Cone-Beam Navigation Can Reduce the Radiation Exposure and Save Fusion Length-Dependent Operation Time in Comparison to Conventional Fluoroscopy in Pedicle-Screw-Based Lumbar Interbody Fusion

This study investigates the advantages and disadvantages of cone-beam-based navigated standardized posterior lumbar interbody fusion surgery (PLIF), regarding the radiation exposure and perioperative time management, compared to the use of fluoroscopy. Patients treated receiving an elective one- to three-level PLIF were retrospectively enrolled in the study. The surgery time, preparation time, operation room time, and effective dose (mSv) were analyzed for comparison of the radiation exposure and time consumption between cone-beam and fluoroscopy; Results: 214 patients were included (108 cone-beam navigated, and 106 traditional fluoroscopies). Using cone-beam navigation, reductions in the effective dose (2.23 ± 1.96 mSv vs. 3.39 ± 2.32 mSv, p = 0.002) and mean surgery time of 30 min (143.62 ± 43.87 min vs. 171.10 ± 48.91 min, p < 0.001) were demonstrated, which leveled out the extended preparation time of 7−8 min (37.25 ± 9.99 min vs. 29.65 ± 7.69 min, p < 0.001). These effects were fusion length dependent and demonstrated additional benefits in multisegmental surgeries. The cone-beam navigation system led to a reduction in the perioperative time requirements and radiation exposure. Furthermore, the controversially discussed longer preparation time when using cone-beam navigation was amortized by a shortened surgery time, especially in multilevel surgery.

Distance of Peritoneum to Inferior Mesenteric Artery Predicts the Operation Time During Laparoscopic Colectomy for Sigmoid or Rectosigmoid Colon Cancer

BACKGROUND/AIM

Obesity is a major technical limiting factor for laparoscopic surgery because abundant visceral fat is known to extend the operation time. However, special hardware is needed to assess it. We hypothesized that the depth from the peritoneum to the bifurcation of the inferior mesenteric artery (IMA) defined as 'peritoneum to IMA distance (PID)' might be a simple predictive factor for extended operation time during laparoscopic colectomy.

PATIENTS AND METHODS

One hundred twenty-four patients who were diagnosed with sigmoid or rectosigmoid colon cancer and underwent laparoscopic colectomy were included. The patients were divided into two groups based on the operation time (210 min). The vertical distance from the peritoneum to the bifurcation of the inferior mesenteric artery was defined as PID. The factors eliciting an operation time longer than 210 min were investigated.

RESULTS

There was significant difference in sex, BMI, cT, cN, and PID between the Early group (<210 min) and Late group (≥210 min). Less blood loss was observed in the Early group than in the Late group. Multivariate analysis showed that PID was the only independent factor that affected operation time (p<0.001).

CONCLUSION

PID predicts the operation time during laparoscopic colectomy for sigmoid or rectosigmoid colon cancer.

Application of Gross Tissue Response System in Gastric Cancer After Neoadjuvant Chemotherapy: A Primary Report of a Prospective Cohort Study

OBJECTIVE

We previously established a gross tissue response (GTR) system to evaluate the intraoperative response of perigastric tissue in patients with gastric cancers to neoadjuvant chemotherapy. This prospective cohort study aims to confirm the relationship between gross tissue response and clinicopathological characteristics and explore the possibility of using the GTR system to predict the difficulty of surgery and the occurrence of postoperative complications within 30 days.

METHODS

A total of 102 patients with gastric cancer from January 2019 to April 2020 were enrolled in this study. The degrees of fibrosis, edema, and effusion in the perigastric tissues were assessed intraoperatively according to the GTR system. We systematically analyzed the relations between GTR and clinicopathological characteristics, and then a prediction model that includes GTR was established to predict the difficulty of surgery and the occurrence of postoperative complications within 30 days.

RESULTS

Finally, the study included 71 male patients and 31 female patients. The patients had an average age of 58.79 ± 1.03 years, BMI of 22.89 ± 0.29, and tumor diameter of 4.50 ± 0.27 cm. Among these patients, 17 underwent laparoscopic gastrectomy, 85 underwent open gastrectomy, the average operation time was 294.63 ± 4.84 minutes, and the mean volume of intraoperative blood loss was 94.65 ± 5.30 ml. The overall 30-day postoperative complication rate was 19.6% (20/102). The total GTR was significantly related to the primary tumor stage, operation time and 30-day postoperative complication rate (p<0.05). Edema and effusion were significantly related to intraoperative blood loss (p<0.05). The logistic regression analysis identified that the total GTR score (score: 4-9, OR 2.888, 95% CI: 1.035-8.062, p = 0.043) was an independent risk factor for postoperative complications within 30 days, and the total GTR score (score 4-9, OR 3.32, 95% CI 1.219-9.045, p=0.019) was also an independent risk factor for operation time. The AUC of the total GTR score for predicting postoperative complications within 30 days was 0.681.

CONCLUSION

According to the results of the present study, the gross tissue response (GTR) system is an effective tool that may be used to predict the risk of a difficult operation after neoadjuvant chemotherapy and postoperative complications. Although neoadjuvant chemotherapy improves the therapeutic effect, it also increases the risk of surgical trauma and postoperative complications.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT03791268.

A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total hip arthroplasty

BACKGROUND

Delirium is a common postoperative complication of total hip arthroplasty (THA), excessively long time surgery may be one of the factors associated with it. This article aimed to employ literature retrieval and meta-analysis to investigate the correlation between operation time and postoperative delirium in THA.

METHODS

The databases of PubMed and Springerlink libraries were searched for retrospective case-control studies on delirium-related factors after THA. The retrieved studies were screened according to the inclusion criteria. Newcastle-Ottawa scale (NOS) was used to assess the quality of literatures. After extracting the data of included literatures, RevMan 5.3.5 software was used to analyze the data and obtain a forest plot and funnel plot.

RESULTS

A total of 137 literatures were initially screened in this study. According to the inclusion and exclusion criteria and literature quality evaluation, 6 studies were finally included, involving a total of 3,494 patients. The NOS scores were above 6 points in all 6 literatures. Meta-analysis revealed statistical heterogeneity among the 6 studies (I2=80%, P=0.0002). The random effects model was used, revealing that the operation time of patients with postoperative delirium was longer, and the difference was statistically significant [standardized mean difference (SMD) =0.43, 95% confidence interval (CI): 0.20 to 0.66, P=0.0003]. The 6 studies were divided into unilateral or bilateral THA subgroups according to the type of surgery. Homogeneity was detected between the internal literatures: bilateral subgroup (I2=5%, P=0.37), unilateral subgroup (I2=0%, P=0.78). Postoperative delirium was associated with longer operation time in both subgroups, which was consistent with the combined analysis: bilateral subgroup (SMD =0.25, 95% CI: 0.12 to 0.37, P=0.0001), unilateral subgroup (SMD =0.70, 95% CI: 0.55 to 0.84, P=0.0001).

DISCUSSION

Operation time is one of the related factors of delirium after THA. The longer the operation time, the greater the possibility of delirium.

Open Resection Compared to Mini-Invasive in Colorectal Cancer and Liver Metastases: A Meta-Analysis

Background: We performed a meta-analysis to evaluate the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases. Methods: A systematic literature search up to April 2021 was done and 13 studies included 1,181 subjects with colorectal cancer and synchronous colorectal liver metastases at the start of the study; 425 of them were using minimally invasive surgery and 756 were open surgery. They were reporting relationships between the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to assess the outcomes of minimally invasive surgery and open surgery in the simultaneous resection of colorectal cancer and synchronous colorectal liver metastases using the dichotomous or continuous method with a random or fixed-effect model. Results: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases was significantly related to longer operation time (MD, 35.61; 95% CI, 7.36-63.87, p = 0.01), less blood loss (MD, -151.62; 95% CI, -228.84 to -74.40, p < 0.001), less blood transfusion needs (OR, 0.61; 95% CI, 0.42-0.89, p = 0.01), shorter length of hospital stay (MD, -3.26; 95% CI, -3.67 to -2.86, p < 0.001), lower overall complications (OR, 0.59; 95% CI, 0.45-0.79, p < 0.001), higher overall survival (OR, 1.66; 95% CI, 1.21-2.29, p = 0.002), and higher disease-free survival (OR, 1.49; 95% CI, 1.13-1.97, p = 0.005) compared to open surgery. Conclusions: Minimally invasive surgery in subjects with colorectal cancer and synchronous colorectal liver metastases may have less blood loss, less blood transfusion needs, shorter length of hospital stay, lower overall complications, higher overall survival, and higher disease-free survival with longer operation time compared with the open surgery. Furthers studies are required to validate these findings.

Laparoscopic sacrocolpopexy for pelvic organ prolapse: Comparison of standard versus tacker combination method

OBJECTIVE

To compare the surgical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse between a group in which only sutures were used (standard method), and a group in which a combination of tackers and sutures were used (tacker combination method).

METHODS

A total of 77 patients who underwent laparoscopic sacrocolpopexys from June 2016 to October 2019 were divided into a suture group (36 patients) and a suture + tacker group (41 patients). We retrospectively compared operation time, amount of blood loss, postoperative length of hospital stay, incidence of perioperative complications and anatomical cure rate 1 year after surgery. Lower urinary tract symptoms were evaluated using symptom questionnaires and objective parameters.

RESULTS

Operation time in the suture + tacker group was shorter (104.9 ± 27.0 vs 147.5 ± 33.7 min; P < 0.0001). The incidence of perioperative complications in the suture group and the suture + tacker group was 2.8% and 2.4%, respectively (P = 0.9409). Anatomical cure rates at 1 year after surgery were 94.4% and 100%, respectively (P = 0.2153). Both groups showed significant improvement after 1 year for International Prostate Symptom Score total and quality of life score, Overactive Bladder Symptom Score total score, voided volume, maximum urinary flow rate and post-void residual. [Corrections added on 7 September 2021 after first online publication: the first two P-values have been updated.] CONCLUSIONS: The combined use of sutures and tackers in laparoscopic sacrocolpopexy simplifies the procedure and translates into shorter operation time. Surgical outcomes at 1 year and improvement of lower urinary tract symptoms are similar regardless of the technique.

Effect of different operation time on surgical effect and quality of life in patients with severe hypertensive intracerebral hemorrhage

OBJECTIVE

To investigate the effect of different operation time on the surgery effect and quality of life of patients with severe hypertensive cerebral hemorrhage.

METHODS

A total of 98 patients with severe hypertensive cerebral hemorrhage were selected in this prospective study. According to the random number table, 98 patients were divided into group A and group B. About 47 patients in group A received surgical treatment within 6 hours after onset of a cerebral hemorrhage and 51 patients in group B received surgical treatment within 6-24 hours after onset of a cerebral hemorrhage. The effect of the operation, quality of life (the World Health Organization Quality of Life Scale Brief Version, WHOQOL-BREF) score, neuro function (National Institute of Health stroke scale, NIHSS), the ability of daily living (Barthel index), athletic ability (Fugl-Meyer motor function score), complications and prognosis (GOS) were compared between the two groups.

RESULTS

The total effective rate of operation in group A (91.49%) was higher than that in group B (76.47%), and the incidence of complications (8.70%) was lower than that in group B (27.08%; all P<0.05). NIHSS score of group A was lower than that of group B, and the WHOQOL-BREF score was higher than that of group B three months after the operation (all P<0.05). Barthel Index and Fugl-Meyer motor function scores of group A were higher than those of group B three months after the operation (all P<0.05). The prognosis of group A was better than group B three months after the operation (P<0.05).

CONCLUSION

Operation performed within 6 hours after the onset of cerebral hemorrhage is useful in the treatment of severe hypertensive intracerebral hemorrhage. It can effectively improve patients' neurological function, the ability of daily living and motor function without increasing complications and, the quality of life, as well as the prognosis of patients.

Correlation analysis of sacrococcygeal pressure and operation time in patients undergoing general anesthesia in the supine position

OBJECTIVE

This prospective study was performed to explore the change in sacrococcygeal pressure during an operation under general anesthesia in the supine position and identify the correlation between pressure injury and body mass index.

METHODS

This study involved 99 patients who underwent general anesthesia. Sacrococcygeal pressure was measured and recorded at seven time points: before general anesthesia, 5 minutes after general anesthesia, and 1, 2, 3, 4, and 5 hours after the beginning of the operation. The pressure change at each time point was compared, and the factors affecting the pressure were analyzed.

RESULTS

The correlation analysis showed that the operation time was significantly and positively associated with the occurrence of pressure injury.

CONCLUSION

Perioperative management should be strengthened to speed up the surgical process and shorten the operation time, which will help to reduce the occurrence of intraoperative pressure injury.

Clinical outcomes of powered and manual staplers in video-assisted thoracic surgery lobectomy for lung cancer

Methods: This retrospective cohort study identified patients who underwent video-assisted thoracic surgery (VATS) lobectomy for lung cancer from January 2016 to December 2018 in a Chinese tertiary general hospital. The electronic hospital medical records associated with the VATS lobectomy for lung cancer were the data sources. Results: Based on the analysis of 433 patients with the utilization of staplers in their VATS lobectomy for lung cancer, using powered stapler was associated with significantly shorter operation time and postsurgery hospital stay length than using the manual stapler in the multivariable generalized linear regression analyses with the adjustment of patient characteristics. However, no other significant differences were observed for other clinical outcomes between the two staplers.

The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases

To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient's medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16-5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87-22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14-0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5-9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: A retrospective study

Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ± 19.0 compared with 94.4 ± 29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

Risk factors for acute pulmonary embolism in patients with off-pump coronary artery bypass grafting: implications for nursing

Objective

Acute pulmonary embolism (APE) is a serious complication after off-pump coronary artery bypass grafting (OPCABG). We aimed to analyze the risk factors for APE in patients with OPCABG.

Methods

In this retrospective, observational study, patients with OPCABG who were treated in our hospital from 1 January 2018 to 31 March 2020 were included. The basic characteristics of patients and results of preoperative laboratory examinations were collected and analyzed.

Results

A total of 707 patients with OPCABG were included and the incidence of APE was 3.21%. Left ventricular ejection fraction (LVEF), a history of smoking, number of bypass grafting, duration of surgery, and age were significant risk factors for APE in patients with OPCABG. The areas under the curves of LVEF, number of bypass grafting, duration of surgery, and age were 0.773, 0.759, 0.738, and 0.723, respectively. The cutoff values of LVEF, number of bypass grafting, duration of surgery, and age were 59.84, 3.18, 237.42, and 73.28, respectively.

Conclusions

LVEF, a history of smoking, number of bypass grafting, duration of surgery, and age may be risk factors for APE in patients with OPCABG. Early measures should be taken to target these risks to prevent APE.

Preoperative Vision, Gender, and Operation Time Predict Visual Improvement After Epiretinal Membrane Vitrectomy: A Retrospective Study

Background

To evaluate the efficacy of micro-incision vitrectomy surgery using a non-contact wide-angle viewing system for fovea-attached type epiretinal membrane, and to report the factors influencing the outcome.

Methods

A retrospective, comparative case series that included 50 patients with fovea-attached type epiretinal membrane who received micro-incision vitrectomy surgery using a non-contact wide-angle viewing system.

Results

All patients were followed-up for a minimum of 12 months. Seven cases were classified as group 1A (mainly outer retinal thickening), 17 were group 1B (more tenting of outer retina and distorted inner retina), and 26 were group 1C (prominent inner retina thickening and inward tenting of outer retina). Outcome measures included operation time, recurrent rate, postoperative BCVA, and CRT. The mean operative time was 26.2 minutes. The mean change of BCVA (LogMAR) was −0.43 (p< 0.001). The mean change of CRT was 135.3 μm (p< 0.001). The mean change of CRT was significantly higher in group 1C. Worse preoperative BCVA, male gender, and longer operative time can predict better postoperative BCVA found by multivariate logistic regression and multiple regression models.

Conclusion

Significant improvement in BCVA and CRT is noted after micro-incision vitrectomy surgery to operate fovea-attached type epiretinal membranes. Worse preoperative BCVA, male, and longer operation time could predict better improvement. These findings may assist surgeons in better evaluating the potential of this method to help their patients with epiretinal membranes.

Radiographic factors to predict operation time of direct anterior total hip arthroplasty for dysplastic hips

BACKGROUND

This study aimed to identify radiographic factors that could predict surgical difficulty in direct anterior total hip arthroplasty (THA) for dysplastic hips.

PATIENTS AND METHODS

The clinical records of 160 patients (204 hips) who underwent primary THA for the treatment of developmental dysplasia of the hip were retrospectively investigated. All THAs were performed through a direct anterior approach by a single surgeon. A multiple regression analysis was developed to identify the independent predictor of operation time, including variables such as age, sex, height, body mass index (BMI), the use of bone cement, previous hip surgery, and radiographic references, including the pelvic horizontal to vertical ratio, the extent of proximal and horizontal migration of the femoral head, flatness of the femoral head, and the vertical distance between the tips of the greater trochanter and the femoral head.

RESULTS

A multiple regression analysis revealed that as radiographic factors, proximal migration of the femoral head, and lower position of the femoral head related to the greater trochanter were significantly associated with longer operation time. In addition, our results revealed that younger age, male sex, height, high BMI, cement use, and previous hip surgery were also significantly associated with longer operation time.

CONCLUSIONS

Our findings indicate that proximal migration of the femoral head and high-riding greater trochanter are isolated radiographic predictors of the longer operation time of direct anterior THA for dysplastic hips.

Minimal Access vs. Open Spine Surgery in Patients With Metastatic Spinal Cord Compression - A One-Center Randomized Controlled Trial

BACKGROUND/AIM

We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC).

PATIENTS AND METHODS

A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing.

RESULTS

The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing.

CONCLUSION

The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.

Robotic surgery enables safe and comfortable single-incision cholecystectomy: A comparison of robotic and laparoscopic approaches for single-incision surgery

Background:

Although single-incision robotic cholecystectomy (SIRC) overcomes various limitations of single-incision laparoscopic cholecystectomy (SILC), it is associated with high cost. In this study, we intended to investigate if SIRC is recommendable and advantageous to patients despite its high cost.

Materials and Methods:

We prospectively collected and analysed data of patients who had undergone either SILC (n = 25) or SIRC (n = 50) for benign gallbladder diseases, with identical inclusion criteria, between November 2017 and February 2019.

Results:

SILC and SIRC showed similar operative outcomes in terms of intra- and post-operative complications and verbal numerical rating scale (VNRS) for pain. However, the SIRC group exhibited significantly longer operation time than the SILC group (83.2 ± 32.6 vs. 66.4 ± 32.8, P = 0.002). The SIRC group also showed longer hospital stay (2.4 ± 0.7 vs. 2.2 ± 0.6, P = 0.053). Although the SILC and SIRC groups showed no significant difference in VNRS, the SIRC group required a higher amount (126.0 ± 88.8 mg vs. 87.5 ± 79.7 mg, P = 0.063) and frequency (3.0 ± 2.1 vs. 2.0 ± 1.8, P = 0.033) of intravenous opioid analgesic administration. During surgery, the critical view of safety (CVS), the prerequisite for safe cholecystectomy, was identified in only 24% (n = 6) of patients undergoing SILC and in 100% (n = 50) of patients undergoing SIRC (P < 0.05).

Conclusion:

We conclude that although SILC and SIRC have similar operative outcomes, SIRC is advantageous over SILC because of its potential to markedly enhance the safety of patients by proficiently acquiring CVS.

The efficacy of 3D printing-assisted surgery in treating distal radius fractures: systematic review and meta-analysis

Aim: To compare the efficacy of 3D printing-assisted surgery with routine surgery in the treatment of distal radius fractures to evaluate whether 3D printing technology has more advantages. Materials & methods: To retrieve all published studies that compared the efficacy of 3D printing-assisted surgery with routine surgery for distal radius fractures. Operation time, frequency of intraoperative fluoroscopy, blood loss and other outcomes were assessed. Results: The results suggested that 3D printing-assisted surgery was better than routine surgery in the fields of operation time, frequency of intraoperative fluoroscopy, and blood loss. Conclusion: In the treatment of distal radius fractures, 3D printing-assisted surgery may be superior to routine surgery.

Investigation of recurrent laryngeal palsy rates for potential associations during thyroidectomy

BACKGROUND

There are many clinical associations and potential mechanisms of injury resulting in recurrent laryngeal nerve palsy (RLNP) after thyroidectomy. One possible cause of RLNP is focal intralaryngeal compression of the recurrent laryngeal nerve (RLN), which may be associated with the tracheal tube (TT). Therefore, we examined current RLNP rates to investigate potential associations, including intralaryngeal, airway, anaesthetic and anthropometric factors.

METHODS

We analysed 1003 patients undergoing thyroid surgery at The Alfred from 2010 to 2017, who had anatomically intact RLNs at the conclusion of thyroidectomy. All included patients underwent pre- and post-operative flexible nasendoscopy. The primary outcome was RLNP rate. We analysed potential associated factors including age, sex, operative time, surgical indication, pathology, American Society of Anaesthesiologists Physical Status, Mallampati scores, body mass index, intubation grade, TT size and specimen weight. The independent risk factors were identified by logistic regression analysis.

RESULTS

Overall, RLNP occurred in 83 patients (8.3%) of which one was permanent (0.1%). On univariate analysis, RLNP was associated with male sex (P = 0.02), and duration of surgery (P = 0.002). On multivariate analysis, both male sex (P = 0.047) and duration of surgery (P = 0.04) remained significant. Further, factors postulated to cause intralaryngeal compression of the RLN, including TT size, body mass index, intubation grade and Mallampati score, were not significantly associated with RLNP.

CONCLUSION

Our study showed a RLNP rate of 8.3%, and associations with longer operative duration, and male sex. Potential intralaryngeal factors were not identified.

Analysis of risk factors for perioperative hidden blood loss in patients undergoing transforaminal lumbar interbody fusion

Objective

This study was performed to analyze the correlation between perioperative hidden blood loss (HBL) and the general condition of patients undergoing transforaminal lumbar interbody fusion (TLIF).

Methods

We retrospectively analyzed patients who underwent TLIF from July 2017 to July 2019 in our hospital. Sex, age, body mass index, underlying diseases, American Society of Anesthesiologists classification, coagulation function, preoperative and postoperative hemoglobin level and hematocrit, surgery time, fusion level, intraoperative blood loss, and drainage volume were recorded. Postoperative complications were also recorded. The amount of HBL was calculated, and its correlation with related variables was analyzed.

Results

The mean surgery time was 153.32 ± 54.86 minutes. The total perioperative blood loss was 789.22 ± 499.68 mL, including HBL of 315.69 ± 199.87 mL. Pearson correlation analysis showed statistically significant differences in HBL according to the body mass index, hypertension, fibrinogen, surgery time, and fusion level. Multiple linear regression analysis indicated that the surgery time and fusion level were independent risk factors for HBL.

Conclusions

A certain amount of HBL occurs in TLIF surgery and cannot be ignored in daily clinical work. The operation time and surgery level are independent risk factors for HBL.

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse - a single centre's experience

OBJECTIVES

The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy.

MATERIAL AND METHODS

This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors.

RESULTS

Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1-1.4)], low preoperative haemoglobin [OR: 0.96 (0.94-0.98)], uterine weight [OR: 2.69 (2.62-2.76)], and long operation time [OR: 1.04 (1.02-1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96-1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve.

CONCLUSIONS

Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.

Pediatric Scoliosis Surgery-A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia

Background and Objectives: There are currently no data available regarding pediatric scoliosis surgery in Latvia. The aim of this article is to present treatment specific variables, investigate their interrelation, and identify predictors for the length of stay after surgical pediatric scoliosis correction. Materials and Methods: This retrospective study included all surgical pediatric scoliosis corrections in Latvia for the years 2012 to 2016. Analyzed parameters were chosen to portray the patients' demographics, pathology, as well as treatment specific variables. Descriptive, inferential, and linear regression statistics were calculated. Results: A total of 69 cases, 74% female and 26% male, were identified. The diagnostic subgroups consisted of 62% idiopathic (IDI) and 38% non-idiopathic (non-IDI) scoliosis cases. Non-IDI cases had significantly increased operation time, hospital stay, Cobb angle before surgery, and instrumented levels, while IDI cases showed significantly higher Cobb angle percentage correction. For all operated cases, the operation time and the hospital stay decreased significantly over the investigated time period. Early post-operative complications (PCs) occurred in 15.9% of the cases and were associated with increased hospital stay, instrumented levels, and Cobb angle before surgery. The linear regression analysis revealed that operation time and the presence of PCs were significant predictors for the length of the hospital stay. Conclusions: This is the first study to provide comprehensive insight into pediatric scoliosis surgery since its establishment in Latvia. Our regression model offers clinically applicable predictors and further underlines the significance of the operation length on the hospital stay. These results build the foundation for international comparison and facilitate improvement in the field.

Risk factors for progressive sarcopenia 6 months after complete resection of lung cancer: what can thoracic surgeons do against sarcopenia?

Background

Our previous report described how postoperative progression of sarcopenia predicted long-term prognosis after complete resection of non-small cell lung cancer (NSCLC) in heavy smokers. However, there are currently no effective means to treat progressive sarcopenia. In this study, we aimed to confirm our previous findings in a larger population and to identify factors associated with postoperative progression of sarcopenia to propose possible preventative measures.

Methods

This retrospective study analyzed the data of 1,095 patients who underwent curative lobar resection for NSCLC at Kanagawa Cancer Center. We divided patients into four groups according to sex and Brinkman index (BI) above or below 600. Six-month postoperative changes in the skeletal muscle index (SMI) were calculated and associations between clinicopathological factors including changes in SMI and mortality from postoperative 6 months were examined. Only in groups in which postoperative depletion of SMI was shown to be associated with the prognosis, we identified clinicopathological factors associated with depletive SMI.

Results

The overall survival rates of 1,095 patients were 89.8% and 82.5% at 3 and 5 years, respectively. The median 6-month change in SMI was –3.4% (range, −22.3% to +17.9%). Multivariate analysis revealed that poor prognosis was independently predicted by a large reduction in the SMI (cut-off value: −10%) in males with a BI ≥600. In 391 heavy-smoking males, factors associated with a postoperative change in SMI ≤−10% were history of other cancers (including gastric cancer) low forced expiratory volume in one second (FEV 1.0, cut-off value: 1,870 mL), and prolonged operation time (cut-off value: 200 minutes).

Conclusions

Perioperative measures to prevent postoperative sarcopenia are appropriate for heavy smokers. We obtained some clues regarding countermeasures, one of which may be avoiding long-time operation. Further studies including clinical trials to assess perioperative anti-sarcopenia treatments, are needed.

Characteristics of pulmonary mucormycosis and the experiences of surgical resection

Background

Pulmonary mucormycosis (PM) is a relatively rare but fatal infection. However, detailed surgery data have been lacking. We summarized the characteristics of this rare disease and clarified the experiences of surgical resection

Methods

We conducted a single-center retrospective study of seven patients with PM who underwent surgical resection at China-Japan Friendship Hospital from May 2011 to May 2018.

Results

Patient ages ranged from 18 to 70 years, with a median age of 47 years. Manual workers (85.7%) were the most common occupation and their educational level was also below high school. Diabetes was the most common underlying condition. The most common radiographic finding was lobar consolidation. Three patients directly underwent open thoracotomy, one patient underwent video-assisted thoracic surgery (VATS) and three patients converted from VATS to thoracotomy. The median operation time was 240 min [interquartile range (IQR), 150–390 min], the median intraoperative blood loss was 500 mL (IQR, 100–1,200 mL) and the median intraoperative blood transfusion was 600 mL (IQR, 0–1,600 mL). In-hospital, 90-day, 1-year and 5-year mortality were 14.3%, 14.3%, 28.8% and 42.9%, respectively.

Conclusions

PM is a rare but fatal infection. Due to chest adhesion and vascular invasion, the proportion of massive bleeding and long operation time has increased sharply.

Therapeutic effect of pre-operative tirofiban on patients with acute ischemic stroke with mechanical thrombectomy within 6-24 hours

OBJECTIVE

The objective of this study was to investigate and discuss the therapeutic effect of pre-operative tirofiban on patients with acute ischemic stroke (AIS) with mechanical thrombectomy (MT) within 6-24 h.

PATIENTS AND METHODS

We retrospectively queried our AIS database from January to November 2018, and selected 99 patients with AIS within 6-24 h and evidence of proximal large vessel occlusion who were suitable for MT. They were divided into two groups, group A (with tirofiban, n = 56) and group B (without tirofiban, n = 43), according to whether they were intravenously infused with tirofiban before MT. The baseline characteristics and outcomes of patients were subjected to statistical analysis, including age, gender and risk factors, occlusion site, the time from onset to door, time of door to puncture, baseline National Institutes of Health Stroke Scale (NIHSS), pre-operative Alberta stroke programme early CT (ASPECT) score, angioplasty/stenting, modified Rankin Scale score 0-2 at 3 months, symptomatic haemorrhage and mortality, the time of door to recanalization, endovascular procedure time, 7-day (7d) NIHSS score, and a modified treatment in cerebral infarction (m-TICI) grade of 2b or 3. All of the thrombi were analysed by histopathology.

RESULTS

The differences in the time of door to recanalization, endovascular procedure time, 7d NIHSS score and the m-TICI were significantly different between groups (P < 0.05). The other agents were not significantly different between groups (P > 0.05 each). Histopathological analysis showed that all thrombi contained different amounts of platelets, fibrinogen, Haemamoebas and red blood cells.

CONCLUSION

The use of tirofiban before MT can shorten the procedure time and improve the recanalization rate of occluded vessels in AIS patients.

Predictors for Surgery-Related Emergency Department Visits within 30 Days of Foot and Ankle Surgeries

Presentation to an emergency department (ED) after foot and ankle surgeries not only causes inconvenience to patients but also increases healthcare costs. To minimize this, many major institutions have tracked these data as a part of quality improvement measures. Our previous study showed that factors associated with any (surgery-related and unrelated) postoperative ED visits were not easily modifiable by surgeons. Therefore, in the current study, we focused on factors associated specifically with surgery-related postoperative ED visits, because this may provide some insights for surgeons rather than just administrators. We examined 513 foot and ankle surgeries, of which 114 resulted in 30-day postoperative ED visits for surgery-related reasons. Demographic, medical, and surgical factors were evaluated, and risk factors were identified after adjusting for potential clinically relevant covariates. Both inpatient and outpatient surgical settings and outpatient surgical settings alone were analyzed separately. Regardless of the setting, we found that shorter surgery was protective against postoperative ED visits, as was having a previous ED visit within 6 months before surgery. In the outpatient setting, younger age and having no insurance were also proxies for a postoperative ED visit, in addition to the above factors.