount of HGB and HCT, the RBC, the WBC, and the PLT were not statistically significant, which may be associated with good tissue perfusion. Discussion: Since no serious complications occurred with either anaesthetic option, we have concluded that isoflurane and sevoflurane have similar effects on the cardiopulmonary systems of calves. In addition, the effects of propofol, which is used for induction, have been evaluated and observed and this drug is an effective and reliable option to initiate inhalation anaesthesia. The research on the use of this anaesthetic in calves is limited and most of the existing studies investigated its combination with injectable anaesthetics. As a result, in this research, we concluded that isoflurane and sevoflurane induce similar physiological measurement results, blood parameters, and ECG results and that both anaesthetics cause minimal complications. © 2019 Universidade Federal do Rio Grande do Sul. All rights reserved., VF-57, Funding. This study (It is abstract of the unpublished PhD thesis) was supported by the Kafkas University Scientific Research Projects Committee (VF-57).

Published
2019

31. Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery.

Author

Shen X, Zhou C, Hua Q, Yang L, Zhao W, and Xu P

Abstract

Purpose : The objective of this study was to evaluate the impact of operation duration on short- and long-term outcomes of colorectal cancer patients following surgical resection. Methods : 6224 consecutive patients who underwent radical colorectal surgery were retrospectively assessed and were divided into short operation duration group (SOD) and long operation duration group (LOD) according to the operation duration cutoff value of 110 minutes. Results : Compared with patients in LOD group, patients in SOD group had significantly lower total costs in hospital, reduced expenses for drugs and antibiotics, shorter length of stay (LOS) in hospital and in the ICU. Moreover, 5-year overall survival (OS) and disease-free survival (DFS) for patients in the SOD group were markedly higher than for patients in the LOD group. Mutivariate regression analysis indicated that longer operation duration was associated with poor prognosis, with a hazard ratio of 1.004 (1.003, 1.005) for OS and 1.005 (1.003, 1.006) for DFS. Finally, surgeons' qualifications had meaningful correlation with operation duration (r= 0.450). Conclusions : Operation duration is an independent risk factor for patients' short-term and long-term outcome after radical colorectal surgery. Improve the surgical skills of the surgeon may shorten the operation duration, and further improve the outcome for patients., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Published
2022
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32. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes

Author

Kadir Ömür Günseren, Ismet Yavascaoglu, Hakan Kilicarslan, Burhan Coskun, Yakup Kordan, Onur Kaygisiz, Rustam Kadirov, Uludağ Üniversitesi/Tıp Fakültesi/Üroloji Anabilim Dalı., Kadirov, Rüstam, Coşkun, Burhan, Kaygısız, Onur, Günseren, Kadir Ömür, Kordan, Yakup, Yavaşçaoğlu, İsmet, Kılıçarslan, Hakan, L-9439-2019, AAH-9704-2021, AAM-9726-2020, and ABC-9924-2020

Subjects
Male, Deformities, Endocrinology, Diabetes and Metabolism, 030232 urology & nephrology, lcsh:Medicine, Behavioral Neuroscience, 0302 clinical medicine, Endocrinology, Urologic surgery, Urology & nephrology, Original Research, Priority journal, Penile Plication, 030219 obstetrics & reproductive medicine, Degloving plication technique, Patient satisfaction, Congenital Penile Curvature, lcsh:Other systems of medicine, Medicine, general & internal, Psychiatry and Mental health, Retrospective study, medicine.anatomical_structure, Operation duration, Peyronie's disease, Human, Peyronie Disease, Clostridiopeptidase A, Penis, Adult, medicine.medical_specialty, Foley balloon catheter, Urology, Dermatology, Major clinical study, Article, 03 medical and health sciences, Minimally invasive surgery, Degloving, medicine, Peyronie disease, Postoperative period, Peyronies-disease, Tunical plication, Peyronie's Disease, Curvature, business.industry, Intermethod comparison, lcsh:R, Surgical technique, medicine.disease, lcsh:RZ201-999, Surgery, Clinical effectiveness, Reproductive Medicine, Length of stay, Penile curvature, General & internal medicine, business
Abstract

Background Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature. Aim To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis. Methods We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature. Outcomes Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups. Results The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups. Clinical Implications The results of the present study indicate the two techniques can be used for penile plication. Conclusion With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142–e147.

Published
2017

33. Çocuk önkol çift kırıklarında ESIN ve K-teli tespiti benzer sonuçlara sahiptir

Author

Şahin, Namık, Akalın, Yavuz, Türker, Oğuz, Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı., Özkaya, Güven, and A-4421-2016

Subjects
Male, Kırık, Procedures, Pediatrics, Intramedüller çivi, Child, Children, Range of motion, Çocuk, Forearm injuries, Injuries, Clinical outcome, Bone wire, Bone radiography, Limitation, Önkol, Goniometry, Forearm, Radius Fractures, Intramedullary Nailing, Operation duration, Emergency medicine, Cohort studies, Female, Cohort analysis, Infection, Human, Adolescent, Clinical article, Wire fixation, Outcomes, Pediatric surgery, Internal-fixation, Article, Immobilization, Fracture fixation, Intramedullary, Humans, Prospective study, Bone wires, Exercise, Forearm injury, Elbow flexion, Pin tract infection, Intramedullary fixation, Diaphysis, Skin irritation, Follow up, Plate fixation, Fractureintramedullary nail, Forearm fracture, Statistics and numerical data, Fluoroscopy, Intramedullary nailing, School child, Diaphyses, Controlled study
Abstract

