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Giorgi PD, Legrenzi S, Sacchi L, Boeris D, Villa FG, Bove F, Puglia F, Schirò GR. Implementation of Robotic Exoscope in Minimally Invasive Corpectomy at Thoracolumbar Junction for the Treatment of Traumatic Spinal Cord Compression. World Neurosurg 2024; 184:23-28. [PMID: 38184228 DOI: 10.1016/j.wneu.2023.12.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
The development and diffusion of minimally invasive (MI) approaches have coincided with improvements in magnification systems. The exoscope will probably open a new era in new technologies in spinal surgery. This study reports a retrospective series of 19 thoracolumbar (T11-L2) burst fractures with anterior column failure and cord compression, treated with MI corpectomy and spinal decompression assisted by a three-dimensional high-definition exoscope (Video 1). Exclusion criteria were pathologic or osteoporotic fractures, multilevel fractures, and previous surgery at the site of the fracture. Three key indicators were recorded: surgical time, blood loss, and intraoperative complications. A questionnaire was administered to assess the users' exoscope experience with ergonomics, preparation, magnification, image definition, illumination, and user-friendliness, compared with the operative microscope. To the best of our knowledge, this is the first study reporting on exoscope-assisted MI corpectomy. This procedure permitted low blood loss and less surgical time without intraoperative complications. The exoscope offers clear advantages in terms of ergonomics, definition, and user-friendliness. Moreover, it is a suitable instrument for training and education, providing an opportunity for better interaction with other members of the surgical staff.
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Affiliation(s)
- Pietro Domenico Giorgi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simona Legrenzi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Sacchi
- Orthopedics and Traumatology Residency in Università degli Studi Di Brescia, Brescia, Italy.
| | - Davide Boeris
- Neurosurgery Unit, Neurosurgery Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Giuseppe Villa
- Neurosurgery Unit, Neurosurgery Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Bove
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Puglia
- Orthopedics and Traumatology Unit, Pediatric Orthopedics and Traumatology Department, Milan, Italy
| | - Giuseppe Rosario Schirò
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Lu Z, Chen Q, Lan Y, Xie S, Lin F, Feng E. Subtrochanteric Osteotomy in Direct Anterior Approach Total Hip Arthroplasty for Crowe IV Dysplasia-Surgical Technique and Literature Review. Orthop Surg 2024; 16:766-774. [PMID: 38296797 PMCID: PMC10925515 DOI: 10.1111/os.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
For Crowe IV dysplasia, the clinical efficacy and surgical technique of subtrochanteric osteotomy (SO) within the direct anterior approach total hip arthroplasty (DAA-THA) was a subject of debate. This study aimed to describe the surgical technique and clinical outcomes in 11 cases of SO in DAA-THA and to summarize the relevant literature on this topic. Between June 2016 and June 2023, we retrospectively evaluated patients diagnosed with Crowe IV hip dysplasia at our institution. Criteria identified 11 patients who underwent SO during DAA-THA. Comprehensive data encompassing demographic information, radiological data, prosthetic implant type, and surgical intricacies were collected. In addition, an exhaustive review of existing case series literature was undertaken utilizing the PubMed databases. There were no revisions, deaths, dislocations, or infections. One hip (9.09%) had an intraoperative proximal split fracture, two hips (18.2%) had lower limb deep vein thrombosis, and one hip (9.09%) had symptoms of femoral nerve injury. Radiological data showed improved bilateral femoral offset, leg length discrepancy, and anatomical acetabular. During the mean follow-up of 2.18(1.06-2.46) years, patients demonstrated enhanced functional outcomes, with average changes of 25.2 in the Harris hip score and 47 in the WOMAC score. Reviewing the literature, most studies have favored S-ROM prostheses and transverse osteotomy techniques. Intraoperative fractures were notably frequent, with rates peaking at 25%. Nonunion and nerve injury were secondary common complications. SO via DAA-THA may offer satisfactory clinical and radiographic outcomes, but the literature review underscores the need for heightened awareness of intraoperative fracture risk. Proximal detachment of the vastus intermedius plays a pivotal role in SO exposure through the DAA.
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Affiliation(s)
- Zhiming Lu
- Department of Arthrosis SurgeryFujian Medical University Union HospitalFuzhouChina
| | - Qinghuang Chen
- Department of OrthopedicAnxi County HospitalQuanzhouChina
| | | | | | | | - Eryou Feng
- Department of Arthrosis SurgeryFujian Medical University Union HospitalFuzhouChina
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Tran E, Sun J, Gundara J. Systematic review of robotic ventral hernia repair with meta-analysis. ANZ J Surg 2024; 94:37-46. [PMID: 38087977 DOI: 10.1111/ans.18822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Despite being one of the most common operations performed by general surgeons, there is a lack of consensus regarding the recommended approach for ventral hernia repair (VHR). Recent times have seen the rapid development of new techniques, such as robotic ventral hernia repair (RVHR). This systematic review and meta-analysis aims to evaluate the currently available evidence relating to RVHR, in comparison to open VHR (OVHR) and laparoscopic VHR (LVHR). METHODS A systematic search of the following databases was conducted: PubMed, Embase, Scopus and Web of Science. A meta-analysis was performed for the outcomes of length of stay (LOS), recurrence, operative time, intraoperative complications, wound complications, 30-day readmission, 30-day reoperation, mortality and costs. RESULTS A total of 39 studies met inclusion criteria. Overall, RVHR reduced LOS, intra-operative complications, wound complications and readmission compared to OVHR. Compared to LVHR, RVHR was associated with increased operative time and costs, with comparable clinical outcomes. CONCLUSION There is currently a lack of robust evidence to support the robotic approach in VHR. It does not demonstrate major benefits in comparison to LVHR, which is more affordable and accessible. Strong quality, long-term data is required to help with establishing a gold standard approach in VHR.
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Affiliation(s)
- Elisa Tran
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Justin Gundara
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Department of General Surgery, Logan Hospital, Meadowbrook, Queensland, Australia
- Department of General Surgery, Redland Hospital, Cleveland, Queensland, Australia
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Csirzó Á, Kovács DP, Szabó A, Fehérvári P, Jankó Á, Hegyi P, Nyirády P, Sipos Z, Sára L, Ács N, Szabó I, Valent S. Robot-assisted laparoscopy does not have demonstrable advantages over conventional laparoscopy in endometriosis surgery: a systematic review and meta-analysis. Surg Endosc 2024; 38:529-539. [PMID: 38062181 PMCID: PMC10830624 DOI: 10.1007/s00464-023-10587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/04/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Endometriosis is a chronic condition affecting 6-10% of women of reproductive age, with endometriosis-related pain and infertility being the leading symptoms. Currently, the gold standard treatment approach to surgery is conventional laparoscopy (CL); however, the increasing availability of robot-assisted surgery is projected as a competitor of CL. This study aimed to compare the perioperative outcomes of robot-assisted laparoscopy (RAL) and CL in endometriosis surgery. OBJECTIVES We aimed to compare the effectiveness and safety of these two procedures. METHODS A systematic search was conducted in three medical databases. Studies investigating different perioperative outcomes of endometriosis-related surgeries were included. Results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS Our search yielded 2,014 records, of which 13 were eligible for data extraction. No significant differences were detected between the CL and RAL groups in terms of intraoperative complications (OR = 1.07, CI 0.43-2.63), postoperative complications (OR = 1.3, CI 0.73-2.32), number of conversions to open surgery (OR = 1.34, CI 0.76-2.37), length of hospital stays (MD = 0.12, CI 0.33-0.57), blood loss (MD = 16.73, CI 4.18-37.63) or number of rehospitalizations (OR = 0.95, CI 0.13-6.75). In terms of operative times (MD = 28.09 min, CI 11.59-44.59) and operating room times (MD = 51.39 min, CI 15.07-87.72;), the RAL technique remained inferior. CONCLUSION RAL does not have statistically demonstrable advantages over CL in terms of perioperative outcomes for endometriosis-related surgery.
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Affiliation(s)
- Ádám Csirzó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Dénes Péter Kovács
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Árpád Jankó
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Zoltán Sipos
- Medical School, Institute for Translational Medicine, University of Pécs, Pecs, Hungary
- Medical School, Institute of Bioanalysis, University of Pécs, Pecs, Hungary
| | - Levente Sára
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - István Szabó
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Sándor Valent
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, 1082, Budapest, Hungary.
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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Caye P, Rappeti JCDS, Perera SC, Segat HJ, Vives PS, Braga FDVA, Cleff MB, Meinerz ARM, Cavalcanti GADO, Milech V, Antunes BN, Müller DCDM, Brun MV. Nephrectomy in 52 dogs for the treatment of Dioctophyme renale infection - Knowing the enemy to win. Top Companion Anim Med 2024; 58:100828. [PMID: 37890579 DOI: 10.1016/j.tcam.2023.100828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/15/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
Dioctophyme renale (D. renale) is a nematode that parasitizes the kidney of mammals. Treatment is often surgical, with removal of the affected organ. This retrospective study aims to evaluate the epidemiological, clinical, and surgical aspects, the interval between diagnosis and treatment, the occurrence of pre- and intraoperative complications, and the postoperative survival time of dogs parasitized by D. renale undergoing therapeutic nephrectomy. Records of fifty-two dogs treated in a single hospital service were analyzed. We collected epidemiological data, laboratory results, diagnostic method, anesthetic protocol, surgical technique and time, type of antimicrobial prophylaxis, pre- and intraoperative complications, location and number of parasites, and postoperative survival time. Of the 52 dogs undergoing right nephrectomy by laparotomy, 61.5 % were female and 63.4 % were adults. Although the most common clinical sign was hematuria (25 %), 61.5 % of the patients were asymptomatic. Eosinophilia and increased serum urea were the only laboratory changes found. The interval between diagnosis and surgery was 27.4 ± 23 days and no patient showed changes suggestive of surgical emergency. The most common surgical approach was the right paracostal (61.5 %), and a continuous suture pattern was predominant. Intraoperative complications occurred in 9.6 % of the procedures, varying from mild to severe hemorrhage. Mean postoperative survival was 835.5 ± 428 days. Dioctophymosis was effectively controlled by nephrectomy of the affected kidney, allowing a mean survival of more than 830 days. No serious complications caused by intervals between diagnosis and treatment have been reported. This is the largest retrospective study evaluating dogs infected with D. renale that were surgically treated.
