Laparoendoscopic single site surgery in urology: A single centre experience

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Arvind P Ganpule

2012-01-01

Full Text Available Objective : To analyze our experience of 87 cases with single port surgery, which is also known as laparoendoscopic single site surgery (LESS. Materials and Methods: Case records of all LESS procedures performed between December 2007 and June 2010 were analysed. The procedures performed were donor nephrectomy (n=45, simple nephrectomy (n=27, radical nephrectomy (n=5, pyeloplasty (n=9, and ureteroneocystostomy (n=1. Parameters analysed were operating room (OR time, estimated blood loss (EBL, visual analogue score (VAS, and complications in all patients undergoing LESS procedure and additionally, warm ischaemia time (WIT and graft outcome in patients undergoing LESS donor nephrectomy. In reconstructive procedures, the functional assessment was performed with a diuretic renogram at 6 months. Results: In LESS donor nephrectomy, the mean WIT was 6.9 ± 1.9 min. Mean serum creatinine in recipients at 1 month was 0.96 ± 0.21 mg%. We encountered one instance each of renal artery injury, renal vein injury, large bowel injury, minor cortical laceration at the upper pole and two instances of diaphragmatic injury. In LESS simple nephrectomy, the average OR time was 148.7 ± 52.2 min and hospital stay was 3.7 ± 1.2 days. There was one instance of large bowel injury during specimen retrieval. In LESS radical nephrectomy, the average OR time was 202.5 ± 35.7 min and average hospital stay was 4.2 ± 1.3 days. 6 patients of LESS pyeloplasty completed follow up with a diuretic renogram showing a good drainage. LESS ureteroneocystostomy could also be performed successfully without any complications. Conclusion: LESS surgery can be accomplished safely in nephrectomy and reconstructive procedures such as pyeloplasty and ureteroneocystostomy with equivalent outcomes as standard laparoscopy and with added benefits of cosmesis and quicker convalescence. LESS donor nephrectomy is a technically feasible procedure; current status of procedure needs to be proved with

Single-incision laparoscopic surgery through an ostomy site: a natural approach by an unnatural orifice.

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Lopez, Nicole E; Peterson, Carrie Y; Ramamoorthy, Sonia L; McLemore, Elisabeth C; Sedrak, Michael F; Lowy, Andrew M; Horgan, Santiago; Talamini, Mark A; Sicklick, Jason K

2015-02-01

Single-incision laparoscopic surgery (SILS) is gaining popularity for a wide variety of surgical operations and capitalizes on the benefits of traditional laparoscopic surgery without incurring multiple incision sites. Traditionally, SILS is performed by a midline periumbilical approach. However, such a minimally invasive approach may be utilized in patients who already have an abdominal incision. Our series retrospectively reviews 7 cases in which we utilized the fascial defect at the time of after ostomy reversal as our SILS incision site. In turn, we performed a variety of concurrent intra-abdominal procedures with excellent technical success and outcomes. Our study is the largest single-institution case series of this novel approach and suggests that utilizing an existing ostomy-site abdominal incision is a safe and effective location for SILS port placement and should be considered in patients undergoing concurrent procedures.

Single-incision laparoscopic distal gastrectomy for early gastric cancer through a homemade single port access device.

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Jiang, Zhi-Wei; Zhang, Shu; Wang, Gang; Zhao, Kun; Liu, Jiang; Ning, Li; Li, Jieshou

2015-01-01

We presented a series of single-incision laparoscopic distal gastrectomies for early gastric cancer patients through a type of homemade single port access device and some other conventional laparoscopic instruments. A single-incision laparoscopic distal gastrectomy with D1 + α lymph node dissection was performed on a 46 years old male patient who had an early gastric cancer. This single port access device has facilitated the conventional laparoscopic instruments to accomplish the surgery and we made in only 6 minutes. Total operating time for this surgery was 240 minutes. During the operation, there were about 100 milliliters of blood loss, and 17 lymph-nodes were retrieved. This homemade single port access device shows its superiority in economy and convenience for complex single-incision surgeries. Single-incision laparoscopic distal gastrectomy for early gastric cancer can be conducted by experienced laparoscopic surgeons. Fully take advantage of both SILS and fast track surgery plan can bring to successful surgeries with minimal postoperative pain, quicker mobilization, early recovery of intestinal function, and better cosmesis effect for the patients.

Implementation and usefulness of single access laparoscopic segmental and total colectomy.

LENUS (Irish Health Repository)

Baig, Muhammad N

2012-02-06

Aim:  Single access laparoscopic surgery is a recent vogue in the field of minimally invasive colorectal surgery. While selected series have indicated feasibility, we prospectively examined its usefulness for resectional surgery in routine practice. Method:  All patients undergoing laparoscopic colorectal resection over a twelve month period were considered for a single access approach by a single surgical team in a university hospital. This utilised a \\'Glove\\' port via a 3-5 cm periumbilical or stomal site incision with standard rigid laparoscopic instruments then being used. Results:  Of 74 planned laparoscopic colorectal resections, 35 (47%) were performed by this single incision laparoscopic modality without disruption of theatre list efficiency or surgical training obligations. The mean (range) age and BMI of these 25 consecutive right sided resections, 8 total colectomies (7 urgent operations) and 2 anterior resections was 58 (22-82) years and 23.9 (18.6-36.2) kg\\/m(2) respectively. The modal postoperative day of discharge was 4. For right sided resections, the mean (range) post-op stay in those undergoing surgery for benign disease was 4, while for those undergoing operation for neoplasia (n=18, mean age 71 years) it was 5.8 days and the average lymph node harvest was 13. Use of the glove port reduced trocar cost by 58% (€60\\/£53) by allowing use of trocar sleeves alone without obturators. Conclusion:  Single incision laparoscopic surgery is an effective option for abdominal surgery and seems especially suited for laparoscopic-assisted right sided colonic resections. The Glove port technique facilitates procedural frequency and familiarity and proves economically favourable.

Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

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Yasuhiro Sumino

2011-01-01

Full Text Available Laparoendoscopic single-site surgery (LESS is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

Ergon-trial: ergonomic evaluation of single-port access versus three-port access video-assisted thoracic surgery.

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Bertolaccini, Luca; Viti, Andrea; Terzi, Alberto

2015-10-01

Single-port access video-assisted thoracic surgery (VATS), a technique progressively developed from the standard three-port approach in minimally invasive surgery, offers ergonomic advantages but also new challenges for the surgeon. We compared the ergonomics of three-port versus single-port VATS. Posture analysis of surgeons was evaluated during 100 consecutive VATS wedge resections (50 triportal vs. 50 uniportal). Technically demanding procedures (major lung resection) were excluded. Operating table height, monitor height, distance and inclination were adjusted according to operator preference. Body posture was assessed by measuring head-trunk axial rotation and head flexion. Perceived physical strain was self-evaluated on the Borg Category Ratio (CR-10) scale. Mental workload was assessed with the National Aeronautics Space Administration-Task Load indeX (NASA-TLX), a multidimensional tool that rates workloads on six scales (mental, physical and temporal demand; effort; performance; frustration). All procedures were completed without complications. Head-trunk axial rotation was significantly reduced and neck flexion significantly improved in uniportal VATS. Viewing direction significantly declined (p = 0.01), body posture as measured on the Borg CR-10 scale was perceived as more stressful and the NASA-TLX score for overall workload was higher (p = 0.04) during triportal VATS. The NASA-TLX score for frustration was higher with uniportal VATS (p = 0.02), but the score for physical demand was higher in triportal VATS (p = 0.006). The surgeon can maintain a more neutral body posture during uniportal VATS by standing straight and facing the monitor with only minimal neck extension/rotation; however, frustration is greater than with triportal VATS.

Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery.

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Autorino, Riccardo; Stein, Robert J; Lima, Estevão; Damiano, Rocco; Khanna, Rakesh; Haber, Georges-Pascal; White, Michael A; Kaouk, Jihad H

2010-05-01

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

The accessibility, readability, and quality of online resources for gender affirming surgery.

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Vargas, Christina R; Ricci, Joseph A; Lee, Michelle; Tobias, Adam M; Medalie, Daniel A; Lee, Bernard T

2017-09-01

The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of Internet resources for information about gender affirming surgery is particularly important. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information. An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument. Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites. Web sites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of different sets of instruments for laparoendoscopic single-site surgery in a surgical simulator with novices.

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Wang, Dong; Shi, Long-Qing; Wang, Jing-Min; Jiang, Xiao-Hua; Ji, Zhen-Ling

2016-04-01

Given the parallel entry of working instruments through a single incision in laparoendoscopic single-site surgery, loss of triangulation in the abdominal cavity and counteracting movements of the instruments are inevitable obstacles. Some specially designed devices have emerged to ameliorate these challenges. Twenty-four novice participants were randomized into four groups using assigned instruments, conventional straight instruments, single-curved instruments, double-curved instruments and articulating instruments, respectively, to perform two basic tasks (peg transferring and pattern cutting) 14 times in a modified simulator. A test of the tasks and a resection of the intestine segment of a rat were performed. The task scores and evaluation of intraoperative skills during the resection of the intestine segment were recorded. The instrument of modified National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed. The task scores of the groups using single-curved instruments and articulating instruments were better than the other two groups on the simulator tasks, consistent with the evaluation of intraoperative skills during the resection of intestine segment. As the proficiency with the instruments increased, the task scores improved, as demonstrated by the learning curve. The workload measured by the modified NASA-TLX tool demonstrated that the groups using articulating instruments and double-curved instruments had a heavier workload in most of the categories compared with the other two groups. Single-curved and articulating instruments are more effective than conventional straight and double-curved devices, and are favourable in laparoendoscopic single-site surgery for novice learners. © 2013 Royal Australasian College of Surgeons.

Reduced-port robotic total mesorectal resection for rectal cancer using a single-port access: a technical note.

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Bae, Sung Uk; Jeong, Woon Kyung; Baek, Seong Kyu

2017-12-01

Single-port laparoscopic surgery has some advantages, including improved cosmetic outcomes and minimized parietal trauma. However, pure single-port laparoscopic rectal cancer surgery is challenging because of the difficulties in creating triangulation and applying the laparoscopic staplers with sufficient distal margins in the narrow pelvic cavity. Recently, a reduced-port robotic operation with a robotic single-port access plus one wristed robotic arm for colon cancer was introduced to overcome the limitations of single-port laparoscopic rectal surgery. Single-port laparoscopic surgery has some advantages, including improved cosmetic outcomes and minimized parietal trauma. However, the pure single-port laparoscopic rectal cancer operation is challenging. Recently, a reduced-port robotic operation with a robotic single-port access plus one wristed robotic arm for colon cancer was introduced to overcome the limitations of single-port laparoscopic rectal surgery. We performed a single-port plus an additional port robotic operation using a robotic single-port access through the umbilical incision, and the wristed robotic instruments were inserted through an additional robotic port in the right lower quadrant. The total operative and docking times were 310 min and 25 min, respectively. The total number of lymph nodes harvested was 12, and the proximal and distal resection margins were 11.1 and 2 cm, respectively. The patient was discharged on postoperative day 12 uneventfully. Based on a representative case, reduced-port robotic total mesorectal excision for rectal cancer using the single-port access appears to be feasible and safe. This approach could overcome the limitations of single-port laparoscopic rectal surgery.

Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory.

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Schoenthaler, Martin; Avcil, Tuba; Sevcenco, Sabina; Nagele, Udo; Hermann, Thomas E W; Kuehhas, Franklin E; Shariat, Shahrokh F; Frankenschmidt, Alexander; Wetterauer, Ulrich; Miernik, Arkadiusz

2015-01-01

To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model. Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy. Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.

Single port access for laparoscopic lateral segmentectomy.

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Inoue, Yoshihiro; Asakuma, Mitsuhiro; Hirokawa, Fumitoshi; Hayashi, Michihiro; Shimizu, Tetsunosuke; Uchiyama, Kazuhisa

2017-12-01

Single-port access laparoscopic lateral segmentectomy (LLS) has been developed as a novel minimally invasive surgery. We have experience with this LLS technique. To report our technique and patients' postoperative course in a series of single-port access LLS performed in our department. We also examine the cosmetic outcome, safety, and utility of the procedure. Between February 2010 and October 2016, 54 patients who underwent single- or multiple-port laparoscopic or open lateral segmentectomy (LS) were retrospectively analyzed with respect to cosmetic outcome, safety, and utility. In the single LLS group, the laparoscopic procedure was successfully completed for all 14 patients. The median operative time was significantly shorter in the single LLS group (123 min; range: 50-270 min) than in the other groups. Estimated blood loss was also significantly lower in the single LLS group (10 ml; range: 0-330 ml). During the first 7 postoperative days, the visual analog scale pain score and the use of additional analgesia were not significantly different between groups. The single LLS group had a 7.1% complication rate (Clavien-Dindo classification > IIIA); this was not significantly different between groups. Single-port access LLS is a procedure with excellent cosmetic results, although, with regard to invasiveness, there are no major differences from conventional LLS.