BACKGROUND: The purpose of this study was to compare short-term radiographic and clinical results of pediatric both-bone diaphyseal forearm fractures treated with intramedullary nail fixation using titanium nails or K-wires. METHODS: This was a prospective comparative trial. In total, 43 patients with both-bone open or closed forearm fractures who underwent surgical treatment with intramedullary fixation were randomly classified into two groups. Three patients did not return for the follow-up and were excluded from the study. Twenty of the 40 patients were assigned to the elastic stable intramedullary nail group and 20 were assigned to the K-wire group. Demographic data suggested no difference between the two groups except for the side of injury. Perioperative data and radiological and clinical outcomes were evaluated. RESULTS: The cohort comprised 5 girls and 35 boys whose mean age was 11.60 +/- 2.69 years. Except the proportion of patients who were conservatively followed up preoperatively, all perioperative data were similar between the groups. Radiographic and functional results were similar. There were two delayed unions; one pin track infection and one re-fracture. CONCLUSION: Intramedullary fixation of forearm fractures in children with titanium nail or K-wire does not affect radiological and clinical results. Both elastic stable intramedullary nail and K-wire fixation were effective in stabilizing pediatric diaphyseal forearm fractures. AMAÇ: Bu çalışmanın amacı titanium çivi ya da K-telleri kullanılarak intramedüller çivileme ile tedavi edilen çocuk önkol kırıklarının kısa dönem radyolojik ve klinik sonuçlarının karşılaştırılmasıdır. GEREÇ VE YÖNTEM: Bu çalışma ileriye yönelik karşılaştırmalıdır. İntramedüller tespit ile cerrahi olarak tedavi edilen açık ya da kapalı önkol çift kırıklı 43 hasta randomize olarak iki gruba ayrıldı. Takibi yapılamayan üç hasta çalışmadan çıkarıldı. Kırk hastadan 20’si elastik stabil intramedüller çivi grubuna ve 20’si de K-teli grubuna dahil edildi. Demografik veriler yaralanmanın tarafı dışında iki grup arasında benzerdi. Perioperatif veriler, radyolojik ve klinik sonuçlar değerlendirildi. BULGULAR: Kohort yaş ortalaması 11.60 (±2.69) olan 5 kız ve 35 erkek çocuktan oluşuyordu. Ameliyattan önce konservatif olarak takip eilen hastaların oranı dışında tüm perioperatif veriler gruplar arasında benzerdi. Radyolojik ve klinik sonuçlar da benzer idi. Toplamda iki kaynama gecikmesi, bir tel dibi enfeksiyonu ve bir refraktür gözlendi. TARTIŞMA: Çocuklarda önkol kırıklarının titanyum çivi ya da K-teli ile intramedüller tespitinin radyolojik ve klinik sonuçları benzerdir. Hem elastik stabil intramedüller çivi hem de K-teli tespiti pediatrik diafizeal önkol kırıklarının tedavisinde etkindir.

Published
2017

34. Laparoskopik histerektominin klinik sonuçları: Tek merkez deneyimi

Author

İnal, Zeynep Özturk, İnal, Hasan Ali, and NEÜ, Meram Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Kadın Hastalıkları ve Doğum Anabilim Dalı

Subjects
Hastanede Kalış Süresi, Complications, Ameliyat Süresi, Laparoscopic Hysterectomy, Komplikasyonlar, Operation Duration, Laparoskopik Histerektomi, Duration of Dospitalization
Abstract

Purpose: The aim of this study was to evaluate the clinicalresults of laparoscopic hysterectomy (LH).Materials and Methods: In this retrospective study, theoriginal files of 511 patients who underwent LH betweenJanuary 2010 and December 2016 were analyzed. Thefollowing parameters were recorded and assessedaccording to the years studied: mean age, body mass index(BMI), parity, indications for surgery, uterine weight,operation duration, blood loss, duration of hospitalization,analgesic needs, and intra- and post-operativecomplications.Results: The lowest LH rate was 10.14% in 2012, and thehighest rate was 47.73% in 2016. Uterine myoma (31.51%)and menometrorrhagia (25.63%) resistant to medicaltreatment were the most common indications. There wereno differences in terms of age, BMI, parity, blood loss,analgesic requirements, uterus weight, previous intraabdominalsurgery rate, laparoscopy to laparatomyconversion rate, and intra- or post-operative complicationsduring the period assessed. However, operation time andhospital stay durations were significantly reduced after thefirst 3 years.Conclusion: An emphasis on endoscopy training forgynecological surgeons, along with technological advancesand the use of surgical techniques, has improvedpostoperative LH recovery, and the length of the requiredhospital stay has become shorter. LH should be thepreferred surgical option in hysterectomy indications, as itis effective and safe for the patient., Amaç: Bu çalışmanın amacı laparoskopik histerektominin(LH) klinik sonuçlarını değerlendirmektir.Gereç ve Yöntem: Bu retrospektif çalışmada, Ocak 2010ile Aralık 2016 arasında LH uygulanan 511 hastanın orijinaldosyaları incelendi. Yaş ortalamaları, vücut kitle indeksi(VKİ), doğum sayısı, ameliyat endikasyonları, uterusağırlığı, operasyon süresi, kan kaybı, hastanede kalmasüresi, analjezik ihtiyaçları, intraoperatif veya postoperatifkomplikasyonlar kaydedildi ve yıllara göre değerlendirildi.Bulgular: En düşük LH oranı %10.14 ile 2012 yılında, enyüksek oran %47.73 ile 2016 yılında idi. Medikal tedaviyedirençli uterin myom (%31.51) ve menometroraji (%25.63)en sık görülen endikasyonlardı. Değerlendirilen süreiçerisinde yaş, VKİ, doğum sayısı, kan kaybı, analjezikgereksinimi, uterus ağırlığı, önceden karın içi cerrahioperasyon geçirme oranı, laparoskopiden laparatomiyedönüşüm oranı, intraoperatif veya postoperatifkomplikasyonlar açısından fark yoktu. Ancak ameliyatsüresi ve hastanede kalış süresi ilk 3 yıldan sonra önemliölçüde azalmıştı.Sonuç: Jinekolojik cerrahlar için endoskopi eğitimine,teknolojik gelişmelere ve cerrahi tekniklerin kullanımınaverilen önem LH sonrası iyileşmeyi geliştirmiş vehastanede kalış süresini kısaltmıştır. LH hasta için etkin vegüvenli olduğundan histerektomi endikasyonlarında tercihedilen cerrahi seçenek olmalıdır.