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Affiliation(s)
- Pâmela Caye
- Post-graduate Program in Veterinary Medicine, University Veterinary Hospital, Federal University of Santa Maria, Santa Maria, Brazil.
| | | | | | - Hecson Jesser Segat
- Post-graduate Program in Biochemistry and Molecular Biology, Department of Chemistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Patrícia Silva Vives
- Veterinary Clinics Hospital, School of Veterinary Medicine, Federal University of Pelotas, Pelotas, Brazil
| | | | - Marlete Brum Cleff
- Department of Veterinary Clinics, School of Veterinary Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Ana Raquel Mano Meinerz
- Department of Veterinary Clinics, School of Veterinary Medicine, Federal University of Pelotas, Pelotas, Brazil
| | | | - Vanessa Milech
- Post-graduate Program in Veterinary Medicine, University Veterinary Hospital, Federal University of Santa Maria, Santa Maria, Brazil
| | - Bernardo Nascimento Antunes
- Post-graduate Program in Veterinary Medicine, University Veterinary Hospital, Federal University of Santa Maria, Santa Maria, Brazil
| | | | - Maurício Veloso Brun
- Department of Small Animal Medicine, Center for Rural Sciences, Federal University of Santa Maria, Santa Maria, Brazil; CNPq Research Productivity Scholarship - Level 1C (3304353/2021-3)
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Salo JC. Major Intraoperative Complications during Minimally Invasive Esophagectomy: Experience is a Hard Teacher. Ann Surg Oncol 2024; 31:23-24. [PMID: 37899409 DOI: 10.1245/s10434-023-14457-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Jonathan C Salo
- Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
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7
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Kim A, Goodloe JB, Garcia-Lopez E, Klott JD, Dopke KM, Feeley B, Miller MD, Azar FM, Gallo RA. How to Recognize, Correct, and Avoid Intraoperative Complications During Anterior Cruciate Ligament Reconstructions. Instr Course Lect 2024; 73:765-777. [PMID: 38090939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Technical complications are a leading cause of graft failure following anterior cruciate ligament reconstructions. Complications can occur during any phase of the procedure, from graft harvesting to tunnel preparation to graft fixation. Predicting potential causes of technical difficulty and developing strategies to avoid potential pitfalls can limit the number of intraoperative complications. If adverse events do occur intraoperatively, prompt recognition and treatment can lead to favorable outcomes. It is important to discuss strategies to understand potential complications and develop tactics to avoid and correct adverse events that can occur during anterior cruciate ligament reconstruction.
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Miltenberg B, Puzzitiello RN, Ruelos VCB, Masood R, Pagani NR, Moverman MA, Menendez ME, Ryan SP, Salzler MJ, Drager J. Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review. Am J Sports Med 2024; 52:258-268. [PMID: 36779579 DOI: 10.1177/03635465221142868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. PURPOSE To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. RESULTS A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). CONCLUSION Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
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Affiliation(s)
| | | | | | - Raisa Masood
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Nicholas R Pagani
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Michael A Moverman
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Mariano E Menendez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Scott P Ryan
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Matthew J Salzler
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Justin Drager
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Putnik SS, Ilic MD, Stefanovic SM, Milisavljevic SS. A model to determine factors influencing intraoperative complications in sleeve gastrectomy. CIR CIR 2023; 91:780-784. [PMID: 37156261 DOI: 10.24875/ciru.22000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/29/2023] [Indexed: 05/10/2023]
Abstract
Objective The study presents a logistic regression model describing the factors leading to intraoperative complications in laparoscopic sleeve gastrectomy (LSG) and a detailed description of the intraoperative complications that occurred in our operations. Material and methods The study was designed as a retrospective and cohort study. It includes patients who underwent laparoscopic sleeve gastrectomy between January 2008 and December 2020. Results The study included 257 patients. The mean (SD) age of all patients included in the study was 40.28 (9.58) years. The body mass index of our patients ranged from 31.2 to 86.6 kg/m2. The Stepwise Backward model was used (Cox and Snell R2 = 0.051, Nagelkerke R2 = 0.072, Hosmer-Lemesxow χ2 = 1.968, df = 4, p = 0.742, overall model accuracy of 70.4%). The model shows that pre-operative diabetes mellitus or hypertension Stage 3 significantly increases the probability or risk of intraoperative complications. Conclusions The study shows which intraoperative complications occur in LSG, how they can be remedied and which factors can lead to them and influence the outcome of the operation itself. The recognition and successful treatment of intraoperative complications are very important as they reduce the number of reoperations and treatment costs.
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Affiliation(s)
- Srdjan S Putnik
- Department of General Surgery, General Hospital Vrsac, Vrsac, Serbia
| | - Miroslav D Ilic
- Department of Surgery, Faculty of Medical Science, University of Novi Sad, Novi Sad, Serbia
| | - Srdjan M Stefanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan S Milisavljevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Akkawi I, Draghetti M, Zmerly H. Outcome of simultaneous bi-unicompartmental knee arthroplasty: a systematic review. Acta Biomed 2023; 94:e2023240. [PMID: 38054676 PMCID: PMC10734244 DOI: 10.23750/abm.v94i6.15006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/25/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIM Simultaneous medial and lateral tibiofemoral osteoarthritis (OA) could be treated with bi-unicompartmental knee arthroplasty (Bi-UKA) as an alternative to total knee arthroplasty (TKA). The present systematic review aims to assess if simultaneous Bi-UKA is a feasible option for treating medial and lateral tibiofemoral OA. MATERIALS AND METHODS A comprehensive search of PubMed, MEDLINE, Cochrane Library, and Google Scholar was performed to find studies that reported on the outcome of simultaneous Bi-UKA for both medial and lateral tibiofemoral OA. RESULTS Seven studies were considered eligible for inclusion in the present systematic review. Intraoperative fractures occurred 8 times. Overall, there were 22 revisions of the prosthetic components for any reason with a survival rate that ranged from 83 to 100%. Of these, 16 revisions were for the aseptic loosening of the prosthetic components. Out of 302 surgeries, three were revised due to symptomatic OA progression in the patello-femoral joint. All clinical scores improved at the latest follow-up compared to preoperative values. Moreover, there were no differences in clinical scores of Bi-UKA compared to unicompartmental knee arthroplasty (UKA), or medial UKA plus patello-femoral prosthesis. Whereas, compared to TKA, Bi-UKA patients had comparable or superior scores. Finally, the Bi-UKA group had a significantly shorter hospital stay compared to the TKA group. CONCLUSIONS The use of simultaneous Bi-UKA is a valid option to address bicompartmental knee OA in selected patients with low intraoperative fracture rate, low revision rate, satisfactory clinical outcome, and fast recovery.
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Affiliation(s)
| | - Maurizio Draghetti
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
| | - Hassan Zmerly
- Orthopaedics and Traumatology Unit, Villa Erbosa Hospital, Bologna, Italy.
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11
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Si S, Zhang J. An Electrocoagulation Fixation Technique for One-Piece Intraocular Lens Scleral Flapless Fixation With Sutures Without Knots. Retina 2023; 43:2068-2071. [PMID: 36800862 PMCID: PMC10659249 DOI: 10.1097/iae.0000000000003756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE To present an electrocoagulation fixation technique for one-piece intraocular lens (IOL) scleral flapless fixation with sutures without knots. METHODS First of all, after repeated tests and comparisons, we chose 8-0 polypropylene suture as the material for electrocoagulation fixation of one-piece IOL haptics because of its proper elasticity and size. A transscleral tunnel puncture at the pars plana was performed using an arc-shaped needle with 8-0 polypropylene suture. The suture was subsequently guided out of the corneal incision by a 1-mL syringe needle and then guided by the needle into the inferior haptics of the IOL. The suture was cut off and heated into a shape of a probe with a spherical tip using a monopolar coagulation device to prevent slippage from the haptics. RESULTS In the end, 10 eyes underwent our new surgical procedures, and the average operation time was 42.5 ± 12.4 minutes. At the 6-month follow-up, seven of 10 eyes achieved significant vision improvement and nine of 10 kept the implanted one-piece IOL stable in the ciliary sulcus. No serious intraoperative/postoperative complications were observed. CONCLUSION The electrocoagulation fixation was a safe and effective alternative technique for previously implanted one-piece IOL scleral flapless fixation with sutures without knots.