Robotic right colectomy using the Da Vinci Single-Site® platform: case report.

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Morelli, Luca; Guadagni, Simone; Caprili, Giovanni; Di Candio, Giulio; Boggi, Ugo; Mosca, Franco

2013-09-01

While single-port laparoscopy for abdominal surgery is technically challenging, the Da Vinci Single-Site® robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present a case of single-incision, robotic right colectomy using this device. A 74-year-old female with malignant polyp of caecum was operated on with a single-site approach using the Da Vinci Single-Site® robotic surgery device. Resection and anastomosis were performed extra-corporeally after undocking the robot. The procedure was successfully completed in 200 min. No surgical complications occurred during the intervention and the post-operative stay and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of right colectomy using the Da Vinci Single-Site® robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are restoration of triangulation and reduced instrument clashes. Copyright © 2013 John Wiley & Sons, Ltd.

Single access laparoscopic nephrectomy

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Jay D Raman

2008-01-01

Full Text Available Laparoscopic nephrectomy has assumed a central role in the management of benign and malignant kidney diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions each at least 1-2 cm in length. Each incision carries morbidity risks of bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single access or keyhole surgery, which utilizes magnetic anchoring and guidance system (MAGS technology or articulating laparoscopic instruments. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing for the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series demonstrate feasibility as well as safe and successful completion of keyhole nephrectomy. Future work is necessary to improve existing instrumentation, increase clinical experience, assess benefits of this surgical approach, and explore other potential applications for this technique.

Da Vinci single site© surgical platform in clinical practice: a systematic review.

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Morelli, Luca; Guadagni, Simone; Di Franco, Gregorio; Palmeri, Matteo; Di Candio, Giulio; Mosca, Franco

2016-12-01

The Da Vinci single-site© surgical platform (DVSSP) is a set of single-site instruments and accessories specifically dedicated to robot-assisted single-site surgery. The PubMed database from inception to June 2015 was searched for English literature on the clinical use of DVSSP in general surgery, urology and gynecology. Twenty-nine articles involving the clinical application of DVSSP were identified; 15 articles on general surgery (561 procedures), four articles on urology (48 procedures) and 10 articles on gynecology (212 procedures). All studies have proven the safety and feasibility of the use of DVSSP. The principal reported advantage is the restoration of intra-abdominal triangulation, while the main reported limitation is the lack of the endowrist. Da Vinci systems have proven to be valuable assets in single-site surgery, owing to the combination of robot use with the dedicated single-incision platform. However, case-control or prospective trials are warranted to draw more definitive conc lusions. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

NARCIS (Netherlands)

Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a

Robotic-assisted single-port donor nephrectomy using the da Vinci single-site platform.

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LaMattina, John C; Alvarez-Casas, Josue; Lu, Irene; Powell, Jessica M; Sultan, Samuel; Phelan, Michael W; Barth, Rolf N

2018-02-01

Although single-port donor nephrectomy offers improved cosmetic outcomes, technical challenges have limited its application to selected centers. Our center has performed over 400 single-port donor nephrectomies. The da Vinci single-site robotic platform was utilized in an effort to overcome the steric, visualization, ergonomic, and other technical limitations associated with the single-port approach. Food and Drug Administration device exemption was obtained. Selection criteria for kidney donation included body mass index da Vinci single-site platform. Our experience supported the safety of this approach but found that the technology added cost and complexity without tangible benefit. Development of articulating instruments, energy, and stapling devices will be necessary for increased application of robotic single-site surgery for donor nephrectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

OpenAIRE

Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

2013-01-01

Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery.

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Chen, Kuo-Hu; Chen, Li-Ru; Seow, Kok-Min

2015-01-01

To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. Prospective cohort study (Canadian Task Force classification: II-2). University teaching hospital. One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All

Laparo-Endoscopic Single-Site Surgery for Radical and Cytoreductive Nephrectomy, Renal Vein Thrombectomy, and Partial Nephrectomy: A Prospective Pilot Evaluation

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Ithaar H. Derweesh

2010-01-01

Full Text Available Introduction. Laparo-endoscopic single-site surgery (LESS may diminish morbidity of laparoscopic surgery. We prospectively evaluated feasibility and outcomes of LESS-Radical Nephrectomy (LESS-RN and Partial Nephrectomy (LESS-PN. Methods. 10 patients underwent LESS-RN (6 and LESS-PN (4 between 2/2009-5/2009. LESS-RN included 2 with renal vein thrombectomy, one of which was also cytoreductive. Transperitoneal LESS access was obtained by periumbilical incision. Patient/tumor characteristics, oncologic, and quality of life (QoL outcomes were analyzed. Results. 3 Men/7 Women (mean age 58.7 years, median follow-up 9.8 months underwent LESS. 9/10 cases were completed successfully. All had negative margins. Mean operative time was 161 minutes, estimated blood loss was 125 mL, and incision size was 4.4 cm. Median tumor size for LESS-RN and -PN was 5.0 and 1.7 cm (=.045. Median LESS-PN ischemia time was 24 minutes; mean preoperative/postoperative creatinine were 0.7/0.8 mg/dL (=.19. Mean pain score at discharge was 1.3. Mean preoperative, 3-, and 6-month postoperative SF-36 QoL Score was 73.8, 74.4 and 77.1 (=.222. All patients are currently alive. Conclusions. LESS-RN, renal vein thrombectomy, and PN are technically feasible and safe while maintaining adherence to oncologic principles, with excellent QoL preservation and low discharge pain scores. Further study is requisite.

Single-access laparoscopic low anterior resection with vertical suspension of the rectum.

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Uematsu, Dai; Akiyama, Gaku; Narita, Maiko; Magishi, Akiko

2011-05-01

Single-access laparoscopic surgery was first introduced for colectomy and later adapted for anterior resection. During single-access laparoscopic pelvic procedures, such as total mesorectal excision, it is often difficult to obtain an adequate operative field. By suspending the rectum vertically, we were able to execute a total mesorectal excision with single-access laparoscopy. We describe here the use of this new procedure to treat rectal cancer. The selected 7 patients (1 male and 6 female) with stage II or III rectal cancer underwent the procedure. Single-port access to the abdomen was provided by a 3.0-cm incision at the right iliac fossa. The descending mesocolon was dissected by use of a medial approach, and a columnar magnet was placed on the surface of the abdominal wall to restore triangulation. The inferior mesenteric artery was skeletonized and the superior rectal artery divided during lymph node dissection. The total mesorectal excision extended to the pelvic floor and the rectum was vertically retracted with a suspending bar in collaboration with an extracorporeal magnet tool. The rectum was then transected below the reflection of the peritoneum. Intracorporeal anastomosis was performed with the double-stapling technique. Two pelvic drains were inserted through the single incision and the anus, respectively, for all patients. A defunctioning ileostomy was not created in any patient. Median total surgical time was 205 minutes (range, 175-245 min). Intraoperative blood loss was minimal in all patients (range, 1-20 mL). None of the cases required conversion to open surgery or addition of a second port. The only preoperative or postoperative complication occurred in one patient with clinical anastomotic leakage. Low anterior single-access laparoscopic resection seems safe and feasible when the rectum is suspended like a swing to ensure an adequate operative field.

Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

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Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

2013-01-01

Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.

Single versus Two-Site Phacoemulsification and Mitomycin-C Trabeculectomy

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Alireza Baradaran-Rafiee

2008-11-01

Full Text Available

PURPOSE: To compare the outcomes of single-site versus two-site mitomycin-C (MMC augmented phacotrabeculectomy. METHODS: This matched randomized clinical trial included 34 eyes of 30 patients with visually significant cataracts and poorly controlled glaucoma. Equal numbers of eyes were randomly assigned to the single-site and two-site groups. In the single-site approach, phacoemulsification was performed under a superior scleral tunnel followed by trabeculectomy. The two-site approach included a temporal clear corneal phaco-emulsification combined with a separate superior trabeculectomy. MMC 0.2 mg/ml was similarly applied for one minute in both groups. RESULTS: Patients were followed for a mean period of 13±1.4 (range, 12 to 15 months. Mean best corrected visual acuity one year after surgery was 0.6±0.4 LogMAR in the single-site group and 0.4±0.28 LogMAR in the two-site group (P=0.12. In the single-site group, mean preoperative intraocular pressure (IOP was 26.4±6.6 mmHg which was decreased to 14.8±2.5 mmHg, one year after the operation (P < 0.001. Corresponding figures for the two-site group were 22.9±3.3 and 13.6±1.7 mmHg respectively (P < 0.001. At final follow up no significant difference in IOP existed between the study groups. Mean number of anti-glaucoma medications was 0.06±0.24 in the two-site group vs 0

Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

Directory of Open Access Journals (Sweden)

Deepak Dubey

2011-01-01

Conclusions : Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

Immune and stress mediators in response to bilateral adnexectomy: comparison of single-port access and conventional laparoscopy in a porcine model.

Science.gov (United States)

Gracia, Meritxell; Sisó, Cristian; Martínez-Zamora, M Àngels; Sarmiento, Laura; Lozano, Francisco; Arias, Maria Teresa; Beltrán, Joan; Balasch, Juan; Carmona, Francisco

2014-01-01

To evaluate systemic markers of immune and stress responses after bilateral adnexectomy performed using 2 different laparoscopic techniques in pigs. Prospective comparative study (Canadian Task Force classification II-2). University teaching hospital, research hospital, and tertiary care center. Twenty female Yorkshire pigs undergoing laparoscopic surgery. Animals underwent bilateral salpingo-oophorectomy (ovary and fallopian tube extraction), performed via conventional laparoscopy (n = 10) or the single-port access approach (n = 10). Injury provokes an acute-phase response, primarily produced by cytokines. The inflammatory response has been well described for major surgery and for conventional laparoscopy; however, little information is currently available for single-port laparoscopy, and none in the gynecologic field. This is the first study to compare serum cytokine interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) concentrations at baseline and in the early postoperative period (2, 4, and 20 hours) after bilateral salpingo-oophorectomy performed via conventional laparoscopy (n = 10) or single-port access (n = 10) in a porcine model. The stress response was measured using glucose and cortisol concentrations and the animals' response to surgery via a 6-category observation-based behavior test. Both IL-6 and TNF-α concentrations peaked at 4 hours after surgery, and were significantly lower in the single-port access group (p = .02) than in the conventional laparoscopy group (p = .02). In addition, in the single-port access group, concentrations of stress markers were slightly lower at all intervals recorded and were statistically significant at 2 hours after the operation for glucose concentration (mean [SD], 164.50 [26.73] mg/dL for conventional laparoscopy vs 86.50 [17.93] mg/dL for single-port access; p = .02). Evidence of improved inflammatory and stress responses was recorded in the minimally invasive single-port group. More clinical

Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?

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Son, Andrew; Mannoia, Kristyn; Herrera, Anthony; Chizari, Mohammad; Hagdoost, Muhammad; Molkara, Afshin

2016-05-01

Creation of an arteriovenous fistula (AVF) is the preferred method of establishing long-term dialysis access. There are multiple anesthetic techniques used for patients undergoing this surgery including general endotracheal intubation, laryngeal mask airway, regional anesthesia with nerve blocks, and monitored anesthesia care with local infiltration. It is unclear what effect the method of anesthesia has on AVF creation success rate. It is our objective to determine if anesthesia type affects success of these surgeries defined by complication and maturation rates. A retrospective review was performed in a single institution, single surgeon study of 253 patients who underwent AVF creation between January 2003 and December 2010. Patients were cross analyzed between 3 anesthesia types (General Endotracheal Intubation, Laryngeal Mask Airway and Local Infiltration with Monitored Anesthesia Care) and AVF creation surgeries (radiocephalic, brachiocephalic, and basilic vein transposition). No patients had regional anesthesia performed. Demographic data including comorbidities and risk factors were stratified among all categories. Analysis of variance, chi-squared testing, and Fisher's exact P testing was performed across all anesthesia types and specific operations and measured according to success of fistula maturation and complication rates (including death within 30 days, myocardial infarction within 30 days, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome). There were no significant differences in maturation rate in terms of all 3 anesthesia types for radiocephalic (P = 0.191), brachiocephalic (P = 0.191), and basilic vein transposition surgeries (P = 0.305). In addition, there were no differences in complication rates between the surgeries and the 3 types of anesthesia (P = 0.557). Our study shows that despite anesthesia type, outcomes in terms of maturation and complication rate are not statistically

Laparoendoscopic single-site surgery (LESS) for the treatment of different urologic pathologies in pediatrics: single-center single-surgeon experience.