Published
2017

35. Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era

Author

Michael P. Manns, Alexander Kaltenborn, Harald Schrem, Johannes Klose, Nils Hoppe, Juergen Klempnauer, Michelle A. Klose, Courtney Metz, and Frank Lehner

Subjects
Male, age distribution, Survival, medicine.medical_treatment, retrospective study, treatment indication, Liver transplantation, Gastroenterology, preschool child, Cholangiocarcinoma, Liver disease, Model for End-Stage Liver Disease, Postoperative Complications, Germany, middle aged, statistics and numerical data, postoperative complication, Child, Outcome, liver transplantation, adult, Health Policy, digestive, oral, and skin physiology, risk assessment, primary sclerosing cholangitis, operation duration, Middle Aged, Survival Rate, aged, female, multivariate analysis, Treatment Outcome, health care policy, Autoimmune liver disease, Child, Preschool, Cohort, end stage liver disease, epidemiology, Original Article, Female, Adult, medicine.medical_specialty, Adolescent, Waiting Lists, Model For End Stage Liver Disease Score, Cholangitis, Sclerosing, Operative Time, resource allocation, Risk Assessment, Article, Primary sclerosing cholangitis, End Stage Liver Disease, length of stay, Internal medicine, medicine, follow up, Humans, controlled study, ddc:610, human, Survival rate, outcome assessment, Aged, Retrospective Studies, MELD-based allocation, business.industry, Postoperative complication, Retrospective cohort study, Length of Stay, medicine.disease, graft recipient, mortality, Liver Transplantation, hospital discharge, body regions, hospital admission, Multivariate analysis, observational study, Surgery, Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit, business, cholestasis
Abstract

Purpose: Survival after liver transplantation (LTX) has decreased in Germany since the implementation of Model for end-stage liver disease (MELD)-based liver allocation. Primary sclerosing cholangitis (PSC) is known for its otherwise excellent outcome after LTX. The influence of MELD-based liver allocation and subsequent allocation policy alterations on the outcome of LTX for PSC is analyzed.Methods: This is a retrospective observational study including 126 consecutive patients treated with LTX for PSC between January 1, 1999 and August 31, 2012. The PSC cohort was further compared to all other indications for LTX in the study period (n = 1420) with a mean follow-up of 7.9 years (SD 3.2). Multivariate risk-adjusted analyses were performed. Alterations of allocation policy have been taken into account systematically.Results: Transplant recipients suffering from PSC are significantly younger (p < 0.001), can be discharged earlier (p = 0.018), and have lower 3-month mortality than patients with other indications (p = 0.044). The observed time on the waiting list is significantly longer for patients with PSC (p < 0.001), and there is a trend toward lower match MELD points in the PSC cohort (p = 0.052). No improvement in means of short-term mortality could be shown in relation to alterations of allocation policy within the MELD era (p = 0.375). Survival rates of the pre-MELD era did not differ significantly from those of the MELD era (p = 0.097) in multivariate risk-adjusted analysis. Patients in the MELD era suffered pre-transplant significantly more frequently from dominant bile duct stenosis (p = 0.071, p = 0.059, p = 0.048, respectively; chi2).Conclusions: Progress is stagnating in LTX for PSC. Current liver allocation for PSC patients should be reconsidered.

Published
2014

36. Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate.

Author

Ma YC, Jian ZY, Yuan C, Li H, and Wang KJ

Subjects
Female, Humans, Risk Factors, Stents adverse effects, Treatment Outcome, Ureteroscopy adverse effects, Lithotripsy, Ureter
Abstract

Background: Multiple studies have reported that gender, pre-operative stent insertion, positive pre-operative urine culture results, and diabetes mellitus are associated with infectious complication after ureteroscopy. A previous meta-analysis focused on this topic is based, however, on crude estimate. Further analysis based on adjusted estimates is needed. Methods: PubMed, Web of Science, Embase, and the Cochrane Library database were searched with ureteroscopy, ureteroscopies, ureteroscopic surgical procedures, ureteroscopic surgery, ureteroscopic lithotripsy, flexible ureteroscopic lithotripsy, ureteroscopy (URS), flexible ureterorenoscopy, risk factor, predictor, predicting model, and nomogram until December 15, 2019. The quality of research was evaluated by Newcastle-Ottawa Scale system. Odds ratio (OR) and 95% confidence intervals (CI) of each risk factor were extracted. Meta-analysis was performed with Stata 15.0 software. Heterogeneity was assessed by I 2 . Publication bias was tested by the Egger test, and funnel plot. Meta-regressions and subgroup analysis were further performed. Results: There were 16 studies; 12,357 patients finally were included in this meta-analysis. The association between gender (OR = 1.82, 95% CI: 1.48-2.23, I 2  = 0%, p = 0.701), pre-operative ureteric stent insertion (OR = 1.91, 95% CI: 1.26-2.91, I 2  = 40.4%, p = 0.109), diabetes mellitus (OR: 1.40, 95% CI: 1.07-1.85, I 2  = 34.1%, p = 0.168), positive urine culture before URS (OR: 2.18, 95% CI: 1.34-3.57, I 2  = 47.2%, p = 0.092), operation duration (OR: 1.03, 95% CI: 1.01-1.04, I 2  = 70.6%, p = 0.001) and infectious complications was positively significant. All four pooled results were different from results of meta-analysis based on crude estimate. Conclusion: Female gender, pre-operative ureteric stent insertion, diabetes mellitus, positive urine culture results before URS, and operation duration are risk factors for infectious complications after URS. Meta-analysis based on adjusted estimates may be more convincing.

Published
2020
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37. Renal autotransplantation at three academic institutions in Turkey

Author

Fazil Tuncay Aki, Senol Tonyali, Saban Sarikaya, Yarkın Kamil Yakupoğlu, Ender Ozden, Hakan Vuruşkan, Yakup Kordan, Yakup Bostanci, Cenk Yucel Bilen, Uludağ Üniversitesi/Tıp Fakültesi/Üroloji Anabilim Dalı., Kordan, Yakup, Vuruşkan, Hakan, and Ondokuz Mayıs Üniversitesi

Subjects
Male, Ureter disease, Percutaneous, Turkey, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Ureteral replacement, Kidney, Nephrectomy, Turkey (republic), Avulsion, Kidney transplantation, 0302 clinical medicine, Autotransplantation, Urology & nephrology, Disease, Laparoscopy, Middle aged, Priority journal, medicine.diagnostic_test, Percutaneous transluminal renal artery angioplasty, Interposition, Retrospective study, medicine.anatomical_structure, Double J stent, Transplantation, autologous, Operation duration, Female, Treatment indication, Human, Adult, medicine.medical_specialty, Urology, Clinical article, Appendix, Trauma, Article, 03 medical and health sciences, Renal autotransplantation, Ureter, Robotics, Cystovaginal Fistula, Minimally invasive surgery, medicine, Ureteroscopy, Safety wire, Humans, Aged, Transplantation, business.industry, Kidney autotransplantation, Renal artery aneurysm, Surgical technique, Ureteral avulsion, Disease classification, Surgery, Postoperative complication, Retrospective studies, Reconstruction, business
Abstract

