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Yurick S, Ray S, El-Nashar S, Brennand E, Kim-Fine S, Sanaee M, Regan S, Geoffrion R, Occhino J, Hijaz A, Sheyn D. Prediction of Postoperative Urinary Tract Infection Following Benign Gynecologic Surgery. Int Urogynecol J 2024:10.1007/s00192-024-05773-9. [PMID: 38625604 DOI: 10.1007/s00192-024-05773-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to develop a prediction model for urinary tract infection (UTI) after pelvic surgery. METHODS We utilized data from three tertiary care centers of women undergoing pelvic surgery. The primary outcome was a UTI within 8 weeks of surgery. Additional variables collected included procedural data, severity of prolapse, use of mesh, anti-incontinence surgery, EBL, diabetes, steroid use, estrogen use, postoperative catheter use, PVR, history of recurrent UTI, operative time, comorbidities, and postoperative morbidity including venous thromboembolism, surgical site infection. Two datasets were used for internal validation, whereas a third dataset was used for external validation. Algorithms that tested included the following: multivariable logistic regression, decision trees (DTs), naive Bayes (NB), random forest (RF), gradient boosting (GB), and multilayer perceptron (MP). RESULTS For the training dataset, containing both University of British Columbia and Mayo Clinic Rochester data, there were 1,657 patients, with 172 (10.4%) UTIs; whereas for the University of Calgary external validation data, there were a total of 392 patients with a UTI rate of 16.1% (n = 63). All models performed well; however, the GB, DT, and RF models all had an area under the curve (AUC) > 0.97. With external validation the model retained high discriminatory ability, DT: AUC = 0.88, RF: AUC = 0.88, and GB: AUC = 0.90. CONCLUSIONS A model with high discriminatory ability can predict UTI within 8 weeks of pelvic surgery. Future studies should focus on prospective validation and application of randomized trial models to test the utility of this model in the prevention of postoperative UTI.
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Affiliation(s)
- Sarah Yurick
- Case Western Reserve University College of Engineering, Cleveland, OH, USA
| | - Soumya Ray
- Case Western Reserve University College of Engineering, Cleveland, OH, USA
| | | | | | | | - May Sanaee
- University of Alberta, Edmonton, AB, Canada
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Subba K, Lambert E, El-Ghobashy A. Tips and tricks in gynaecological robotic surgery. Best Pract Res Clin Obstet Gynaecol 2024; 93:102453. [PMID: 38219641 DOI: 10.1016/j.bpobgyn.2023.102453] [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: 11/22/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
It was the dawn of a new era for robotic surgery when the Food and Drug Administration (FDA) approved da Vinci robotic surgical system for general laparoscopic procedures in 2000. The surgical practice saw a transformative breakthrough towards minimally invasive approach with the ever-increasing uptake of advanced robots proven to benefit patients and surgeons in various ways. However, these innovative machines only complement and enhance a surgeon's operating skills, and with such privilege come responsibilities and new challenges. Heavy reliance on such advanced devices while operating on humans necessitates thorough training and supervision to ensure safe and efficient applications. It is the surgeon's responsibility to direct the procedure constantly and lead other team members who assist during the surgery. In this chapter, we provide miscellaneous tips and tricks that can help beginners navigate through robotic surgery with more confidence and enthusiasm.
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Affiliation(s)
- Kamana Subba
- Obstetrics and Gynaecology, Gynaecological Oncology, UK.
| | | | - Alaa El-Ghobashy
- Department of Gynaecological Oncology, The Royal Wolverhampton NHS Trust, West Midlands, UK
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Robin F, Roux L, Zaheer MA, Sulpice L, Dion L, Lavoue V, Landreau J, Morandi X, Nyangoh Timoh K. A reappraisal of the deep uterine vein: a multimodal exploration with implications for pelvic surgery. Surg Radiol Anat 2024; 46:381-390. [PMID: 38493417 DOI: 10.1007/s00276-024-03316-x] [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: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Pelvic gynecological surgeries, whether for malignant or benign conditions, frequently result in functional complications due to injuries to the autonomic nervous system. Recognizing the deep uterine vein (DUV) as an essential anatomical reference can aid in preserving these structures. Despite its significance, the DUV is infrequently studied and lacks comprehensive documentation in Terminologia Anatomica. This research endeavors to elucidate a detailed characterization of the DUV. METHODS We undertook a systematic literature review aligning with the "PRISMA" guidelines, sourcing from PUBMED and EMBASE. Our comprehensive anatomical examination encompassed cadaveric dissections and radio-anatomical evaluations utilizing the Anatomage® Table. RESULTS The literary exploration revealed a consensus on the DUV's description based on both anatomical and surgical observations. It arises from the merger of cervical, vesical, and vaginal veins, coursing through the paracervix in a descending and rearward direction before culminating in the internal iliac vein. The hands-on anatomical study further delineated the DUV's associations throughout its course, highlighting its role in bifurcating the uterus's lateral aspect into two distinct zones: a superior vascular zone housing the uterine artery and ureter and an inferior nervous segment below the DUV representing the autonomic nerve pathway. CONCLUSION A profound understanding of the subperitoneal space anatomy is paramount for pelvic surgeons to mitigate postoperative complications. The DUV's intricate neurovascular interplays underscore its significance as an indispensable surgical guide for safeguarding nerves and the ureter.
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Affiliation(s)
- Fabien Robin
- Department of Digestive Surgery and Liver Transplantation, Rennes University Hospital, Rennes, France
- INSERM OSS U1242, University Hospital, Rennes 1 University, Rennes, France
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Léa Roux
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Myra A Zaheer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Laurent Sulpice
- Department of Digestive Surgery and Liver Transplantation, Rennes University Hospital, Rennes, France
- INSERM OSS U1242, University Hospital, Rennes 1 University, Rennes, France
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Ludivine Dion
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
| | - Vincent Lavoue
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Julien Landreau
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Xavier Morandi
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Krystel Nyangoh Timoh
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France.
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France.
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France.
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Dai J, Li S, Weng Q, Long J, Wu D. Opioid-free anesthesia with ultrasound-guided quadratus lumborum block in the supine position for lower abdominal or pelvic surgery: a randomized controlled trial. Sci Rep 2024; 14:4652. [PMID: 38409359 PMCID: PMC10897418 DOI: 10.1038/s41598-024-55370-5] [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: 09/06/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
In the past, quadratus lumborum block (QLB) was mostly used for postoperative analgesia in patients, and few anesthesiologists applied it during surgery with opioid-free anesthesia (OFA). Consequently, it is still unclear whether QLB in the supine position can provide perfect analgesia and inhibit anesthetic stress during surgery under the OFA strategy. To observe the clinical efficacy of ultrasound-guided quadratus lumborum block (US-QLB) in the supine position with OFA for lower abdominal and pelvic surgery. A total of 122 patients who underwent lower abdominal or pelvic surgery in People's Hospital of Wanning between March 2021 and July 2022 were selected and divided into a quadratus lumborum block group (Q) (n = 62) and control group (C) (n = 60) according to the random number table method. Both groups underwent general anesthesia combined with QLB in the supine position. After sedation, unilateral or bilateral QLB was performed via the ultrasound guided anterior approach based on images resembling a "human eye" and "baby in a cradle" under local anesthesia according to the needs of the operative field. In group Q, 20 ml of 0.50% lidocaine and 0.20% ropivacaine diluted in normal saline (NS) were injected into each side. In group C, 20 ml of NS was injected into each side. The values of BP, HR, SPO2, SE, RE, SPI, NRS, Steward score, dosage of propofol, dexmedetomidine, and rocuronium, the number of patients who needed remifentanil, propofol, or diltiazem, puncture point, block plane, duration of anesthesia, catheter extraction, and wakefulness during the operation were monitored. There were no significant differences in the general data, number of cases requiring additional remifentanil, propofol, or diltiazem treatment, as well as puncture point and puncture plane between the two groups (P > 0.05). HR, SBP, and DBP values were higher in group Q than in group C at T1; HR, SPI, and SE, while RE values were lower in group Q than in group C at T3, SE, and RE; the Steward score was higher in group Q than in group C at T4 and T5, and the difference was statistically significant (P < 0.05). The extubation and awake times were lower in group Q than in group C, and the difference was statistically significant (P < 0.05). The SE, RE, and SPI values were lower at T1, T2, T3, and T4 than at T0. The Steward scores at T4 and T5 were higher in group Q than in group C, and were lower than at T0, with a statistically significant difference (P < 0.05). There were significant differences in the effectiveness of postoperative analgesia between the two groups at t1, t3 and t4 (P < 0.05). US-QLB in the supine position with OFA is effective in patients undergoing lower abdominal or pelvic surgery with stable intraoperative vital signs, complete recovery and better postoperative analgesia.
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Affiliation(s)
- Jingwei Dai
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Shanliang Li
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Qijun Weng
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Jinxiong Long
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Duozhi Wu
- Department of Anesthesiology, Hainan General Hospital, Haikou, 570311, Hainan, China.
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Sighinolfi MC, De Maria M, Meneghetti I, Felline M, Ceretti AP, Mosillo L, Catalano C, Morandi A, Calcagnile T, Panio E, Sangalli M, Turri F, Terzoni S, Assumma S, Sarchi L, Afonina M, Marconi A, Bianchi PP, Micali S, Rocco B, Gaia G. The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes. World J Urol 2024; 42:31. [PMID: 38217724 PMCID: PMC10787883 DOI: 10.1007/s00345-023-04730-3] [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: 07/11/2023] [Accepted: 10/16/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Versius CMR is a novel robotic system characterized by an open surgical console and independent bedside units. The system has potentials of flexibility and versatility, and has been used in urological, gynecological, and general surgical procedure. The aim is to depict a comprehensive analysis of the Versius system for pelvic surgery. METHODS This is a study involving two Institutions, ASST Santi Paolo and Carlo, Milan, and Apuane Hospital, Massa, Italy. All interventions performed in the pelvic area with the Versius were included. Data about indications, intra-, and post-operative course were prospectively collected and analyzed. RESULTS A total of 171 interventions were performed with the Versius. Forty-two of them involved pelvic procedures. Twenty-two had an oncological indication (localized prostate cancer), the remaining had a non-oncological or functional purpose. The mostly performed pelvic procedure was radical prostatectomy (22) followed by annexectomy (9). No intra-operative complication nor conversion to other approaches occurred. A Clavien II complication and one Clavien IIIb were reported. Malfunctioning/alarms requiring a power cycle of the system occurred in 2 different cases. An adjustment in trocar placement according to patients' height was required in 2 patients undergoing prostatectomy, in which the trocar was moved caudally. In two cases, a pelvic prolapse was repaired concomitant with other gynecological procedures. CONCLUSIONS Pelvic surgery with the Versius is feasible without major complications; either dissection and reconstructive steps could be accomplished, provided a proper OR setup and trocar placement are pursued. Versius can be easily adopted by surgeons of different disciplines and backgrounds; a further multi-specialty implementation is presumed and long-term oncological and functional outcomes are awaited.