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Abdel-Karim, Aly M; Elmissery, Mostafa; Elsalmy, Salah; Moussa, Ahmed; Aboelfotoh, Ahmed

2015-02-01

Recently LESS has been reported as a valid minimally option for treatment of some urologic pathologies in pediatrics. However, the initial reports of pediatric LESS are still limited to case reports and initial case series. This may be due to the inherent technical difficulty of LESS and the currently available LESS instruments. In this report, we present the largest case series of pediatric LESS for treatment of different urologic pathologies in pediatrics. Included in this study are children who had LESS during the period of January 2011 to June 2013. Both Olympus TriPort (Olympus, New York, USA and Advance Surgical Concept, Wicklow, Ireland) and Covedien SILS access port (Covedien, Chicopec, Massachusetts, USA) were used and were inserted through the umbilicus. Exclusion criteria included children less than 3 years old, history of previous transperitoneal abdominal surgery, malignant indications, and complex urogenital congenital anomalies. All LESS procedures were done by a single experienced laparoscopist and data were reviewed retrospectively. Twenty-two children had 39 LESS procedures without conversion to conventional laparoscopy or open surgery. No intraoperative or postoperative complications were reported and no extra-port was added in any of the patients. The following table shows the mean age, operative time, hospital stay, VAS as well as the overall mean of different LESS procedures. In all patients the umbilical scar was invisible and all patients and their parents had high wound satisfaction. At a mean follow up of 18.6 ± 6.4 months, all patients with UPJO had successful repair. Our study included 13 boys with undescended testis who were managed in different ways according to the length of spermatic vessels and the size of the testis. One of the arguments against LESS management of undescended testis is that it requires a 2.5-cm incision, which is collectively larger than a 5-mm camera and two 3-mm working ports of conventional laparoscopy. However

Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices.

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Di Stasi, Leandro L; Díaz-Piedra, Carolina; Ruiz-Rabelo, Juan Francisco; Rieiro, Héctor; Sanchez Carrion, Jose M; Catena, Andrés

2017-11-01

Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves). Copyright © 2017 Elsevier Ltd. All rights reserved.

Preliminary application of a single-port access technique for laparoscopic ovariohysterectomy in dogs

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Sánchez-Margallo, F. M.; Tapia-Araya, A.; Díaz-Güemes, I.

2015-01-01

Laparoscopic ovariohysterectomy using single-portal access was performed in nine selected owned dogs admitted for elective ovariohysterectomy and the surgical technique and outcomes were detailed. A multiport device (SILS Port, Covidien, USA) was placed at the umbilical area through a single 3 cm incision. Three cannulae were introduced in the multiport device through the access channels and laparoscopic ovariohysterectomy was performed using a 5-mm sealing device, a 5-mm articulating grasper and a 5-mm 30° laparoscope. The mean total operative time was 52.66±15.20 minutes and the mean skin incision during surgery was 3.09±0.20 cm. Of the nine cases examined, in the one with an ovarian tumour, the technique was converted to multiport laparoscopy introducing an additional 5-mm trocar. No surgical complications were encountered and intraoperative blood loss was minimum in all animals. Clashing of the instruments and reduced triangulation were the main limitations of this technique. The combination of articulated and straight instruments facilitated triangulation towards the surgical field and dissection capability. One month after surgery a complete wound healing was observed in all animals. The present data showed that ovariohysterectomy performed with a single-port access is technically feasible in dogs. The unique abdominal incision minimises the abdominal trauma with good cosmetic results. PMID:26568831

Disparities in access to emergency general surgery care in the United States.

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Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

Towards ubiquitous access of computer-assisted surgery systems.

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Liu, Hui; Lufei, Hanping; Shi, Weishong; Chaudhary, Vipin

2006-01-01

Traditional stand-alone computer-assisted surgery (CAS) systems impede the ubiquitous and simultaneous access by multiple users. With advances in computing and networking technologies, ubiquitous access to CAS systems becomes possible and promising. Based on our preliminary work, CASMIL, a stand-alone CAS server developed at Wayne State University, we propose a novel mobile CAS system, UbiCAS, which allows surgeons to retrieve, review and interpret multimodal medical images, and to perform some critical neurosurgical procedures on heterogeneous devices from anywhere at anytime. Furthermore, various optimization techniques, including caching, prefetching, pseudo-streaming-model, and compression, are used to guarantee the QoS of the UbiCAS system. UbiCAS enables doctors at remote locations to actively participate remote surgeries, share patient information in real time before, during, and after the surgery.

Step-wise integration of single-port laparoscopic surgery into routine colorectal surgical practice by use of a surgical glove port.

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Hompes, R; Lindsey, I; Jones, O M; Guy, R; Cunningham, C; Mortensen, N J; Cahill, R A

2011-06-01

The cost associated with single-port laparoscopic access devices may limit utilisation of single-port laparoscopic surgery by colorectal surgeons. This paper describes a simple and cheap access modality that has facilitated the widespread adoption of single-port technology in our practice both as a stand-alone procedure and as a useful adjunct to traditional multiport techniques. A surgical glove port is constructed by applying a standard glove onto the rim of the wound protector/retractor used during laparoscopic resectional colorectal surgery. To illustrate its usefulness, we present our total experience to date and highlight a selection of patients presenting for a range of elective colorectal surgery procedures. The surgical glove port allowed successful completion of 25 single-port laparoscopic procedures (including laparoscopic adhesiolysis, ileo-rectal anastomosis, right hemicolectomy, total colectomy and low anterior resection) and has been used as an adjunct in over 80 additional multiport procedures (including refashioning of a colorectal anastomosis made after specimen extraction during a standard multiport laparoscopic anterior resection). This simple, efficient device can allow use of single-port laparoscopy in a broader spectrum of patients either in isolation or in combination with multiport surgery than may be otherwise possible for economic reasons. By separating issues of cost from utility, the usefulness of the technical advance inherent within single-port laparoscopy for colorectal surgery can be better appreciated. We endorse the creative innovation inherent in this approach as surgical practice continues to evolve for ever greater patient benefit.

Equity of access to elective surgery: reflections from NZ clinicians.

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McLeod, Deborah; Dew, Kevin; Morgan, Sonya; Dowell, Anthony; Cumming, Jackie; Cormack, Donna; McKinlay, Eileen; Love, Tom

2004-10-01

To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

Early and late surgical site infections in ear surgery.

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Bastier, P L; Leroyer, C; Lashéras, A; Rogues, A-M; Darrouzet, V; Franco-Vidal, V

2016-04-01

A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach. During follow-up, surgical site infections were defined as "early" if occurring within 30 days after surgery or as "late" if occurring thereafter. The data of 102 patients were analysed. Concerning early surgical site infections, four cases were diagnosed (3.9%) and a significant association was found with preoperative antibiotic therapy, wet ear at pre-operative examination, class III (contaminated) in the surgical wound classification, NNIS (National Nosocomial Infection Surveillance) index > 1, and oral post-operative antibiotic use. Seven late surgical site infections were diagnosed (7.1%) between 90 and 160 days after surgery and were significantly correlated to otorrhoea during the 6 months before surgery, surgery duration ≤60 minutes, canal wall down technique and use of fibrin glue. Surgical site infections after chronic otitis media surgery seem to be associated with factors related to the inflammatory state of the middle ear at the time of surgery in early infections and with chronic inflammation in late infections. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

Does minimal access tubular assisted spine surgery increase or decrease complications in spinal decompression or fusion?

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Fourney, Daryl R; Dettori, Joseph R; Norvell, Daniel C; Dekutoski, Mark B

2010-04-20

Systematic review. The purpose of this review was to attempt to answer the following 2 clinical questions: (1) Does minimal access tubular assisted spine surgery (MAS) decrease the rate of complications in posterior thoracolumbar decompression and/or fusion surgery compared with traditional open techniques? (2) What strategies to reduce the risk of complications in MAS have been shown to be effective? The objective of minimal access spine surgery is to reduce damage to surrounding tissues while accomplishing the same goals as conventional surgery. Patient demand and marketing for MAS is driven by the perception of better outcomes, although the purported advantages remain unproven. Whether the risk of complications is affected by minimal access techniques is unknown. A systematic review of the English language literature was undertaken for articles published between 1990 and July 2009. Electronic databases and reference lists of key articles were searched to identify published studies that compared the rate of complications after MAS to a control group that underwent open surgery. Single-arm studies were excluded. Two independent reviewers assessed the strength of literature using GRADE criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. From the 361 articles identified, 13 met a priori criteria and were included for review. All of the studies evaluated only lumbar spine surgery. The single large randomized study showed less favorable results for MAS discectomy, but no significant difference in complication rates. The quality of the other studies, particularly for fusion surgery, was low. Overall, the rates of reoperation, dural tear, cerebrospinal fluid leak, nerve injury, and infection occurred in similar proportions between MAS and open surgery. Blood loss was reduced in MAS fusion; however, the quality of those studies was very low. Operation time and hospital length of stay was variable across studies

Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery-initial experience with a new operation approach.

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Kuo, Li-Jen; Ngu, James Chi-Yong; Tong, Yiu-Shun; Chen, Chia-Che

2017-02-01

Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery. Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon. The clinical and pathological results were retrospectively analyzed. The median operative time was 473 (range, 335-569) min, and the estimated blood loss was 33 (range, 30-50) mL. The median number of lymph nodes harvested was 12 (range, 8-18). The median distal resection margin was 1.4 (range, 0.4-3.5) cm, and all patients had clear circumferential resection margins. We encountered a left ureteric transection intraoperatively in one patient, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality. R-taTME followed by radical proctectomy using the R-SSPO technique for patients with low rectal lesions is technically feasible and safe without compromising oncologic outcomes. However, there were considerable limitations and a steep learning curve using current robotic technology.

Fermilab Security Site Access Request Database

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Fermilab Security Site Access Request Database Use of the online version of the Fermilab Security Site Access Request Database requires that you login into the ESH&Q Web Site. Note: Only Fermilab generated from the ESH&Q Section's Oracle database on May 27, 2018 05:48 AM. If you have a question

Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

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Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

2018-02-01

Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

Comparative Study of 2D and 3D Optical Imaging Systems: Laparoendoscopic Single-Site Surgery in an Ex Vivo Model.

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Vilaça, Jaime; Pinto, José Pedro; Fernandes, Sandra; Costa, Patrício; Pinto, Jorge Correia; Leão, Pedro

2017-12-01

Usually laparoscopy is performed by means of a 2-dimensional (2D) image system and multiport approach. To overcome the lack of depth perception, new 3-dimensional (3D) systems are arising with the added advantage of providing stereoscopic vision. To further reduce surgery-related trauma, there are new minimally invasive surgical techniques being developed, such as LESS (laparoendoscopic single-site) surgery. The aim of this study was to compare 2D and 3D laparoscopic systems in LESS surgical procedures. All participants were selected from different levels of experience in laparoscopic surgery-10 novices, 7 intermediates, and 10 experts were included. None of the participants had had previous experience in LESS surgery. Participants were chosen randomly to begin their experience with either the 2D or 3D laparoscopic system. The exercise consisted of performing an ex vivo pork cholecystectomy through a SILS port with the assistance of a fixed distance laparoscope. Errors, time, and participants' preference were recorded. Statistical analysis of time and errors between groups was conducted with a Student's t test (using independent samples) and the Mann-Whitney test. In all 3 groups, the average time with the 2D system was significantly reduced after having used the 3D system ( P 3D system. This study suggests that the 3D system may improve the learning curve and that learning from the 3D system is transferable to the 2D environment. Additionally, the majority of participants prefer 3D equipment.

Single-incision total laparoscopic hysterectomy

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Sinha Rakesh

2011-01-01

Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

American Thyroid Association Statement on Remote-Access Thyroid Surgery.

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Berber, Eren; Bernet, Victor; Fahey, Thomas J; Kebebew, Electron; Shaha, Ashok; Stack, Brendan C; Stang, Michael; Steward, David L; Terris, David J

2016-03-01

Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption. A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery. Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision. Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.

Comparison between magnetic anchoring and guidance system camera-assisted laparoendoscopic single-site surgery nephrectomy and conventional laparoendoscopic single-site surgery nephrectomy in a porcine model: focus on ergonomics and workload profiles.

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Han, Woong Kyu; Tan, Yung K; Olweny, Ephrem O; Yin, Gang; Liu, Zhuo-Wei; Faddegon, Stephen; Scott, Daniel J; Cadeddu, Jeffrey A

2013-04-01

To compare surgeon-assessed ergonomic and workload demands of magnetic anchoring and guidance system (MAGS) laparoendoscopic single-site surgery (LESS) nephrectomy with conventional LESS nephrectomy in a porcine model. Participants included two expert and five novice surgeons who each performed bilateral LESS nephrectomy in two nonsurvival animals using either the MAGS camera or conventional laparoscope. Task difficulty and workload demands of the surgeon and camera driver were assessed using the validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Surgeons were also asked to score 6 parameters on a Likert scale (range 1=low/easy to 5=high/hard): procedure-associated workload, ergonomics, technical challenge, visualization, accidental events, and instrument handling. Each step of the nephrectomy was also timed and instrument clashing was quantified. Scores for each parameter on the Likert scale were significantly lower for MAGS-LESS nephrectomy. Mean number of internal and external clashes were significantly lower for the MAGS camera (pNASA-TLX workload ratings by the surgeon and camera driver showed that MAGS resulted in a significantly lower workload than the conventional laparoscope during LESS nephrectomy (p<0.05). The use of the MAGS camera during LESS nephrectomy lowers the task workload for both the surgeon and camera driver when compared to conventional laparoscope use. Subjectively, it appears to also improve surgeons' impressions of ergonomics and technical challenge. Pending approval for clinical use, further evaluation in the clinical setting is warranted.