Tonyali, Senol/0000-0003-1657-4044; Yakupoglu, Yarkin Kamil/0000-0002-4764-0289; AKI, FAZIL TUNCAY T/0000-0002-3625-9968; Ozden, Ender/0000-0003-3196-4024 WOS: 000389566900016 PubMed: 27505010 Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 +/- 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 +/- 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail. (C) 2016 S. Karger AG, Basel

Published
2016

38. Percutaneous cystolithotomy in a patient with a Mitrofanoff urinary diversion

Author

Ruiz, María Juliana Arcila and Bernal, Andrés Felipe Puentes

Subjects
Lithotomy, Pelvis fracture, Foley balloon catheter, Bladder, Cystolithiasis, Bladder obstruction, Percutaneous cystolithotripsy, Article, Bladder stone, Catheterization, Hospitalization, Non neurogenic bladder, Operation duration, Percutaneous cystolithotomy, Urinary diversion, Treatment outcome, Mitrofanoff, Amplatz sheath, Human
Abstract

Introduction and objectives Bladder stones are the most common calculi of the lower genitourinary tract. The most common predisposing factor is the bladder outlet obstruction. The present case concerns a patient who suffered urethral trauma after a pelvis fracture, requiring a Mitrofanoff urinary diversion, and was diagnosed with multiple cystolithiasis up to 1 cm. The objective of these paper is to show the possibility of performing a percutaneous cystolithotomy in a patient with a complex urinary diversion, being an intervention with low morbidity, and with shorter recovery time and comparable results in terms of stone free percentage rate. Materials y methods The procedure starts with a prior Mitrofanoff catheterisation with a Foley catheter 12. An ultrasound-guided suprapubic left paramedian puncture was performed, followed by Chiba needle hydrophilic guidewire, stiletto, telescoped Alken dilators 9Fr-22Fr, and 28Fr Amplatz sheath. Once the percutaneous tract is established, the nephroscope and foreign body forceps were introduced and complete stone removal was achieved. The procedure ended with the extraction of the Amplatz sheath and occlusion of the wound with gauze dressing, maintaining the bladder diversion with the Foley catheter to a draining collector system. Discharge was given at day 1 post-operative, nad the Foley catheter was removed after 5 days. Results No complications occurred, the operative time was 1 hour, and 1 day of hospital stay. Satisfactory recovery with a successful outcome in terms of complete stone removal in only 1 surgery. Conclusions Percutaneous cystolithotomy is a management option which offers advantages comparable with other techniques. It should not just be considered in patients with urethral restricted access. © 2015 Sociedad Colombiana de Urología

Published
2016

39. Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions

Author

Alper Biler, Ömer Tolga Güler, Nuri Peker, Ahmet Kale, Hasan Terzi, Ömer Demirtaş, and Acibadem University Dspace

Subjects
Laparoscopic surgery, Turkey, medicine.medical_treatment, retrospective study, laparoscopy, 0302 clinical medicine, Postoperative Complications, Laparotomy, middle aged, postoperative complication, Laparoscopy, gestational age, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, Gestational age, operation duration, General Medicine, laparoscopic surgery, female, pelvis surgery, priority journal, parity, 030220 oncology & carcinogenesis, Total laparoscopic hysterectomy, teaching hospital, Adult, Laparoscopic hysterectomy, medicine.medical_specialty, Operative Time, blood transfusion, Hysterectomy, surgical technique, Article, 03 medical and health sciences, laparotomy, length of stay, medicine, Humans, controlled study, human, procedures, Learning curve, Aged, Retrospective Studies, business.industry, statistical model, Postoperative complication, Retrospective cohort study, hemoglobin, major clinical study, body mass, Surgery, Female, Hysterectomy/adverse effects/*methods, Laparoscopy/adverse effects/*methods, Learning Curve, Length of Stay, Linear Models, Middle Aged, Postoperative Complications/*epidemiology/etiology, age, linear regression analysis, adverse effects, surgeon, business, Body mass index
Abstract

Objective: To assess the learning curve for total laparoscopic hysterectomy. Methods: This study was a retrospective analysis of the learning curve for two surgeons during their first 257 consecutive cases of total laparoscopic hysterectomy at a teaching hospital. Patients were divided sequentially into groups comprising the first 75 patients, the next 75, and the final 107 patients. Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operating time, haemoglobin decline, complications, need for transfusion, and length of hospital stay were evaluated. Results: The mean operating time for total laparoscopic hysterectomy reduced significantly from 76.2 min to 68.9 min (p = 0.001) between the first and second 75-patient groups. Linear regression analysis showed a plateau was reached on the learning curve after 71-80 cases. The rate of all complications started at 8\% in the first group of 75 patients, reduced to 6.7\% in the next group, and decreased further in the final group to 4.7\%. The decline was not statistically significant (p = 0.6). The difference in the need for transfusion was statistically significant between the first 75 patients and the second group of 75 (p = 0.04). Conversion from laparoscopy to laparotomy was required in five patients, four in the early group and one in the final group. Age, body mass index, parity, previous pelvic surgery, decline in haemoglobin, and length of hospital stay were similar among the three groups. Conclusions: A plateau in the learning curve for TLH was reached after the first 75 cases. We can infer that there is a learning curve for TLH as confirmed by the decrease in operating time (accompanied by no change in complications) correlated to gain in experience. On the other hand, one should not disregard the fact that laparoscopy is not a complication-free surgery and achievement of the learning curve does not exclude complications. Gynaecological surgeons can perform TLH securely during the learning curve. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Published
2016

40. Effect of perioperative inadvertent hypothermia on the ECG parameters in patients undergoing transurethral resection

Author

Bayir, H., Yildiz, I., Erdem, F., Tekelioglu,Ümit Yaşar, Ozyalvacli, M.E., Bilgi, M., and Kocoglu, H.