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12
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Overton E, Wen T, Friedman AM, Azad H, Nhan-Chang CL, Booker WA, Khoury-Collado F, Mourad M. Outcomes associated with peripartum hysterectomy in the setting of placenta accreta spectrum disorder. Am J Obstet Gynecol MFM 2023; 5:101174. [PMID: 37802412 DOI: 10.1016/j.ajogmf.2023.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Although peripartum hysterectomy for placenta accreta spectrum disorder is known to be associated with complications at the time of delivery, there are limited data on postpartum outcomes and readmission risk in this population. OBJECTIVE This study aimed to analyze risks for adverse outcomes and postpartum readmissions in the setting of peripartum hysterectomy for placenta accreta spectrum disorder by severity of placenta accreta spectrum disorder subcategory. STUDY DESIGN Using the 2016-2020 Nationwide Readmissions Database, this retrospective cohort study identified peripartum hysterectomies with a diagnosis of placenta accreta spectrum disorder. The primary exposure was placenta accreta spectrum disorder, subcategorized as placenta accreta vs increta/percreta. The primary outcome was readmission rate and delivery complications. Complications evaluated included the following: (1) nontransfusion severe maternal morbidity (ntSMM), (2) venous thromboembolism, (3) reoperation, (4) intraoperative complications, (5) hemorrhage, (6) sepsis, and (7) surgical site complications. We additionally evaluated delivery hospitalization and readmission mean length of stay, and hospital costs. Unadjusted and adjusted logistic regression models were fit for outcomes adjusting for clinical, demographic, and hospital factors. The association measures were expressed as unadjusted and adjusted odds ratios with 95% confidence intervals. RESULTS Between 2016 and 2020, 7864 hysterectomies during a delivery hospitalization with a diagnosis of placenta accreta spectrum disorder were identified (66.5% with placenta accreta and 33.5% with placenta increta/percreta diagnoses). The overall 60-day all-cause readmission rate was 7.3%. Most readmissions (57.2%) occurred within 10 days of hospital discharge. Compared with peripartum hysterectomy with a diagnosis of placenta accreta, hysterectomies with placenta increta/percreta diagnoses carried significantly increased risk of 60-day readmission (adjusted odds ratio, 1.31; 95% confidence interval, 1.01-1.71), inpatient mortality (odds ratio, 13.23; 95% confidence interval, 3.35-52.30), nontransfusion severe maternal morbidity (adjusted odds ratio, 1.43; 95% confidence interval, 1.20-1.71), intraoperative complications (adjusted odds ratio, 2.31; 95% confidence interval, 1.93-2.77), and surgical site complications (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.95). The median length of stay during delivery hospitalization was longer for placenta increta/percreta (5.8 days; 95% confidence interval, 5.4-6.1) than for placenta accreta (4.2 days; 95% confidence interval, 4.1-4.3; P<.05). In addition, delivery hospitalization costs were higher in cases of placenta increta/percreta (median, $30,686; 95% confidence interval, $28,922-$32,449) than placenta accreta (median, $21,321; 95% confidence interval, $20,480-$22,163). CONCLUSION Complication and readmission risks after peripartum hysterectomy with placenta accreta spectrum disorder are high. Compared with patients with placenta accreta, patients with placenta increta/percreta had increased risk for delivery and postoperative complications and postpartum readmission, and increased costs and length of stay.
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Affiliation(s)
- Eve Overton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad).
| | - Timothy Wen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA (Dr Wen)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Hooman Azad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Fady Khoury-Collado
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Friedman, Azad, Nhan-Chang, Booker, Khoury-Collado, and Mourad)
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Söderström H, Moons J, Nafteux P, Uzun E, Grimminger P, Luyer MDP, Nieuwenhuijzen GAP, Nilsson M, Hayami M, Degisors S, Piessen G, Vanommeslaeghe H, Van Daele E, Cheong E, Gutschow CA, Vetter D, Schuring N, Gisbertz SS, Räsänen J. ASO Visual Abstract: Major Intraoperative Complications During Minimally Invasive Esophagectomy. Ann Surg Oncol 2023; 30:8294-8295. [PMID: 37821789 DOI: 10.1245/s10434-023-14386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- H Söderström
- Department of Thoracic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - J Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - P Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - E Uzun
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - M Nilsson
- Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - M Hayami
- Department of Upper Abdominal Surgery, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Degisors
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez Place de Verdun, Lille Cedex, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez Place de Verdun, Lille Cedex, France
| | - H Vanommeslaeghe
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Van Daele
- Department of Gastro-intestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - E Cheong
- Norfolk and Norwich University Hospital NHS FT, Norwich, UK
| | - Ch A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - D Vetter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - N Schuring
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Räsänen
- Department of Thoracic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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14
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Edergren Å, Sandblom G. Author response to: Intraoperative gallbladder perforation and risk of postoperative abscess with or without antibiotics: national cohort study of more than 108 000 cholecystectomies. Br J Surg 2023; 110:1902. [PMID: 37844291 DOI: 10.1093/bjs/znad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Åsa Edergren
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
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15
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Li Y, Song Y, Liang R, Xu B, Wei L. Comment on: Intraoperative gallbladder perforation and risk of postoperative abscess with or without antibiotics: national cohort study of more than 10 000 cholecystectomies. Br J Surg 2023; 110:1904. [PMID: 37844288 DOI: 10.1093/bjs/znad328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Yibo Li
- Department of General Surgery, First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yunjie Song
- Department of General Surgery, First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Renjie Liang
- Department of General Surgery, First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Bin Xu
- Department of General Surgery, First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Limin Wei
- Department of General Surgery, First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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16
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Tariel F, Dourmap C, Prudhomme T, Hascoet J, Soulie M, Moreau B, Thoulouzan M, Vezzosi D, Guenego A, Manunta A, Huyghe E, Peyronnet B. Adrenalectomy for Pheochromocytoma: Complications and Predictive Factors of Intraoperative Hemodynamic Instability. Am Surg 2023; 89:4772-4779. [PMID: 36302517 DOI: 10.1177/00031348221135774] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Surgery is the treatment of choice for pheochromocytoma. However, this surgery carries a risk of hemodynamic instability (HDI). The aim of this study was to report complications associated with this procedure, to identify risk factors for HDI during surgery, and its impact on postoperative outcomes. METHODS The charts of all patients who underwent adrenalectomy for pheochromocytoma in two academic centers between 2006 and 2020 were retrospectively reviewed. The primary outcome was HDI defined by a systolic blood pressure >160 mmHg or a mean blood pressure <60 mmHg intraoperatively. The secondary outcomes of interest were the total duration of HDI, the occurrence of intraoperative arrhythmia, perioperative cardiovascular events, and postoperative complications. RESULTS 205 patients were included. HDI occurred intraoperatively in 155 patients (75.6%) but only 6 (3.2%) experienced arrhythmia. Thirty-eight postoperative complications were reported (18.6%) but only nine were ≥3 according to Clavien-Dindo (4.4%). There were 10 postoperative cardiovascular events (5.7%). Patients with intraoperative HDI had higher rates of postoperative complications (21.3% vs 10%; P = .07), major postoperative complications (5.8% vs 0%; P = .12) and cardiovascular events (6.5% vs 0%; P = .12). Factors associated with intraoperative HDI in univariate analysis were age (OR = 8.14; P = .006), high blood pressure preoperatively (OR = 2.16; P = .04), tumor size (OR = 15.83; P = .0001), and urinary normetanephrine level (OR = 9.33; P = .04). DISCUSSION In multidisciplinary centers, the overall morbidity of adrenalectomy for pheochromocytoma is low. HDI during adrenalectomy for pheochromocytoma is highly prevalent but rarely associated with major cardiovascular events. There might be a link between HDI and postoperative cardiovascular events.
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Affiliation(s)
| | | | | | | | - Michel Soulie
- Department of Urology, University of Toulouse, Toulouse, France
| | - Benjamin Moreau
- Department of Endocrinology, University of Rennes, Rennes, France
| | | | - Delphine Vezzosi
- Department of Endocrinology, University of Toulouse, Toulouse, France
| | - Agathe Guenego
- Department of Endocrinology, University of Rennes, Rennes, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Eric Huyghe
- Department of Urology, University of Toulouse, Toulouse, France
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17
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Ma L, Luo H, Kou S, Gao Z, Bai D, Qin X, Ouchi T, Gong L, Hu J, Tian Y. Robotic versus laparoscopic surgery for hiatal hernia repair: a systematic literature review and meta-analysis. J Robot Surg 2023; 17:1879-1890. [PMID: 37247119 DOI: 10.1007/s11701-023-01636-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
The number of robotic hiatal hernia repairs (RHHR) is increasing. However, the superiority of this minimally invasive approach remains controversial. The aim of this study was to evaluate the available literature reporting on outcomes of RHHR compared with laparoscopic hiatal hernia repair (LHHR) in adult patients. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, PubMed, the Cochrane Library, and ClinicalTrials.gov databases were searched. Identified publications were reviewed independently by two authors. High heterogeneity was further explored through sensitivity analysis. The primary endpoint was the development of postoperative complications. Secondary endpoints included operation time, intraoperative complications, 30 day readmission rates and length of stay. The analysis was performed using Stata 17.0 software. A total of 7 studies totaling 10078 patients met the inclusion criteria. Five studies included postoperative complications. The postoperative complications rate was 4.25% (302/7111) in the LHHR group, and 3.49% (38/1088) in the RHHR group. Postoperative complications significantly decreased after RHHR compared with LHHR (OR 0.52; 95% CI 0.36 to 0.75, P = 0.000). Three studies involving 2176 patients reported length of hospital stay. In the three studies, the mean Length of hospital stay was 3.2 days in the RHHR group, and 4.2 days in the LHHR group. Length of hospital stay was decreased by a mean of 0.68 days for RHHR compared with LHHR (WMD, - 0.68 days; 95% CI - 1.32 to - 0.03, P = 0.02). There was no significant difference between the RHHR group and the LHHR group regarding operative time, intraoperative complications, and 30 day readmission (P > 0.05). Our research shows that RHHR may be the better option, as the approach decreases postoperative complications and length of hospital stay.