Laparoendoscopic Single-Site Surgery for the Treatment of Benign Adnexal Disease: A Prospective Trial

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Anna Fagotti

2010-01-01

Full Text Available Background. To validate feasibility, efficacy, and safeness of laparoscopic treatment of benign adnexal diseases through a single transumbilical access (LESS in a prospective series of patients. Methods. A prospective clinical trial including 30 women has been conducted at the Division of Gynecology of Catholic University of Sacred Hearth of Rome. Patients underwent different laparoscopic procedures by LESS utilizing a multiport trocar and conventional straight laparoscopic instrumentation. Intra and perioperative outcome has been reported. Results. Ten mono/bilateral adnexectomies and 20 cystectomies have been performed by LESS approach. Laparoscopic procedures were completed through a single access in 28 cases (93.4%. No major intra- or postoperative complications were observed. Mean hospital stay was 1.3 days. Conclusions. LESS approach is feasible to treat benign adnexal disease with a very low conversion rate and no early or late complications. More clinical data are needed to confirm these advantages compared to standard laparoscopic technique.

Complications of Minimally Invasive, Tubular Access Surgery for Cervical, Thoracic, and Lumbar Surgery

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Donald A. Ross

2014-01-01

Full Text Available The object of the study was to review the author’s large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases (n=1231 were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases. There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery.

[Risk factors related to surgical site infection in elective surgery].

Science.gov (United States)

Angeles-Garay, Ulises; Morales-Márquez, Lucy Isabel; Sandoval-Balanzarios, Miguel Antonio; Velázquez-García, José Arturo; Maldonado-Torres, Lulia; Méndez-Cano, Andrea Fernanda

2014-01-01

The risk factors for surgical site infections in surgery should be measured and monitored from admission to 30 days after the surgical procedure, because 30% of Surgical Site Infection is detected when the patient was discharged. Calculate the Relative Risk of associated factors to surgical site infections in adult with elective surgery. Patients were classified according to the surgery contamination degree; patient with surgery clean was defined as no exposed and patient with clean-contaminated or contaminated surgery was defined exposed. Risk factors for infection were classified as: inherent to the patient, pre-operative, intra-operative and post-operative. Statistical analysis; we realized Student t or Mann-Whitney U, chi square for Relative Risk (RR) and multivariate analysis by Cox proportional hazards. Were monitored up to 30 days after surgery 403 patients (59.8% women), 35 (8.7%) developed surgical site infections. The factors associated in multivariate analysis were: smoking, RR of 3.21, underweight 3.4 hand washing unsuitable techniques 4.61, transfusion during the procedure 3.22, contaminated surgery 60, and intensive care stay 8 to 14 days 11.64, permanence of 1 to 3 days 2.4 and use of catheter 1 to 3 days 2.27. To avoid all risk factors is almost impossible; therefore close monitoring of elective surgery patients can prevent infectious complications.

Surgical site infection in lumbar surgeries, pre and postoperative antibiotics and length of stay: a case study

International Nuclear Information System (INIS)

Khan, I.U.; Janjua, M.B.; Hasan, S.; Shah, S.

2009-01-01

Postoperative wound infection also called as surgical site infection (SSI), is a trouble some complication of lumbar spine surgeries and they can be associated with serious morbidities, mortalities and increase resource utilization. With the improvement in diagnostic modalities, proper surgical techniques, antibiotic therapy and postoperative care, infectious complications can result in various compromises afterwards. The objective was to study the relation of surgical site infection in clean lumbar surgeries with the doses of antibiotics. This Retrospective study was conducted at Shifa International Hospital, from January 2006 to March 2008. Methods: Hundred post operated cases of lumber disc prolapse, lumbar stenosis or both studied retrospectively by tracing their operated data from hospital record section for the development of surgical site infection (SSI). The patients were divided into three groups depending upon whether they received single, three or more than three doses of antibiotics respectively. Complete data analyses and cross tabulation done with SPSS version 16. Result: Of 100 cases, only 6% had superficial surgical site infection; only 1 case with co morbidity of hypertension was detected. Twenty-one cases had single dose of antibiotic (Group-I), 59 cases had 3 doses (Group-II) and 20 cases received multiple doses (Group-III). There was no infection in Group-I. Only one patient in Group-II and 5 patients in Group-III developed superficial SSI. While 4 in Group-II, 3 in Group-III, and none of Group-I had >6 days length of stay (LOS). Conclusion The dose of antibiotic directly correlates with the surgical site infection in clean lumbar surgeries. When compared with multiple doses of antibiotics a single preoperative shot of antibiotic is equally effective for patients with SSI. (author)

Novel Use of a Pneumatic Compression Device for Haemostasis of Haemodialysis Fistula Access Catheterisation Sites

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O’Reilly, Michael K., E-mail: moreilly1@mater.ie; Ryan, David; Sugrue, Gavin; Geoghegan, Tony; Lawler, Leo P.; Farrelly, Cormac T. [Mater Misericordiae University Hospital, Department of Interventional Radiology (Ireland)

2016-12-15

PurposeTransradial pneumatic compression devices can be used to achieve haemostasis following radial artery puncture. This article describes a novel technique for acquiring haemostasis of arterio-venous haemodialysis fistula access sites without the need for suture placement using one such compression device.Materials and MethodsA retrospective review of fistulograms with or without angioplasty/thrombectomy in a single institution was performed. 20 procedures performed on 12 patients who underwent percutaneous intervention of failing or thrombosed arterio-venous fistulas (AVF) had 27 puncture sites. Haemostasis was achieved using a pneumatic compression device at all access sites. Procedure details including size of access sheath, heparin administration and complications were recorded.ResultsTwo diagnostic fistulograms, 14 fistulograms and angioplasties and four thrombectomies were performed via access sheaths with an average size (±SD) of 6 Fr (±1.12). IV unfractionated heparin was administered in 11 of 20 procedures. Haemostasis was achieved in 26 of 27 access sites following 15–20 min of compression using the pneumatic compression device. One case experienced limited bleeding from an inflow access site that was successfully treated with reinflation of the device for a further 5 min. No other complication was recorded.ConclusionsHaemostasis of arterio-venous haemodialysis fistula access sites can be safely and effectively achieved using a pneumatic compression device. This is a technically simple, safe and sutureless technique for acquiring haemostasis after AVF intervention.

Port-site metastases following robot-assisted laparoscopic surgery for gynecological malignancies.

Science.gov (United States)

Lönnerfors, Celine; Bossmar, Thomas; Persson, Jan

2013-12-01

To evaluate the incidence and possible predictors associated with port-site metastases following robotic surgery. Prospective study. University Hospital. Women with gynecological cancer. The occurrence of port-site metastases in the first 475 women undergoing robotic surgery for gynecological cancer was reviewed. Rate of port-site metastases. A port-site metastasis was detected in nine of 475 women (1.9%). Eight women had either an unexpected locally advanced disease or lymph-node metastases at the time of surgery. All nine women received postoperative adjuvant therapy. Women with ≥ stage III endometrial cancer and women with node positive cervical cancer had a significantly higher risk of developing a port-site metastasis, as did women with high-risk histology endometrial cancer. Port-site metastases were four times more likely to occur in a specimen-retrieval port. One (0.2%) isolated port-site metastasis was detected. The median time to occurrence of a port-site metastasis was 6 months (range 2-19 months). Six of the nine women (67%) have died and their median time of survival from recurrence was 4 months (range 2-16 months). In women with gynecological cancer, the incidence of port-site metastases following robotic surgery was 1.9%. High-risk histology and/or advanced stage of disease at surgery seem to be contributing factors. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Wrong site surgery! How can we stop it?

Directory of Open Access Journals (Sweden)

Vishwanath Hanchanale

2014-01-01

Full Text Available Introduction: "Primum non nocere" (first do no harm: Hippocrates (c. 460 BC-377 BC. Wrong site surgery is the fourth commonest sentinel event after patient suicide, operative and post-operative complications, and medication errors. Misinterpretation of the clinic letters or radiology reports is the commonest reason for the wrong site being marked before surgery. Materials and Methods: We analyzed 50 cases each of operations carried out on the kidney, ureter, and the testis. The side mentioned on clinic letters, the consent form, and radiology reports lists were also studied. The results were analyzed in detail to determine where the potential pitfalls were likely to arise. Results: A total of 803 clinic letters from 150 cases were reviewed. The side of disease was not documented in 8.71% and five patients had the wrong side mentioned in one of their clinic letters. In the radiology reports, the side was not mentioned in three cases and it was reported wrongly in two patients. No wrong side was ever consented for and no wrong side surgery was performed. Conclusion: The side of surgery was not always indicated in clinic letter, theatre list, or the consent form despite the procedure being carried on a bilateral organ. As misinterpretation is a major cause of wrong side surgery, it is prudent that the side is mentioned every time in every clinic letter, consent form, and on the theatre list. The WHO surgical safety checklist has already been very effective in minimizing the wrong site surgery in the National Health Service.

Effect of portal access system and surgery type on surgery times during laparoscopic ovariectomy and salpingectomy in captive African lions and cheetahs.

Science.gov (United States)

Hartman, Marthinus Jacobus; Monnet, Eric; Kirberger, Robert Murco; Schoeman, Johan Petrus

2016-03-02

A prospective randomized study was used to compare surgery times for laparoscopic ovariectomy and salpingectomy in female African lion (Panthera leo) (n = 14) and cheetah (Acinonyx jubatus) (n = 20) and to compare the use of a multiple portal access system (MPAS) and single portal access system (SPAS) between groups. Two different portal techniques were used, namely MPAS (three separate ports) in lions and SPAS (SILS™ port) in cheetahs, using standard straight laparoscopic instruments. Portal access system and first ovary was not randomized. Five different surgery times were compared for the two different procedures as well as evaluating the use and application of MPAS and SPAS. Carbon dioxide volumes for lions were recorded. In adult lionesses operative time (OPT) (P = 0.016) and total surgical time (TST) (P = 0.032) were significantly shorter for salpingectomy compared to ovariectomy. Similarly in cheetahs OPT (P = 0.001) and TST (P = 0.005) were also shorter for salpingectomy compared to ovariectomy. In contrast, in lion cubs no difference was found in surgery times for ovariectomy and salpingectomy. Total unilateral procedure time was shorter than the respective bilateral time for both procedures (P = 0.019 and P = 0.001) respectively and unilateral salpingectomy was also faster than unilateral ovariectomy (P = 0.035) in cheetahs. Port placement time, suturing time and TST were significantly shorter for SPAS compared to MPAS (P = 0.008). There was, however, no difference in OPT between SPAS and MPAS. Instrument cluttering with SPAS was found to be negligible. There was no difference in mean volume CO2 required to complete ovariectomy in lions but the correlation between bodyweight and total volume of CO2 in lions was significant (rs = 0.867; P = 0.002). Laparoscopic salpingectomy was faster than ovariectomy in both adult lions and cheetahs. Using SPAS, both unilateral procedures were faster than bilateral procedures in cheetahs

A comparison of Percutaneous femoral access in Endovascular Repair versus Open femoral access (PiERO): study protocol for a randomized controlled trial.

Science.gov (United States)

Vierhout, Bastiaan P; Saleem, Ben R; Ott, Alewijn; van Dijl, Jan Maarten; de Kempenaer, Ties D van Andringa; Pierie, Maurice E N; Bottema, Jan T; Zeebregts, Clark J

2015-09-14

Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar(™) and Proglide(™) devices (Abbott Vascular). Positive effects of these devices seem to consist of a lower infection rate, and shorter operation time and hospital stay. This conclusion was published in previous reports comparing techniques in patients in two different groups (cohort or randomized). Access techniques were never compared in one and the same patient; this research simplifies comparison because patient characteristics will be similar in both groups. Percutaneous access of the CFA is compared to surgical cutdown in a single patient; in EVAR surgery, access is necessary in both groins in each patient. Randomization is performed on the introduction site of the larger main device of the endoprosthesis. The contralateral device of the endoprosthesis is smaller. When we use this type of randomization, both groups will contain a similar number of main and contralateral devices. Preoperative nose cultures and perineal cultures are obtained, to compare colonization with postoperative wound cultures (in case of a surgical site infection). Furthermore, patient comfort will be considered, using VAS-scores (Visual analog scale). Punch biopsies of the groin will be harvested to retrospectively compare skin of patients who suffered a surgical site infection (SSI) to patients who did not have an SSI. The PiERO trial is a multicenter randomized controlled clinical trial designed to show the consequences of using percutaneous access in EVAR surgery and focuses on the occurrence of surgical site infections. NTR4257 10 November 2013, NL44578.042.13.