Subjects
QT interval, Adult, Male, core temperature, electrocardiography, very elderly, QTc interval, Hypothermia, electrocardiogram, postoperative period, Article, Body Temperature, middle aged, transurethral resection, Humans, controlled study, perioperative inadvertent hypothermia, human, Perioperative hypothermia, outcome assessment, Aged, Aged, 80 and over, body temperature measurement, operation duration, major clinical study, elective surgery, female, urologic surgery, Elective Surgical Procedures, Urologic Surgical Procedures, disease severity
Abstract

OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 °C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study. Patients with operation times more than 30 minutes were included. Core temperatures were measured and standard 12-lead ECG readings were taken before surgery and immediately upon arrival in the postanesthesia care unit. RESULTS: 59 patients were included this study. Prevalence of PIH (< 36°C) was (57.6%). The postoperative temperature was found to be significantly lower than the preoperative of all patients (preop 36.46±0.39; postop 35.68±0.59, paired sample t-test, p

Published
2016

41. Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique

Author

Federica Burattini, Alessia Corsi, Elisa Castellani, Alban Cacurri, Giuseppe Noya, Nicola Avenia, Amilcare Parisi, Alberto Santoro, Claudio Renzi, Carlo Boselli, Jacopo Desiderio, Veronica Grassi, Roberto Cirocchi, Chiara Listorti, Francesco Barberini, Daniele Pironi, and Stefano Trastulli

Subjects
medicine.medical_specialty, medicine.medical_treatment, preservation, retrospective study, Splenectomy, Outcome analysis, Distal pancreatectomy, surgical technique, varicosis, Article, Medium term, computer assisted tomography, Pancreatectomy, adult, aged, clinical article, female, human, male, operation duration, operative blood loss, pancreas resection, priority journal, splenic preservation, treatment outcome, warshaw technique, Splenic preservation, Warshaw technique, medicine, Postoperative results, Humans, Laparoscopy, Retrospective Studies, medicine.diagnostic_test, business.industry, Retrospective cohort study, General Medicine, Middle Aged, Surgery, Pancreatic Neoplasms, Radiology, Varices, business, Spleen
Abstract

Introduction Spleen-preserving left pancreatectomy (SPDP) with splenic vessels preservation (SVP) or without (Warshaw technique, WT) has been described with robotic, laparoscopy and open surgery. Nevertheless, significant data on medium- and long-term follow-up are still not available, since data in literature are scarce and the level of evidence is low. Methods In this retrospective study, we describe and compare short and medium term results of spleen-preserving distal pancreatectomy in eight patients. Results In WT group the duration and the intraoperative bleeding was superior than SVP group. The incidence of perigastric collateral vessels and presence of submucosal varices evidenced at CT scan was 66% in WT group, while only one case occurred in SVP group. Discussion The limit of laparoscopic approach is the fact that it needs advanced laparoscopic skills, which might result in intraoperative bleeding and splenectomy. The most of literature considered salvage WT intraoperatively performed in case of classical SVP and not only elective WT. The consequence is that there is no difference in immediate postoperative results (operative time, intraoperative bleeding, hospital stay) that are in favour of SVP because WT is performed only in case of failure in preserving the splenic vessels. In fact when this intervention is performed electively, the procedure time is reduced as well as the intraoperative bleeding. Conclusions WT is safe and feasible, even if there are not definitive evidences that demonstrate it is superior to classic SVP. RCTs are needed to determine advantages and disadvantages of WT compared to the classic SVP.

Published
2015

42. Perioperative management of tonsilloadenoidectomy and circumcision of a patient with Bernard-Soulier syndrome: Case report

Author

Ersin Gözkeser, Aziz Polat, Yasemin Isik Balci, Özkan Herek, Merve Gürses, and Cüneyt Orhan Kara

Subjects
Male, medicine.medical_treatment, Disease, physical examination, Bernard–Soulier syndrome, Adenoidectomy, Prolonged bleeding time, partial thromboplastin time, hemic and lymphatic diseases, blood analysis, Perioperative management, Platelet, anticoagulation, Child, tonsillectomy, mean corpuscular volume, operation duration, tonsilloadenoidectomy, Hematology, General Medicine, Antifibrinolytic Agents, fibrin glue, blood smear, priority journal, Tranexamic Acid, leukocyte, hospitalization, medicine.medical_specialty, thrombocyte transfusion, epistaxis, perioperative period, peroperative care, antifibrinolytic agent, Platelet Transfusion, thrombocyte count, Article, circumcision, blood, Bernard Soulier disease, medicine, Coagulopathy, pediatric surgery, case report, Humans, human, Tonsillectomy, Intraoperative Care, business.industry, Platelet Count, managed care, international normalized ratio, Bernard-Soulier Syndrome, Perioperative, hemoglobin, medicine.disease, school child, prothrombin time, Surgery, hospital discharge, hospital admission, thrombocyte volume, Circumcision, Male, hemoglobin determination, FVIIa, business, mucosal bleeding
Abstract

Bernard-Soulier syndrome is an autosomal recessive coagulopathy characterized by thrombocytopenia, prolonged bleeding time and large platelets. Because of the rarity of this disease, standard perioperative treatment protocols have not been developed and there are not enough available data for the management of surgical procedures. In this case, we successfully performed adenoidectomy and tonsillectomy and circumcision surgery concurrently under the preventive and intermittent transfusion of platelets. During hospitalization, no intraoperative or postoperative bleeding complications occurred. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Published
2014

43. Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study

Author

Kandasami, Sangam V, Mamoulakis, Charalampos, El-Nahas, Ahmed R, Averch, Timothy, Tuncay, O Levent, Rawandale-Patil, Ashish, Cormio, Luigi, de la Rosette, Jean J, Osther, Palle Jørn Sloth, Urology, CCA -Cancer Center Amsterdam, and APH - Amsterdam Public Health

Subjects
Male, Complications, Prospective data, postoperative period, hospital readmission, statistics and numerical data, Ureteral stones, perforation, postoperative complication, Ureteroscopy, Treatment outcome, medical society, Societies, Medical, medicine.diagnostic_test, Case volume, urolithiasis, operation duration, Middle Aged, hospital patient, Treatment Outcome, standards, Regression Analysis, Female, Clinical Competence, hospitalization, prospective study, Adult, medicine.medical_specialty, Hospitals, Low-Volume, Ureteral Calculi, Urology, Stone free, Urinary system, Operative Time, utilization, high volume hospital, low volume hospital, Patient Readmission, Article, avulsion injury, intraoperative period, medicine, Humans, In patient, human, Patient summary, ureter stone, Aged, business.industry, General surgery, Length of Stay, bleeding, Clavien grade, major clinical study, Surgery, Clinical research, clinical research, adverse effects, surgeon, business, Hospitals, High-Volume
Abstract

