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Robertson D, van Duijn M, Arezzo A, Mintz Y, Horeman-Franse T. The influence of prolonged instrument manipulation on gas leakage through trocars. Surg Endosc 2023; 37:7325-7335. [PMID: 37442835 PMCID: PMC10462547 DOI: 10.1007/s00464-023-10240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND During laparoscopic surgery, CO2 insufflation gas could leak from the intra-abdominal cavity into the operating theater. Medical staff could therefore be exposed to hazardous substances present in leaked gas. Although previous studies have shown that leakage through trocars is a contributing factor, trocar performance over longer periods remains unclear. This study investigates the influence of prolonged instrument manipulation on gas leakage through trocars. METHODS Twenty-five trocars with diameters ranging from 10 to 15 mm were included in the study. An experimental model was developed to facilitate instrument manipulation in a trocar under loading. The trocar was mounted to a custom airtight container insufflated with CO2 to a pressure of 15 mmHg, similar to clinical practice. A linear stage was used for prolonged instrument manipulation. At the same time, a fixed load was applied radially to the trocar cannula to mimic the reaction force of the abdominal wall. Gas leakage was measured before, after, and during instrument manipulation. RESULTS After instrument manipulation, leakage rates per trocar varied between 0.0 and 5.58 L/min. No large differences were found between leakage rates before and after prolonged manipulation in static and dynamic measurements. However, the prolonged instrument manipulation did cause visible damage to two trocars and revealed unintended leakage pathways in others that can be related to production flaws. CONCLUSION Prolonged instrument manipulation did not increase gas leakage rates through trocars, despite damage to some individual trocars. Nevertheless, gas leakage through trocars occurs and is caused by different trocar-specific mechanisms and design issues.
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Affiliation(s)
- Daniel Robertson
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - Matthijs van Duijn
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tim Horeman-Franse
- Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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2
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Koch A, Quartucci C, Buchner A, Schlenker B, Becker A, Catchpole K, Weigl M. Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies. Surg Endosc 2023; 37:6964-6974. [PMID: 37336845 PMCID: PMC10462499 DOI: 10.1007/s00464-023-10162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Technological advancements in the operating room (OR) have sparked new challenges for surgical workflow, OR professionals, and patient safety. Disruptive events are frequent across all surgical specialties, but little is known about their effects on patient outcomes and the influence of systemic factors. The aim was to explore the associations of intraoperative flow disruptions (FDs) with patient outcomes, staff workload, and surgery duration. METHODS Prospective, single-center, and multi-source study comprising direct and standardized OR observations of urologic surgical procedures, clinical patient outcomes, and staff- and patient-reported outcome data (PROMs; 3-month follow-up). All data were recorded between 01/2020 and 10/2021. FDs were assessed using standardized procedure observations. Linear and logistic regression analyses including multiple system factors were used to explore the effects of FDs on surgical outcomes. RESULTS 61 robotic-assisted radical prostatectomy procedures were captured (with 61 patients and 243 staff reports). High rates of FDs were observed; however, our analyses did not show significant relationships with patient complication rates. Equipment- and patient-related FDs were associated with increased staff workload. No association was found between higher rates of FDs and procedure duration. CONCLUSIONS FDs were not related to inferior patient outcomes. Our findings may inform future OR investigations that scrutinize the complex interplay of human, team, process, and technological components that mitigate the effects of FDs during surgery.
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Affiliation(s)
- Amelie Koch
- Institute for Patient Safety, University Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
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3
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Gawria L, Jaber A, Ten Broek RPG, Bernasconi G, Rosenthal R, Van Goor H, Dell-Kuster S. Appraisal of Intraoperative Adverse Events to Improve Postoperative Care. J Clin Med 2023; 12:jcm12072546. [PMID: 37048631 PMCID: PMC10095268 DOI: 10.3390/jcm12072546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications. Methods: All patients enrolled in the multicenter ClassIntra® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other’s ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI®), a weighted sum of all postoperative complications according to the Clavien–Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra® on CCI® was assessed with a multivariable mixed-effects generalized linear regression analysis. Results: Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI® was observed. Conclusion: Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.
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Affiliation(s)
- Larsa Gawria
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, 4051 Basel, Switzerland
- Correspondence: or
| | - Ahmed Jaber
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
- Department of Surgery, Yitzhak Shamir Medical Centre, Tel Aviv 7030083, Israel
| | | | - Gianmaria Bernasconi
- Clinic for Anesthesiology and Pain Therapy, Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - Rachel Rosenthal
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Harry Van Goor
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Salome Dell-Kuster
- Department of Surgery, Yitzhak Shamir Medical Centre, Tel Aviv 7030083, Israel
- Clinic for Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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4
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Interprofessional differences in preoperative planning—the individualist surgeon. Eur Surg 2022. [DOI: 10.1007/s10353-022-00761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Summary
Background
Perioperative processes have a great impact on the quality of surgery. In a high-risk surrounding, proper planning and communication is of upmost importance. We have identified other professions next to surgery with comparable circumstances and conducted a survey to elaborate on the impact of perioperative processes.