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Affiliation(s)
- Longyin Ma
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Heng Luo
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Shien Kou
- School of Medical Clinical, North Sichuan Medical College, Nanchong, 637000, Sichuan, China
| | - Zhenguo Gao
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Dan Bai
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Xiangzhi Qin
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Takahiro Ouchi
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Lei Gong
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Yunhong Tian
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China.
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18
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Fouche D, Chenais G, Haissaguerre M, Bouriez D, Gronnier C, Collet D, Tabarin A, Najah H. Risk factors for intraoperative complications, postoperative complications, and prolonged length of stay after laparoscopic adrenalectomy by transperitoneal lateral approach: a retrospective cohort study of 547 procedures. Surg Endosc 2023; 37:7573-7581. [PMID: 37442834 DOI: 10.1007/s00464-023-10148-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/19/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard for the resection of most adrenal lesions. A precise delineation of factors influencing its outcomes is lacking. The aim of this study was to assess factors associated with intraoperative complications, postoperative complications, and prolonged length of stay (LOS) after LA. METHODS Patients who underwent LA from 1999 to 2021 in a single-academic-institution were included. Patient and disease-specific data, intraoperative complications, postoperative complications according to Dindo-Clavien (DC) scale, and LOS were recorded. Predictive factors of complications and prolonged LOS were determined by logistic regression. RESULTS We identified 530 patients who underwent 547 LA. Intraoperative complications occurred in 33 patients (6.0%). Postoperative complications ≥ DC grade 2 occurred in 73 patients (13.35%); severe postoperative complications ≥ DC grade 3 in 14 patients (2.56%). Postoperative complications were positively associated with age ≥ 72 (OR 1.14 [95% CI 1.02-1.29]), intraoperative complications (OR 1.36 [95% CI 1.14-1.63]), and negatively associated with non functional adenomas (OR 0.88 [95% CI 0.7-0.99]), and right adrenalectomy (OR 0.91 [95% CI 0.86-0.97]). Severe postoperative complications were positively associated with chronic obstructive pulmonary disease (COPD, OR 1.08 [95% CI 1.00-1.17]), and negatively associated with right adrenalectomy (OR 0.97 [95% CI 0.92-0.99]). Prolonged LOS was associated with age ≥ 72 (OR 1.21 [95% CI 1.05-1.41]), and COPD (OR 1.20 [95% CI 1.01-1.44]). CONCLUSIONS LA remains safe when performed by surgeons with expertise. Right adrenalectomy resulted in less postoperative overall and severe complications. The risk-benefit equation should be carefully assessed before left LA in older patients with COPD.
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Affiliation(s)
- Donatien Fouche
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Gabrielle Chenais
- University of Bordeaux, INSERM, BPH U1219, F-33000, Bordeaux, France
| | - Magalie Haissaguerre
- Endocrinology Department, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Damien Bouriez
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Denis Collet
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Antoine Tabarin
- Endocrinology Department, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Haythem Najah
- Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
- Department of Endocrine Surgery, Hôpital Haut Lévêque, University Hospital of Bordeaux, Avenue Magellan, 33604, Pessac, France.
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Frączek MJ, Błoński MJ, Kliś KM, Krzyżewski RM, Polak J, Stachura K, Kwinta BM. Predictors of intraoperative intracranial aneurysm rupture in patients with subarachnoid hemorrhage: a retrospective analysis. Acta Neurol Belg 2023; 123:1717-1724. [PMID: 35759212 DOI: 10.1007/s13760-022-02005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Intraoperative cerebral aneurysm rupture (IOR) is a common phenomenon with a frequency of around 19%. Research regarding IOR lacks an analysis of its predictors. METHODS We retrospectively examined all saccular aneurysms, in 198 patients with subarachnoid hemorrhage, surgically treated from 2013 to 2019. Operative reports, patient histories, blood test results, discharge summaries, and radiological data were reviewed. IOR was defined as any bleeding from the aneurysm during surgery, preceding putting a clip on its neck, regardless of how trivial. RESULTS The frequency of IOR was 20.20%. Patients with IOR had higher aneurysm dome size (9.43 ± 8.39 mm vs. 4.96 ± 2.57 mm; p < 0.01). The presence of blood clot on the aneurysm dome was significantly associated with IOR (12.50% vs. 2.53%; p < 0.01). We also associated lamina terminalis fenestration during surgery (7.50% vs. 21.52%; p = 0.04) and multiple aneurysms (5.00% vs. 18.35%; p = 0.038) with a lower risk of IOR. Glucose blood levels were also elevated in patients with IOR (7.47 ± 2.78 mmol/l vs. 6.90 ± 2.22 mmol/l; p = 0.04). Multivariate analysis associated that urea blood levels (OR 0.55, 0.33 to 0.81, p < 0.01) and multiple aneurysms (OR 0.04, 0.00 to 0.37, p = 0.014) were protective factors against the occurrence of IOR. CONCLUSION Large dome size of an aneurysm, a blood clot on the aneurysm dome and elevated glucose blood levels can be IOR predictive. Lamina terminalis fenestration, the appearance of multiple aneurysms, and high urea blood levels may be associated with a lower risk of such an event.
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Affiliation(s)
- Maciej J Frączek
- Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12 Street 31-008, Kraków, Poland.
| | - Miłosz J Błoński
- Faculty of Medicine, Jagiellonian University Medical College, Św. Anny 12 Street 31-008, Kraków, Poland
| | - Kornelia M Kliś
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Jarosław Polak
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
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20
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D'Amore T, Chisari E, Scaramella A, Frenz B, Courtney PM. Intraoperative Greater Trochanteric Fractures During Revision Total Hip Arthroplasty May Not Always Need Surgical Fixation. Orthopedics 2023; 46:297-302. [PMID: 36921230 DOI: 10.3928/01477447-20230310-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Many fixation techniques have been described to manage intraoperative greater trochanteric (GT) fractures during revision total hip arthroplasty (rTHA), but complications such as broken hardware and bursitis are common. The purpose of this study was to determine whether surgical fixation of an intraoperative GT fracture resulted in improved outcomes in rTHA. We reviewed a consecutive series of 1442 rTHA patients at our institution from 2008 to 2019. We identified all patients with an intraoperative GT fracture and noted whether the fracture was fixed surgically or left without fixation. Demographics, comorbidities, complications, radiographic union, and dislocations were compared between the groups. Of the 44 (3%) intra-operative GT fractures identified, 23 (52%) underwent fixation, most commonly with claw plates (8 patients) and cables (10 patients). There were no differences in the rates of radiographic union (86% vs 100%, P=.100), dislocations (4% vs 10%, P=.599), or re-revision (10% vs 13%, P=1.000) between the groups. Patients undergoing fixation had a higher rate of bursitis postoperatively, but it was not significant with the numbers available (35% vs 10%, P=.072). Our cohort of GT fractures at a large revision referral institution represents the largest reported series of GT fractures during rTHA. Surgical fixation in rTHA did not show improved outcomes in terms of dislocation, re-revision, and radiographic union compared with those fractures that were not fixed. There was a trend toward increased postoperative bursitis in the group undergoing surgical fixation. Further research is needed on this topic, as the number of rTHAs continues to increase. [Orthopedics. 2023;46(5):297-302.].
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21
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Sucandy I, Kang RD, Adorno J, Crespo K, Syblis C, Ross S, Rosemurgy A. Validity of the Institut Mutualiste Montsouris classification system for robotic liver resection. HPB (Oxford) 2023; 25:1022-1029. [PMID: 37217370 DOI: 10.1016/j.hpb.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/29/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Institut Mutualiste Montsouris (IMM) classification system is one of several widely accepted difficulty scoring systems for laparoscopic liver resections. Nothing is yet known about the applicability of this system for robotic liver resections. METHODS We conducted a retrospective review of 359 patients undergoing robotic hepatectomies between 2016 and 2022. Resections were classified into low, intermediate, and high difficulty level. Data were analyzed utilizing ANOVA of repeated measures, 3 x 2 contingency tables, and area under the receiving operating characteristic (AUROC) curves. Data are presented as median (mean ± SD). RESULTS Of the 359 patients, 117 were classified as low-difficulty level, 92 as intermediate, and 150 as high. The IMM system correlates well with tumor size (p = 0.002). The IMM system was a strong predictor of intraoperative outcomes including operative duration (p<0.001) and estimated blood loss (EBL) (p<0.001). The IMM system also showed a strong calibration for predicting an open conversion (AUC=0.705) and intraoperative complications (AUC=0.79). In contrast, the IMM system was a poor predictor of postoperative complications, mortality, and readmission. CONCLUSION The IMM system provides a strong correlation with intraoperative, but not postoperative outcomes. A dedicated difficulty scoring system should be developed for robotic hepatectomy.