Outcome measurements and statistical analysis Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications, and hospital stay were explored using multivariate regression analysis., Results and limitations Across all centres, the median case volume was 67; 58 and 56 centres were designated as low volume and high volume, respectively. URS procedures at high-volume centres took significantly less time to conduct. Mean SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (p < 0.001); the adjusted probability of a stone-free outcome increased with increasing case volume (p < 0.001). Patients treated at a high-volume centre were less likely to need retreatment, had shorter postoperative hospital stay, were less likely to be readmitted within 3 mo, and had fewer and less severe complications. At case volumes approximately >200, the probability of complications decreased with increasing case volume (p = 0.02). The study is limited by the heterogeneity of participating centres and surgeons and the inclusion of patients treated by more than one approach., Conclusions In the treatment of ureteral stones with URS, high-volume centres achieve better outcomes than low-volume centres. Several outcome measures for URS improve with an increase in case volume., Patient summary Outcomes following treatment of ureteral stones by ureteroscopy (URS) were studied in a large group of patients at centres worldwide. The proportion of successful procedures (ie, those in which patients became stone free) increased as the annual volume of URS at a hospital increased. Hospital stays were shorter and postoperative complications were less likely at high-volume hospitals. We conclude that for URS, the best outcomes are seen in patients treated at high-volume hospitals., Background The Clinical Research Office of the Endourological Society (CROES) undertook the Ureteroscopy Global Study to establish a prospective global database to examine the worldwide use of ureteroscopy (URS) and to determine factors affecting outcome., Design, setting, and participants The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median overall annual case volume. © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. -absp. Objective To investigate the influence of case volume on the outcomes of URS for ureteral stones.

Published
2014

44. On the way toward better evidence for minimally invasive treatment of pelvic organ prolapse

Author

Alessandro Volpe and Giacomo Novara

Subjects
medicine.medical_specialty, Reconstructive surgery, editorial, Urology, Uterosacral ligament, clinical effectiveness, follow up, human, laparoscopic surgery, minimally invasive surgery, operation duration, pelvic organ prolapse, postoperative complication, postoperative hemorrhage, priority journal, robotics, treatment outcome, medicine, Laparoscopy, Surgical repair, Pelvic floor, medicine.diagnostic_test, business.industry, Robotic Surgical Procedures, Perioperative, Surgery, medicine.anatomical_structure, Orthopedic surgery, business
Abstract

Surgical treatment of pelvic organ prolapse (POP) can be performed with several different methods, and more than 40 reconstructive surgical techniques have been described [1]. Surgical repair can be performed vaginally or abdominally with retropubic, conventional laparoscopic, and, more recently, robot-assisted approaches. Sacrospinous vault suspension, iliococcygeus muscle fixation, uterosacral ligament fixation, McCall culdoplasty, and posterior intravaginal slingplasty are the most commonly used vaginal techniques [2], whereas abdominal sacrocolpopexy is the most common abdominal procedure on the market. Theoretically speaking, vaginal surgery might allow several advantages over the abdominal approach, including shorter operative time, lower morbidity, the possible use of local or regional anesthesia, the potential to repair other concomitant pelvic defects, and quicker recovery. In contrast, the presence of orthopedic deformities, concomitant intra-abdominal pathology, and reduced vaginal length might be conditions that could favor an abdominal approach [3]. Surgical experience with the specific approach plays also a major role, with significant differences in clinical practice among gynecologists, urologists, and urogynecologists. Laparoscopic pelvic floor reconstructive surgery aims to maximize the efficacy of the abdominal approach by maintaining its advantages and simultaneously reducing perioperative morbidity and length of hospital stay. Laparoscopic sacrocolpopexy, however, is a complex surgical procedure that requires extensive suturing of the mesh to the pelvic floor structures, making it a difficult surgical procedure for surgeonswithout advanced laparoscopic skills.

Published
2014

45. Choroidal changes after cardiopulmonary bypass

Author

İhsan Alur, Yusuf Izzettin Alihanoglu, Gökhan Pekel, R Yagci, and Bilgin Emrecan

Subjects
choroidal thickness, Male, Intraocular pressure, heart surgery, intraocular pressure, genetic structures, correlation analysis, Hemodynamics, choroid vascularization, hemodynamics, postoperative period, law.invention, law, middle aged, Prospective Studies, pathophysiology, clinical article, Cardiopulmonary Bypass, ocular pulse amplitude, medicine.diagnostic_test, operation duration, clinical trial, General Medicine, Middle Aged, preoperative evaluation, female, spectral domain optical coherence tomography, medicine.anatomical_structure, Anesthesia, visual system parameters, tonometer, Cardiology and Cardiovascular Medicine, Safety Research, prospective study, Adult, medicine.medical_specialty, optical coherence tomography device, Spectral domain, subfoveal choroidal thickness, Article, Optical coherence tomography, Ophthalmology, cardiopulmonary bypass, medicine, Cardiopulmonary bypass, cross-sectional study, follow up, Humans, Radiology, Nuclear Medicine and imaging, human, Pulse, Intraocular Pressure, Aged, Advanced and Specialized Nursing, Retina, business.industry, Choroid, Mean age, Choroid/*pathology/*physiopathology, Cross-Sectional Studies, eye diseases, pulse rate, choroid blood flow, pathology, sense organs, business
Abstract

Aim: Choroid, which is the vascular tissue responsible for blood supply to the outer parts of the retina, might be affected by hemodynamic events. We aimed to reveal choroidal thickness and ocular pulse amplitude changes after cardiopulmonary bypass in which gross hemodynamic alterations occur., Methods: Forty-two eyes of 42 patients who underwent heart surgery with cardiopulmonary bypass were examined in this prospective, cross-sectional case series. The spectral domain optical coherence tomography (Spectralis, Heidelberg, Germany) was used to analyze sub-foveal choroidal thickness. The ocular pulse amplitude, the surrogate of gross choroidal blood flow, was measured with the Pascal dynamic contour tonometer (Pascal DCT, Swiss Microtechnology AG, Port, Switzerland)? The intraocular pressure was also measured with this tonometer. The examinations were performed pre-operatively and post-operatively at the first week and first month., Results: The mean age of the patients was 58.8 ± 12.4 years. The mean sub-foveal choroidal thickness and ocular pulse amplitude values did not change statistically significantly after the operations at the follow-up visits (p>0.05). Also, there were no important correlations between cardiopulmonary bypass time and mean sub-foveal choroidal thickness and ocular pulse amplitude changes at the post-operative first week (p>0.05). The intraocular pressure values were decreased markedly at the control visits (p, Conclusions: Sub-foveal choroidal thickness and ocular pulse amplitude are unchanged, while intraocular pressure decreases one week and one month after cardiopulmonary bypass. © 2014 The Author(s).

