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The placement of a penile prosthesis has been considered the most reliable and effective treatment for erectile dysfunction in men with failed medical treatment. The 2-piece system eliminates a need for separate reservoir making the surgery easy for the treating surgeon/urologist. We report the use of this two-piece prosthesis in a 50-year-old patient with erectile dysfunction and describe the surgical steps of the same.

Background. The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, and health facilities reduced non-essential activity, including many surgical services. Objectives. Primary objective: to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020 general surgery operative volume and proportion at six district and regional hospitals. Secondary objective: to compare the operative volume of appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years. Methods. This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data were obtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020. Results. Total general surgery operations decreased by 44% between 2019 ( n =3 247) and 2020 ( n =1 810) ( p

Objective Stereoscopic video recordings of operative microscopy during neuroanatomic dissections are an important component of surgical training and research in well-financed medical schools and teaching hospitals. However, the high cost of the latest operative microscopes with integrated video recording equipment can be a limiting factor in their worldwide use. The aim of the present work is to provide a simple low-cost 3-dimensional (3D) stereoscopic operative microscope recording system that can be used even in economically and resource-limited locations. This is achieved by using readily available smartphones, smartphone accessories, and computer software. Methods Stereoscopic recording is accomplished by attaching and aligning matched or similar smartphones to the eyepieces of an operative microscope using readily available smartphone mounting connectors. Video recordings from the smartphones are then transferred to a personal computer and processed with a video-editing software to generate stereoscopic movies that are viewed on a smartphone using virtual-reality glasses. Results The setup time to mount and align the smartphone cameras typically requires 15–30 minutes. Video image quality and 3D depth presentation is more than sufficient for surgical training and research purposes. The implementation cost ranges from $1,315–$7,066, or much less if smartphones and a computer are already available. Conclusions The 3D video system demonstrated herein can be implemented on any type of operative microscope, including older units for which commercial stereo recording systems are not available. The system and method presented herein can be readily and affordably implemented in low-budget environments for clinical training and research.

ObjectiveTo determine the long-term results of above-knee femoro-popliteal bypass with autologous saphenous vein (SV) or expanded polytetrafluoroethylene (ePTFE) in routine surgical practice.MethodsData from the Swedish vascular registry, Swedvasc was reviewed retrospectively. Patients with bypass surgery in 1996 and 1997 were assessed 5–7 years later. Data were gathered from the case-records and from clinical follow-up. The composite endpoint of graft failure included death within 30 days, occlusion, major amputation, extension of the graft to below-knee position and removal of an infected graft. Kaplan–Meier curves and Cox' proportional hazard ratios were calculated.ResultsFour hundred and ninety-nine patients undergoing bypass for critical limb ischemia (CLI) (56%) or claudication (44%), SV (28%) or ePTFE (72%), were included. There were no significant differences in patient characteristics between patients with SV or ePTFE. CLI and ePTFE were risk factors for graft failure. For patients with both claudication and CLI SV grafts yielded better long-term results than ePTFE grafts (p

The almost complete disappearance of benign gastric ulcer disease has led to the perception that there may be an insufficient gastric surgery experience for surgery residents. This study analyzed resident-reported gastric procedure experience by chief residents from U.S. programs. The Resident Statistic Summaries (Report C) for 1990-2001 were compiled and analyzed. Results are expressed as the average number of operations performed per resident, standard deviation (SD), and the percentage (%) of total gastric operative cases. For all gastric-related surgery, the average reported cases per chief resident ranged from 9.8-12.4 with a peak in 1990 and a nadir in 1999; in 2001 the reported case average was 11.3 (SD ranged from 6-8). Over the same interval, vagotomy decreased from 24% in 1990 to 7% in 2001, whereas gastric-reduction operations increased from 5%-34%. Total gastrectomy remained a constant less than 1.0 per chief resident (range 0.6-0.8), whereas partial gastric resection (PGR) was unchanged. The percentage of all types of gastric resections slightly diminished from 34% in 1990 to 29% in 2001. U.S. surgical chief residents report a widely variable experience in gastric surgery over the period analyzed. However, their overall experience has not significantly diminished since 1990 although specific procedural volume has varied.