Face, content, and construct validity of four, inanimate training exercises using the da Vinci ® Si surgical system configured with Single-Site ™ instrumentation.

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Jarc, Anthony M; Curet, Myriam

2015-08-01

Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da Vinci (®) Si surgical system configured with Single-Site (™) instrumentation. New (N = 21) and experienced (N = 6) surgeons participated in the study. New surgeons (11 Gynecology [GYN] and 10 General Surgery [GEN]) had not completed any da Vinci Single-Site cases but may have completed multiport cases using the da Vinci system. They participated in this study prior to attending a certification course focused on da Vinci Single-Site instrumentation. Experienced surgeons (5 GYN and 1 GEN) had completed at least 25 da Vinci Single-Site cases. The surgeons completed four inanimate training exercises and then rated them with a questionnaire. Raw metrics and overall normalized scores were computed using both video recordings and kinematic data collected from the surgical system. The experienced surgeons significantly outperformed new surgeons for many raw metrics and the overall normalized scores derived from video review (p da Vinci Single-Site surgery and actually testing the technical skills used during da Vinci Single-Site surgery. In summary, the four training exercises showed face, content, and construct validity. Improved overall scores could be developed using additional metrics not included in this study. The results suggest that the training exercises could be used in an overall training curriculum aimed at developing proficiency in technical skills for surgeons new to da Vinci Single-Site instrumentation.

Occult Radiographically Evident Port-Site Hernia After Robot-Assisted Urologic Surgery: Incidence and Risk Factors.

Science.gov (United States)

Christie, Matthew C; Manger, Jules P; Khiyami, Abdulaziz M; Ornan, Afshan A; Wheeler, Karen M; Schenkman, Noah S

2016-01-01

Laparoscopic trocar-site hernias (TSH) are rare, with a reported incidence of 1% or less. The incidence of occult radiographically evident hernias has not been described after robot-assisted urologic surgery. We evaluated the incidence and risk factors of this problem. A single-institution retrospective review of robot-assisted urologic surgery was performed from April 2009 to December 2012. Patients with preoperative and postoperative CT were included for analysis. Imaging was reviewed by two radiologists and one urologist. One hundred four cases were identified, including 60 partial nephrectomy, 38 prostatectomy, and 6 cystectomy. Mean age was 58 years and mean body mass index (BMI) was 29 kg/m(2). The cohort was 77% male. Ten total hernias were identified by CT in 8 patients, 2 of which were clinically evident hernias. Excluding these two hernias, occult port-site hernias were identified radiographically in seven patients. Per-patient incidence of occult TSH was 6.7% (7/104), and per-port incidence was 1.4% (8/564). All hernias were midline and 30% contained bowel. Eight of the 10 occurred at 12 mm sites (p = 0.0065) and 3 of the 10 occurred at extended incisions. Age, gender, BMI, smoking status, diabetes mellitus, immunosuppressive drug therapy, ASA score, procedure, blood loss, prior abdominal surgery, and history of hernia were not significant risk factors. Specimen size >40 g (p = 0.024) and wound infection (p = 0.0052) were significant risk factors. While the incidence of clinically evident port-site hernia remains low in robot-assisted urologic surgery, the incidence of CT-detected occult hernia was 6.7% in this series. These occurred most often in sites extended for specimen extraction and at larger port sites. This suggests more attention should be paid to fascial closure at these sites.

SWS: accessing SRS sites contents through Web Services.

Science.gov (United States)

Romano, Paolo; Marra, Domenico

2008-03-26

Web Services and Workflow Management Systems can support creation and deployment of network systems, able to automate data analysis and retrieval processes in biomedical research. Web Services have been implemented at bioinformatics centres and workflow systems have been proposed for biological data analysis. New databanks are often developed by taking into account these technologies, but many existing databases do not allow a programmatic access. Only a fraction of available databanks can thus be queried through programmatic interfaces. SRS is a well know indexing and search engine for biomedical databanks offering public access to many databanks and analysis tools. Unfortunately, these data are not easily and efficiently accessible through Web Services. We have developed 'SRS by WS' (SWS), a tool that makes information available in SRS sites accessible through Web Services. Information on known sites is maintained in a database, srsdb. SWS consists in a suite of WS that can query both srsdb, for information on sites and databases, and SRS sites. SWS returns results in a text-only format and can be accessed through a WSDL compliant client. SWS enables interoperability between workflow systems and SRS implementations, by also managing access to alternative sites, in order to cope with network and maintenance problems, and selecting the most up-to-date among available systems. Development and implementation of Web Services, allowing to make a programmatic access to an exhaustive set of biomedical databases can significantly improve automation of in-silico analysis. SWS supports this activity by making biological databanks that are managed in public SRS sites available through a programmatic interface.

Current Status of Single-incision Laparoscopic Surgery

DEFF Research Database (Denmark)

Ahmed, Irfan; Ciancio, Fabio; Ferrara, Vincenzo

2012-01-01

Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future...

Technique and Short-Term Outcomes of Single-Port Surgery for Rectal Cancer

DEFF Research Database (Denmark)

Bulut, O; Aslak, K K; Rosenstock, S

2013-01-01

Although conventional laparoscopic surgery is less traumatic than open surgery, it does cause tissue trauma and multiple scar formation. The size and number of ports determine the extent of the trauma. Single-port laparoscopic surgery is assumed to minimize and perhaps eliminate the potential adv...... adverse effects of conventional laparoscopy. The aim of this study was to examine short-term outcomes of single-port laparoscopic surgery for rectal cancer.......Although conventional laparoscopic surgery is less traumatic than open surgery, it does cause tissue trauma and multiple scar formation. The size and number of ports determine the extent of the trauma. Single-port laparoscopic surgery is assumed to minimize and perhaps eliminate the potential...

Web Accessibility in Romania: The Conformance of Municipal Web Sites to Web Content Accessibility Guidelines

OpenAIRE

Costin PRIBEANU; Ruxandra-Dora MARINESCU; Paul FOGARASSY-NESZLY; Maria GHEORGHE-MOISII

2012-01-01

The accessibility of public administration web sites is a key quality attribute for the successful implementation of the Information Society. The purpose of this paper is to present a second review of municipal web sites in Romania that is based on automated accessibility checking. A number of 60 web sites were evaluated against WCAG 2.0 recommendations. The analysis of results reveals a relatively low web accessibility of municipal web sites and highlights several aspects. Firstly, a slight ...

Robotic single-site pelvic lymphadenectomy.

Science.gov (United States)

Tateo, Saverio; Nozza, Arrigo; Del Pezzo, Chiara; Mereu, Liliana

2014-09-01

To examine the feasibility of performing pelvic lymphadenectomy with robotic single site approach. Recent papers described the feasibility of robotic-single site hysterectomy [1-3] for benign and malign pathologies but only with the development of new single site 5mm instruments as the bipolar forceps, robotic single site platform can be safely utilized also for lymphadenectomy. A 65 year-old, multiparous patient with a body mass index of 22.5 and diagnosed with well differentiated adenocarcinoma of the endometrium underwent a robotic single-site peritoneal washing, total hysterectomy, bilateral adnexectomy and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2,5 cm umbilical incision, with a multi-channel system and two single site robotic 5mm instruments. A 3-dimensional, HD 8.5mm endoscope and a 5mm accessory instrument were also utilized. Type I lymphonodes dissection for external iliac and obturator regions was performed [4]. Total operative time was 210 min; incision, trocar placement and docking time occurring in 12 min. Total console time was 183 min, estimated blood loss was 50 ml, no intra-operative or post-operative complications occurred. Hospital discharge occurred on post operative day 2 and total number of lymphnodes removed was 33. Difficulties in term of instrument's clashing and awkward motions have been encountered. Robotic single-site pelvic lymphadenectomy using bipolar forceps and monopolar hook is feasible. New developments are needed to improve surgical ergonomics and additional studies should be performed to explore possible benefits of this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

Science.gov (United States)

Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

2017-07-19

Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

Reexamining microRNA site accessibility in Drosophila: a population genomics study.

Directory of Open Access Journals (Sweden)

Kevin Chen

Full Text Available Kertesz et al. (Nature Genetics 2008 described PITA, a miRNA target prediction algorithm based on hybridization energy and site accessibility. In this note, we used a population genomics approach to reexamine their data and found that the PITA algorithm had lower specificity than methods based on evolutionary conservation at comparable levels of sensitivity.We also showed that deeply conserved miRNAs tend to have stronger hybridization energies to their targets than do other miRNAs. Although PITA had higher specificity in predicting targets than a naïve seed-match method, this signal was primarily due to the use of a single cutoff score for all miRNAs and to the observed correlation between conservation and hybridization energy. Overall, our results clarify the accuracy of different miRNA target prediction algorithms in Drosophila and the role of site accessibility in miRNA target prediction.

Current status of pediatric minimal access surgery at Sultan Qaboos ...

African Journals Online (AJOL)

Keywords: current status, laparoscopy, minimal access surgery, thoracoscopy. Departments of ... Materials and methods ... procedures, the open technique was used for the creation ... operated for bilateral inguinal herniotomy had recurrence.

Entrance C - Meyrin site: new access conditions

CERN Multimedia

2013-01-01

Entrance C on the Meyrin site, which drivers of motorised vehicles can use Mondays to Fridays from 7 a.m. to 9 a.m. and from 5 p.m. to 7 p.m., has been altered to include a turnstile to allow cyclists and pedestrians to use their access card to get in and out of the site from 6 a.m. until 10 p.m.   The following video illustrates how to use the new turnstile: A new type of entrance gate fitted with a number plate reader similar to that installed at the entrance to the Prévessin site should, once fully tested, allow drivers of motorised vehicles to access the site. For the time being, the conditions of use of Entrance C remain unchanged. Further information on the entry into force of new arrangements will be issued in due course. For further information about CERN entrances: CERN opening hours CERN control access GS Department

Pelvic Surgical Site Infections in Gynecologic Surgery

Directory of Open Access Journals (Sweden)

Mark P. Lachiewicz

2015-01-01

Full Text Available The development of surgical site infection (SSI remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

Minimal access surgery for mitral valve endocarditis.

Science.gov (United States)

Barbero, Cristina; Marchetto, Giovanni; Ricci, Davide; Mancuso, Samuel; Boffini, Massimo; Cecchi, Enrico; De Rosa, Francesco Giuseppe; Rinaldi, Mauro

2017-08-01

Minimal access mitral valve surgery (MVS) has already proved to be feasible and effective with low perioperative mortality and excellent long-term outcomes. However, experience in more complex valve diseases such as infective endocarditis (IE) still remains limited. The aim of this retrospective study was to evaluate early and long-term results of minimal access MVS for IE. Data were entered into a dedicated database. Analysis was performed retrospectively for the 8-year period between January 2007 and April 2015. During the study period, 35 consecutive patients underwent minimal access MVS for IE at our department. Twenty-four had diagnosis of native MV endocarditis (68.6%) and 11 of mitral prosthesis endocarditis (31.4%).Thirty patients underwent early MVS (85.7%), and 5 patients were operated after the completion of antibiotic treatment (14.3%). Seven patients underwent MV repair (20%), 17 patients underwent MV replacement (48.6%), and 11 patients underwent mitral prosthesis replacement (31.4%). Thirty-day mortality was 11.4% (4 patients). No neurological or vascular complications were reported. One patient underwent reoperation for prosthesis IE relapse after 37 days. Overall actuarial survival rate at 1 and 5 years was 83%; freedom from MV reoperation and/or recurrence of IE at 1 and 5 years was 97%. Minimally invasive MVS for IE is feasible and associated with good early and long-term results. Preoperative accurate patient selection and transoesophageal echocardiography evaluation is mandatory for surgical planning. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Single-incision laparoscopic bariatric surgery

Directory of Open Access Journals (Sweden)

Huang Chih-Kun

2011-01-01

Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon

Directory of Open Access Journals (Sweden)

Pao-Ling Torng

2013-11-01

Conclusion: LESS is a safe and feasible alternative to conventional laparoscopic surgery for adnexal and uterine diseases. A learning curve is not required for LESS surgery for experienced laparoscopic surgeons.

Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma.

Science.gov (United States)

Huang, Jian-Kang; Ma, Ling; Song, Wen-Hua; Lu, Bang-Yu; Huang, Yu-Bin; Dong, Hui-Ming

2016-01-01

Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC). Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group). A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively. The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery. The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general state of health and are likely to participate in social activities. It is worthy of being clinically used for patients with PTC.