Objective
To identify standards in preoperative planning in high-risk professions and determine possible shortcomings in surgical practice.
Methods
Two surveys were constructed and distributed to surgeons, mountain guides, and soldiers. Questions were designed to investigate preoperative planning behavior and compare the different professions.
Results
Nearly every participant (97%) agreed to the fact that preoperative planning helps to avoid complications. Most surgeons agreed that the preoperative and postoperative phase of care had the greatest ability to improve overall quality of care. The opinions about planning were divided. The minority of surgeons agreed to the importance of sharing a plan preoperatively. Soldiers were the profession with the highest rate of plan sharing.
Conclusion
The readiness to communicate varies between professions and is lowest for surgeons. Missing standardization of procedures and the surgeon’s ego might be explanations for this behavior. Interventions to overcome this shortcoming, like the preoperative team timeout, have already been implemented but further improvements are needed.
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Mcmullan RD, Urwin R, Gates P, Sunderland N, Westbrook JI. Are operating room distractions, interruptions and disruptions associated with performance and patient safety? A systematic review and meta-analysis. Int J Qual Health Care 2021; 33:6226362. [PMID: 33856028 DOI: 10.1093/intqhc/mzab068] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The operating room is a complex environment in which distractions, interruptions and disruptions (DIDs) are frequent. Our aim was to synthesize research on the relationships between DIDs and (i) operative duration, (ii) team performance, (iii) individual performance and (iv) patient safety outcomes in order to better understand how interventions can be designed to mitigate the negative effects of DIDs. METHODS Electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) and reference lists were systematically searched. Included studies were required to report the quantitative outcomes of the association between DIDs and team performance, individual performance and patient safety. Two reviewers independently screened articles for inclusion, assessed study quality and extracted data. A random-effects meta-analysis was performed on a subset of studies reporting total operative time and DIDs. RESULTS Twenty-seven studies were identified. The majority were prospective observational studies (n = 15) of moderate quality. DIDs were often defined, measured and interpreted differently in studies. DIDs were significantly associated with extended operative duration (n = 8), impaired team performance (n = 6), self-reported errors by colleagues (n = 1), surgical errors (n = 1), increased risk and incidence of surgical site infection (n = 4) and fewer patient safety checks (n = 1). A random-effects meta-analysis showed that the proportion of total operative time due to DIDs was 22.0% (95% confidence interval 15.7-29.9). CONCLUSION DIDs in surgery are associated with a range of negative outcomes. However, significant knowledge gaps exist about the mechanisms that underlie these relationships, as well as the potential clinical and non-clinical benefits that DIDs may deliver. Available evidence indicates that interventions to reduce the negative effects of DIDs are warranted, but current evidence is not sufficient to make recommendations about potentially useful interventions.
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Affiliation(s)
- Ryan D Mcmullan
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Rachel Urwin
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Peter Gates
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Neroli Sunderland
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - Johanna I Westbrook
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia
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6
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Non-technical skills and device-related interruptions in minimally invasive surgery. Surg Endosc 2020; 35:4494-4500. [PMID: 32886238 DOI: 10.1007/s00464-020-07962-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Device-related interruptions in the operating room (OR) may create stress among health care providers and delays. Although non-technical skills (NTS) of the OR teams, such as situational awareness and communication, are expected to influence device-related interruptions, empirical data on this relationship are limited. METHODS We performed a prospective cohort study of 144 consecutive elective laparoscopic operations during 13 months. A data capture system called the OR Black Box® was used to characterize device-related interruptions, NTS, and distractions. Device-related interruptions were classified according to a priori established categories. Positive and negative NTS instances were identified according to validated measurement tools specific for nurses and surgeons. We assessed the relationship between NTS and device-related interruptions after adjusting for potential confounders. RESULTS A total of 86 device-related interruptions occurred in 48 of 144 operations (33%). They were most frequently classified as device failure (54%) followed by improper assembly (19%) and disconnection (14%). Medians of 1 [interquartile range (IQR) 0-3] and 1 (IQR 0-2) negative NTS instance per operation were demonstrated by nurses and surgeons, respectively. Medians of 28 (IQR 15-38) and 40 (IQR 28-118) positive NTS instances per operation were demonstrated by nurses and surgeons. In a multivariable analysis, a higher frequency of negative NTS instances demonstrated by nurses was associated with device-related interruptions after risk adjustment (Odds Ratio 1.33, p = 0.02). CONCLUSIONS In elective laparoscopic operations, an increased likelihood of device-related interruptions in the OR was associated with more frequent negative NTS demonstrations by nursing teams.
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7
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Koch A, Burns J, Catchpole K, Weigl M. Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis. BMJ Qual Saf 2020; 29:1033-1045. [DOI: 10.1136/bmjqs-2019-010639] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/04/2022]
Abstract
BackgroundPerformance in the operating room is an important determinant of surgical safety. Flow disruptions (FDs) represent system-related performance problems that affect the efficiency of the surgical team and have been associated with a risk to patient safety. Despite the growing evidence base on FDs, a systematic synthesis has not yet been published.ObjectiveOur aim was to identify, evaluate and summarise the evidence on relationships between intraoperative FD events and provider, surgical process and patient outcomes.MethodsWe systematically searched databases MEDLINE, Embase and PsycINFO (last update: September 2019). Two reviewers independently screened the resulting studies at the title/abstract and full text stage in duplicate, and all inconsistencies were resolved through discussion. We assessed the risk of bias of included studies using established and validated tools. We summarised effects from included studies through a narrative synthesis, stratified based on predefined surgical outcome categories, including surgical process, provider and patient outcomes.ResultsWe screened a total of 20 481 studies. 38 studies were found to be eligible. Included studies were highly heterogeneous in terms of methodology, medical specialty and context. Across studies, 20.5% of operating time was attributed to FDs. Various other process, patient and provider outcomes were reported. Most studies reported negative or non-significant associations of FDs with surgical outcomes.ConclusionApart from the identified relationship of FDs with procedure duration, the evidence base concerning the impact of FDs on provider, surgical process and patient outcomes is limited and heterogeneous. We further provide recommendations concerning use of methods, relevant outcomes and avenues for future research on associated effects of FDs in surgery.
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8
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Jung JJ, Kashfi A, Sharma S, Grantcharov T. Characterization of device-related interruptions in minimally invasive surgery: need for intraoperative data and effective mitigation strategies. Surg Endosc 2019; 33:717-723. [PMID: 30693388 DOI: 10.1007/s00464-018-6254-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The burden of device-related interruptions is expected to increase as modern surgical practices adopt complex minimally invasive surgery devices. Currently, there is a paucity of empiric data that examined the nature of device-related interruptions using comprehensive intraoperative data. METHODS We performed a cross-sectional study of consecutive elective laparoscopic general surgery cases performed in one operating room (OR) at a referral center between April 2014 and April 2016. The included cases were directly observed using a comprehensive multiport data recorder called the OR Black Box. The data were synchronized, encrypted, and reviewed by expert surgeon assessors. The assessors characterized device-related interruptions that occurred during operations. The prevalence of the cases with device-related interruptions was calculated. Device-related interruptions were classified into a priori categories of (1) absent/wrong device; (2) improper assembly; (3) loss of sterility; (4) disconnection; and (5) device failure. RESULTS In a cohort of 210 cases, 64 (30%) had at least one device-related interruption. Sleeve gastrectomy (52%) and oncologic gastrectomy (43%) procedures experienced the highest prevalence of device-related interruptions. Device failure was the most frequently chosen category with laparoscopic staplers implicated in more than half of these failures. Three failure modes were described for laparoscopic stapler, of which stapler malfunction (46%) was the most common. CONCLUSIONS Device-related interruptions occurred frequently in the OR and could be characterized into one of the five categories. Understanding the nature of the device-related interruptions can help guide implementation of safety interventions and user training in the future.
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Affiliation(s)
- James J Jung
- Department of Surgery, University of Toronto, Toronto, Canada. .,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Arash Kashfi
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Sahil Sharma
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Teodor Grantcharov
- Department of Surgery, University of Toronto, Toronto, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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von Strauss Und Torney M, Aghlmandi S, Zeindler J, Nowakowski D, Nebiker CA, Kettelhack C, Rosenthal R, Droeser RA, Soysal SD, Hoffmann H, Mechera R. High-resolution standardization reduces delay due to workflow disruptions in laparoscopic cholecystectomy. Surg Endosc 2018; 32:4763-4771. [PMID: 29785458 DOI: 10.1007/s00464-018-6224-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/09/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Optimal resource utilization in high-cost environments like operating theatres is fundamental in today's cost constrained health care systems. Interruptions of the surgical workflow, i.e. microcomplications (MC), lead to prolonged procedure times and higher costs and can be indicative of surgical mistakes. Reducing MC can improve operating room efficiency and prevent intraoperative complications. We, therefore, aimed to evaluate the impact of a high-resolution standardized laparoscopic cholecystectomy protocol (HRSL) on operative time and intraoperative interruptions in a teaching hospital. METHODS HRSL consisted of a detailed stepwise protocol for the procedure, supported by a teaching video, both to be reviewed as mandatory preparation by each team member before surgery. Audio-video records of laparoscopic cholecystectomies were reviewed regarding type, frequency and duration of MC before and after implementation of HRSL. RESULTS Thirty-nine (20 control and 19 HRSL) audio-video records of laparoscopic cholecystectomies with a total duration of 51.36 h (28.92 pre 22.44 post) were reviewed. The majority of operations (86%) were performed by teams who had completed less than 10 procedures together previously. Communication-related interruptions and instrument changes accounted for the majority of MC. Median frequency and duration of MC were 95 events/h and 15.6 min/h, respectively, of surgery pre-intervention. With HRSL this was reduced to 76 events/h and 10.6 min/h of operating. In multivariable analysis, HRSL was an independent predictor for shorter delay and lower frequency of MC [percentage decrease 27% (95% CI 18-35%), resp. 30% (95% CI 19-40%)]. Procedure-related risk factors for the longer delay due to MC in multivariable analysis were less experience of the surgeon and intraoperative adhesiolysis. CONCLUSIONS HRSL is effective in reducing delays due to MC in a teaching institution with limited team experience. These findings should be tested in larger potentially cluster-randomized controlled trials. The trial has been registered with clinicaltrials.gov: NCT03329859.
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Affiliation(s)
| | - Sohelia Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jasmin Zeindler
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Debora Nowakowski
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Christian A Nebiker
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland.,Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Christoph Kettelhack
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Rachel Rosenthal
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Raoul A Droeser
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Savas D Soysal
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Henry Hoffmann
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
| | - Robert Mechera
- Department of General and Visceral Surgery, University Hospital Basel, Basel, Switzerland
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Predictors of postoperative hemoglobin drop after laparoscopic myomectomy. Wideochir Inne Tech Maloinwazyjne 2017; 12:81-87. [PMID: 28446936 PMCID: PMC5397549 DOI: 10.5114/wiitm.2017.66515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/01/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Laparoscopic myomectomy (LM) can be associated with significant bleeding. Aim To identify factors influencing the postoperative hemoglobin (Hb) drop after LM. Material and methods This is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015. Results The median age of the patients was 37 (23–53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5–12) cm. The mean surgical time was 83 ±38 (35–299) min. The median number of sutures was 3 (1–11). The mean postoperative Hb drop was 1.6 ±1.2 (0–6) g/dl, and the mean estimated blood loss was 261 ±159 (50–1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients’ age or number of intramural myomas. In the multivariable analysis, the surgical time (β = 0.395, p < 0.001), diameter of the largest myoma (β = 0.292, p = 0.03) and preoperative Hb concentration (β = 0.299, p < 0.001) predicted the postoperative Hb change. Conclusions Surgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.
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Comparison of the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery in the Trendelenburg position: study protocol for a randomized controlled trial. Trials 2016; 17:488. [PMID: 27724965 PMCID: PMC5057242 DOI: 10.1186/s13063-016-1609-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Robot-assisted laparoscopic radical prostatectomy and robot-assisted radical cystectomy have gradually become the preferred choices for urologists as they allow surgeons to perform complex procedures more precisely and effectively. The pneumoperitoneum, which is normally applied in these surgeries to provide visual clarity and space to perform the procedure, may cause hemodynamic disturbance, potentially myocardial injury. Thus surgeons have recently considered opting for the low-pressure pneumoperitoneum to lower this negative impact. Herein we describe a protocol for a clinical trial to compare the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery. Methods/design This study is designed to be a bicenter clinical trial. In total 280 patients scheduled to undergo robot-assisted laparoscopic radical prostatectomy or robot-assisted radical cystectomy will be enrolled and randomized into two groups, with standard- (12–16 mmHg) and low-pressure (7–10 mmHg) pneumoperitoneum, respectively. Troponin T will be measured as the primary endpoint to assess the extent of myocardial injury. Nt-proBNP and hemodynamic indexes will also be recorded for further analysis. Discussion The significance of this study is emphasized by the fact that there are few studies that have focused on the impact of prolonged pneumoperitoneum on myocardial injury, which is relevant to postoperative mortality. We hope that the conclusions drawn from this study could provide reference and basis to the future of the pneumoperitoneum in clinical practice. Trial registration Registered at https://www.clinicaltrials.gov with the Identifier NCT02600481 on November 5, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1609-5) contains supplementary material, which is available to authorized users.
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