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Affiliation(s)
- Iswanto Sucandy
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA.
| | - Richard D Kang
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | | | - Kaitlyn Crespo
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Cameron Syblis
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
| | - Sharona Ross
- AdventHealth Tampa, Digestive Health Institute, Tampa, FL, USA
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22
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Peltrini R, Iacone B, Pacella D, Ilardi M, Sannino D, Tedesco A, Gargiulo A, Martirani M, Bracale U, Corcione F. Laparoscopic Radical Nephrectomy with Transperitoneal Approach for Large Renal Tumors: Standardized Surgical Technique and Outcomes. J Laparoendosc Adv Surg Tech A 2023; 33:879-883. [PMID: 37262180 DOI: 10.1089/lap.2023.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Background: Minimally invasive surgery is used only in selected cases of renal masses greater than 7 cm, and few studies exist in this setting. This study aimed to evaluate the safety and effectiveness of a laparoscopic surgical approach for the treatment of large renal tumors using a standardized technique. Materials and Methods: Data of patients who underwent laparoscopic nephrectomy (LN) using the transperitoneal approach were retrospectively evaluated from December 2019 to September 2022. The study population was divided into two groups: patients with renal masses <7 cm (Group A) and those with renal masses ≥7 cm in diameter (Group B). The intraoperative and postoperative outcomes were compared. Results: Forty patients were enrolled (16 in Group A and 24 in Group B) in this study. Although significant difference in terms of age and American Society of Anesthesiologists score were detected, the two groups did not differ in mean operative time (130 minutes standard deviation [SD] ± 64 versus 148 minutes DS ± 56; P = .376), intraoperative complications (0% versus 8.3%; P = .508), need for postoperative transfusion (12% versus 12%; P > .999), and length of stay (3.38 DS ± 0.62 days versus 3.92 DS ± 2.47; P = .313). One patient had a local recurrence and died ∼13 months after surgery. Furthermore, 2 patients developed trocar-site incisional hernia in Group B. Conclusion: In this cohort of patients, LN for large renal tumors appeared to be safe and feasible. Larger mass dimension does not appear to influence the outcomes when the surgery is performed using a standardized technique by experienced surgeons.
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Affiliation(s)
- Roberto Peltrini
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Biancamaria Iacone
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Daniela Pacella
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Mariangela Ilardi
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Daniele Sannino
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Anna Tedesco
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Antonio Gargiulo
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Mirko Martirani
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Minimally Invasive General and Oncologic Surgery Unit, Department of Public Health, Federico II University Hospital, University of Naples Federico II, Naples, Italy
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23
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Edergren Å, Sandblom G, Agustsson T, Jaafar G. Intraoperative gallbladder perforation and risk of postoperative abscess with or without antibiotics: national cohort study of more than 108 000 cholecystectomies. Br J Surg 2023; 110:896-900. [PMID: 36308340 PMCID: PMC10361683 DOI: 10.1093/bjs/znac351] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/11/2022] [Accepted: 09/30/2022] [Indexed: 07/20/2023]
Affiliation(s)
- Åsa Edergren
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Thorhallur Agustsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Gona Jaafar
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Department of Emergency Care, Karolinska University Hospital, Stockholm, Sweden
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24
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Zelenski NA, Oishi T, Shin AY. Intraoperative Neuromonitoring for Peripheral Nerve Surgery. J Hand Surg Am 2023; 48:396-401. [PMID: 36623946 DOI: 10.1016/j.jhsa.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/21/2022] [Accepted: 11/09/2022] [Indexed: 01/09/2023]
Abstract
Intraoperative neuromonitoring is a valuable surgical resource that can assist in decision-making during peripheral nerve surgery using real-time electrophysiologic data. By stimulating a nerve and recording action potentials from a point on the nerve ("nerve action potential") or from a muscle ("triggered electromyography"), nerve lesions can be localized and the extent of nerve damage evaluated. The purpose of this article is to provide an overview of the role, indications, and techniques of intraoperative neuromonitoring of peripheral nerve injuries.
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25
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Abstract
BACKGROUND To explore the risk factors of bile duct injury in laparoscopic cholecystectomy (LC) in China through meta-analysis. METHODS The study commenced with a search and selection of case-control studies on the risk factors for bile duct injury in LC in China using the following databases: PubMed, EMBASE, ScienceNet.cn, CNKI, Wanfang Data, and VIP. Data were extracted from the collected documents independently by 2 researchers, following which a meta-analysis of these data was performed using Revman 5.3. RESULTS The compilation of all data from a total of 19 case-control studies revealed that among 41,044 patients, 458 patients experienced bile duct injury in LC, accounting for the incidence rate of 1.12% for bile duct injury. The revealed risk factors for bile duct injury were age (≥40 years) (odds ratio [OR] = 6.23, 95% CI [95% confidence interval]: 3.42-11.33, P < .001), abnormal preoperative liver function (OR = 2.01, 95% CI: 1.50-2.70, P < .001), acute and subacute inflammation of gallbladder (OR = 8.35, 95% CI: 5.32-13.10, P < .001; OR = 4.26, 95% CI: 2.73-6.65, P < .001), thickening of gallbladder wall (≥4 mm) (OR = 3.18, 95% CI: 2.34-4.34, P < .001), cholecystolithiasis complicated with effusion (OR = 3.05, 95% CI: 1.39-6.71, P = .006), and the anatomic variations of the gallbladder triangle (OR = 11.82, 95% CI: 6.32-22.09, P < .001). However, the factors of gender and overweight (body mass index ≥ 25 kg/m2) were not significantly correlated with bile duct injury in LC. CONCLUSIONS In the present study, age (≥40 years), abnormal preoperative liver function, gallbladder wall thickening, acute and subacute inflammation of the gallbladder, cholecystolithiasis complicated with effusion, and anatomic variations of the gallbladder triangle were found to be closely associated with bile duct injury in LC.
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Affiliation(s)
- Shaohua Yang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Sheng Hu
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaohui Gu
- The Second People’s Hospital of Qujing City, Qujing, China
| | - Xiaowen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Xiaowen Zhang, Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650105, China (e-mail: )
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26
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Markan A, Ayyadurai N, Singh SR, Katoch D. Intraoperative haemorrhagic choroidal detachment during MicroIncision Vitrectomy Surgery (MIVS): a unique mechanism. BMJ Case Rep 2022; 15:e245307. [PMID: 35217551 PMCID: PMC8883204 DOI: 10.1136/bcr-2021-245307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/03/2022] Open
Abstract
Haemorrhagic choroidal detachment (HCD) is a dreaded intraoperative complication of ophthalmic surgery, despite being rare. Multiple systemic and ocular risk factors of HCD have been reported. Acute hypotony during surgery is considered one of the most important precipitating factors. We herein describe a series of events during pars plana vitrectomy surgery for management of rhegmatogeneous retinal detachment which lead to localised HCD. We believe that the pathogenesis of localised HCD is related to compressive decompressive forces during the final tie of the encircling element after fluid air exchange.
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Affiliation(s)
- Ashish Markan
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Nikitha Ayyadurai
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Simar Rajan Singh
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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27
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Vendrametto F, Pierri A, Mancinelli P, Proclemer A, Belfiore R, Ussi D, Piazza R, Barbisan D, Pavan D, Sinagra G. An attractive endovascular strategy for combined - aneurysmal and stenotic - coronary artery disease. J Cardiovasc Med (Hagerstown) 2021; 22:e32-e34. [PMID: 34261082 DOI: 10.2459/jcm.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fauzia Vendrametto
- Division of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste
| | - Paolo Mancinelli
- Department of Radiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - Alberto Proclemer
- Division of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone
| | - Rita Belfiore
- Division of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone
| | - Donatella Ussi
- Division of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone
| | - Rita Piazza
- Division of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone
| | - Davide Barbisan
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste
| | - Daniela Pavan
- Division of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Ospedale Santa Maria degli Angeli, Pordenone
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste
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28
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Araujo-Castro M, Garcia Centeno R, López-García MC, Lamas C, Álvarez-Escolá C, Calatayud Gutiérrez M, Blanco-Carrera C, de Miguel Novoa P, Valdés N, Gracia Gimeno P, Fernández-Ladreda MT, Mínguez Ojeda C, Percovich Hualpa JC, Mora M, Vidal Ó, Serrano Romero A, Hanzu FA, Gómez Dos Santos V. Risk factors for intraoperative complications in pheochromocytomas. Endocr Relat Cancer 2021; 28:695-703. [PMID: 34379605 DOI: 10.1530/erc-21-0230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/11/2021] [Indexed: 11/08/2022]
Abstract
We aimed to identify presurgical and surgical risk factors for intraoperative complications in patients with pheochromocytomas. A retrospective study of patients with pheochromocytomas who underwent surgery in ten Spanish hospitals between 2011 and 2021 was performed. One hundred and sixty-two surgeries performed in 159 patients were included. The mean age was 51.6 ± 16.4 years old and 52.8% were women. Median tumour size was 40 mm (range 10-110). Laparoscopic adrenalectomy was performed in 148 patients and open adrenalectomy in 14 patients. Presurgical alpha- and beta-blockade was performed in 95.1% and 51.9% of the surgeries, respectively. 33.3% of the patients (n = 54) had one or more intraoperative complications. The most common complication was the hypertensive crisis in 21.0%, followed by prolonged hypotension in 20.0%, and hemodynamic instability in 10.5%. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more commonly than patients pre-treated with other antihypertensive drugs (51.1% vs 26.5%, P = 0.002). Intraoperative complications were more common in patients with higher levels of urine metanephrine (OR = 1.01 for each 100 μg/24 h, P = 0.026) and normetanephrine (OR = 1.00 for each 100 μg/24 h, P = 0.025), larger tumours (OR = 1.4 for each 10 mm, P < 0.001), presurgical blood pressure > 130/80 mmHg (OR = 2.25, P = 0.027), pre-treated with doxazosin (OR = 2.20, P = 0.023) and who had not received perioperative hydrocortisone (OR = 3.95, P = 0.008). In conclusion, intraoperative complications in pheochromocytoma surgery are common and can be potentially life-threatening. Higher metanephrine and normetanephrine levels, larger tumour size, insufficient blood pressure control before surgery, pre-treatment with doxazosin, and the lack of treatment with perioperative hydrocortisone are associated with higher risk of intraoperative complications.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Unit, Department of Endocrinology and Nutrition, Instituto Ramón y Cajal de Investigación Sanitaria (IRICYS), Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Health Science, Universidad de Alcalá, Madrid, Spain