Evaluation of single port access gastropexy and ovariectomy using articulating instruments and angled telescopes in dogs.

Science.gov (United States)

Runge, Jeffrey J; Mayhew, Philipp D

2013-10-01

To describe in dogs, a technique for single port access gastropexy and ovariectomy (SPAGO) using a commercially available multitrocar port and to evaluate short-term outcome. Retrospective case series. Dogs (n = 18). A commercially available multitrocar port was inserted into the abdomen lateral to the rectus abdominis muscle and 2-5 cm caudal to the right rib. Dogs were tilted 45° in both left and right recumbency and bilateral ovariectomy performed using articulating graspers, a bipolar vessel sealing device and a 30° telescope. The laparoscopic assisted incisional gastropexy was performed after ovariectomy at the multitrocar port insertion site by grasping the antral portion of the stomach with a 10 mm DuVall forceps and suturing the seromuscular layer of the antral region of the stomach to the transversus abdominis muscle. Eighteen dogs (median weight, 34.5 kg; range, 14.7-59.2 kg) met the inclusion criteria. Median surgical time for SPAGO was 65 minutes (range, 50-225 minutes). Intra-operative complications included, incorrect multitrocar port placement location (n = 3) and mild hemorrhage from a splenic laceration (1) All dogs recovered from surgery and were discharged from the hospital. Single port access gastropexy and ovariectomy is a feasible procedure to provide prophylaxis against gastric dilation-volvulus and a simultaneous means of sterilization in female dogs. Careful and accurate initial multitrocar port insertion is necessary to have optimal operative viewing as well as to reduce the chances of inadvertent splenic laceration. © Copyright 2013 by The American College of Veterinary Surgeons.

Ocean Drilling Program: Web Site Access Statistics

Science.gov (United States)

web site ODP/TAMU Science Operator Home Ocean Drilling Program Web Site Access Statistics* Overview See statistics for JOIDES members. See statistics for Janus database. 1997 October November December

Fluid Overload and Cumulative Thoracostomy Output Are Associated With Surgical Site Infection After Pediatric Cardiothoracic Surgery.

Science.gov (United States)

Sochet, Anthony A; Nyhan, Aoibhinn; Spaeder, Michael C; Cartron, Alexander M; Song, Xiaoyan; Klugman, Darren; Brown, Anna T

2017-08-01

To determine the impact of cumulative, postoperative thoracostomy output, amount of bolus IV fluids and peak fluid overload on the incidence and odds of developing a deep surgical site infection following pediatric cardiothoracic surgery. A single-center, nested, retrospective, matched case-control study. A 26-bed cardiac ICU in a 303-bed tertiary care pediatric hospital. Cases with deep surgical site infection following cardiothoracic surgery were identified retrospectively from January 2010 through December 2013 and individually matched to controls at a ratio of 1:2 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery category, primary cardiac diagnosis, and procedure. None. Twelve cases with deep surgical site infection were identified and matched to 24 controls without detectable differences in perioperative clinical characteristics. Deep surgical site infection cases had larger thoracostomy output and bolus IV fluid volumes at 6, 24, and 48 hours postoperatively compared with controls. For every 1 mL/kg of thoracostomy output, the odds of developing a deep surgical site infection increase by 13%. By receiver operative characteristic curve analysis, a cutoff of 49 mL/kg of thoracostomy output at 48 hours best discriminates the development of deep surgical site infection (sensitivity 83%, specificity 83%). Peak fluid overload was greater in cases than matched controls (12.5% vs 6%; p operative characteristic curve analysis, a threshold value of 10% peak fluid overload was observed to identify deep surgical site infection (sensitivity 67%, specificity 79%). Conditional logistic regression of peak fluid overload greater than 10% on the development of deep surgical site infection yielded an odds ratio of 9.4 (95% CI, 2-46.2). Increased postoperative peak fluid overload and cumulative thoracostomy output were associated with deep surgical site infection after pediatric

Hospital costs associated with surgical site infections in general and vascular surgery patients.

Science.gov (United States)

Boltz, Melissa M; Hollenbeak, Christopher S; Julian, Kathleen G; Ortenzi, Gail; Dillon, Peter W

2011-11-01

Although much has been written about excess cost and duration of stay (DOS) associated with surgical site infections (SSIs) after cardiothoracic surgery, less has been reported after vascular and general surgery. We used data from the National Surgical Quality Improvement Program (NSQIP) to estimate the total cost and DOS associated with SSIs in patients undergoing general and vascular surgery. Using standard NSQIP practices, data were collected on patients undergoing general and vascular surgery at a single academic center between 2007 and 2009 and were merged with fully loaded operating costs obtained from the hospital accounting database. Logistic regression was used to determine which patient and preoperative variables influenced the occurrence of SSIs. After adjusting for patient characteristics, costs and DOS were fit to linear regression models to determine the effect of SSIs. Of the 2,250 general and vascular surgery patients sampled, SSIs were observed in 186 inpatients. Predisposing factors of SSIs were male sex, insulin-dependent diabetes, steroid use, wound classification, and operative time (P surgery. Although the excess costs and DOS associated with SSIs after general and vascular surgery are somewhat less, they still represent substantial financial and opportunity costs to hospitals and suggest, along with the implications for patient care, a continuing need for cost-effective quality improvement and programs of infection prevention. Copyright © 2011 Mosby, Inc. All rights reserved.

Minnesota Walk-In Access Sites

Data.gov (United States)

Minnesota Department of Natural Resources — The Minnesota Walk-In Access site (WIA) GIS data represents areas of private land that have been made open to the public for the purpose of walk-in (foot travel)...

Laparoendoscopic single site (LESS) cholecystectomy.

Science.gov (United States)

Hodgett, Steven E; Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona B; Albrink, Michael; Rosemurgy, Alexander S

2009-02-01

The journey from conventional "open" operations to truly "minimally invasive" operations naturally includes progression from operations involving multiple trocars and multiple incisions to operations involving access through the umbilicus alone. Laparoscopic operations through the umbilicus alone, laparoendoscopic single site surgery (LESS), offer improved cosmesis and hopes for less pain and improved recovery. This study was undertaken to evaluate our initial experience with LESS cholecystectomy and to compare our initial experience to concurrent outcomes with more conventional multiport, multi-incision laparoscopic cholecystectomy. All patients referred for cholecystectomy over a 6-month period were offered LESS. Outcomes, including blood loss, operative time, complications, and length of stay were recorded. Outcomes with our first LESS cholecystectomies were compared to an uncontrolled group of concurrent patients undergoing multiport, multi-incision laparoscopic cholecystectomy at the same hospital by the same surgeon. Twenty-nine patients of median age 50 years undergoing LESS cholecystectomy from November 2007 until May 2008 were compared to 29* patients, median age 48 years, undergoing standard multiport, multiple-incision laparoscopic cholecystectomy over the same time period. Median operative time for patients undergoing LESS cholecystectomy was 72 min and was not different from that of patients undergoing multiport, multi-incision laparoscopic cholecystectomy (p = 0.81). Median length of hospital stay was 1.0 day for patients undergoing LESS cholecystectomy and was not different from patients undergoing standard laparoscopic cholecystectomy (p = 0.46). Operative estimated blood loss was less than 100 cc for all patients. No patients undergoing attempted LESS cholecystectomy had conversions to "open" operations; two patients had an additional trocar(s) placed distant from the umbilicus to aid in exposure. Three patients undergoing LESS cholecystectomy had

Port-Access cardiac surgery: from a learning process to the standard.

Science.gov (United States)

Greco, Ernesto; Barriuso, Clemente; Castro, Miguel Angel; Fita, Guillermina; Pomar, José L

2002-01-01

Port-Access surgery has been one of the most innovative and controversial methods in the spectrum of minimally invasive techniques for cardiac operations and has been widely used for the treatment of several cardiac diseases. The technique was introduced in our center to evaluate its efficacy in reproducing standardized results without an additional risk. Endovascular cardiopulmonary bypass (CPB) through femoral access and endoluminal aortic occlusion were used in 129 patients for a variety of surgical procedures, all of which were video-assisted. A minimal (4-6 cm) anterior thoracotomy through the fourth intercostal space was used in all cases as the surgical approach. More than 96% of the planned cases concluded as true Port-Access procedures. Mean CBP and crossclamp times were 87.2 min. +/- 51.2 (range of 10-457) and 54.9 min. +/- 30.6 (range of 10-190), respectively. Hospital mortality for the overall group was 1.5%, and mitral valve surgery had a 2.2% hospital death rate. The incidence of early neurological events was 0.7%. Mean extubation time, ICU stay, and total length of hospital stay were 5 hours +/- 6 hrs. (range of 2-32), 12 hours +/- 11.8 hrs. (range of 5-78), and 7 days +/- 7.03 days (range of 1-72), respectively. Our experience indicates that the Port- Access technique is safe and permits reproduction of standardized results with the use of a very limited surgical approach. We are convinced that this is a superior procedure for certain types of surgery, including isolated primary or redo mitral surgery, repair of a variety of atrial septal defects (ASDs), and atrial tumors. It is especially useful in high-risk patients, such as elderly patients or those requiring reoperation. Simplification of the procedure is nevertheless desirable in order to further reduce the time of operation and to address other drawbacks.

A systematic review of laparoscopic port site hernias in gastrointestinal surgery.

LENUS (Irish Health Repository)

Owens, M

2012-02-01

INTRODUCTION: Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it. METHODS: Medline was searched using the words "port site hernia", "laparoscopic port hernia" "laparoscopic complications" and "trocar site hernias". The search was limited to articles on cholecystectomy, colorectal, bariatric or anti-reflux surgery published in English. A total of 42 articles were analysed and of these 35 were deemed eligible for review. Inclusion criteria were laparoscopic gastrointestinal surgery in English only with reported incidence of port site herniation. Studies were excluded if insufficient data was provided. Eligible studies were also cross-referenced. RESULTS: Analysis of 11,699 patients undergoing laparoscopic gastrointestinal procedures demonstrated an incidence of port site hernias of 0.74% with a mean follow-up of 23.9 months. The lowest incidence of port site herniation was for bariatric surgery with 0.57% in 2644 patients with a mean follow-up of 67.4 months while the highest incidence was for laparoscopic colorectal surgery with an incidence of 1.47% in 477 patients with a mean follow-up of 71.5 months. CONCLUSION: All fascial defects larger than or equal to 10mm should be closed with peritoneum, while smaller defects may require closure in certain circumstances to prevent herniation. Laparoscopic port site herniation is a completely preventable cause of morbidity that requires a second surgical procedure to repair.

Prophylaxis of surgical site infection in adult spine surgery: A systematic review.

Science.gov (United States)

Yao, Reina; Tan, Terence; Tee, Jin Wee; Street, John

2018-06-01

Surgical site infection (SSI) remains a significant source of morbidity in spine surgery, with reported rates varying from 0.7 to 16%. To systematically review and evaluate the evidence for strategies for prophylaxis of SSI in adult spine surgery in the last twenty years. Two independent systematic searches were conducted, at two international spine centers, encompassing PubMed, ClinicalTrials.gov, Cochrane Database, EBSCO Medline, ScienceDirect, Ovid Medline, EMBASE (Ovid), and MEDLINE. References were combined and screened, then distilled to 69 independent studies for final review. 11 randomized controlled trials (RCTs), 51 case-controlled studies (CCS), and 7 case series were identified. Wide variation exists in surgical indications, approaches, procedures, and even definitions of SSI. Intra-wound vancomycin powder was the most widely studied intervention (19 studies, 1 RCT). Multiple studies examined perioperative antibiotic protocols, closed-suction drainage, povidone-iodine solution irrigation, and 2-octyl-cyanoacrylate skin closure. 18 interventions were examined by a single study only. There is limited evidence for the efficacy of intra-wound vancomycin. There is strong evidence that closed-suction drainage does not affect SSI rates, while there is moderate evidence for the efficacy of povidone-iodine irrigation and that single-dose preoperative antibiotics is as effective as multiple doses. Few conclusions can be drawn about other interventions given the paucity and poor quality of studies. While a small body of evidence underscores a select few interventions for SSI prophylaxis in adult spine surgery, most proposed measures have not been investigated beyond a single study. Further high level evidence is required to justify SSI preventative treatments. Copyright © 2018 Elsevier Ltd. All rights reserved.

Accessibility to editorial information in Oral and Maxillofacial Surgery journals: The authors' point of view.