Childhood vaginal anomalies are frequently encountered, often in association with significant anorectal or urinary tract abnormalities. As a result, reconstruction poses a number of technical challenges. We maintain that the best results are achieved by single stage perineal reconstruction. The primary goal of achieving a functional and cosmetically adequate vagina must not be at the expense of the optimal repair of associated urinary and anorectal abnormalities. In addition, since these repairs are performed early in childhood, vaginal growth is an issue that further limits the choice of reconstructive technique. We present a series of successful vaginal reconstructions in complex cases and an outline of the principles of surgical care.

Although injuries to the vertebral arteries are relatively uncommon, there are several different methods used to gain access to these vessels, and to control any bleeding arising from them. We describe a case of torrential oropharyngeal bleeding following a stab wound to the neck in which rapid access to the vertebral artery was gained using a paramedian mandibulotomy; this approach has not previously been documented. The other approaches are discussed.

• Surgical management of cataracts in children is markedly different from adults. Children have reduced scleral and corneal rigidity, more inflammation after surgery, and a propensity to develop reopacification of the visual axis.

Se describe la experiencia temprana del Hospital Nacional Daniel Alcides Carrión, Callao, en el tratamiento de la apendicitis aguda por abordaje videolaparoscópico, entre enero y diciembre de 1997. De 35 pacientes operados, veinte (57,1%) fueron varones. El promedio global de edad fue 23,8 años (rango 10-47), en 10 de ellos (28,5%) el cuadro apendicular estaba complicado. En el 14,2% (5 pacientes) hubieron complicaciones intraoperatorias menores, todas sin alteración de los resultados finales. Tres pacientes presentaron infección en el sitio del trócar. No hubieron reoperaciones. El promedio de hospitalización fue 2 días en los no complicados y 7 en los complicados. Un paciente falleció por problemas posquirúrgicos. Se describe la técnica utilizada y se hace una revisión acerca de ella., Our initial experience with laparoscopic appendectomy in the management of patients with acute appendicitis at the Hospital Nacional Daniel Alcides Carrion, between January 1997 and December 1997, is reported. A total of 35 laparoscopic procedures, were performed. The median age was 23,8 years (range, 10 to 47 years) with 57,1% males (n = 20) and 42,9% females (n = 15). 10 patients (28,5%) had perforated appendicitis; 5 patients (14,2%) had minor intraoperative complications, none of them modified final results. Trochar wound infection was present in three patients. The median postoperative length of stay was 2 days for non complicated and 7 days for complicated patients. Length of time for the procedure was, in most of cases, adequate.

Background The GMC9s Good Medical Practice document advises that doctors should ‘keep clear, accurate and legible records.’1 Patient care, potential complaints and litigation may be hampered by illegible or incomplete documentation. Aim To assess if basic documentation was being completed in operative delivery/postnatal surgery operative notes. Method 50 postnatal case notes for the period January until May 2009, were randomly obtained from the discharge boxes of the Wishaw General Hospital. The following basic data were recorded within spreadsheet format: Whether the date, time, type of procedure, legible signature, grade and GMC or page number of the operating surgeon were documented. Results 50 case notes were obtained of which 7 Consultants, 2 Staff Grades and 41 Registrars had completed operation notes. The date and time had been recorded in 82% and 46%, respectively. In 100% the type of procedure was documented. 68% contained a legible signature. None contained the surgeon9s GMC number, but one did contain the surgeon9s page number. Conclusion Within our unit there was an inadequate level of documentation within the operative delivery and postnatal surgery operation notes. This information was disseminated at postgraduate teaching and will be re-audited.

This audit report details early post-operative complications following surgery for chronic otitis media. One hundred and forty-five cases were assessed. There were no facial nerve palsies, a bone conduction threshold elevation occurred in 4.6 per cent of cases. A wound infection occurred in six per cent of cases as did BIPP allergy. Twenty-six per cent of patients reported symptoms consistent with chorda tympani trauma. Short-lived symptoms of jaw discomfort were reported by 46 per cent of patients and imbalance or vertigo by 10 per cent of patients. The findings are compared with other published reports of complications following ear surgery.

A case is reported in which an inhaled sewing needle, stuck fast in the trachea, became displaced through the tracheal wall during attempted removal via flexible bronchoscopy. The inherent risks and pitfalls of this procedure are highlighted.

A case is described in which a middle-aged male presented with a large tracheocele in the neck arising from the right postero-lateral aspect of trachea at the level of T2 vertebra. It was not associated with any predisposing factors and except for the swelling in the neck the patient was asymptomatic. It was excised completely through the cervical approach and there has been no recurrence in two years follow-up.