Published
2014

46. Impact of case volume on outcomes of ureteroscopy for ureteral stones: The clinical research office of the endourological society ureteroscopy global study

Author

Kandasami, S.V., Mamoulakis, C., El-Nahas, A.R., Averch, T., Tuncay, Ömer Levent, Rawandale-Patil, A., Cormio, L., and De La Rosette, J.J.

Subjects
Male, Ureteral Calculi, Hospitals, Low-Volume, Complications, Operative Time, utilization, high volume hospital, low volume hospital, postoperative period, Patient Readmission, Article, regression analysis, avulsion injury, length of stay, hospital readmission, middle aged, Ureteroscopy, intraoperative period, Ureteral stones, statistics and numerical data, Humans, perforation, postoperative complication, human, Treatment outcome, medical society, ureter stone, Societies, Medical, adult, urolithiasis, operation duration, Case volume, Clavien grade, bleeding, major clinical study, hospital patient, aged, female, clinical research, adverse effects, standards, surgeon, Clinical Competence, Hospitals, High-Volume, hospitalization, prospective study
Abstract

Outcome measurements and statistical analysis Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications, and hospital stay were explored using multivariate regression analysis. Results and limitations Across all centres, the median case volume was 67; 58 and 56 centres were designated as low volume and high volume, respectively. URS procedures at high-volume centres took significantly less time to conduct. Mean SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (p < 0.001); the adjusted probability of a stone-free outcome increased with increasing case volume (p < 0.001). Patients treated at a high-volume centre were less likely to need retreatment, had shorter postoperative hospital stay, were less likely to be readmitted within 3 mo, and had fewer and less severe complications. At case volumes approximately >200, the probability of complications decreased with increasing case volume (p = 0.02). The study is limited by the heterogeneity of participating centres and surgeons and the inclusion of patients treated by more than one approach. Conclusions In the treatment of ureteral stones with URS, high-volume centres achieve better outcomes than low-volume centres. Several outcome measures for URS improve with an increase in case volume. Patient summary Outcomes following treatment of ureteral stones by ureteroscopy (URS) were studied in a large group of patients at centres worldwide. The proportion of successful procedures (ie, those in which patients became stone free) increased as the annual volume of URS at a hospital increased. Hospital stays were shorter and postoperative complications were less likely at high-volume hospitals. We conclude that for URS, the best outcomes are seen in patients treated at high-volume hospitals. Background The Clinical Research Office of the Endourological Society (CROES) undertook the Ureteroscopy Global Study to establish a prospective global database to examine the worldwide use of ureteroscopy (URS) and to determine factors affecting outcome. Design, setting, and participants The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median overall annual case volume. © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved. -absp. Objective To investigate the influence of case volume on the outcomes of URS for ureteral stones.

Published
2014

47. Single-Incision, Two-Port Laparoscopic Appendectomy as an Alternative to Transumbilical Single-Port Laparoscopic Appendectomy.

Author

Chung HS, Jung SM, Lee MR, Shin YC, Jun HM, Kim JI, and Choi PW

Abstract

Purpose: We designed a modified technique to perform an advanced procedure using conventional instruments and did not employ specialized single-incision laparoscopic surgery (SILS) port equipment. We compared postoperative results for transumbilical, single-port laparoscopic appendectomy (TUSPLA) and single-incision, 2-port laparoscopic appendectomy (SITPLA)., Methods: This retrospective study enrolled 77 patients who underwent TUSPLA or SITPLA to provide more minimally invasive surgery between May 2017 and April 2018. TUSPLA was performed in 39 patients and 38 underwent SITPLA. In the SITPLA group, two 5-mm trocars were inserted through the umbilicus and an extra puncture site was used for a left-handed instrument. Demographic characteristics, operative data, and postoperative outcomes were collected and compared between the groups., Results: The mean total operative time in the SITPLA group was shorter than in the TUSPLA group ( p =0.003). The mean laparoscopic instrumental time was also shorter ( p <0.001) in the SITPLA. The number of postoperative analgesics in the SITPLA group was less than in the TUSPLA group ( p =0.002). The length of hospital day after surgery was shorter in the SITPLA group than in the TUSPLA group ( p =0.008). There were no other significant differences between the groups., Conclusion: SITPLA had a shorter operative time, required less pain management, and had a similar cosmetic outcome when compared with TUSPLA., (Copyright © 2019 The Journal of Minimally Invasive Surgery.)

Published
2019
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48. Expanding utilization of robotic partial nephrectomy for clinical T1b and complex T1a renal masses

Author

Riccardo Schiavina, Alexandre Mottrie, Melanie Gan, Vincenzo Ficarra, Marco Borghesi, Giacomo Novara, Borghesi M, SCHIAVINA R., Gan M, Novara G, Mottrie A, and Ficarra V.

Subjects
Nephrology, medicine.medical_treatment, kidney carcinoma, Blood Loss, Surgical, Nephrectomy, article, classification, human, ischemia, kidney carcinoma, kidney tumor, laparoscopy, methodology, minimally invasive surgery, nephrectomy, operation duration, operative blood loss, pathology, robotics, treatment outcome, tumor volume, Blood Loss, Surgical, Carcinoma, Renal Cell, Humans, Kidney Neoplasms, Laparoscopy, Nephrectomy, Operative Time, Robotics, Surgical Procedures, Minimally Invasive, Treatment Outcome, Tumor Burden, Warm Ischemia, Renal cell carcinoma, Surgical, Minimally Invasive, Medicine, Warm Ischemia, robotic partial nephrectomy, Laparoscopy, minimally invasive surgery, kidney tumor, medicine.diagnostic_test, article, operation duration, methodology, Robotics, Kidney Neoplasms, Tumor Burden, Treatment Outcome, classification, medicine.medical_specialty, Urology, Operative Time, MEDLINE, Renal function, ischemia, Internal medicine, operative blood loss, Carcinoma, Humans, Minimally Invasive Surgical Procedures, human, Carcinoma, Renal Cell, Surgical Procedures, business.industry, Renal Cell, Perioperative, medicine.disease, Surgery, tumor volume, pathology, business
Abstract

INTRODUCTION: Partial nephrectomy is the standard of care for cT1a renal masses, offering equivalent oncologic outcomes and lower renal function impairment when compared to radical nephrectomy, with excellent overall survival results. Robot-assisted partial nephrectomy (RAPN) allows to perform a precise tumor excision, simplifying the reconstruction steps of the procedure, especially in the treatment of complex or large renal tumors. Aim of this study was to summarize the available perioperative, functional, and oncological outcomes of RAPN performed for complex and/or large (cT1b) renal cell carcinoma (RCC). MATERIALS AND METHODS: We performed a nonsystematic review of the literature using a free-text protocol in the Medline database, using the terms "robot-assisted partial nephrectomy" and "robotic partial nephrectomy." Two Authors reviewed separately to select RAPN series reporting data about complex and cT1b RCC. Other significant studies cited in the reference lists of the selected papers were also evaluated. EVIDENCE SYNTHESIS: According to the currently available evidences, RAPN offers promising results in terms of perioperative, functional, and oncological outcomes for the conservative management of complex or large renal tumors, even when compared with open and laparoscopic partial nephrectomy. Robot-assisted procedure allows surgeons to treat large and challenging renal masses, even if with higher warm ischemia time, operating time, and estimated blood loss in comparison with those obtained for the treatment of smaller lesions. CONCLUSIONS: In the hands of experienced surgeons, RAPN is a safe and reproducible approach for the treatment of cT1b and more challenging renal tumors, and could represent the way to expand the indications for minimally invasive conservative approach to RCC.

Published
2013

49. Comparison of only T3 and T3-T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating

Author

Figen Türk, Gökhan Yuncu, Cansel Atinkaya, and Gökhan Öztürk

Subjects
T3 sympathectomy, Time Factors, Turkey, patient satisfaction, hematothorax, medicine.medical_treatment, T3-T4 sympathectomy, postoperative period, endotracheal tube, Quality of life, gender, hyperhidrosis, sympathectomy, education.field_of_study, medicine.diagnostic_test, Hyperhidrosis, Compensatory sweating, adult, article, operation duration, analgesic agent, cohort analysis, Axillary hyperhidrosis, medicine.anatomical_structure, female, priority journal, sweating, Anesthesia, medicine.symptom, Cardiology and Cardiovascular Medicine, postoperative pain, Pulmonary and Respiratory Medicine, medicine.medical_specialty, pneumothorax, Population, surgical technique, Thoracic Vertebrae, Young Adult, Patient satisfaction, male, medicine, Thoracoscopy, Humans, controlled study, human, education, intermethod comparison, Chi-Square Distribution, business.industry, cauterization, subcutaneous emphysema, Original Articles, therapy effect, major clinical study, Sweat Glands, Surgery, Axilla, Sympathectomy, age, quality of life, adolescent, Thoracic vertebrae, randomized controlled trial, incidence, treatment outcome, observational study, business, thoracic sympathectomy
Abstract

Objectives: Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3-T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3-T4 sympathectomies among our 60-patient population. Methods One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3-T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data associated with the resolution of axillary hyperhidrosis, the degree of patient satisfaction with the surgical outcome and the quality of life in parallel with compensatory sweating after the procedure as reported by the patient and confirmed by the examiner. Moreover, the Results were compared statistically. Results No statistically significant difference was observed between the groups based on age (P = 0.56), gender (P = 0.81), duration of the surgery (P = 0.35) or postoperative satisfaction levels (P = 0.45). However, the incidence and degree of compensatory sweating were lower in the T3 group than the T3-T4 group at the 1-year follow-up (P = 0.008). Conclusions T3 sympathectomy was as effective as T3-T4 sympathectomy for the treatment of axillary hyperhidrosis based on the patients' reported postoperative satisfaction, and the T3 group demonstrated lower compensatory sweating at the 1-year follow-up. © 2013 The Author.

Published
2013

50. Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures

Author

Kaplan, Tolga, Uludağ Üniversitesi/Tıp Fakültesi/Ortopedi ve Travmatoloji Anabilim Dalı., Akesen, Burak, Demirağ, Burak, Bilgen, Sadık, Durak, Kemal, AAI-1638-2021, and AAH-9833-2021

Subjects
musculoskeletal diseases, System, Adult, Male, Cannulated screw, Bone plate, Fracture healing, Harris hip score, Outcomes, Major clinical study, Fractures of the femoral neck, Intracapsular fractures, Dynamic hip screw, Article, Treatment outcome, Percutaneous, Aged, Sweden, Internal fixator, Subcapital fractures, Intermethod comparison, Rehabilitation, Bleeding, Osteosynthesis, Bone screw, Percutaneous cannulated screw, Fixation, Management, Postoperative complication, Retrospective study, Avascular necrosis, Operation duration, Hip-fractures, Femur neck fracture, Femoral Neck Fractures, Hemiarthroplasty, Femur Neck, Emergency medicine, Female, Proximal femur, Controlled study, Human
Abstract

BACKGROUND The purpose of this study was to compare the period of union, functional outcomes and complications of patients with femoral neck fracture treated with percutaneous cannulated screws versus dynamic hip screw (DHS). METHODS Sixty-six patients with femoral neck fracture were treated with percutaneous cannulated screws (n=33) or with DHS (n=33) between August 1999 and October 2003. Functional outcome was measured using Harris Hip Score, and period of union, amount of bleeding and complications were also recorded. RESULTS The period of union and functional outcomes were not different between the two groups. Risk of avascular necrosis (AVN) was associated mainly with the grade of fracture displacement. In the percutaneous cannulated screw group, duration of surgery was shorter and blood loss was less than in the other group. CONCLUSION There was no superiority between cannulated screws and DHS according to union times and functional results. Risk of AVN is related to the degree of displacement. However, a prospective randomized study is needed to determine the outcome of each technique for patients suffering similar displacement rates.

Published
2012

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