Science.gov (United States)

Castelo-Baz, Pablo; Leira-Feijoo, Yago; Seoane-Romero, Juan Manuel; Varela-Centelles, Pablo; Seoane, Juan

2015-09-01

To evaluate the accessibility to editorial information in Oral & Maxillofacial Surgery journals. A cross-sectional study using the WOS-Web of Science database in three categories: "Surgery," "Otorhinolaryngology," and "Dentistry, Oral Surgery & Medicine" was designed. Journals were filtered by title and classified under three headings: OMFS specialty; OMFS subspecialty and related sciences; and multidisciplinary journals. Specialty scope (OMFS vs. other); impact factor; path for the manuscript; blinding policy; accessibility to reviewers' criteria; and percentage of acceptance. Only 46 of 330 journals met the inclusion criteria. All OMFS journals provided comprehensive information about the review process, compared to 5 of 27 (18.5%) of Oral Surgery and related sciences periodicals. Most specialty journals do not inform about the blind review mode used (20 of 33; 60.6%). Generally, information about the reviewers' assessment criteria is scarce, but is available from all OMFS journals, which also state the percentage of manuscript acceptance (100% vs. 14.8%). OMFS JCR journals provide adequate information about their editorial process in terms of path for the manuscript, accessibility to reviewers' criteria, and percentage of acceptance. Additional efforts are needed to increase accessibility to information about blinding policy and average time from submission to acceptance. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery

Science.gov (United States)

Barnaś, Edyta; Książek, Mariusz; Raś, Renata; Skręt, Andrzej; Skręt- Magierło, Joanna; Dmoch- Gajzlerska, Ewa

2017-01-01

Introduction Benign metastasizing leiomyoma (BML) is a rare disorder that affects women with a history of uterine leiomyoma, which is found to metastasise within extrauterine sites. The aetiology of BML remains unexplained. Because BML is rare, and most publications contain descriptions of single cases, no statistically determined time relations were found between the primary and secondary surgeries, which may have aetiological implications. Objectives To determine age before BML surgery, age during diagnosis of BML, type of prior surgery, and location of metastasis based on the literature. Methods A systematic review of four databases (Medline/PubMed, Embase, Web of Science, and Cochrane) covering articles published from 1 January 1965 to 10 April 2016. The inclusion criteria were full-text articles in English and articles containing case reports. Articles in languages other than English (39), articles containing incomplete data (14), i.e. no information regarding the time of surgery and/or the site of metastasis, articles bereft of case studies (25), and articles with access only to summaries, without access to the complete text (10) were excluded. Of 321 titles identified, only 126 articles met the aforementioned criteria. Results and conclusions The mean age during primary surgery and BML diagnosis was 38.5 years and 47.3 years, respectively. The most common surgery was total hysterectomy. The most frequent site of metastasis was the lungs; other organs were affected less frequently.The site of metastases and their number were not related to the longer time span between the patient’s initial surgery and occurrence of metastasis. The analysed data, such as the age during primary surgery, age during BML diagnosis, site and type of metastasis, do not provide us a clear answer. Thus, BML pathogenesis is most probably complex in nature and requires further multidirectional research. PMID:28426767

Robot-assisted posterior retroperitoneoscopic adrenalectomy using single-port access: technical feasibility and preliminary results.

Science.gov (United States)

Park, Jae Hyun; Kim, Soo Young; Lee, Cho-Rok; Park, Seulkee; Jeong, Jun Soo; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo

2013-08-01

clinicopathologic data were analyzed retrospectively. The mean patient age was 56.6 ± 8.7 (range, 47-69) years. Right and left side approaches were used in two and three patients, respectively. All cases were adrenal cortical adenoma. The mean tumor size was 1.48 ± 0.28 (range, 1.0-1.7) cm. The mean surgery duration (skin to skin) was 159.4 ± 57.6 (range, 103-245) minutes, and the mean estimated blood loss was 46.0 ± 56.8 (range, 5-120) ml. The average time to oral intake and postoperative hospital stay were 0.65 ± 0.11 (range, 0.54-0.79) days and 4.0 ± 2.23 (range, 3-8) days, respectively. There were no conversions to open surgery or postoperative compli- cations. Some trials of minimally invasive single-access surgery of the adrenal gland have recently been performed.4 (,) 5 However, these new techniques have several limitations as a result of restrictions on instrumentation movement because of the small access ports used and relatively low-quality images produced. The recent introduction of the da Vinci S surgical robot system (Intuitive Surgical) to endoscopic surgery has improved instrumental dexterity and provided the surgeon with an ergonomically designed operating system. This system is also potentially safer and more meticulous in performing operations than endoscopic procedures as a result of a 3-D, magnified, stable operative view.6 (,) 7 The advantages of the da Vinci S surgical robot system and the numerous benefits of the posterior retroperitoneal approach motivated us to utilize single-port robot-assisted PRA. The primary selection criteria were small tumor size and a minimal amount of periadrenal fatty tissue because robot-assisted PRA using single-port access provides a small operative space, which causes manipulation problems when tumors are large. To ensure the safe application of these new techniques, we recommend that novice surgeons begin using single-port robot-assisted PRA for smaller tumors safe and feasible, further experience and

Single-incision laparoscopic surgery for pyloric stenosis.

Science.gov (United States)

Kozlov, Yury; Novogilov, Vladimir; Podkamenev, Alexey; Rasputin, Andrey; Weber, Irina; Solovjev, Alexey; Yurkov, Pavel

2012-04-01

Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

Laparoendoscopic single-site Heller myotomy with anterior fundoplication for achalasia.

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Barry, Linda; Ross, Sharona; Dahal, Sujat; Morton, Connor; Okpaleke, Chinyere; Rosas, Melissa; Rosemurgy, Alexander S

2011-06-01

Laparoendoscopic single-site (LESS) surgery is beginning to include advanced laparoscopic operations such as Heller myotomy with anterior fundoplication. However, the efficacy of LESS Heller myotomy has not been established. This study aimed to evaluate the authors' initial experience with LESS Heller myotomy for achalasia. Transumbilical LESS Heller myotomy with concomitant anterior fundoplication for achalasia was undertaken for 66 patients after October 2007. Outcomes including operative time, complications, and length of hospital stay were recorded and compared with those for an earlier contiguous group of 66 consecutive patients undergoing conventional multi-incision laparoscopic Heller myotomy with anterior fundoplication. Symptoms before and after myotomy were scored by the patients using a Likert scale ranging from 0 (never/not severe) to 10 (always/very severe). Data were analyzed using the Mann-Whitney U test, the Wilcoxon matched-pairs test, and Fisher's exact test where appropriate. Patients undergoing LESS Heller myotomy were similar to those undergoing conventional laparoscopic Heller myotomy in gender, age, body mass index (BMI), blood loss, and length of hospital stay. However, the patients undergoing LESS Heller myotomies had operations of significantly longer duration (median, 117 vs. 93 min with the conventional laparoscopic approach) (pHeller myotomy, additional ports/incisions were required. No patients were converted to "open" operations, and no patients had procedure-specific complications. Symptom reduction was dramatic and satisfying after both LESS and conventional laparoscopic myotomy with fundoplication. The symptom reduction was similar with the two procedures. The LESS approach left no apparent umbilical scar. Heller myotomy with anterior fundoplication effectively treats achalasia. The findings showed LESS Heller myotomy with anterior fundoplication to be feasible, safe, and efficacious. Although the LESS approach increases operative

Effect of Pre-Operative Use of Medications on the Risk of Surgical Site Infections in Patients Undergoing Cardiac Surgery.

Science.gov (United States)

Eton, Vic; Sinyavskaya, Liliya; Langlois, Yves; Morin, Jean François; Suissa, Samy; Brassard, Paul

2016-10-01

Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013. Exposure of interest was use of medications for heart disease and cardiovascular conditions in the seven days prior to surgery and those for comorbid conditions. The main outcome was SSIs occurring within 90 d after surgery. Univariate and multivariate logistic regression (adjusted odds ratio [AOR]) was used to evaluate the effect. The cohort included 1,077 cardiac surgery patients, 79 of whom experienced SSIs within 90 d of surgery. The rates for sternal site infections and harvest site infections were 5.8 (95% confidence interval [CI]: 4.4-7.3) and 2.5 (95% CI: 1.4-3.7) per 100 procedures, respectively. The risk of SSI was increased with the pre-operative use of immunosuppressors/steroids (AOR 3.47, 95% CI: 1.27-9.52) and α-blockers (AOR 3.74, 95% CI: 1.21-1.47). Our findings support the effect of immunosuppressors/steroids on the risk of SSIs and add evidence to the previously reported association between the use of anti-hypertensive medications and subsequent development of infection/sepsis.

Comparative evaluation of prophylactic single-dose intravenous antibiotic with postoperative antibiotics in elective urologic surgery

Directory of Open Access Journals (Sweden)

Mohammad K Moslemi

2010-11-01

site infection rates of categories A and B in Group 1 were 0 and two (0.86%, respectively, while those in Group 2 were 0 and five (0.92%, respectively. There was no significant difference in infection rates in terms of remote infection and surgical site infection between Group 1 and Group 2 (P = 0.670. The amounts, as well as the prices, for intravenously administered antibiotics decreased to approximately one quarter.Conclusion: Our protocol effectively decreased the amount of antibiotics used without increasing perioperative infection rates. Thus, our protocol of prophylactic antibiotic therapy can be recommended as an appropriate method for preventing perioperative infection in urologic surgery. Keywords: surgical site infection, antibiotic prophylaxis, single dose, urologic surgery

Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma

Directory of Open Access Journals (Sweden)

Huang JK

2016-07-01

Full Text Available Jian-kang Huang,1 Ling Ma,2 Wen-hua Song,1 Bang-yu Lu,3 Yu-bin Huang,3 Hui-ming Dong1 1Department of Surgical Oncology, 2Department of Gynecologic Tumor, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 3Department of Minimally Invasive Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC.Patients and methods: Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group. A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively.Results: The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery.Conclusion: The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general

Single port laparoscopic colorectal surgery in debilitated patients and in the urgent setting.

LENUS (Irish Health Repository)

Moftah, M

2012-09-01

Single port laparoscopy is a relatively new niche in the expanding spectrum of minimal access surgery for colorectal disease. To date the published experience has predominantly focused on planned operations for neoplasia in the elective setting. It seems probable however that the benefits of minimal abdominal wounding will be greatest among those patients with the highest risk of impaired wound healing. Combining this with the impression of improved cosmesis suggests that (the mostly young) patients with inflammatory bowel disease needing urgent operation are the most likely to appreciate and benefit from the extraoperative effort. The extension of single port surgery to the acute setting and for debilitated individuals is therefore a likely next step advance in broadening the category of patients for whom it represents a real benefit and ultimately aid in focusing by selection the subgroups for whom this technique is best suited and most appropriate. We describe here our approach (including routine use of a surgical glove port) to patients presenting for urgent colorectal operation for benign disease. As provision of specialized approaches regardless of timing or mode of presentation is a defining component of any specialty service, this concept will soon be more fully elucidated and established.

Transsphenoidal surgery for pituitary tumors from microsurgery to the endoscopic surgery. Single surgeon's experience

International Nuclear Information System (INIS)

Iwai, Yoshiyasu; Yoshimura, Masaki; Terada, Aiko; Yamanaka, Kazuhiro; Koshimo, Naomi

2011-01-01

We reviewed results of the surgical outcome of pituitary tumors treated via the transsphenoidal approach between January, 1994 and January, 2010 at our institution. This data included 100 patients (124 procedures) treated through the sublabial transsphenoidal approach and 45 patients (54 procedures) treated through the endoscopic endonasal (bilateral nostrils) transsphenoidal approach performed by a single surgeon. The extent of tumor removal was significantly improved with endoscopic surgery; adjuvant gamma knife radiosurgery was needed for 65% of patients undergoing microsurgery vs. 30% for patients who had endoscopic surgery (p<0.0001). Patients who underwent endoscopic surgery had less intraoperative blood loss (mean volume: 100 mL for microsurgery patients vs. 30 mL for endoscopic surgery patients, p<0.0001), less pain, and less need for postoperative hormone replacement therapy (19% for microsurgery patients vs. 6% for endoscopic surgery patients; p<0.05). Cerebrospinal fluid (CSF) leakage and meningitis were experienced in one microsurgery patient (1%) and one endoscopic surgery patient (2.2%). Endoscopic surgery is a reasonable alternative to microsurgery and our experience supports the concept that an otolaryngologist/neurosurgeon team skilled in endoscopic techniques and pituitary surgery can safely make the transition from microsurgery to endoscopic surgery. (author)

Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon′s initial experience

Directory of Open Access Journals (Sweden)

Sanoop K Zachariah

2013-01-01

Full Text Available Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52 years, mean BMI was 22.7 (range 17-28 kg/m 2 and the mean operative time was 85.5 (range 45-150 min. The mean postoperative stay was 3.6 (range 1-7 days. The commonest position of the appendix was retro-caecal (50% followed by pelvic (30%. In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.

Limited access atrial septal defect closure and the evolution of minimally invasive surgery.