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Affiliation(s)
| | | | | | - Mauro Felline
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | | | | | | | - Enrico Panio
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Filippo Turri
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | - Simone Assumma
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Luca Sarchi
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | | | | - Salvatore Micali
- Unit of Urology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Bernardo Rocco
- Unit of Urology, ASST Santi Paolo and Carlo, Milan, Italy
| | - Giorgia Gaia
- Unit of Gynecology, ASST Santi Paolo and Carlo, Milan, Italy
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Pagano S, Müller K, Alt V, Maderbacher G, Holzapfel DE, Baumann F, Freigang V. [Navigated or conventional acetabular surgery : Comparison of positional accuracy exemplified by the infra-acetabular screw]. Unfallchirurgie (Heidelb) 2024; 127:44-53. [PMID: 36929038 PMCID: PMC10786994 DOI: 10.1007/s00113-023-01304-1] [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] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The principle of joint-preserving treatment of acetabular fractures is the anatomic reduction of joint-bearing elements and internal osteosynthesis. For stabilization of the anterior and posterior columns against each other, the infra-acetabular screw (IAS) is regularly used in the clinical routine. OBJECTIVE The aim of this study was to compare the position of the IAS in the infra-acetabular corridor after navigated placement and after freehand placement. MATERIAL AND METHOD The position of the screw was evaluated in 42 patients using multiplanar reconstructions. The screw was placed freehand in 30 patients and using image-guided navigation in 12 patients. In addition to measurement of the position of the screw, demographic data, operating time, radiation exposure and blood loss were recorded. RESULTS The vast majority of the patients were male (86%), the median age was 67 years and the median body mass index (BMI) was 25 kg/m2. The median operating time was 166 min and the median blood loss was 900 ml. The adjusted values in the whole sample considering the position of the screw were: distance of screw to cartilage mean value (m) = 3.8 mm, distance of screw to corridor center m = 3.5 mm and angle of screw to corridor m = 1.4°. There were no differences between the groups in the demographic parameters and the accuracy of positioning of the screw (p-value > 0.05). There was a longer irradiation time and a higher radiation dose in the navigated group compared to the group without navigation (p-value < 0.001). CONCLUSION With appropriate experience both procedures are comparable taking into account the accuracy. Taking into consideration other perioperative parameters, such as radiation exposure and planned operating time, patient-related factors should be taken into consideration.
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Affiliation(s)
- Stefano Pagano
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Karolina Müller
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Günther Maderbacher
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Dominik E Holzapfel
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - Viola Freigang
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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Lim WH, Lamaro VP, Livingstone S. Pre-operative ureteric catherisation for major endoscopic gynaecological surgery. Surg Endosc 2023; 37:8335-8339. [PMID: 37697117 DOI: 10.1007/s00464-023-10359-5] [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: 06/05/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Several strategies have been implemented to better identify the course of the ureters intra-operatively due of the morbidity associated with ureteric injuries especially during gynaecological surgery. We described our experience with pre-operative ureteric catherisation in women who underwent major endoscopic gynaecological surgery. METHODS A case-controlled study of 862 women who underwent major endoscopic gynaecological surgery sourced from two health institutions were conducted. Two groups were compared: those who had pre-operative prophylactic ureteric catherisation (study group) and those who had routine cystoscopy performed immediately post surgery (control group). RESULTS There were no intra-operative ureteric injuries or associated complications noted in the study group. When compared to the control group, length of hospital stay (2 days vs 5 days; p < 0.05) and overall mean time for cystoscopy (11 min vs 35 min; p < 0.05) was significantly shorter in the study group. There was no long-term morbidity recorded in the study group. CONCLUSION Our experiences with prophylactic pre-operative bilateral ureteric catheterisation for major endoscopic gynaecological surgeries were favourable and are associated with low complication rates. Routine or adjunct use before major gynaecological and pelvic surgery combined with meticulous surgical technique can help reduce iatrogenic and unintentional ureteric injuries.
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Affiliation(s)
- Wei How Lim
- Department of Gynaecology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, 2500, Australia.
| | - Vincent P Lamaro
- Department of Gynaecology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Sarah Livingstone
- Department of Gynaecology, St Vincent's Hospital Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
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Chang S, Liu Y, Guo J, Bi X. Bi's purse-string suture: an effective method for presacral venous bleeding. Updates Surg 2023; 75:2043-2046. [PMID: 37432569 DOI: 10.1007/s13304-023-01586-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
Presacral venous bleeding (PSVB) is an intractable situation during rectal mobilization. Till now, various methods for PSVB are introduced, but each of them has limitations. This article aims to introduce an effective approach for PSVB, which is created by Professor Xiaogang Bi. In the case of PSVB, a purse-string suture which highlighted each stitch penetrates periosteum of sacrum was performed around the bleeding site. After that, the branches of presacral venous plexus around the bleeding site were compressed to the sacrum when the stitches were tightened, the blood flow of the venous branches was blocked by the thread across them, the bleeding was controlled, and then, the knot was tied. From April 24th 2017 to November 6th 2022, ten patients who suffered PSVB during surgery accepted Bi's suture. With Bi's suture, all of the ten cases of PSVB were controlled effectively. Nine of ten cases were controlled immediately only by Bi's suture, one case which accompanied with blood oozing of sacrum wound was controlled by Bi's suture, bone wax, and pelvic gauze packing. Bi's suture is an effective approach for PSVB. It could be easily performed without the need of special materials.
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Affiliation(s)
- Shaofei Chang
- Department of Gastroenteropancreas, Shanxi Provincial People's Hospital, Shuangta Street, Yingze District, Taiyuan, 030012, China
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin's Clinical Research Center For Cancer, Huanhuxi Road, Hexi District, Tianjin, 300060, China
| | - Yaohua Liu
- Department of Ultrasound, The Second People's Hospital of Shanxi Province, Kouzhuangxi Road, Yingze District, Taiyuan, 030012, China
- Shanxi Medical University, Daxue Street, Yuci District, Jinzhong, 030600, China
| | - Jien Guo
- Department of Gastroenteropancreas, Shanxi Provincial People's Hospital, Shuangta Street, Yingze District, Taiyuan, 030012, China
| | - Xiaogang Bi
- Department of Gastroenteropancreas, Shanxi Provincial People's Hospital, Shuangta Street, Yingze District, Taiyuan, 030012, China.
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La Riva A, Sayegh AS, Perez LC, Poncel J, Medina LG, Adamic B, Powers R, Cacciamani GE, Aron M, Gill I, Sotelo R. Obturator Nerve Injury in Robotic Pelvic Surgery: Scenarios and Management Strategies. Eur Urol 2023; 83:361-368. [PMID: 36642661 DOI: 10.1016/j.eururo.2022.12.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Obturator nerve injury (ONI) is an uncommon complication of pelvic surgery, usually reported in 0.2-5.7% of cases undergoing surgical treatment of urological and gynecological malignancies involving pelvic lymph node dissection (PLND). OBJECTIVE To describe how an ONI may occur during robotic pelvic surgery and the corresponding management strategies. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed video content on intraoperative ONI provided by robotic surgeons from high-volume centers. SURGICAL PROCEDURE ONI was identified during PLND and managed according to the type of nerve injury. RESULTS AND LIMITATIONS The management approach varies with the type of injury. Crush injury frequently occurs at an advanced stage of PLND. For a crush injury to the obturator nerve caused by a clip, management only requires its safe removal. Three situations can occur if the nerve is transected: (1) transection with feasible approximation and tension-free nerve anastomosis; (2) transection with challenging approximation requiring certain strategies for proper nerve anastomosis; and (3) transection with a hidden proximal nerve ending that may initially appear intact, but is clearly injured when revealed by further dissection. Each case has different management strategies with a common aim of prompt repair of the anatomic disruption to restore proper nerve conduction. CONCLUSIONS ONI is a preventable complication that requires proper identification of the anatomy and high-risk areas when performing pelvic lymph node dissection. Prompt intraoperative recognition and repair using the management strategies described offer patients the best chance of recovery without sequelae. PATIENT SUMMARY We describe the different ways in which the obturator nerve in the pelvic area can be damaged during urological or gynecological surgeries. This is a preventable complication and we describe how it can be avoided and different management options, depending on the type of nerve injury.
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Affiliation(s)
- Anibal La Riva
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S Sayegh
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura C Perez
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaime Poncel
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luis G Medina
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brittany Adamic
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Powers
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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10
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Gomez Ruiz M, Ballestero Diego R, Tejedor P, Cagigas Fernandez C, Cristobal Poch L, Suarez Pazos N, Castillo Diego J. Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality. Updates Surg 2023; 75:589-597. [PMID: 36763301 DOI: 10.1007/s13304-023-01450-6] [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: 07/19/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
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Affiliation(s)
- Marcos Gomez Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Roberto Ballestero Diego
- Urology, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Patricia Tejedor
- Colorectal Surgery Unit, General Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Carmen Cagigas Fernandez
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Lidia Cristobal Poch
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Natalia Suarez Pazos
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Julio Castillo Diego
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
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11
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Rocco B, Giorgia G, Simone A, Tommaso C, Mattia S, Stefano T, Ahmed E, Giorgio B, De Concilio B, Celia A, Salvatore M, Sighinolfi MC. Rectal Perforation During Pelvic Surgery. EUR UROL SUPPL 2022; 44:54-59. [PMID: 36093319 PMCID: PMC9449548 DOI: 10.1016/j.euros.2022.04.006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Rectal perforations during pelvic surgery are rare but serious complications. The occurrence of rectal involvement is generally lower than that of the involvement of other portions of the bowel. The urologic field is responsible for the majority of iatrogenic rectal injuries from pelvic surgery; general and gynecologic surgeries are prone to the occurrence as well, the latter especially in the case of rectal shaving for deep infiltrating endometriosis. Attention should be posed to the prevention of rectal injuries, especially in case of challenging or salvage procedures; some tricks may be recommended to avoid thermal and mechanical damages and to realize a safe dissection. Intraoperative detection of rectal injuries is of paramount importance; once confirmed, immediate management with the closure of the defect is recommended. In general, rectal injuries diagnosed after surgery are liable to significantly worse outcomes than those detected and managed intraoperatively. Patient summary Rectal perforation is a rare but possible complication of pelvic surgeries. The more challenging the procedure (ie, surgery for locally advanced tumors or after radiation therapy), the higher the risk of rectal lesion. Intraoperative management of the injury should be attempted, with direct repair of the defect with or without fecal diversion.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Corresponding author. Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy. Tel. +39 335 830 6522.
| | - Gaia Giorgia
- Department of Gynecology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Assumma Simone
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Calcagnile Tommaso
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sangalli Mattia
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Terzoni Stefano
- SIG Group on Continence Care, European Association of Urology Nurses, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Eissa Ahmed
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Antonio Celia
- San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Micali Salvatore
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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12
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Grothe T, Günther KP, Hartmann A, Blum S, Haselhoff R, Goronzy J. The incidence of adverse local tissue reaction due to head taper corrosion after total hip arthroplasty using V40 taper and 36 mm CoCr head. Bone Joint J 2022; 104-B:852-858. [PMID: 35775169 DOI: 10.1302/0301-620x.104b7.bjj-2021-1769.r1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. METHODS Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. RESULTS A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. CONCLUSION Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852-858.
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Affiliation(s)
- Tim Grothe
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Albrecht Hartmann
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Sophia Blum
- Department of Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Richard Haselhoff
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jens Goronzy
- Centre of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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13
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Chen E, Kowalski JT. Natural history of postoperative neuropathies in gynecologic surgery. Int Urogynecol J 2022; 33:2471-2474. [PMID: 35384477 DOI: 10.1007/s00192-022-05183-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Neuropathy following pelvic surgery is an uncommon but important complication. The current literature about the natural history and treatment of these neuropathies is limited. We aim to describe the characteristics, treatments and natural history of postoperative neuropathy following benign gynecologic surgery. METHODS This retrospective case series included patients who underwent benign gynecologic surgery for ≥ 60 min in lithotomy. Patients with preexisting neurologic disease were excluded. Patient demographics, identification of postoperative neuropathy and details regarding evaluation and treatment were obtained from the medical record. Neuropathies were characterized by anatomic location and nerve/dermatome distribution. Duration of symptoms was classified as < 1 week, 1 week to 3 months or > 3 months with neuropathy symptoms grouped as resolved, persistent but improved or persistent. Data were analyzed with appropriate descriptive statistics, Pearson correlation and chi-square test. RESULTS The study included 2449 patients who had undergone benign gynecologic surgery, with 78 (3.2%) patients identified as having postoperative neuropathy. Most patients with neuropathies demonstrated either complete resolution [59 (75.6%)] or persistent but improved [13 (16.7%)] symptoms. Twenty-eight (35.9%) had symptoms of ≥ 3 months. Most neuropathies were sensory only [63 (80.8%)], and the most frequently documented nerve distribution was femoral [23 (29.5%)]. Evaluation and treatment of neuropathy most commonly included physical therapy consult [17 (21.8%)] and neurology consult [8 (10.3%)]. CONCLUSIONS The incidence of postoperative neuropathy in this large, benign gynecologic surgery population was 3.2%. Most neuropathies are sensory only and self-limited. While physical therapy was the most common treatment, most patients received no specific intervention.
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Affiliation(s)
- Edison Chen
- Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Joseph T Kowalski
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA, 52245, USA.
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14
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Abstract
In the pelvis, anatomic complexity and difficulty in visualization and access make surgery a formidable task. Surgeons are prone to work-related musculoskeletal injuries from the frequently poor design and flow of their work environment. This is exacerbated by the strain of surgery in the pelvis. These injuries can result in alterations to a surgeons practice, inadvertent patient injury, and even early retirement. Human factors examines the relationships between the surgeon, their instruments and their environment. By bridging physiology, psychology, and ergonomics, human factors allows a better understanding of some of the challenges posed by pelvic surgery. The operative approach involved (open, laparoscopic, robotic, or perineal) plays an important role in the relevant human factors. Improved understanding of ergonomics can mitigate these risks to surgeons. Other human factors approaches such as standardization, use of checklists, and employing resiliency efforts can all improve patient safety in the operating theatre.
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Affiliation(s)
- Matthew M Symer
- Division of Colorectal Surgery, NewYork/Presbyterian-Weill Cornell Medicine, New York, NY, USA.
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis, Sacramento, CA, USA.
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15
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Privalov M, Beisemann N, Swartman B, Vetter SY, Grützner PA, Franke J, Keil H. First experiences with intraoperative CT in navigated sacroiliac (SI) instrumentation: An analysis of 25 cases and comparison with conventional intraoperative 2D and 3D imaging. Injury 2021; 52:2730-2737. [PMID: 32113742 DOI: 10.1016/j.injury.2020.02.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intraoperative imaging is regularly used for intraoperative reduction control and evaluation of the implant position in trauma surgery. 2D imaging is limited, especially in complex anatomical regions such as the pelvis. The introduction of mobile 3D C-arms (CBCT: cone-beam computed tomography) has significantly improved intraoperative assessment. Nevertheless, there are still limitations regarding the field of view and metal artifacts. The purpose of this study was to evaluate the potential of intraoperative computed tomography (iCT) in surgical treatment of sacroiliac (SI) injuries. METHODS Twenty-five cases with injuries of the posterior pelvic ring involving the SI region that were surgically treated with navigated SI screws using the mobile iCT Airo (Brainlab, Munich, Germany) were analysed. Subsequently, the data were compared with historical control groups (CBCT with and without navigation; 2D fluoroscopy only). RESULTS The average score for subjective image quality achieved using the Likert scale is significantly higher for the iCT (4.48 ± 0.65) than for the CBCT (3.04 ± 0.69) with p = 0.00. The average duration of surgery using iCT was 189.32 ± 88.64 min, which was not significantly different from the control groups (p = 0.14 - 0.70). The average fluoroscopy time using iCT was 81.96 ± 97.34 s, which was significantly shorter than in all of the control groups (p = 0.00 - 0.03). The rate for postoperatively detected complications after using iCT was 0% (n = 0). Compared with the 2D-only control group (25%; n = 1), there is a significant difference (p = 0.01). The remaining two control groups showed no significant differences (p = 0.09 - 0.19). CONCLUSIONS The iCT provides excellent image quality that allows reliable assessment of fracture reduction and implant placement even in complex anatomical regions. The radiation exposure for the medical staff is reduced by decreasing the fluoroscopy time without significantly prolonging the surgical time. Overall, the possibility of intraoperative correction improves clinical outcome and patient treatment in the long term.
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Affiliation(s)
- Maxim Privalov
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Nils Beisemann
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Benedict Swartman
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Sven Y Vetter
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Paul A Grützner
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Jochen Franke
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
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16
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Walton E, Wolner Z, Hammett J. Vaginal cuff pyoderma gangrenosum with associated ureteral stricture: A case report. Urol Case Rep 2021; 39:101826. [PMID: 34522619 PMCID: PMC8424502 DOI: 10.1016/j.eucr.2021.101826] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/18/2022] Open
Abstract
Pyoderma gangrenosum is a sterile inflammatory disease of unknown etiology characterized by recurrent cutaneous ulcers. It can occur in extracutaneous locations, especially at operative sites, and has been reported following gynecologic surgery. This report is the first case of pyoderma gangrenosum as a remote complication of pelvic surgery with associated ureteral stricture. It demonstrates the diagnostic challenge of this rare disease and the importance of broadening the differential diagnosis when apparent infections do not respond to treatment to minimize the morbidity of ineffective antibiotic and surgical interventions.
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Affiliation(s)
- Eric Walton
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite B 1400, Atlanta, GA, 30322, USA
| | - Zachary Wolner
- Department of Dermatology, Emory University School of Medicine, 1525 Clifton Rd #3, Atlanta, GA, 30322, USA
| | - Jessica Hammett
- Department of Urology, Emory University School of Medicine, 1365 Clifton Road NE, Building B, Suite B 1400, Atlanta, GA, 30322, USA
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17
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Stefan S, Wagh M, Siddiqi N, Naqvi S, Rawlinson E, Shepherd A, Khan J. Self-assembling peptide haemostatic gel reduces incidence of pelvic collection after total mesorectal excision: Prospective cohort study. Ann Med Surg (Lond) 2021; 68:102553. [PMID: 34434548 PMCID: PMC8376673 DOI: 10.1016/j.amsu.2021.102553] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pelvic surgery has the potential to leave behind a large raw surface, which can bleed and ooze postoperatively. The adoption of precision surgical approach for rectal cancers has led to reduction in blood loss. We aimed to assess 1) the feasibility and 2) the safety of using a self-assembling peptide (SAP) haemostatic agent (PuraStat®) after rectal cancer surgery to reduce the incidence of pelvic collections. MATERIALS AND METHODS This prospective cohort pilot study compared the results of 25 consecutive cases of total mesorectal excision (TME) with use of 5-10 ml of SAP, and 25 consecutive cases without PuraStat® application (CON, control group). The groups were compared for complications (Clavien-Dindo grade III and IV classification), postoperative drain output and length of hospital stay (LOS). Statistical analysis was carried out using paired samples T test and Fisher's exact test. RESULTS Fifty patients (SAP = 25, CON = 25) were enrolled into this study. Mean drain outputs (ml) on day 1, day 2 and day 3 were 60 ± 18, 89 ± 42 and 64 ± 45 in SAP group, and 102 ± 31, 95 ± 52, 66 ± 37 in CON group. This was significantly better for SAP group in day one after surgery. The mean LOS was shorter in SAP group (5.7 versus 7.4 days in CON, p 0.04). Clavien-Dindo III & IV complications were seen in two and five cases respectively (p 0.18). R0 resection rate (p 0.32) and lymph node harvest (p 0.13) were similar in both groups. There were no complications seen in relation to the application of the SAP. CONCLUSIONS These initial data suggest that SAP is a safe product, and feasible to apply in the pelvis after TME surgery. It appears to shorten the LOS and reduce the postoperative drain output and may reduce the incidence of Clavien-Dindo grade III & IV complications.
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Affiliation(s)
- Samuel Stefan
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mira Wagh
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Syed Naqvi
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Emma Rawlinson
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Anthony Shepherd
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, UK
| | - Jim Khan
- Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Professor of Surgery, University of Portsmouth, UK
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Virzì A, Muller CO, Marret JB, Mille E, Berteloot L, Grévent D, Boddaert N, Gori P, Sarnacki S, Bloch I. Comprehensive Review of 3D Segmentation Software Tools for MRI Usable for Pelvic Surgery Planning. J Digit Imaging 2020; 33:99-110. [PMID: 31236743 DOI: 10.1007/s10278-019-00239-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Patient-specific 3D modeling is the first step towards image-guided surgery, the actual revolution in surgical care. Pediatric and adolescent patients with rare tumors and malformations should highly benefit from these latest technological innovations, allowing personalized tailored surgery. This study focused on the pelvic region, located at the crossroads of the urinary, digestive, and genital channels with important vascular and nervous structures. The aim of this study was to evaluate the performances of different software tools to obtain patient-specific 3D models, through segmentation of magnetic resonance images (MRI), the reference for pediatric pelvis examination. Twelve software tools freely available on the Internet and two commercial software tools were evaluated using T2-w MRI and diffusion-weighted MRI images. The software tools were rated according to eight criteria, evaluated by three different users: automatization degree, segmentation time, usability, 3D visualization, presence of image registration tools, tractography tools, supported OS, and potential extension (i.e., plugins). A ranking of software tools for 3D modeling of MRI medical images, according to the set of predefined criteria, was given. This ranking allowed us to elaborate guidelines for the choice of software tools for pelvic surgical planning in pediatric patients. The best-ranked software tools were Myrian Studio, ITK-SNAP, and 3D Slicer, the latter being especially appropriate if nerve fibers should be included in the 3D patient model. To conclude, this study proposed a comprehensive review of software tools for 3D modeling of the pelvis according to a set of eight criteria and delivered specific conclusions for pediatric and adolescent patients that can be directly applied to clinical practice.
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Di Donna MC, Cucinella G, Sozzi G, Gueli Alletti S, Lo Re G, Scambia G, Chiantera V. Surgical Neuropelveology: Lateral Femoral Cutaneous Nerve Endometriosis. Laparoscopic Resection and Nerve Transplantation. J Minim Invasive Gynecol 2021; 28:1978-1979. [PMID: 34224872 DOI: 10.1016/j.jmig.2021.06.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/08/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To demonstrate the application of surgical neuroanatomic principles for the diagnosis and treatment of deep infiltrating endometriosis involving the lateral femoral cutaneous nerve. DESIGN Video demonstration of laparoscopic lateral femoral cutaneous endometriosis resection with nerve transplant. SETTING Endometriosis infiltrating somatic nerves is a poorly known condition, which can cause severe neuropathic symptoms [1] and is often unrecognized with a subsequent treatment delay [1]. Intimate knowledge of pelvic neuroanatomy and expertise in minimally invasive surgery are essential to manage this challenging surgical scenario [2-4]. INTERVENTIONS Thirty-six years old patient with primary infertility and chronic pelvic pain associated with dysmenorrhea, dyspareunia, dysuria, and dyschezia. Preoperative magnetic resonance imaging detected a 3-cm parauterine and a 2-cm retrocervical endometriosis nodule. Magnetic resonance imaging did not demonstrate pelvic nerve involvement. Preoperative neuropelveologic assessment demonstrated a significant hypoesthesia of the corresponding lateral femoral cutaneous nerve dermatome, representing the primary complaint. A swab test showed spotting areas of allodynia. These findings prompted us to investigate for a right lateral femoral cutaneous entrapment. Laparoscopy showed an endometriosis nodule infiltrating the right lateral femoral cutaneous nerve. A resection of the nerve was necessary, and a subsequent reconstruction with a collagen bovine neuro-guide was carried out. The operative time was 300 minutes, and the estimated blood loss was 150 mL. Hospital stay was 3 days. After 3 months, the patient showed a clinical improvement in the pain and hypoesthesia on the reconstructed nerve dermatome. CONCLUSION Neuropelvic anatomic assessment should be considered during the preoperative evaluation for patients with endometriosis who have pelvic pain and neuropathy as part of the diagnostic process [5]. This unique case demonstrates that nerve resection and transplantation can be used in specific situations for neuropathy related to deep infiltrative endometriosis of pelvic nerves.
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Affiliation(s)
- Mariano Catello Di Donna
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy.
| | - Giuseppe Cucinella
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy
| | - Gulio Sozzi
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy
| | - Giuseppe Lo Re
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy
| | - Giovanni Scambia
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology (Drs. Di Donna, Cucinella, Sozzi, and Chiantera); Department of Surgical, Oncological and Oral Sciences (Dr. Di Donna); Department of Biomedicine, Neuroscience and Advanced Diagnostics (Dr. Re), University of Palermo, Palermo; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A.Gemelli IRCSS, Università Cattolica del Sacro Cuore (Dr. Alletti); Department of Women and Children's Health, Division of Gynecologic Oncology, "Agostino Gemelli" University Hospital and Institute for Research and Care (Dr. Scambia), Rome, Italy
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Sat-Muñoz D, Balderas-Peña LMA, Cortés-Torres EJ, Gómez-Álvarez RG, Mora-Mora JC, Gómez-Sánchez E. Posterior extrapelvic tributaries to the internal iliac veins: Morphometrics, types, and variants. CIR CIR 2021; 88:306-313. [PMID: 32538999 DOI: 10.24875/ciru.19001325] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In the distribution of the veins, it corresponds in the path and by its affluent to their arterial counterpart. For the pelvic surgeon faced with pelvic surgical pathology, the knowledge of the distribution of the venous vessels is especially important in view of novel surgical techniques and current approaches. The majority of the reports are on common iliac vein (CIV) or the inferior vena cava. To the best of our knowledge, there are no papers describing posterior extrapelvic affluents that drain into the internal iliac vein (IIV). Objective The aim of this work was to describe the pattern of the constitution of the IIV in 17 dissection specimens taken at our institution. Materials and methods We dissected and registered the anatomic variations of the posterior extrapelvic tributaries to the IIVs. Results Moreover, we describe the presence of a vein here that is, as far as we know, the first report of a vein that is formed from the posterior extrapelvic veins that drain exactly onto the anterior surface of the CIV. We also describe herein the variants that we have found. Conclusions The ignorance of the anatomic variations in the posterior extra-pelvic tributaries to the IIVs (internal iliac veins) can lead to fatal consequences in the patients undergoing pelvic surgery.
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Affiliation(s)
- Daniel Sat-Muñoz
- Departamento Clínico de Oncología Quirúrgica, Unidad Médica de Alta Especialidad (UMAE), Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS). Guadalajara, Jalisco, México.,Departamento de Morfología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG). Guadalajara, Jalisco, México
| | - Luz Ma A Balderas-Peña
- Departamento de Morfología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG). Guadalajara, Jalisco, México.,Unidad de Investigación Biomédica 02, Unidad Médica de Alta Especialidad (UMAE), Hospital de Especialidades, CMNO, IMSS. Guadalajara, Jalisco, México
| | - Edgar J Cortés-Torres
- Departamento Clínico de Oncología Quirúrgica, Unidad Médica de Alta Especialidad Hospital de Especialidades, CMNO, IMSS. Guadalajara, Jalisco, México
| | - Rocío G Gómez-Álvarez
- Departamento de Coordinación de la Licenciatura Médico Cirujano y Partero, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara. Guadalajara, Jalisco, México
| | - Jesús C Mora-Mora
- Departamento de Morfología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara (UdG). Guadalajara, Jalisco, México
| | - Eduardo Gómez-Sánchez
- División de Disciplinas Básicas para la Salud, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara (UdG). Guadalajara, Jalisco, México
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Saul D, Hünicke P, Böker KO, Spering C, Maheshwari AK, Acharya M, Lehmann W. Predicting the disaster - The role of CRP in acetabular surgery. Clin Biochem 2021; 94:48-55. [PMID: 33895126 DOI: 10.1016/j.clinbiochem.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acetabular fractures represent a complex surgical challenge. Given the heterogenous fracture pattern, the patient characteristics and spectrum of complications demand individual solutions. Surgical site infections (SSI) threaten osteosynthesis, and early detection of them and treatment remain crucial. What is the value of postoperative C-reactive protein (CRP) in this group of patients as well as its normal course? DESIGN & METHODS 115 patients with isolated fractures of the acetabulum were retrospectively evaluated. CRP, white blood cell count (WBC) and fracture patterns as well as patient characteristics were assessed for 20 days following operative fixation of the acetabular fracture (n = 71) and in fractures that were managed conservatively (n = 44). RESULTS Twelve patients suffered an infectious complication. With a one-phase decay, 70.55% of the variance of postoperative CRP kinetics was predicted. To anticipate maximum CRP as well as an infection, the preoperative CRP represented the best prognostic parameter. To predict an infection, the single variable "peak CRP value above 100 mg/l" resulted in a sensitivity and specificity of 91.67% and 36.21%, respectively. Combining a second peak of CRP with maximum CRP and day 5 CRP value for receiver-operating characteristic (ROC) analysis resulted in 83.3% and 88.1%, respectively. CONCLUSIONS Predicting surgical site infections after an acetabular fracture is most predictive when analyzing the maximum overall CRP, the second peak and the CRP after day 5. With a combination of these parameters, a sensitivity and specificity of 83.3% and 88.1% to detect an infection was achieved.
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Affiliation(s)
- D Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany; Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA.
| | - P Hünicke
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
| | - K O Böker
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
| | - C Spering
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
| | - A K Maheshwari
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
| | - M Acharya
- Trauma & Orthopaedics, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - W Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Goettingen, Germany
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22
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Oikonomou C, Gourgiotis S, Cirocchi R, Piagkou M, Protogerou V, Troupis T, Biondi A, Sileri P, Filippou D, Di Saverio S; Pelvic-Neuroanatomy Collaborating Group. Re-exploring the pelvic neuroanatomy from a new perspective and a potential guidance for TaTME: a "bottom-up" approach. Updates Surg 2021; 73:503-12. [PMID: 33534125 DOI: 10.1007/s13304-020-00968-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/27/2020] [Indexed: 12/15/2022]
Abstract
Neuro-anatomy of the perineum has gained renewed attention due to its significance in the transanal procedures for rectal cancer (eg TaTME). Surgeons embarking on this technique must have sophisticated knowledge and a precise anatomical understanding of the perineum before proceeding with this reversed rectal approach. We report anatomical observations deriving from a relevant experience in the colorectal surgery field. The collective multicenter experience of the present study is clinically relevant and based on the rectal and transanal resections performed in colorectal centers of excellence from Greece, UK, and Italy over the last 10 years (2011-2020). From the original anatomical and intraoperative observations derived from collective cases operated by this multicenter group of colorectal surgical centers in three European countries, data were retrieved and analyzed in collaboration with specialist researchers of human anatomy and interpreted for their clinical significance and potential use for preoperative planning and intraoperative guidance during TaTME. This descriptive article demonstrates in detail the neurogenic pathways encountered in the perineum and pelvic cavity during transanal procedures. Specific anatomical and topographic implications are also included serving as a guide for colorectal surgeons to perform a nerve-sparing procedure. transanal approach for rectal excision offers new insights into the complex pelvic and perineal neuroanatomy while the procedure itself remains a challenge for surgeons. Preoperative anatomical planning and 3D reconstruction may help in anticipating technical difficulties, resulting in more precise surgical dissections and decreased postoperative complications.
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Behnia-Willison F, Nguyen T, Rezaeimotlagh A, Baekelandt J, Hewett PJ. Middle Eastern women's attitudes and expectations towards vaginal natural orifice transluminal endoscopic surgery (vNOTES): a survey-based observational study. Surg Endosc 2021. [PMID: 33398552 DOI: 10.1007/s00464-020-08193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Trans-vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a recently popularised minimally invasive surgical procedure, aimed at minimising abdominal wall scars and improving pain and patient recovery times. Although vNOTES has been studied in the context of post-operative pain and cosmesis, women's acceptance of the technique has only been cursorily examined. In this survey-based observational study, we assessed the acceptability of this technique among a cohort of Middle Eastern women. MATERIALS AND METHODS A cohort of 175 Middle Eastern women were surveyed using a 13-item questionnaire at a single gynaecology centre. The survey used was a translated version of a questionnaire from a previous study (1) and comprised open-response, five-point Likert Scale and agree-disagree items. RESULTS Among 175 Middle Eastern women participated in this study most of them holding neutral view on abdominal and gynaecological procedures via vagina. 47% of participants were unsure regarding the effect of surgery via vagina on their sexual function. Although 61% of the participants showed no preference towards vNOTES over laparoscopic cholecystectomy, more than half of them indicated preference if vNOTES shown to be as effective and safe as laparoscopic cholecystectomy. The gender of the surgeon was shown to have no influence on the perspectives of the majority of participants to undergo vNOTES. CONCLUSIONS vNOTES may hold value for women who have conservative upbringing and/or value cosmesis. This study provides information regarding Middle Eastern women's perspectives on vNOTES, which may be of considerable clinical use as the popularity of this surgical technique continues to increase.
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Radwan RW, Tang AM, Harries RL, Davies EG, Drew P, Evans MD. Vertical rectus abdominis flap (VRAM) for perineal reconstruction following pelvic surgery: A systematic review. J Plast Reconstr Aesthet Surg 2020; 74:523-529. [PMID: 33317983 DOI: 10.1016/j.bjps.2020.10.100] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/04/2020] [Accepted: 10/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The vertical rectus abdominis myocutaneous (VRAM) flap is an established technique employed to reconstruct pelvic and perineal defects not amenable to primary closure. The aim of this study was to systematically review the morbidity of VRAM flap reconstruction following exenterative pelvic surgery. MATERIALS AND METHODS A systematic literature search was conducted by using Medline, EMBASE, and Cochrane databases. Abstracts of all studies published from inception to November 2019 were identified. Search terms used included 'vertical rectus abdominis myocutaneous', 'vertical rectus abdominis musculocutaneous' and 'VRAM'. Only studies that described outcomes when a VRAM flap was used during exenterative pelvic surgery were included; case reports were excluded. The primary outcome measure was VRAM flap morbidity. Secondary outcome measures included donor site morbidity and hospital length of stay. RESULTS Sixty-five studies with a total of 1827 patients were identified and included. Perineal reconstruction was most commonly performed following abdominal perineal excision of the rectum (APER) (n = 636 and 34.8%). Median patient age at surgery ranged from 38 to 78 years. Mean perineal flap morbidity was 27%, with a complete flap loss rate of 1.8% and a perineal hernia rate of 0.2%. Mean donor site morbidity was 15%, with an abdominal dehiscence rate of 5.5% and an incisional hernia rate of 3.3%. CONCLUSIONS While overall morbidity after VRAM flap reconstruction in pelvic visceral surgery is high; the risk of major complications remains low. These data are important when counselling patients for surgery.
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Affiliation(s)
- Rami W Radwan
- Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom.
| | - Alethea M Tang
- Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom
| | - Rhiannon L Harries
- Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom
| | - Eleanor G Davies
- Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom
| | - Peter Drew
- Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom
| | - Martyn D Evans
- Swansea Pelvic Oncology Group, Morriston Hospital, Swansea, SA6 6NL, United Kingdom
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25
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Dujardin F, Mouton J, Tobenas-Dujardin AC, Hue AG, Duparc F, Ould-Slimane M, Gauthé R. Extended anterolateral transiliac approach to the sacral plexus. Orthop Traumatol Surg Res 2020; 106:841-844. [PMID: 32620504 DOI: 10.1016/j.otsr.2020.04.011] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 02/03/2023]
Abstract
The approach to the sciatic plexus and lateral part of the sacrum is difficult. A subperitoneal anterolateral approach can be extended by sectioning the iliac bone above the acetabulum and lowering it toward the external part of the iliac wing and buttock. This transiliac anterolateral approach exposes the lumbosacral trunk, first sacral foramina and sciatic plexus to the origin of the sciatic trunk. Exposure can be extended upward by subperitoneal lumbotomy, downward by opening the ischiorectal fossa, or outward by trochanterotomy. This approach was used 18 times by one of the authors (FHD) for resection of 13 malignant tumors and 5 plexus releases. Procedure time was 3-6hours, with 500-4,000ml blood loss. The approach systematically enabled surgical objectives to be met. There was 1 septic complication that healed after debridement.
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Affiliation(s)
- Franck Dujardin
- CHU de Rouen, Department of Orthopaedic Surgery, 76000 Rouen, France
| | - Jordane Mouton
- CHU de Rouen, Department of Orthopaedic Surgery, 76000 Rouen, France
| | | | - Antoine-Guy Hue
- CHU de Rouen, Department of Orthopaedic Surgery, 76000 Rouen, France
| | - Fabrice Duparc
- CHU de Rouen, Department of Orthopaedic Surgery, 76000 Rouen, France; Normandie Univ, UFR de Médecine et de Pharmacie, Laboratoire d'Anatomie, 76000 Rouen, France
| | | | - Rémi Gauthé
- CHU de Rouen, Department of Orthopaedic Surgery, 76000 Rouen, France.
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Florio M, Capasso L, Olivi A, Vitiello C, Leone A, Liuzza F. 3D - Navigated percutaneous screw fixation of pelvic ring injuries - a pilot study. Injury 2020; 51 Suppl 3:S28-S33. [PMID: 32723529 DOI: 10.1016/j.injury.2020.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Screw fixation of pelvic ring fractures is a common, but demanding procedure and navigation techniques were introduced to increase the precision of screw placement. The purpose of this case series is to demonstrate a lower screw malposition rate using percutaneous fixation of pelvic ring fractures and sacroiliac dislocations guided by navigation system based on 3D-fluoroscopic images compared to traditional imaging techniques and to evaluate the functional outcomes of this innovative procedure. PATIENT AND METHODS 10 cases of disrupted pelvic ring lesions treated in our hospital from February 2018 to December 2018 were included for closed reduction and percutaneous screw fixation of using with O-Arm and the acquisition by the Navigator. Preoperative assessment was performed on the patients by means of X Ray imaging and CT scan. Routine CT was carried out on third postoperative day to evaluate screw placement. Measures of radiation exposure were extracted directly from reports provided by system. Quality of life was evaluated by SF 36-questionnaire 6 months after surgery. RESULTS 12 iliosacral- and 2 ramus pubic-screws were inserted. In post-operative CT-scans the screw position was assessed and graded using the score described by Smith. No wound infection or iatrogenic neurovascular damage were observed. No re-operations were performed. The exposure to radiation is, for the patient, slightly greater than that resulting from the use of traditional fluoroscopic systems, while it is naught for the surgical team, which at the time of image acquisition is located outside the room. DISCUSSION AND CONCLUSION The execution of an intraoperative 3D-fluoroscopic scan can on its own suffice as a post-operative control examination since its accuracy is similar to that of the post-operative CT. The use of a navigated 3d fluoroscopy exposes the patient to an amount of radiation slightly greater than that of traditional fluoroscopy, but the dose is lower than a CT examination. For the operating team, exposure to radiation is naught. 3D-fluoroscopic navigation is a safe tool providing high accuracy of percutaneous screw placement for pelvic ring fractures. Finally, despite the small cohort of patients studied, the excellent results obtained regarding the patients' quality of life and the absence of complications allow us to look positively at the future of this technique, which needs further studies and improvement.
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Affiliation(s)
- Michela Florio
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Luigi Capasso
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.
| | - Alessandro Olivi
- Department of Neurosurgery A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Carla Vitiello
- Department of Radiology, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Antonio Leone
- Department of Radiology, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
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Papillon-Smith J, Hobson S, Allen L, Kingdom J, Windrim R, Murji A. Prophylactic internal iliac artery ligation versus balloon occlusion for placenta accreta spectrum disorders: A retrospective cohort study. Int J Gynaecol Obstet 2020; 151:91-96. [PMID: 32506473 DOI: 10.1002/ijgo.13256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/08/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare surgical outcomes between women undergoing prophylactic internal iliac artery ligation or preoperative placement of balloon-occlusive devices at cesarean hysterectomy for placenta accreta spectrum (PAS) disorders. METHODS A retrospective cohort study was conducted at a tertiary-care referral center for PAS disorders in Ontario, Canada. Eligible electronic records were reviewed of women undergoing cesarean hysterectomy for PAS disorders between November 2012 and June 2018. Outcomes for the ligation and balloon groups were compared primarily on procedure-related complications and secondarily on total procedure time, bleeding and transfusion metrics, and intraoperative and postoperative complications. RESULTS Of the 79 cases of cesarean hysterectomy, 47 underwent balloon placement and 32 underwent ligation. Baseline characteristics between the groups were similar except for more emergency procedures in the ligation group (37.5% vs 12.8%, P=0.014). The balloon-related complication rate was 5/47 (10.6%), with no reported complications in the ligation group (P=0.077). Procedural time was longer in the balloon group (353 ± 14 vs 227 ± 13 minutes, P<0.001). Estimated blood loss was similar (1874 ± 245 mL vs 1713 ± 181 mL, P=0.590). CONCLUSION Women undergoing prophylactic placement of endovascular balloons at caesarean hysterectomy for PAS disorders had a 10.6% procedure-related complication rate and increased total procedure time, with no decrease in blood loss compared to those undergoing surgical ligation.
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Affiliation(s)
- Jessica Papillon-Smith
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Sebastian Hobson
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Lisa Allen
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - John Kingdom
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rory Windrim
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Weidert S, Andress S, Linhart C, Suero EM, Greiner A, Böcker W, Kammerlander C, Becker CA. 3D printing method for next-day acetabular fracture surgery using a surface filtering pipeline: feasibility and 1-year clinical results. Int J Comput Assist Radiol Surg 2020; 15:565-575. [PMID: 31897965 PMCID: PMC7973705 DOI: 10.1007/s11548-019-02110-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
Introduction In orthopedic surgery, 3D printing is a technology with promising medical applications. Publications show promising results in acetabular fracture surgery over the last years using 3D printing. However, only little information about the workflow and circumstances of how to properly derive the 3D printed fracture model out of a CT scan is published.
Materials and methods We conducted a retrospective analysis of patients with acetabular fractures in a level 1 trauma center. DICOM data were preoperatively used in a series of patients with acetabular fractures. The 3D mesh models were created using 3D Slicer (https://www.slicer.org) with a newly introduced surface filtering method. The models were printed using PLA material with FDM printer. After reduction in the printed model, the acetabular reconstruction plate was bent preoperatively and sterilized. A clinical follow-up after 12 months in average was conducted with the patients. Results In total, 12 patients included. Mean printing time was 8:40 h. The calculated mean printing time without applying the surface filter was 25:26 h. This concludes an average printing time reduction of 65%. Mean operation time was 3:16 h, and mean blood loss was 853 ml. Model creation time was about 11 min, and mean printing time of the 3D model was 8:40 h, preoperative model reduction time was 5 min on average, and preoperative bending of the plate took about 10 min. After 12 months, patients underwent a structured follow-up. Harris Hip Score was 75.7 points, the Modified Harris Hip Score 71.6 points and the Merle d’Aubigne Score 11.1 points on average. Conclusions We presented the first clinical practical technique to use 3D printing in acetabular fracture surgery. By introducing a new surface filtering pipeline, we reduced printing time and cost compared to the current literature and the state of the art. Low costs and easy handling of the 3D printing workflow make it usable in nearly every hospital setting for acetabular fracture surgery.
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Affiliation(s)
- Simon Weidert
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Andress
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Linhart
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Eduardo M Suero
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Axel Greiner
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher A Becker
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Campus Großhadern, Marchioninistr. 15, 81377, Munich, Germany.
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Artemi S, Vassiliu P, Arkadopoulos N, Smyrnioti ME, Sarafis P, Smyrniotis V. A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non-modifiable risk factors. BMC Res Notes 2019; 12:814. [PMID: 31852527 PMCID: PMC6921531 DOI: 10.1186/s13104-019-4839-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/02/2019] [Indexed: 01/24/2023] Open
Abstract
Objective A pelvic surgery can cause erectile dysfunction. The purpose of this study was to evaluate erectile function at various times after pelvic surgery in male patients; to search the non-modifiable risk factors associated with the presence and intensity of sexuality in these patients. This prospective study used the erectile dysfunction IIEF scale. Results The study population comprised of 106 male patients who had undergone minor pelvic surgery at least 9 months before and during the 2010–2016 period in the 4th Surgical Clinic. A control group of healthy males (N = 106) who underwent no pelvic surgery matched for age was also used for reference values. The main age of the participants was 66.16 ± 13.07 years old. A history of colectomy was present in 36.8%, 18.9% had undergone sigmoidectomy, and 33% inguinal hernia repair. The percentage of severe erectile function increased from 38.7% before surgery to 48.1% (25% increase) after surgery, at the end of the follow-up period (p < 0.05). In the multivariate analysis model, age emerged as an independent predictor of erectile function (p < 0.001). Age was the most important determinant of the IIEF score, which was aggravated by 25% from the first to the last assessment of patients.
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Affiliation(s)
- S Artemi
- Department of Nursing, General Hospital of Athens "ELPIS", Athens University of Technology, Athens, Greece
| | - P Vassiliu
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Arkadopoulos
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - P Sarafis
- Department of Nursing, Cyprus University of Technology, 30 Archbishop Street, 3036, Limassol, Cyprus.
| | - V Smyrniotis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Lee Y, McKechnie T, Springer JE, Doumouras AG, Hong D, Eskicioglu C. Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:2011-2021. [PMID: 31707560 DOI: 10.1007/s00384-019-03404-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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] [Accepted: 09/11/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal. METHODS Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI). RESULTS From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83-2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51-4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05-3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31-0.81, P = 0.005). CONCLUSION Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.
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Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeremy E Springer
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada.
- Division of General Surgery Department of Surgery, St. Joseph's Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
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Goel A, Craven C, Matloob S, Thompson S, Watkins L, Toma A. CSF-diverting shunts: Implications for abdominal and pelvic surgeons; a review and pragmatic overview. Ann Med Surg (Lond) 2019; 48:100-104. [PMID: 31763034 PMCID: PMC6859566 DOI: 10.1016/j.amsu.2019.10.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022] Open
Abstract
The optimal management of patients with ventriculoperitoneal or lumboperitoneal shunts undergoing abdominal or pelvic surgery for unrelated reasons is often unclear due to the paucity of guidelines in this field. In this review, we outline key issues in managing these patients. Specifically, we address issues relating to pre-operative planning, avoidance of shunt-related complications such as infection and malfunction, and specific management of neurological symptoms in the post-operative period. A retrospective study was carried out analysing correspondence between general surgeons and a specialist hydrocephalus unit over a 4-year period relating to management of patients with ventriculoperitoneal and lumboperitoneal shunts undergoing abdominal or pelvic surgery. A literature review was carried out to identify available evidence in this field. 30 queries from general surgeons were identified comprising 12 main themes. 16 relevant publications were identified. We summarised these to answer these queries. The management of shunted patients may present challenges and uncertainties in an abdominal or pelvic surgery setting. This paper provides guidelines and clarity in this field by discussing and summarising reported data in the literature.
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Affiliation(s)
- Aimee Goel
- Corresponding author. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, W1C 3BG, UK.
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Heijkoop B, Parker N, Kiroff G, Spernat D. Effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major pelvic surgery for malignancy: protocol for a systematic review. Syst Rev 2019; 8:249. [PMID: 31666130 PMCID: PMC6822405 DOI: 10.1186/s13643-019-1179-1] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 10/07/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication associated with significant morbidity and mortality. The use of prophylactic heparin postoperatively reduces this risk, and the use of extended duration prophylaxis is becoming increasingly common. Malignancy and pelvic surgery both independently further increase the risk of postoperative VTE and patients undergoing major pelvic surgery for malignancy are at particularly high risk of VTE. However, the optimum duration of prophylaxis specifically in this population currently remains unclear. METHODS We will conduct a systematic review of literature in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.,2011) to evaluate current evidence of the effectiveness and safety of inpatient versus extended VTE prophylaxis with heparin (all forms) following major pelvic surgery for malignancy. We will search PubMed, EMBASE, and the Cochrane Library. Regarding safety, Food and Drug Administration (FDA), and Therapeutic Goods Administration (TGA) websites will be searched, including all levels of evidence. Results will be the postoperative timeframe in which a VTE event can be considered to have been provoked by the surgery, and the number of patients needed to treat with both inpatient and extended prophylaxis to prevent a VTE event in this timeframe, comparing these to determine if there is a significant benefit from extended prophylaxis. DISCUSSION This systematic review will aim to identify the postoperative period in which patients undergoing major pelvic surgery for malignancy are at further increased risk of VTE as a result of their surgery and the optimum duration of heparin VTE prophylaxis with heparin to reduce this risk. Determining this will allow evidence-based recommendations to be made for the optimum duration of heparin VTE prophylaxis post major pelvic surgery for malignancy, leading to improved standards of care that are consistent between different providers and institutions. SYSTEMATIC REVIEW REGISTRATION In accordance with guidelines, our systematic review was submitted to PROSPERO for consideration of registration on 16/12/17 and was registered on 12/1/18 with the registration number CRD42018068961 , and it was last updated on December 1, 2018.
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Affiliation(s)
- Bridget Heijkoop
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
| | - Natalie Parker
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
| | - George Kiroff
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
| | - Daniel Spernat
- Urology Department, The Queen Elizabeth Hospital, The University of Adelaide, Level 7A, 28 Woodville rd, Woodville South, SA 5011 Australia
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Hokenstad ED, Occhino JA. Management of presacral bleeding. Int Urogynecol J 2019; 31:215-217. [PMID: 31187180 DOI: 10.1007/s00192-019-03995-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this video is to demonstrate a variety of available techniques that can be used in the management of acute presacral bleeding. METHODS In this video, we demonstrate different methods for the management of presacral bleeding utilizing a fresh frozen cadaver. RESULTS Presacral bleeding is a potentially catastrophic complication that can be encountered during pelvic surgery, particularly sacrocolpopexy. Various techniques exist to achieve hemostasis in the event of uncontrolled bleeding. This video demonstrates some of the available methods that may be employed in the management of presacral bleeding. The methods demonstrated in this video include direct pressure, pelvic packing, gelatin matrix, bone wax, thumb tack, surgical clip, suture, oxidized regenerated cellulose, omental flap, electrocautery, muscle fragment welding, gelatin matrix combined with thrombin, and microporous polysaccharide spheres. CONCLUSION Familiarity with these techniques and product availability will aid in the management of acute presacral bleeding.
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Affiliation(s)
- Erik D Hokenstad
- Division of Urogynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - John A Occhino
- Division of Urogynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Saridogan E. Role of general gynaecologists in the prevention of infertility. Best Pract Res Clin Obstet Gynaecol 2019; 59:132-136. [PMID: 30837119 DOI: 10.1016/j.bpobgyn.2019.01.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
Gynaecologists are frequently involved in the management of conditions that may result in reduced fertility or treatments they administer can lead to infertility. Sexually transmitted infections and pelvic inflammatory disease are the most common cause of tubal damage. Gynaecologists can play an important role in the identification and early treatment of these diseases. Pelvic surgery for conditions such as leiomyoma, ovarian cysts and endometriosis can lead to pelvic adhesions and iatrogenic infertility. By avoiding unnecessary operations by careful assessment of women with these conditions and by identifying those who can be managed without surgery, the future risk of infertility can be avoided. When surgery is clinically indicated, primary prevention of pelvic adhesions would be of paramount importance. A reliable surgical technique and the use of anti-adhesion agents may reduce the development of pelvic adhesions. Ovarian surgery for endometriomas and other benign cysts should be performed in the hands of experienced surgeons or in 'centres of clinical expertise', and maximum efforts should be made to preserve normal ovarian tissue as much as possible.
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Affiliation(s)
- Ertan Saridogan
- Consultant in Reproductive Medicine and Minimal Access Surgery, University College London Hospitals, UK.
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Palazón P, Saura L, de Haro I, Martín-Solé O, Albert A, Tarrado X, Julià V. Bilateral hydrosalpinx in patients with Hirschsprung's disease. J Pediatr Surg 2018; 53:1945-1950. [PMID: 29467083 DOI: 10.1016/j.jpedsurg.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/30/2017] [Accepted: 01/09/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. AIM to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD. METHODS The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed. RESULTS Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p=0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p=0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program. CONCLUSION An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Pedro Palazón
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Laura Saura
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Irene de Haro
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Asteria Albert
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Tarrado
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Julià
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
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Sedighinejad A, Naderi Nabi B, Ettehad H, Mirbolook A, Atrkarroushan Z, Ghazanfar Tehran S, Biazar G, Haghighi M. Does Adding Lidocaine to Intrathecal Bupivacaine Affect Hemodynamic Parameters during Hip Fracture Surgery? Arch Bone Jt Surg 2018; 6:390-396. [PMID: 30320179 PMCID: PMC6168228] [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] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/28/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Hip fracture is one of the most common problems in elderly that needs surgical repair. As, the majority of these patients have chronic diseases, they are at increased risk of peri-operative mortality and morbidity. The purpose of this study was to evaluate spinal anesthesia with bupivacaine vs bupivacaine in combination with lidocaine in terms of hemodynamic changes in patients undergoing hip fracture surgery. METHODS This double-blind clinical trial was conducted on 292 patients undergoing surgery for hip fracture under spinal anesthesia. Patients were allocated into two groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mg hyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes were consecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for half an hour (T2- T7), and at 45 minutes (T8) and 60 minutes (T9) after injection. RESULTS Patients in the two groups were homogeneous in demographic characteristics including age, sex, BMI, ASA Class, baseline blood pressure and heart rate. The onsets of sensory and motor blocks in group BL were faster than group B (P=0.0001). Also, the durations of sensory and motor blocks in group B were significantly longer than group BL (P=0.0001). The BL group had a significantly lower systolic blood pressure in all periods (P<0.05). Although the heart rate in the BL group was lower than group B at all time points, this difference was only significant during T2-T3 (P=0.033 and P=0.0001, respectively). Group BL had significantly more episodes of hypotension, bradycardia, nausea and vomiting (P=0.0001, P=0.023, P=0.003, and P=0.033, respectively). CONCLUSION According to our findings, using Lidocaine 50 mg in combination with Bupivacaine 5 mg, compared with Bupivacaine 10 mg alone for spinal anesthesia in hip fracture fixation surgeries was associated with more hypotension and bradycardia. As a result, combination of Bupivacaine with Lidocaine at this dose is not recommended for induction of anesthesia in these patients.
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Affiliation(s)
- Abbas Sedighinejad
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Bahram Naderi Nabi
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Hossein Ettehad
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Ahmadreza Mirbolook
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Zahra Atrkarroushan
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Samaneh Ghazanfar Tehran
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Gelareh Biazar
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
| | - Mohammad Haghighi
- Research performed at Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Guilan University of Medical Sciences (GUMS), Rasht, Iran
- Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran
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Sangaré D, Berthé HJG, Diakité ML, Samassekou A, Diakité AS, Diallo MS, Koné O, Sissoko I, Dembélé ID, Coulibaly MT, Ouattara Z, Tembely A. [Urological Complications of Pelvic Surgery at Point-G Hospital, About 23 Cases]. Mali Med 2018; 33:9-12. [PMID: 30484577] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Bladder and ureteral lesions are the most common urologic complications occurring during pelvic surgery with 1% and 0.5% to 3%, respectively. These lesions are rarely recognized intraoperatively and pose a major problem to urologists, gynecologists, and general surgeons. OBJECTIVE To study the factors favoring urologic complications following pelvic surgery at the University Hospital Point-G. PATIENTS AND METHOD We conducted a retrospective study at the University Hospital Point-G between 2006 and 2015. It involved 23 patients with a whole urological lesion following pelvic surgery. These patients underwent a clinical and para-clinical examination (intravenous urography, methylene blue test) to confirm the urological lesion and to determine its management. RESULTS The average age of our patients was 32.00 years with extremes of 18 and 40 years old. The leakage of urine was found in 82.6% (19/23). Interventions that caused urologic injury were: caesarean section 52.2% (12/23), hysterectomy 30.4% (7/23), as well as a caesarean section and hysterectomy 17.4% (4/23). Methylene blue was performed in 19 patients, it was positive in 52.2% (12/23) and intravenous urography (IVU) in 7 patients. The lesions encountered were: retrotrigonal fistula vesico-vaginal 10 cases, vesico-vaginal fistula under trigonal 2 cases, uretero-vaginal fistula 7 cases, and bilateral ureteral ligation 4 cases. Fistulorraphy was performed in 52.2% followed by direct ureterovesical reimplantation. The postoperative outcome was satisfactory in 100% of cases with obtaining a good bladder tightness. The average duration of hospitalization was 12 days (+/- 4 days). CONCLUSION Pelvic surgery results in urological injuries. Caesarean section and hysterectomy are contributing factors. Vesico-vaginal fistula or ureteral lesions are common.
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Segelman J, Nygren J. Best practice in major elective rectal/ pelvic surgery: enhanced recovery after surgery (ERAS). Updates Surg. 2017;69:435-439. [PMID: 29067634 PMCID: PMC5686231 DOI: 10.1007/s13304-017-0492-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
Abstract
Within traditional clinical care, the postoperative recovery after pelvic/rectal surgery has been slow with high morbidity and long hospital stay. The enhanced recovery after surgery program is a multimodal approach to perioperative care designed to accelerate recovery and safely reduce hospital stay. This review will briefly summarize optimal perioperative care, before, during and after surgery in this group of patients and issues related to implementation and audit.
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Garbens A, Goldenberg M, Wallis CJD, Tricco A, Grantcharov TP. The cost of intraoperative adverse events in abdominal and pelvic surgery: A systematic review. Am J Surg 2017; 215:163-170. [PMID: 28709625 DOI: 10.1016/j.amjsurg.2017.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The assessment of intra-operative adverse events (iAEs) is a vastly under researched area with the potential to provide new methods on how to improve patient outcomes and hospital costs. Our objective was to determine the relationship between iAEs and total hospital costs in abdominal and pelvic surgery. DATA SOURCES We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Embase, MEDLINE and EBM Reviews online databases were searched to identify all studies that reported iAE rates and total hospital costs. We then analyzed the costing approach used in each article using the Drummond tool and evaluated articles quality using the GRADE method. CONCLUSIONS In total, 1709 unique references were identified through our literature search. After review, 23 were included. All studies that reported iAE rates and cost as the primary outcome found that iAEs significantly increased total hospital costs. We identified a relationship between iAEs and increased hospital costs. Future studies need to be performed to further evaluate the relationship between iAEs and cost as current studies are of low quality.
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Affiliation(s)
- A Garbens
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - M Goldenberg
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - C J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - A Tricco
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, ON, Canada.
| | - T P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada.
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Charles T, Ameye L, Gebhart M. Surgical treatment for periacetabular metastatic lesions. Eur J Surg Oncol 2017; 43:1727-1732. [PMID: 28483275 DOI: 10.1016/j.ejso.2017.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/02/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Periacetabular bone metastasis present with severe pain and functional loss leading to a poor quality of life. Surgical treatment remains challenging. MATERIAL AND METHODS We reviewed all cases operated at our institution. We analyzed pain scores and functional status as well as complications and their risk factors. RESULTS Thirty-five patients underwent curettage and cemented reconstruction. Mean surgical time was 168 min. Mean surgical blood losses were 3150 ml. Major complications were encountered in 23% and minor complications in 29% of cases. We found a significant pain relief (p < 0.0001) and improvement in functional status in the postoperative period (p < 0.0001). A Harrington grade 4 lesion was correlated with a higher complication rate (p-value = 0.002). CONCLUSIONS In this series we were able to show that surgical management is an effective option in the treatment of metastatic bone disease to the pelvis. However, this treatment is very complex and associated with very high complication rates. Therefore, adequate patient selection and preoperative management is advocated.
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Affiliation(s)
- T Charles
- Department of Orthopedic Surgery, Institut Jules Bordet, Université libre de Bruxelles, Belgium
| | - L Ameye
- Department of Statistics, Data Center, Institut Jules Bordet, Université libre de Bruxelles, Belgium
| | - M Gebhart
- Department of Orthopedic Surgery, Institut Jules Bordet, Université libre de Bruxelles, Belgium.
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Casal Núñez JE, Vigorita V, Ruano Poblador A, Gay Fernández AM, Toscano Novella M&A, Cáceres Alvarado N, Pérez Dominguez L. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol 2017; 23:1712-1719. [PMID: 28321171 PMCID: PMC5340822 DOI: 10.3748/wjg.v23.i9.1712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/26/2017] [Accepted: 02/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer.
METHODS A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined.
RESULTS This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication.
CONCLUSION A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.
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Kiyasu Y, Kano N. Huge rectovesical fistula due to long-term retention of a rectal foreign body: A case report and review of the literature. Int J Surg Case Rep 2017; 31:163-166. [PMID: 28152493 PMCID: PMC5288322 DOI: 10.1016/j.ijscr.2017.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/16/2017] [Indexed: 12/29/2022] Open
Abstract
A long-term retained rectal foreign body is rare, compared to other foreign bodies. We describe a foreign body in the rectum for 5 months. This resulted in a huge rectovesical fistula and requireing emergency laparotomy. These rare foreign bodies could result in a large fistula or diffuse inflammation. In these cases, we should prepare for surgical treatment of multiple pelvic organs.
Introduction Most patients with foreign bodies in their rectums present to medical institutions within a few days. In this report, we describe a foreign body in the rectum in situ for 5 months that resulted in a huge rectovesical fistula 4 cm in diameter, requiring emergency laparotomy. Presentation of case A 59-year-old man, who had undergone rectal foreign body extraction via the anal canal without any complications 7 years previously, presented with abdominal pain and diarrhea. Computed tomography revealed a cup-shaped rectal foreign body and huge rectovesical fistula. We performed an emergency laparotomy. There was no contaminated ascites. The adhesion around the fistula was too stiff to be dissected. We incised the rectal wall, excised the ceramic cup-shaped foreign body, and detected a fistula approximately 4 cm in diameter. We performed sigmoid colostomy, and the incised rectal wall and the bladder wall were sutured, and the residual rectum was supposed to function as a part of the bladder. After the surgery, no severe complications occurred. The patient told us that he inserted the foreign body himself 5 months earlier, and urine had appeared in the stool in the previous month. Discussion A long-term retained rectal foreign body is very rare and could create an abnormal huge fistula between the pelvic organs because of prolonged pressure on the walls of the pelvic organs. Conclusion In patients with a long-term retained rectal foreign body, we should prepare for surgical treatment of not only the rectum but also the other pelvic organs.
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Affiliation(s)
- Yoshiyuki Kiyasu
- Gastroenterological Surgery, Kameda Medical Center, Higashimachi 929, Kamogawa, Chiba 296-8602, Japan.
| | - Nobuyasu Kano
- Gastroenterological Surgery, Kameda Medical Center, Higashimachi 929, Kamogawa, Chiba 296-8602, Japan.
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Thomopoulos T, Zufferey G. Totally laparoscopic treatment of vaginal cuff dehiscence: A case report and systematic literature review. Int J Surg Case Rep 2016; 25:79-82. [PMID: 27337703 PMCID: PMC4919793 DOI: 10.1016/j.ijscr.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/11/2016] [Indexed: 11/28/2022] Open
Abstract
Minimal invasive approaches to hysterectomy, such as total laparoscopic or robotic, can lead to higher incidence of vaginal cuff dehiscence. Vaginal evisceration is a rare but life-threatening complication if it is misdiagnosed. Even if several approaches for the management of the vaginal herniation have been describe in the literature, the entirely laparoscopic treatment seems to be safe and effective, demanding nevertheless a high surgical experience.
Introduction To highlight the laparoscopic management as a feasible treatment option for vaginal cuff dehiscence with intestinal evisceration after hysterectomy. Presentation of case We report a rare case of a 49-year-old postmenopausal woman who was admitted to the emergency department with vaginal herniation of approximately 40 cm of small bowel 3 months after total laparoscopic hysterectomy, treated laparoscopically exclusively. Discussion The patient underwent a laparoscopic reduction of the protruded mass, inspection of the entire small bowel and closure of the vaginal dehiscence. She was discharged home in a good health and the postoperative course remains uneventful 6 months later. Our systematic review of the literature found 116 cases of vaginal evisceration, which were described as early as 1864. There is no consensus on the ideal method of surgical repair. To our knowledge, only 2% (3 cases) were treated totally laparoscopically and 10% by a combined approach (laparoscopic and vaginal). Although the current evidence does not suggest that one approach is preferred to the others, the laparoscopic approach seems to be the new trend for the management of this surgical emergency. Conclusion Totally laparoscopic repair in experience hands seems to be a safe approach to cure vaginal evisceration after pelvic surgery.
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Affiliation(s)
- T Thomopoulos
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
| | - G Zufferey
- Department of General Surgery, Hospital of Nyon (GHOL), Nyon, Switzerland
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Vargas GM, Sieloff EP, Parmar AD, Tamirisa NP, Mehta HB, Riall TS. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery. Surg Endosc 2016; 30:1826-32. [PMID: 26286013 PMCID: PMC5291075 DOI: 10.1007/s00464-015-4463-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/18/2015] [Accepted: 07/22/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION While there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients. METHODS We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project Participant Use Data File. We performed multivariable analyses to determine the independent association between laparoscopy and postoperative complications. RESULTS A total of 26,437 patients underwent rectal resection. The mean age was 58.5 years, 32.6 % were obese, and 47.2 % had cancer. Laparoscopic procedures were slightly less common in obese patients compared to non-obese patients (36.0 vs. 38.2 %, p = 0.0006). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9 vs. 32.4 %, p < 0.0001) and non-obese (15.6 vs. 25.3 %, p < 0.0001) patients. In a multivariable analysis controlling for potential confounders, the risk of postoperative complications increased as the degree of obesity worsened. The likelihood of experiencing a postoperative complication increased by 25, 45, and 75 % for obese class I, obese class II, and obese class III patients, respectively. A laparoscopic approach was associated with a 40 % decreased odds of a postoperative complication for all patients (OR 0.60, 95 % CI 0.56-0.64). CONCLUSION Laparoscopic rectal surgery is associated with fewer complications when compared to open rectal surgery in both obese and non-obese patients. Obesity was an independent risk factor for postoperative complications. In appropriately selected patients, rectal surgery outcomes may be improved with a minimally invasive approach.
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Affiliation(s)
- Gabriela M Vargas
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Surgery, Louisiana State University Health-Shreveport, Shreveport, LA, USA.
| | - Eric P Sieloff
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Abhishek D Parmar
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- The University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Nina P Tamirisa
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- The University of California, San Francisco-East Bay, Oakland, CA, USA
| | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor S Riall
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Ahmed J, Nasir M, Flashman K, Khan J, Parvaiz A. Totally robotic rectal resection: an experience of the first 100 consecutive cases. Int J Colorectal Dis 2016; 31:869-76. [PMID: 26833474 DOI: 10.1007/s00384-016-2503-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Robotic surgery provides an alternative option for a minimal access approach. It provides a stable platform with high definition three-dimensional views and improved access, which enhances the capabilities for precise dissection in a narrow surgical field. These distinctive features have made it an attractive option for colorectal surgeons. AIM The aim of this study was to present a standardised technique for single-docking robotic rectal resection and to analyse clinical outcomes of the first 100 robotic rectal procedures performed in a single centre between May 2013 and April 2015. METHOD Prospectively collected data related to 100 consecutive patients who underwent single-docking robotic rectal surgery was analysed for surgical and oncological outcomes. RESULTS Sixty-six patients were male, the median age was 67 years (range-24-92). Eighteen patients had neo-adjuvant chemoradiotherapy whilst 23 patients had BMI >30. Procedures performed included anterior resection (n = 74), abdominoperineal resection (n = 10), completion proctectomy (n = 9), restorative proctectomy with ileal pouch-anal anastomosis (IPAA) (n = 5) and Hartmann's procedure (n = 2). The median operating time was 240 min (range-135-456), and median blood loss was 10 ml (range 0-200). There was no conversion or intra-operative complication. Median length of stay was 7 days (range, 3-48) and readmission rate was 12 %. Thirty-day mortality was zero. Postoperatively, two patients had an anastomotic leak whilst two had small bowel obstruction. The median lymph node harvest was 18 (range, 6-43). CONCLUSION The single-docking robotic technique should be considered as an alternative option for rectal surgery. This approach is safe and feasible and in our study it has demonstrated favourable clinical outcomes.
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Affiliation(s)
- J Ahmed
- Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.
| | - M Nasir
- Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK
| | - K Flashman
- Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK
| | - J Khan
- Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK
| | - A Parvaiz
- Department of Minimally Invasive Colorectal Unit, Queen Alexandra Hospital NHS Trust, Portsmouth, PO6 3LY, UK.,Head of Laparoscopic & Robotic Programme, Colorectal Cancer Unit, Champalimaud Clinical Foundation, Lisbon, Portugal
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Anthonissen J, Ossendorf C, Hock JL, Steffen CT, Goetz H, Hofmann A, Rommens PM. The role of muscular trauma in the development of heterotopic ossification after hip surgery: An animal-model study in rats. Injury 2016; 47:613-6. [PMID: 26653772 DOI: 10.1016/j.injury.2015.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 10/29/2015] [Accepted: 11/14/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Heterotopic ossification (HO), the formation of bone in soft tissues, is a frequent complication after surgery of the hip and the pelvis. Although the pathophysiological entities responsible for the formation of HO remain largely unclear, muscle trauma is alleged to play a central role in the pathogenic mechanisms underlying HO. However, for this observation, made by many surgeons for decades, no objective evidence has been provided yet. METHODS Fifty male Wistar rats were subjected to surgery of the right hip. The femoral canal was reamed in three steps up to 2mm. Animals formed 2 groups: in group 1 (25 animals) every effort was taken not to injure the muscles. In contrast, in the rats of group 2 (25 animals), an additional muscle lesion was created. Twelve weeks after surgery, the amount of heterotopic bone was assessed using micro-computed tomography, and classified using a modified Brooker classification system. A chi-square test was used to assess the statistical hypothesis comparing both groups. RESULTS A significant higher amount of heterotopic bone was observed in animals that underwent additional muscular trauma. CONCLUSION According to our data, muscle trauma seems to play an important role in the development of HO after hip surgery. Hence, during surgery, particular care not to injure the surrounding muscular tissue should be taken.
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Affiliation(s)
- Joris Anthonissen
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
| | - Christian Ossendorf
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
| | - Johanna L Hock
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
| | - Clara T Steffen
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
| | - Hermann Goetz
- Institute of Applied Structure- and Microanalysis, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
| | - Alexander Hofmann
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
| | - Pol M Rommens
- Department of Orthopedics and Trauma Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany.
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Won HS, Kim JH, Lee UY, Rha KH, Kim DK. Topographical relationships between the obturator nerve, artery, and vein in the lateral pelvic wall. Int Urogynecol J 2016; 27:213-8. [PMID: 26224385 DOI: 10.1007/s00192-015-2806-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aims of this study were to determine the topographical relationships between the obturator nerve (ON), artery (OA), and vein (OV) in the lateral pelvic wall. METHODS One hundred and fifty hemipelvises of 84 Korean cadavers were dissected. RESULTS The ON, OA, and OV ran in that order (from upper to lower) within the lateral pelvic wall in 46.7 % of specimens. In 32 % of cases, the three structures were separated at the posterior portion of the wall and then converged toward the obturator canal (OC). In 10 %, the OA and OV were in contact with each other and separate from the ON; in 2 %, the ON was contiguous with the OA and separate from the OV; in 2.7 %, all three structures were in contact with each another. Alternately, the order of ON, OA, and OV was altered in the lateral pelvic wall in 41.3 % of specimens. Finally, in 12 % specimens, either the OA or OV or both were absent from the lateral pelvic wall. CONCLUSIONS The possibility of the presence of either the OA or OV being between the ON and the external iliac vein, and the potential contact between the ON and either the OA or OV in the lateral pelvic wall, should be borne in mind during pelvic procedures.
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Yaribakht S, Malartic C, Grange G, Morel O. [Operative risk related to tobacco in gynecology]. ACTA ACUST UNITED AC 2014; 42:343-7. [PMID: 24787606 DOI: 10.1016/j.gyobfe.2014.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/06/2014] [Indexed: 11/23/2022]
Abstract
If tobacco has been recognized for many years as a major risk factor for cardiovascular, lung diseases and cancer in the general population, women are insufficiently aware of the consequences and the specific gynecological operative risks related to this intoxication. Thus, a regular tobacco consumption increases the risk for many gynecological conditions may require surgical treatment with in addition a significant negative impact on the healing process and the risk of postoperative complications. The operative risk must be explained by surgeons in daily practice gynecological, pelvic surgery or breast screening. The issue of smoking cessation should precede surgery has been established by a consensus conference of experts on perioperative smoking held in 2005. The implementation of these recommendations during the preoperative period requires improvement of staff training and better practices to allow smoking cessation effective and sustainable. It is lawful in this context to delay scheduled surgery of 6 to 8 weeks to allow an optimal smoking cessation and to continue smoking cessation for the time necessary for healing to reduce the excess operative risk associated with smoking.
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Eftekhar T, Sohrabi M, Haghollahi F, Shariat M, Miri E. Comparison effect of physiotherapy with surgery on sexual function in patients with pelvic floor disorder: A randomized clinical trial. Iran J Reprod Med 2014; 12:7-14. [PMID: 24799856 PMCID: PMC4009589] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/18/2013] [Accepted: 08/25/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Female sexual dysfunction is a common problem among general population, especially in urogynecological patient, and can lead to a decrease in quality of life and affect martial relationship. OBJECTIVE This study was compared the effect of surgical methods versus physiotherapy on sexual function in pelvic floor disorder. MATERIALS AND METHODS This randomized controlled trial was performed in Urogynecology clinic since August 2007 to December 2009 on 90 patients aged from 25-55 years with previous delivery, positive history of sexual dysfunction with stage <3 of pelvic organ prolapsed and divided in two groups. Group A (n=45) received standard rectocele repair and prineorrhaphy, group B (n=45) received physiotherapy for eight weeks twice a week (electrical stimulation, Kegel exercises). The female sexual function index (FSFI) used to evaluate the sexual function in cases before and after intervention. Frequency of variable scores (libido, orgasm, dysparunia) included without disorder, frequently good, sometimes good, very much and extreme were compared between two groups. RESULTS Libido and arousal were improved in both groups (p=0.007, p=0.001 respectively). Orgasm and dyspareunia were improved in group B (p=0.001). Dysparunia was more painful in group A. There was significant difference between two groups (improvement of orgasm and dysparunia in group B) (p=0.001). CONCLUSION It seems that physiotherapy is an appropriate method for treatment of sexual disorder in pelvic floor disorder. REGISTRATION ID IN IRCT IRCT2013031112790N1.
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Affiliation(s)
- Tahereh Eftekhar
- Institute for Family Health, Vali-e-Asr Reproductive Health Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Sohrabi
- Gynecology Ward, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Fedyeh Haghollahi
- Institute for Family Health, Vali-e-Asr Reproductive Health Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mamak Shariat
- Institute for Family Health, Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elahe Miri
- Gynecology Ward, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Caricato M, Ausania F, Marangi GF, Cipollone I, Flammia G, Persichetti P, Trodella L, Coppola R. Surgical treatment of locally advanced anal cancer after male-to-female sex reassignment surgery. World J Gastroenterol 2009; 15:2918-9. [PMID: 19533817 PMCID: PMC2699013 DOI: 10.3748/wjg.15.2918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a case of a transsexual patient who underwent a partial pelvectomy and genital reconstruction for anal cancer after chemoradiation. This is the first case in literature reporting on the occurrence of anal cancer after male-to-female sex reassignment surgery. We describe the surgical approach presenting our technique to avoid postoperative complications and preserve the sexual reassignment.
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