| | - Rogelio Garcia Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lamas
- Department of Endocrinology & Nutrition, Hospital Universitario de Albacete, Albacete, Spain
| | | | | | | | - Paz de Miguel Novoa
- Department of Endocrinology & Nutrition, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nuria Valdés
- Department of Endocrinology & Nutrition, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Royo Villanova, Zaragoza, Spain
| | | | - César Mínguez Ojeda
- Department of Urology, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Mireia Mora
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Óscar Vidal
- Department of General Surgery, Hospital Clinic, Barcelona, Spain
| | - Ana Serrano Romero
- Department of Anesthesia, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Felicia Alexandra Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
- Group of Endocrine Disorders, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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29
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Bendich I, Landy DC, Do H, Krell E, Diane A, Boettner F, Rodriguez J, Alexiades M, Gonzalez Della Valle A. Intraoperative Complications and Early Return to the Operating Room in Total Hip Arthroplasty Performed Through the Direct Anterior and Posterior Approaches. An Institutional Experience of Surgeons After Their Learning Curve. J Arthroplasty 2021; 36:2829-2835. [PMID: 33865647 DOI: 10.1016/j.arth.2021.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Proponents of the direct anterior approach (DAA) for total hip arthroplasty (THA) claim a faster recovery, whereas critics claim an increased risk of early femoral complications. This study analyzed intraoperative and postoperative complications requiring reoperation within one year after THA through the DAA and posterior approach (PA). METHODS A total of 2348 elective, unilateral DAA THAs in patients with osteoarthritis performed between 2016 and 2019 were matched 1:1 for age (±5 years), gender, body mass index (±5), and femoral fixation with 2348 patients who underwent PA THA during the same period. Mixed-effects logistic regression was used. Odds ratios were reported for the occurrence of intraoperative femoral fracture, postoperative femoral fracture, infection, dislocation, and other etiologies requiring reoperation within one year. RESULTS Intraoperative femoral fracture occurred in 12 DAA (0.5%) and 14 PA (0.6%) patients. Twenty-five patients (1.06%) in the DAA and 28 (1.19%) in the PA group underwent reoperation within the first year. Reoperations were due to periprosthetic fracture (40%), infection (28%), dislocation (23%), and other (9%). Regression analysis revealed no difference in intraoperative femoral fracture (odds ratio (OR): 0.86, 95% confidence interval (CI): 0.40-1.86, P = .69), postoperative femoral fracture (OR: 1.10, 95% CI: 0.47-2.60, P = .83), infection (OR: 1.50, 95% CI: 0.53-5.23, P = .44), or reoperation within one year for other reasons (OR: 1.50, 95% CI: 0.25-9.00, P = .65). DAA had fewer dislocations requiring reoperation (OR: 0.20, 95% CI: 0.04-0.91, P = .02). CONCLUSION This comparative study did not find differences in intraoperative or postoperative fracture or infection between DAA and PA. DAA was associated with a lower likelihood of reoperation for dislocation within one year of surgery.
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Affiliation(s)
- Ilya Bendich
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - David C Landy
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Huong Do
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Ethan Krell
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Alioune Diane
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Friedrich Boettner
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Jose Rodriguez
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Michael Alexiades
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Rerplacement, Hospital for Special Surgery, New York, NY
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30
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Kim JH, Lim H, Kim HM, Lim JA. Intraoperative development of pulmonary thromboembolism in a bedridden patient owing to a pelvic bone fracture with negative preoperative computed tomography pulmonary angiographic findings: A case report. Medicine (Baltimore) 2021; 100:e26658. [PMID: 34398025 PMCID: PMC8294909 DOI: 10.1097/md.0000000000026658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/28/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Pulmonary thromboembolism (PTE) is a potentially life-threatening condition with high morbidity and mortality, and computed tomographic pulmonary angiography (CTPA) is an important diagnostic tool for patients in whom PTE is suspected; however, intraoperative PTE is very difficult to diagnose and often has a rapid clinical course. We experienced a case of intraoperative PTE with persistent tachycardia refractory to conventional treatments despite negative preoperative CTPA findings. PATIENT CONCERNS A 53-year-old man with a pelvic bone fracture who had been on bed rest for 10 days underwent open reduction and internal fixation under general anesthesia. He remained tachycardic (heart rate of 120 beats/min) despite treatments with fluid resuscitation, analgesics, and beta-blockers. DIAGNOSES Preoperative CTPA, computed tomography (CT) venography, and transthoracic echocardiography showed no signs of deep vein thrombosis and PTE. However, the levels of D-dimer were elevated. After the start of the surgery, tachycardia (heart rate between 100 and 110 beats/min) could not be treated with fluid resuscitation. Systolic blood pressure was maintained between 90 and 100 mm Hg using continuous infusion of phenylephrine. Ninety minutes after the surgery, systolic and diastolic blood pressures suddenly dropped from 100/60 to 30/15 mm Hg with a decrease in end-tidal carbon dioxide concentration from 29 to 13 mm Hg and development of atrial fibrillation. Arterial blood gas analysis revealed hypercapnia. Under the suspicion of PTE, cardiopulmonary resuscitation (CPR) was immediately initiated. Three CPR cycles raised the blood pressure back to 90/50 mm Hg with sinus tachycardia (115 beats/min). Transesophageal echocardiography showed right ventricular dysfunction and paradoxical septal motion. However, emboli were not found. Postoperative chest CT revealed massive PTE in both pulmonary arteries. INTERVENTIONS Immediately, surgical embolectomy was performed uneventfully. OUTCOMES The patient was discharged from the hospital 1 month later without any complications. LESSONS The patient with moderate risk for PTE (heart rate > 95 beats/min and immobilization, surgery under general anesthesia, and lower limb fracture within 1 month) should be closely monitored and managed intraoperatively even if preoperative CTPA findings are negative. The development of PTE needs to be expected if tachycardia is refractory to conventional treatments.
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Affiliation(s)
- Jong Hae Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University
| | - Hyungseop Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University
| | - Hyun Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung A. Lim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Daegu Catholic University
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31
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Huang X, Cai H, Lu SY. Iatrogenic femoral artery pseudoaneurysm surgically repaired with combined bovine pericardial roll and autologous great saphenous vein grafts. Chin J Traumatol 2021; 24:75-78. [PMID: 33323319 PMCID: PMC8071716 DOI: 10.1016/j.cjtee.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/02/2020] [Accepted: 10/26/2020] [Indexed: 02/04/2023] Open
Abstract
Iatrogenic femoral artery pseudoaneurysm caused by invasive procedures is one of the common complications for endovascular interventions. We present a case of a young male with a complex iatrogenic femoral artery pseudoaneurysm as a result of iatrogenic femoral artery puncture. The defective femoral artery was repaired with combined bovine pericardial tube and autologous great saphenous vein grafts. Computed tomography angiography showed the grafts were still patent one year after the surgery.
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Affiliation(s)
- Xun Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hui Cai
- Department of Vascular Surgery, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Shao-Ying Lu
- Department of Vascular Surgery, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, 710061, China.
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32
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Abstract
This 75-year-old woman had phacomorphic angle closure, dense nuclear sclerosis, deep set eye, miotic pupil and tight corneal wound during phacoemulsification. Phacoemulsification wound burn was noted at the end of surgery. Tenon was harvested from the inferior conjunctiva, placed over the gape and anchored by two radial corneoscleral 10-0 nylon. Ten days later, anterior optical coherence tomography showed good wound apposition and sutures were removed with visual recovery to 20/25 (6/7.5) without astigmatism.
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Affiliation(s)
- Hana A Mansour
- Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Ahmad M Mansour
- Ophthalmology, American University of Beirut Faculty of Medicine, Beirut, Lebanon
- Ophthalmology, Rafic Hariri University Hospital, Lebanon
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33
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Menger R, Lin J, Cerpa M, Lenke LG. Epidural hematoma due to Gardner-Wells Tongs placement during pediatric spinal deformity surgery. Spine Deform 2020; 8:1139-1142. [PMID: 32314179 DOI: 10.1007/s43390-020-00116-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To our knowledge, this is the first documented report of an operative cranial epidural hematoma secondary to skull fracture due to placement of Gardner-Wells Tongs (GWT) in the setting of a spinal deformity reconstruction. PURPOSE The objective is to illustrate the possibility of cranial pathology secondary to GWT placement and the need to properly correlate intraoperative neuromonitoring findings. STUDY DESIGN Case report. METHODS A 14-year-old male with Marfan's Syndrome presented for three-column osteotomy spinal reconstruction for a large and stiff thoracic kyphoscoliosis. Gardner-Wells Tongs (GWT) was placed prior to prone positioning to provide neck stability without issue. During the lumbar posterior column osteotomies the patient began to lose upper and lower extremity motor data. This indicated a cranial pathology. A temporary rod was placed on the concavity and an emergent flip without closure was performed. Upon flip, the patient was fixed and dilated with only right corneal reflex. The patient was rushed to the CT scanner where a large right-sided epidural hematoma was noted with a temporal bone fracture at the pin site, with the patient's right temporal bone noted to be only 1.3 mm in thickness. RESULTS The patient underwent emergent epidural hematoma evacuation by the Neurosurgical team. The patient was discharged to rehabilitation 1 week after his cranial epidural hematoma surgery with a complete recovery including with full strength examination of all extremities. He subsequently underwent a definitive posterior spinal fusion with posterior column osteotomies 8 weeks later. CONCLUSION Cranial pin fixation has the rare possibility to produce cranial pathology and has a specific complication protocol. Proper utilization and interpretation of neuromonitoring is essential to aid in intraoperative decision-making.
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Affiliation(s)
- Richard Menger
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| | - James Lin
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA.
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
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Aguilera A, Gómez Rivas J, Álvarez-Maestro M, Martínez-Piñeiro L. How to deal with major complications during laparoscopic surgery? New training model for vascular lesions. Actas Urol Esp 2020; 44:447-449. [PMID: 32593639 DOI: 10.1016/j.acuro.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- A Aguilera
- Servicio de Urología, Hospital Universitario la Paz, Madrid, España; Instituto de investigación, Hospital Universitario la Paz (IdiPAZ), Madrid, España
| | - J Gómez Rivas
- Servicio de Urología, Hospital Universitario la Paz, Madrid, España; Instituto de investigación, Hospital Universitario la Paz (IdiPAZ), Madrid, España.
| | - M Álvarez-Maestro
- Servicio de Urología, Hospital Universitario la Paz, Madrid, España; Instituto de investigación, Hospital Universitario la Paz (IdiPAZ), Madrid, España
| | - L Martínez-Piñeiro
- Servicio de Urología, Hospital Universitario la Paz, Madrid, España; Instituto de investigación, Hospital Universitario la Paz (IdiPAZ), Madrid, España
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Zhang L, Zhang X, Chang P, Yang J, Zheng D, Zhang D, Wen S, Jing S. A Novel Approach for Repairing Superior Mesenteric Artery Injury During Left Nephrectomy-6-year Follow-up. Urology 2020; 144:241-244. [PMID: 32717246 DOI: 10.1016/j.urology.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/27/2020] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a novel approach for reconstructing the superior mesenteric artery (SMA) during left nephrectomy and review the literature. MATERIALS AND METHODS The patient was a 57-year-old man with left back pain from an unknown cause for more than 3 hours. A computed tomography scan showed a 12- × 15-cm firm mass and a subcapsular hematoma in the left kidney. It was considered to be bleeding and rupture of the solid renal mass, and because of persistent pain and no documented distant metastatic disease, a transperitoneal laparoscopic nephrectomy was elected, but the procedure was converted to open surgery for SMA injury. We reconstructed the SMA with end-to-end anastomosis between the SMA and the left renal artery stump. RESULTS At the 6-year follow-up, the patient had no intestine-related sequelae. CONCLUSION Our novel approach of an end-to-end anastomosis between the SMA and the left renal artery stump is an option for SMA injury, especially when orthotopic anastomosis or repair of the SMA is not indicated.
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Affiliation(s)
- Liyuan Zhang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Xiaokang Zhang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Pengcheng Chang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Jie Yang
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Duo Zheng
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China
| | - Deng Zhang
- Jinchang hospital of integrated traditional Chinese and western medicine, Jinchang, China
| | - Siqi Wen
- The art academy of Lanzhou university, Lanzhou, China
| | - Suoshi Jing
- Department of Urology, the first hospital of Lanzhou university, Lanzhou, China.
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Duethman NC, Statz JM, Trousdale RT, Taunton MJ. Reasons for Failure of Primary Total Hip Arthroplasty Performed Through a Direct Anterior Approach. Orthopedics 2020; 43:239-244. [PMID: 32501515 DOI: 10.3928/01477447-20200521-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Abstract
The direct anterior approach (DAA) for total hip arthroplasty (THA) is a technique popular among some arthroplasty surgeons. There is currently a paucity of data regarding reasons for failure of THA using the DAA. The authors conducted a retrospective review of prospectively collected data on 56 patients who underwent revision THA at their institution after failing primary THA that was performed through a DAA either at their institution (n=8) or elsewhere (n=48) from January 1, 2010, to June 1, 2017. Patients were grouped by modes of failure and compared using patient characteristics, surgical factors, and radiographic outcomes. Total hip arthroplasties performed through the DAA failed due to infection in 21 (38%) patients, aseptic/mechanical loosening in 14 (25%) patients, intraoperative fracture in 6 (11%) patients, postoperative fracture in 6 (11%) patients, tendinitis or pain of unknown etiology in 3 (5%) patients, metallosis in 3 (5%) patients, instability/dislocation in 2 (4%) patients, and leg length discrepancy in 1 (2%) patient. Patients who underwent revision due to unrecognized intraoperative fracture had a lower body mass index (BMI) and weight than patients who had failure due to postoperative fracture, aseptic loosening, or infection. The 4 most common modes of failure included infection, aseptic loosening, unrecognized intraoperative fracture, and postoperative fracture. Together, these made up 84% of failed DAA THAs. Patients with a lower BMI are more likely to have failure due to intraoperative fractures. Patients with a higher BMI are more likely to have failure due to postoperative fracture, aseptic loosening, or infection. [Orthopedics. 2020;43(4);239-244.].
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Mallios A, de Blic R. Iliac Artery Stripping as a TAVI Access Related Complication. Eur J Vasc Endovasc Surg 2020; 59:955. [PMID: 32362488 DOI: 10.1016/j.ejvs.2020.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/19/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Alexandros Mallios
- Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France.
| | - Romain de Blic
- Department of Vascular Surgery, Institut Mutualiste Montsouris, Paris, France
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Vallicelli C, Pirrera B, Alagna V, Fantini E, Palini GM, Zanini N, Garulli G. Intraoperative endoscopy with immediate suture reinforcement of the defect in colorectal anastomosis: a pilot study. Updates Surg 2020; 72:999-1004. [PMID: 32185679 DOI: 10.1007/s13304-020-00746-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/11/2020] [Indexed: 12/21/2022]
Abstract
Colorectal anastomosis is the one at higher risk of complication in alimentary tract surgery. Several techniques have been used to intraoperatively check a colorectal anastomosis, without reaching a clear consensus. The aim of the present study is to evaluate the addition of intraoperative flexible endoscopy to indocyanine green fluorescence in detecting colorectal anastomotic defects in a consecutive series of patients. This was a pilot study conducted over a 15-month period. Patients were scheduled for an elective laparoscopic left colectomy or anterior resection with a planned stapled colorectal anastomosis. Pre-, intra- and postoperative data were collected. Intraoperative endoscopy was routinely performed and the anastomotic defects were classified. A suture reinforcement of the defect encountered was immediately performed either laparoscopically or transanally. The primary endpoint of the study was the rate of postoperative complications. Fitfty-two patients were enrolled. At intraoperative endoscopy, 12 anastomotic defects were detected and corrected with immediate suture reinforcement. Defects were classified as two leaks, two mucosal crash, one simultaneous leak and crash, one mucosal edema and six active bleedings. None of these patients developed any postoperative complication. Moreover, there was no postoperative bleeding complication in the entire cohort. The three patients developing a postoperative leak requiring anastomosis takedown were at high risk due to general status and cancer characteristics. Even though more data and a comparative group are needed, the results of this pilot study are very promising regarding the role of intraoperative endoscopy and suture reinforcement of a colorectal anastomotic defect.
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Affiliation(s)
- Carlo Vallicelli
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy.
| | - Basilio Pirrera
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy
| | - Vincenzo Alagna
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy
| | - Enrico Fantini
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy
| | - Gian Marco Palini
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy
| | - Nicola Zanini
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy
| | - Gianluca Garulli
- General and Minimally Invasive Surgery, Infermi Hospital of Rimini, AUSL Della Romagna, Via Luigi Settembrini 2, 47923, Rimini, Italy
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Kuribayashi S, Matsumura N, Sohda M, Kuwano H, Uraoka T. Risk of perforation during endoscopic resection of esophageal lesions in patients with systemic sclerosis. Gastrointest Endosc 2020; 91:441-442. [PMID: 31445981 DOI: 10.1016/j.gie.2019.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/15/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Nozomi Matsumura
- Department of Human Pathology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
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Panneerselvam A, Ananthakrishna R, Srinivas BC, Hemanna Setty SK, Manjunath SC, Basavanna D, Nanjappa MC. Hemopericardium Following Transseptal Puncture During Balloon Mitral Valvotomy: Management Strategies and Outcomes. J Invasive Cardiol 2020; 32:70-75. [PMID: 31611427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hemopericardium is a major complication of balloon mitral valvotomy (BMV). Only a few studies are available to address this issue following transseptal access. In addition, the management strategy regarding completion of BMV is uncertain. OBJECTIVE We sought to determine the incidence of hemopericardium complicating transseptal puncture during BMV. In addition, the management strategy adopted and outcomes are highlighted. METHODS This prospective study included 29 consecutive patients who developed hemopericardium following transseptal access during BMV. RESULTS Out of 1424 patients who underwent BMV, hemopericardium developed in 29 patients following transseptal access (2.0%). The mean age of the study cohort was 36.9 ± 13.7 years and 82.8% were women. A second transseptal puncture was done and BMV was completed in 26 patients (89.6%). An acceptable hemodynamic result was obtained in 22 patients (84.6%). Six patients (20.7%) underwent emergency surgery for hemopericardium. The sites of perforation were inferior vena cava-right atrial junction in 4 cases, left atrial posterior wall in 1 case, and left atrial appendage in 1 case. In addition to repair of the perforation, a total of 2 patients underwent mitral valve replacement and 1 patient underwent open mitral commissurotomy. The in-hospital mortality rate was 6.9%. CONCLUSIONS The incidence of hemopericardium complicating transseptal access during BMV was 2.0%, and was associated with a mortality rate of 6.9%. BMV can be safely performed in the same sitting with a second transseptal puncture, in patients with a favorable valve morphology. Surgical intervention can be reserved for a subset of patients with persistent pericardial collection.
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Affiliation(s)
| | | | | | | | - Satvic C Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore, India 560069.
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Khelimskii D, Badoyan A, Krestyaninov O. The Deep-Wire Crossing Technique: A Novel Method for Treating Balloon-Uncrossable Lesions. J Invasive Cardiol 2019; 31:E362-E368. [PMID: 31786527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Inability to cross the lesion with a balloon is the second-most common cause of technical failure, with the most common cause being the inability to cross with the wire. We propose a new, effective method for treating balloon-uncrossable lesions, called the "deep-wire crossing" (DWC) technique. OBJECTIVES The aim of this study was to evaluate the procedural outcomes of the DWC technique for treating balloon-uncrossable lesions. METHODS From 2017 to 2018, a total of 95 patients with balloon-uncrossable lesions were treated using the DWC technique at our center. Procedural and in-hospital outcomes were assessed. RESULTS In most cases, the target vessel was the left circumflex (46.3%), followed by the right coronary artery (31.6%) and left anterior descending (22.1%). According to the American College of Cardiology/American Heart Association classification, 41% of lesions were classified as type C, 40% as type B2, and 18.9% as type B1. Chronic total occlusion occurred in 24 patients (25.3%). Overall technical success was achieved in 84 patients (88.4%). Successful DWC technique was achieved in 74 patients (77.9%). In-hospital major adverse cardiac event rate was 3.2%. Coronary perforation required pericardiocentesis in only 1 patient. Periprocedural myocardial infarction occurred in 1 patient and was managed conservatively; urgent revascularization was required for 1 patient. CONCLUSION Our experience with the DWC technique demonstrated that it can be a viable option for treating balloon- uncrossable lesions, and operators should become familiar with it.
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Affiliation(s)
- Dmitrii Khelimskii
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Division of Invasive Cardiology, 15 Rechkunovskaya Street, Novosibirsk, Russia 630055.
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Dalal A, Patil GK, Maydeo AP, Iyer A, Patil N. Basket impaction during the extraction of a pancreatic ductal stone. Indian J Gastroenterol 2019; 38:550-551. [PMID: 31993917 DOI: 10.1007/s12664-019-00997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
| | - Gaurav K Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
| | - Amit P Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India.
| | - Arun Iyer
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
| | - Nikhil Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, 400 012, India
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Talanas G, Siciliano R, Parodi G. Coronary Guidewire Fracture Into a Radial Artery Loop: A New Complication in the Transradial Era? J Invasive Cardiol 2019; 31:E398. [PMID: 31786537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To date, complete fracture of a coronary wire into a radial artery loop has never been reported. We describe the occurrence of a new complication in the transradial intervention era.
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Affiliation(s)
- Giuseppe Talanas
- Clinical and Interventional Cardiology Unit, Sassari University Hospital, Via De Nicola 14, 07100 Sassari, Italy.
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Martí-Fernández R, Muñoz-Forner E, Machado-Fernández F, Martín-González I, Garcés-Albir M. Surgical treatment of ruptured mycotic hepatic artery aneurysm. Cir Esp 2019; 98:239-241. [PMID: 31753285 DOI: 10.1016/j.ciresp.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 05/06/2019] [Accepted: 07/13/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Rosa Martí-Fernández
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - Elena Muñoz-Forner
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario de Valencia, Valencia, España
| | | | - Ivan Martín-González
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Marina Garcés-Albir
- Servicio de Cirugía General y Digestiva, Hospital Clínico Universitario de Valencia, Valencia, España
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Bates KM, Chaudhuri A. Retrograde Femoral Arterial Endoprosthesis Insertion for Access Site Haemorrhage After Percutaneous Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2019; 58:689. [PMID: 31631007 DOI: 10.1016/j.ejvs.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Kersten Morgan Bates
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, UK.
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, UK
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Kumar A, Sato K, Jobanputra Y, Betancor J, Halane M, George R, Banerjee K, Mohananey D, Menon V, Sammour YM, Krishnaswamy A, Jaber WA, Mick S, Svensson LG, Kapadia SR. Time-Integrated Aortic Regurgitation Index Helps Guide Balloon Postdilation During Transcatheter Aortic Valve Replacement and Predicts Survival. J Am Heart Assoc 2019; 8:e012430. [PMID: 31269863 PMCID: PMC6662132 DOI: 10.1161/jaha.119.012430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Balloon postdilation (BPD) has emerged as an effective strategy to reduce paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR). We investigated the utility of a time‐integrated aortic regurgitation index (TIARI) to guide balloon postdilation (BPD) after valve deployment. Methods and Results All consecutive patients who had echocardiography, aortography, and hemodynamic tracings recorded immediately after valve deployment during TAVR were included in the study. Catheter‐derived invasive hemodynamic parameters were calculated offline. Among 157 patients who underwent TAVR, 49 (32%) patients required BPD to reduce significant PVR after valve deployment. Two experienced operators decided whether the patients required BPD for significant PVR. Median TIARI measured immediately after valve deployment was significantly lower in patients who required BPD when compared with patients who did not require BPD (P<0.001). In a multivariable analysis, lower TIARI (odds ratio: 0.81; P=0.003) and higher PVR grade on aortography and echocardiography (P<0.001 for both) were associated with BPD. Adding TIARI to echocardiography and aortographic PVR assessment resulted in a significant increase in global χ2 (P<0.001), an integrated discrimination index of 9% (P=0.002), and combined C‐statistics of 0.99 for predicting BPD. Higher TIARI after valve deployment was associated with better survival (hazard ratio: 0.94, P=0.014), while other hemodynamic and imaging parameters did not predict mortality after TAVR. Conclusions Among patients undergoing TAVR, a TIARI measured immediately after valve deployment adds incremental value to guide BPD over aortography and echocardiography. Higher residual TIARI is associated with better survival after TAVR.
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Affiliation(s)
- Arnav Kumar
- Division of CardiologyAndreas Gruentzig Cardiovascular CenterEmory University School of MedicineAtlantaGA
| | - Kimi Sato
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Yash Jobanputra
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Jorge Betancor
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Mohamed Halane
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Robin George
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Kinjal Banerjee
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | - Vivek Menon
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | | | | | - Wael A. Jaber
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Stephanie Mick
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Lars G. Svensson
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
| | - Samir R. Kapadia
- Heart and Vascular InstituteCleveland Clinic FoundationClevelandOH
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Abstract
RATIONALE Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS A 40-year-old woman presented with repeated chest pain. DIAGNOSIS Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.
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Affiliation(s)
| | - Hui Pan
- Department of Lung Transplantation
| | | | | | - Liang Ma
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kandeel AAMA, El-Saeady AI, Eid TAS. Intra-operative patellar fracture during chronic patellar tendon rupture reconstruction: salvage and prophylactic modified techniques. Eur J Orthop Surg Traumatol 2019; 29:1549-1557. [PMID: 31154509 DOI: 10.1007/s00590-019-02459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022]
Abstract
Management of chronic neglected patellar tendon rupture represents a challenging condition for the orthopedic surgeons to deal with due to many factors such as quadriceps muscle atrophy, superior migration of the patella, e.g., patella alta, peri-patellar adhesions and patellar tendon atrophy. Such difficulties might be further complicated by intra-operative patellar fracture during patellar tendon reconstruction. In the current article, the authors report (1) a salvage procedure for such devastating intra-operative complication, based on bypassing the patella and gaining the advantage of the quadriceps tendon for structural and functional restoration of the knee extensor mechanism, and (2) prophylactically a technical modification of patellar tendon reconstruction guarding against such inadvertent patellar fracture.
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Potts MB, Horbinski CM, Jahromi BS. Rapid Development of an Aneurysm at the Anastomotic Site of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report and Literature Review. World Neurosurg 2019; 128:314-319. [PMID: 31125771 DOI: 10.1016/j.wneu.2019.05.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. CASE DESCRIPTION Here we present the case of a superficial temporal to middle cerebral artery (STA-MCA) anastomosis that was complicated by aneurysm formation at the anastomotic site. This was treated with microsurgical clipping with preservation of the bypass. Pathologic analysis of the lesion was consistent with a pseudoaneurysm. We provide a literature review of this phenomenon, which is most often associated with low-flow STA-MCA bypasses, including review of the pathologic findings associated with it. CONCLUSION Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.
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Affiliation(s)
- Matthew B Potts
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.
| | - Craig M Horbinski
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Pathology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
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Long A, Mahoney P. TAVR Complicated by Thoracic Aortic Perforation and Intussusception of the Right Iliac: Report of Successful Emergent Management With Endovascular Techniques. J Invasive Cardiol 2019; 31:E97. [PMID: 31034445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Percutaneous approaches have become routine in transcatheter aortic valve replacement (TAVR). Despite numerous advantages, vascular complications associated with percutaneous access can occur during and after TAVR, and increase morbidity and mortality significantly. Effective management of potentially catastrophic vascular complications often requires prompt recognition, diagnosis, and management by multidisciplinary teams.
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Affiliation(s)
| | - Paul Mahoney
- Sentara Heart Valve and Structural Disease Center, 600 Gresham Dr, Norfolk, VA 23507 Email.
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