Science.gov (United States)

Izzat, M B; Yim, A P; El-Zufari, M H

1998-04-01

While minimizing the "invasiveness" in general surgery has been equated with minimizing "access", what constitutes minimally invasive intra-cardiac surgery remains controversial. Many surgeons doubt the benefits of minimizing access when the need for cardiopulmonary bypass cannot be waived. Recognizing that median sternotomy itself does entail significant morbidity, we investigated the value of alternative approaches to median sternotomy using atrial septal defect closure as our investigative model. We believe that some, but not all minimal access approaches are associated with reduced postoperative morbidity and enhanced recovery. Our current strategy is to use a mini-sternotomy approach in adult patients, whereas conventional median sternotomy remains our standard approach in the pediatric population. Considerable clinical experiences coupled with documented clinical benefits are fundamental before a certain approach is adopted in routine practice.

Laparoscopic surgery for esophageal achalasia: Multiport vs single-incision approach.

Science.gov (United States)

Fukuda, Shuichi; Nakajima, Kiyokazu; Miyazaki, Yasuhiro; Takahashi, Tsuyoshi; Makino, Tomoki; Kurokawa, Yukinori; Yamasaki, Makoto; Miyata, Hiroshi; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

2016-02-01

SILS can potentially improve aesthetic outcomes without adversely affecting treatment outcomes, but these outcomes are uncertain in laparoscopic Heller-Dor surgery. We determined if the degree of patient satisfaction with aesthetic outcomes progressed with the equivalent treatment outcomes after the introduction of a single-incision approach to laparoscopic Heller-Dor surgery. We retrospectively reviewed 20 consecutive esophageal achalasia patients (multiport approach, n = 10; single-incision approach, n = 10) and assessed the treatment outcomes and patient satisfaction with the aesthetic outcomes. In the single-incision approach, thin supportive devices were routinely used to gain exposure to the esophageal hiatus. No statistically significant differences in the operating time (210.2 ± 28.8 vs 223.5 ± 46.3 min; P = 0.4503) or blood loss (14.0 ± 31.7 vs 16.0 ± 17.8 mL; P = 0.8637) were detected between the multiport and single-incision approaches. We experienced no intraoperative complications. Mild dysphagia, which resolved spontaneously, was noted postoperatively in one patient treated with the multiport approach. The reduction rate of the maximum lower esophageal sphincter pressure was 25.1 ± 34.4% for the multiport approach and 21.8 ± 19.2% for the single-incision approach (P = 0.8266). Patient satisfaction with aesthetic outcomes was greater for the single-incision approach than for the multiport approach. When single-incision laparoscopic Heller-Dor surgery was performed adequately and combined with the use of thin supportive devices, patient satisfaction with the aesthetic outcomes was higher and treatment outcomes were equivalent to those of the multiport approach. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

Laparoendoscopic single-site repair of bladder rupture using a home-made single-port device: initial experience of treatment for a traumatic intraperitoneal bladder rupture.

Science.gov (United States)

Lee, Joo Yong; Kang, Dong Hyuk; Lee, Seung Wook

2012-06-01

We report our initial experience with a laparoendoscopic single-site (LESS) repair of a bladder rupture using a home-made single-port device. A 37-year-old man presented to the emergency department with complaints of voiding difficulty and gross hematuria after blunt trauma. Cystography and computed tomography revealed an intraperitoneal bladder rupture. The patient underwent LESS repair of a bladder rupture using the Alexis wound retractor, which was inserted through the umbilical incision. A home-made single-port device was made by fixing 6½ surgical gloves to the outer rim of the retractor and securing the glove finger to the end of 3 trocars with a tie. Using the flexible laparoscopic instruments and rigid instruments, LESS surgery was performed using a procedure similar to conventional laparoscopic surgery. The patient did not have any voiding problem after removal of the urethral Foley catheter on the 10th postoperative day. To our knowledge, this is the first published report of LESS repair of a traumatic bladder rupture using a home-made single-port device in the literature.

A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

DEFF Research Database (Denmark)

Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

2015-01-01

INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... in either of the groups. There was no difference in median follow-up time between groups (P = .58). CONCLUSION: Both SPLS and RALS may have a role in rectal surgery. The short-term oncological outcomes were similar, although RALS harvested more lymph nodes than the SPLS procedure. However, SPLS seems...

Laparoendoscopic single site cholecystectomy: the first 100 patients.

Science.gov (United States)

Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona; Albrink, Michael; Rosemurgy, Alexander S

2009-08-01

Laparoendoscopic single site (LESS) surgery promises improved cosmesis and possibly less pain. However, given the small series reported to date, true estimates of the advantages and possible disadvantages of LESS surgery remain unknown. This study was undertaken to evaluate the first 100 patients undergoing LESS cholecystectomy at our institution. Patients referred for cholecystectomy since November 2007 were considered for LESS cholecystectomy. Outcomes, including blood loss, operative time, complications, and length of stay, were recorded. Outcomes are compared with an uncontrolled concurrent group of patients undergoing multi-incision laparoscopic (i.e., conventional) cholecystectomy. One hundred patients with a median age of 44 years underwent LESS cholecystectomy; 30 patients with a median age of 46 years underwent conventional cholecystectomy over the same time period. Median operative time (70 vs 66 minutes, P = 0.67, Mann-Whitney) and hospital length of stay (1 vs 1 day, P = 0.81, Mann-Whitney) were not different for patients undergoing LESS or multi-incision cholecystectomies, respectively. Five patients undergoing LESS cholecystectomy had postoperative complications: cystic duct stump leak (one), pain control issues (three), and urinary retention (one). LESS cholecystectomy is a safe and effective alternative to conventional cholecystectomy. It can be undertaken without added operative time and provides patients with minimal, if any, scarring.

Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session

Science.gov (United States)

Kim, Hyoung Ook; Kim, Jae Kyu; Park, Jin Gyoon; Yim, Nam Yeol; Kang, Yang Jun; Jung, Hye Doo

2016-01-01

PURPOSE We aimed to evaluate the efficiency of placing an inferior vena cava (IVC) filter through the same popliteal vein access site used for percutaneous endovenous intervention in patients with extensive lower extremity deep vein thrombosis. METHODS This retrospective study included 21 patients who underwent IVC filter insertion through the popliteal vein over a three-year period. Patient medical records were reviewed for the location of the deep vein thrombosis, result of filter removal, and total number of endovascular procedures needed for filter insertion and recanalization of the lower extremity venous system. Follow-up lower extremity computed tomography (CT) venography was also reviewed in each patient to assess the degree of filter tilt in the IVC. RESULTS All patients had extensive lower extremity deep vein thrombosis involving the iliac vein and/or femoral vein. Seventeen patients showed deep vein thrombosis of the calf veins. In all patients, IVC filter insertion and the recanalization procedure were performed during a single procedure through the single popliteal vein access site. In the 17 patients undergoing follow-up CT, the mean tilt angle of the filter was 7.14°±4.48° in the coronal plane and 8.77°±5.49° in the sagittal plane. Filter retrieval was successful in 16 of 17 patients (94.1%) in whom filter retrieval was attempted. CONCLUSION Transpopliteal IVC filter insertion is an efficient technique that results in low rates of significant filter tilt and enables a single session procedure using a single venous access site for filter insertion and percutaneous endovenous intervention. PMID:27559713

Improving access to surgery in a developing country: experience from a surgical collaboration in Sierra Leone.

Science.gov (United States)

Kushner, Adam L; Kamara, Thaim B; Groen, Reinou S; Fadlu-Deen, Betsy D; Doah, Kisito S; Kingham, T Peter

2010-01-01

Although surgery is increasingly recognized as an essential component of primary health care, there has been little documentation of surgical programs in low- and middle-income countries. Surgeons OverSeas (SOS) is a New York-based organization with a mission to save lives in developing countries by improving surgical care. This article highlights the surgical program in Sierra Leone as a possible model to improve access to surgery. An SOS team conducted a needs assessment of surgical capacity in Sierra Leone in February 2008. Interventions were then developed and programs were implemented. A follow-up assessment was conducted in December 2009, which included interviews of key Sierra Leone hospital personnel and a review of operating room log books. Based on an initial needs assessment, a program was developed that included training, salary support, and the provision of surgical supplies and equipment. Two 3-day workshops were conducted for a total of 44 health workers, salary support given to over 100 staff, and 2 containers of supplies and equipment were donated. Access to surgery, as measured by the number of major operations at Connaught Hospital, increased from 460 cases in 2007 to 768 cases in 2009. The SOS program in Sierra Leone highlights a method for improving access to surgery that incorporates an initial needs assessment with minimal external support and local staff collaboration. The program functions as a catalyst by providing training, salary support, and supplies. The beneficial results of the program can then be used to advocate for additional resources for surgery from policy makers. This model could be beneficial in other resource-poor countries in which improved access to surgery is desired. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Exploring the umbilical and vaginal port during minimally invasive surgery.

Science.gov (United States)

Tinelli, Andrea; Tsin, Daniel A; Forgione, Antonello; Zorron, Ricardo; Dapri, Giovanni; Malvasi, Antonio; Benhidjeb, Tahar; Sparic, Radmila; Nezhat, Farr

2017-09-01

This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.

Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

Science.gov (United States)

Stiles, Mandy; Case, J Brad; Coisman, James

2016-08-01

OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

Risk of port-site metastases in pelvic cancers after robotic surgery.

Science.gov (United States)

Seror, J; Bats, A-S; Bensaïd, C; Douay-Hauser, N; Ngo, C; Lécuru, F

2015-04-01

To assess the risk of occurrence of port-site metastases after robotic surgery for pelvic cancer. Retrospective study from June 2007 to March 2013 of patients with gynecologic cancer who underwent robot-assisted surgery. We collected preoperative data, including characteristics of patients and FIGO stage, intraoperative data (surgery performed, number of ports), and postoperative data (occurrence of metastases, occurrence of port-site metastases). 115 patients were included in the study: 61 with endometrial cancer, 50 with cervical cancer and 4 with ovarian cancer. The surgical procedures performed were: hysterectomy with bilateral salpingo-oophorectomy, radical hysterectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy and omentectomy. All surgical procedures required the introduction of 4 ports, 3 for the robot and 1 for the assistant. With a mean follow-up of 504.4 days (507.7 days for endometrial cancer, 479.5 days for cervical cancer, and 511.3 for ovarian cancer), we observed 9 recurrences but no port-site metastasis. No port-site metastasis has occurred in our series. However, larger, prospective and randomized works are needed to formally conclude. Copyright © 2015 Elsevier Ltd. All rights reserved.

Challenges in Obtaining Property Access: The FUSRAP Maywood Site Experience - 13433

International Nuclear Information System (INIS)

Kollar, William

2013-01-01

The Formerly Utilized Sites Remedial Action Program (FUSRAP) is the US government program started in 1974 to identify, investigate and clean up or control sites that became contaminated as a result of the nation's early atomic programs. Many of these sites are not owned by the federal government and therefore require owner permission to enter. The experience in pursuing such access at the FUSRAP Maywood Superfund Site (the Maywood Site or the Site) in Bergen County, New Jersey, is extensive. Since the US Army Corps of Engineers (the Corps) assumed responsibility for the Maywood Site from the US Department of Energy in 1997, at least 186 separate property access agreements (known in FUSRAP as a Real Estate Right-of- Entry or ROE) have been executed between the Corps and approximately 55 different land owners and tenant occupants at the Maywood Site (agreement renewals with the same owners over time account for the difference). Maywood's experience during the Corps' tenure, reflected here in three case studies of representative property access efforts, offers some lessons and best practices that may apply to other remedial programs. While the Site Community Relations Manager (the author of this paper) managed the property access task, multi-disciplinary support from across the project was also critical to success in this endeavor. (authors)

On multi-site damage identification using single-site training data

Science.gov (United States)

Barthorpe, R. J.; Manson, G.; Worden, K.

2017-11-01

This paper proposes a methodology for developing multi-site damage location systems for engineering structures that can be trained using single-site damaged state data only. The methodology involves training a sequence of binary classifiers based upon single-site damage data and combining the developed classifiers into a robust multi-class damage locator. In this way, the multi-site damage identification problem may be decomposed into a sequence of binary decisions. In this paper Support Vector Classifiers are adopted as the means of making these binary decisions. The proposed methodology represents an advancement on the state of the art in the field of multi-site damage identification which require either: (1) full damaged state data from single- and multi-site damage cases or (2) the development of a physics-based model to make multi-site model predictions. The potential benefit of the proposed methodology is that a significantly reduced number of recorded damage states may be required in order to train a multi-site damage locator without recourse to physics-based model predictions. In this paper it is first demonstrated that Support Vector Classification represents an appropriate approach to the multi-site damage location problem, with methods for combining binary classifiers discussed. Next, the proposed methodology is demonstrated and evaluated through application to a real engineering structure - a Piper Tomahawk trainer aircraft wing - with its performance compared to classifiers trained using the full damaged-state dataset.

Is single port enough in minimally surgery for pneumothorax?

Science.gov (United States)

Ocakcioglu, Ilhan; Alpay, Levent; Demir, