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Bentsen SB, Eide GE, Wiig S, Rustøen T, Heen C, Bjøro B. Patient positioning on the operating table and patient safety: A systematic review and meta-analysis. J Adv Nurs 2024. [PMID: 38186052 DOI: 10.1111/jan.16049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To identify occurrence of harmful incidents related to patient positioning on operating table. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. REVIEW METHODS The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. RESULTS Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). CONCLUSIONS Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. IMPACT This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a review of previous research.
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Affiliation(s)
- Signe Berit Bentsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
| | - Geir Egil Eide
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Siri Wiig
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- SHARE Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Heen
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
| | - Benedikte Bjøro
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Operating Services, Oslo University Hospital, Oslo, Norway
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Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e259. [PMID: 36692838 DOI: 10.1097/jnr.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later. PURPOSE This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors. METHODS A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses. RESULTS Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.
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Hay AK, McDougall A, Hinstridge P, Rajakuldendran S, Yoong W. Prolonged brachial plexus neuropathy: a rare complication following protracted endometriosis surgery in Lloyd-Davies position. BMJ Case Rep 2021; 14:e243408. [PMID: 34844958 PMCID: PMC8634370 DOI: 10.1136/bcr-2021-243408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/04/2022] Open
Abstract
Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient's quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.
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Affiliation(s)
- Anna Katrina Hay
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Anna McDougall
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Peter Hinstridge
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | | | - Wai Yoong
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
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Fiume I, Molena D. Robotic esophagomyotomy for achalasia: technical note and review of the literature. Minerva Surg 2021; 77:157-170. [PMID: 34693674 DOI: 10.23736/s2724-5691.21.08979-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The treatment of achalasia has undergone continuous evolution with the advancement of technology. Since the beginning of the new millennium, the employment of robotics has led to technical facilitation with the execution of the myotomy and consequently to improvement of outcomes and decrease perioperative morbidity. EVIDENCE ACQUISITION We provide a detailed description of the surgical procedure and the perioperative management together with a literature search of Electronic PubMed/Medline database and Cochrane Library. English written studies on robotic assisted myotomy (case reports, reviews, single arm and comparative studies) were included. EVIDENCE SYNTHESIS Between 2001 and 2020, 10 case reports, 13 single arm studies, 10 comparative studies, 2 meta-analysis, 11 reviews and 2 technical notes on robotic assisted esophagomyotomy for achalasia were published. CONCLUSIONS As reported by the studies available in the literature and evaluated in this manuscript, robotic assisted cardiomyotomy seems not only feasible but also a safer operation compared with traditional laparoscopic Heller myotomy, due to a significant lower incidence of intraoperative esophageal perforation. Also if large and randomized controlled studies are advocated, robotic assisted esophagocardiomyotomy might be considered superior to laparoscopic Heller myotomy that, until now, is mostly considered the gold standard in the surgical treatment of achalasia.
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Affiliation(s)
- Irene Fiume
- Department of General, Oncologic and Vascular Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy -
| | - Daniela Molena
- Esophageal Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Cost-effective minimally invasive gynecologic surgery: emphasizing surgical efficiency. Curr Opin Obstet Gynecol 2021; 32:243-247. [PMID: 32371608 DOI: 10.1097/gco.0000000000000636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The United States has the highest healthcare costs among developed countries. This review evaluates surgical practices and equipment choices during endoscopic hysterectomy, highlighting opportunities for the gynecologic surgeon to reduce costs and maximize surgical efficiency. RECENT FINDINGS There are opportunities to economize at every step of the endoscopic hysterectomy. When surgeons are provided education about instrumentation costs, the cost of hysterectomy has been shown to decrease. Colpotomy has been found to be the rate-limiting step in laparoscopic hysterectomy; use of a uterine manipulator likely saves time and money. When evaluating the economic impact of route of surgery, the cost differential between laparoscopic and robotic-assisted hysterectomy has decreased. Robotic-assisted hysterectomy may be more cost-effective in some cases, such as for larger uteri. From a systems-level perspective, dedicating a specific operating room team to the gynecology service can decrease operative time. SUMMARY The gynecologic surgeon is best equipped to control surgery-related costs by making choices that improve surgical efficiency and decrease operating room time. If a costlier piece of equipment leads to a more efficient case, the choice may be more cost-effective. There are multiple systems-level changes that can be implemented to decrease surgery-related costs.
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Erdemir DS, Şenturan L. The Effect of Position Support During Orthopedic Surgery on Postoperative Pain: A Randomized Controlled Trial. Pain Manag Nurs 2020; 21:549-555. [PMID: 32712009 DOI: 10.1016/j.pmn.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 01/17/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Positional pain affect the patient's healing process after the operation. Anti-pressure positioning pads are medical products used to support the patient positioning during surgical procedures. AIMS The aim of the study was to examine pain related to positioning when anti-pressure gel pads and current visoelastic sponge support options are used during orthopedic surgical cases. DESIGN The randomized controlled experimental study. SETTINGS The operating room of an educational research hospital. PARTICIPANTS/SUBJECTS The study consisted of 100 patients (50 control group and 50 study group) undergoing surgery in a supine position. METHODS Information form, McGill Melzack Pain Questionnaire, and Visual Analogue Scale were used for data collection. Routine institutional policy was applied to the control group. Study group patients were additionally supported with antipressure position gel pads on the operating table. RESULTS The rate of pain presence in areas other than the operative area was significantly lower in the patients in the study group (p = .001). The patients in the control group reported that preoperative pain in the waist area increased to unbearable levels during operation. In addition, it was noted that the "addition of the anti-pressure gel pads" resulted in study group patients being mobilized significantly early (p = .001). CONCLUSIONS The conclusion of this study demonstrated that postoperative pain related to positioning, not the surgical procedure itself, was decreased when antipressure gel pads and viscoelastic sponge support were used together. An unanticipated benefit discovered during the study was earlier mobilization of the study group compared to the control group.
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Affiliation(s)
- Döndü Soyer Erdemir
- Baltalimanı Metin Sabancı Bone and Joint Diseases Education and Research Hospital, İstanbul, Turkey
| | - Leman Şenturan
- Baltalimanı Metin Sabancı Bone and Joint Diseases Education and Research Hospital, İstanbul, Turkey; Nursing Department, Biruni University, Istanbul, Turkey.
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Young K, Mou T, Geynisman-Tan J, Tavathia M, Collins S, Mueller M, Lewicky-Gaupp C, Kenton K. Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position. J Minim Invasive Gynecol 2020; 28:26-29. [PMID: 32229258 DOI: 10.1016/j.jmig.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. DESIGN Prospective cohort study. SETTING University medical center. PATIENTS Twenty-nine women undergoing surgery for prolapse or stress incontinence. INTERVENTIONS Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients' medical charts. IAP was measured in centimeters of water (cmH2O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). MEASUREMENTS AND MAIN RESULTS IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH2O ± 7.6; low lithotomy, 17.7 cmH2O ± 6.6; and high lithotomy, 17.1 cmH2O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH2O ± 3.7, p = .05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH2O ± 1.5, p = .004). Neither change is clinically significant based on previous research that suggests 5 cmH2O is a clinically significant change. CONCLUSION Placing patients' legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients' lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.
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Affiliation(s)
- Karen Young
- Northwestern Prentice Women's Hospital, and Northwestern University Feinberg School of Medicine (Ms. Young), Chicago, Illinois
| | - Tsung Mou
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia).
| | - Meera Tavathia
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Sarah Collins
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Margaret Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
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Bjøro B, Mykkeltveit I, Rustøen T, Candas Altinbas B, Røise O, Bentsen SB. Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery - A systematic review. J Adv Nurs 2019; 76:490-503. [PMID: 31736124 DOI: 10.1111/jan.14271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/08/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
AIMS To examine the incidence of intraoperative peripheral nerve injury, symptoms, risk factors, functions, and quality of life in patients undergoing robotic-assisted laparoscopic surgery to lithotomy positioning with steep Trendelenburg. DESIGN A systematic review. DATA SOURCES The Cochrane Library catalogue, PubMed, EMBASE, CINHAL and SveMed + databases were searched from January 2000 - February 2019. REVIEW METHODS Titles and abstracts were screened for inclusion. Full-text assessments of each paper were conducted by two reviewers. The quality of the included papers was assessed using the Mixed Methods Appraisal Tool. Descriptive statistics and thematic analysis were used to synthesize the data. RESULTS Eleven quantitative studies were included with three themes: (a) incidence of intraoperative peripheral nerve injury; (b) upper extremity intraoperative peripheral nerve injury related to steep Trendelenburg positioning; and (c) lower extremity intraoperative peripheral nerve injury related to lithotomy positioning. The overall incidence of intraoperative peripheral nerve injury in robotic-assisted laparoscopic urologic, gynaecologic and colorectal surgery was 0.16%-10.0% and the symptoms appeared immediately after surgical procedures. Risk factors for intraoperative peripheral injury were prolonged operative time, high American Society of Anesthesiologists scores, comorbidities and high body mass index. CONCLUSION Intraoperative peripheral nerve injuries are rare, but occasionally serious when related to lithotomy positioning with steep Trendelenburg. Operating room nurses have a responsibility both for positioning patients and for being familiar with the technological developments that will influence the preoperative handling of patients. IMPACT This systematic review emphasizes the need for operating room nurses together with surgical team to have knowledge about mechanisms for injury, positioning, anatomy/physiology, and evaluation of risk factors to ensure that patients are not exposed for intraoperative peripheral nerve injuries. Increased robotic-assisted laparoscopic surgery necessitates further research examining the incidence of intraoperative peripheral nerve injury related to positioning and how these affect patients' function and the quality of life.
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Affiliation(s)
- Benedikte Bjøro
- Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Ida Mykkeltveit
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Bahar Candas Altinbas
- Department of Surgical Disease Nursing, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
| | - Olav Røise
- Division of Orthopedics Surgery, Faculty of health Sciences, Oslo University Hospital, SHARE-Center for Resilience in Healthcare, University of Stavanger, Stavanger, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Signe Berit Bentsen
- Department of Operating Services, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Xie XX, Wang N, Wang ZH, Zhu YY, Wang JR, Wang XQ. Robotic-assisted resection of ovarian tumors in children: A case report and review of literature. World J Clin Cases 2019; 7:2542-2548. [PMID: 31559290 PMCID: PMC6745331 DOI: 10.12998/wjcc.v7.i17.2542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ovarian tumors are common gynecological diseases in children, and the most commonly seen ovarian tumors are germ cell tumors. Robotic surgery is the new access for children ovarian tumors.
CASE SUMMARY From June to October 2017, 4 children with ovarian tumors were admitted and treated in the Department of Pediatric Surgery of People’s Liberation Army General Hospital. The mean age, height, and weight of these patients were 7.5 (1-13) years old, 123.75 (71-164) cm, and 36.8 (8.5-69.5) kg, respectively. Robotic-assisted resection of ovarian tumors was performed for all 4 patients. The 3-port approach was used for robotic manipulation. The surgical procedures were as follows. After creation of the pneumoperitoneum, the robotic scope was placed to explore and find the left ovarian tumor. The trocars for robotic arms 1 and 2 were placed at the sites to the lower right and left of the port of the scope. The tumor capsule in the fallopian tube was incised, and the tumor was completely stripped by an electric hook along the junction of the tumor and the capsule. The resected tumor was completely removed using an endobag. The average docking time of the robotic system was 18.5 min, the average operative time was 120 min, and the average blood loss was 20 mL. No drainage tube was placed except in one patient with a mucinous tumor of the ovary. No fever, pelvic fluid, or intestinal obstruction was reported after surgery. No antibiotics were used during the perioperative period, and the average length of hospital stay after surgery was 3 d.
CONCLUSION Robotic-assisted resection of ovarian tumors is a simple, safe, and effective surgical procedure for selected patients.
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Affiliation(s)
- Xiao-Xiao Xie
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, China
| | - Ning Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Zi-Hao Wang
- The Fourth Military Medical University, Xi’an 710032, Shanxi Province, China
| | - Yue-Yue Zhu
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jing-Ru Wang
- Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Xian-Qiang Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
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Prospective randomized controlled trial comparing cephalad migration in robotic gynecologic surgery using egg-crate foam versus the Pink Pad®. J Robot Surg 2019; 14:343-347. [DOI: 10.1007/s11701-019-00990-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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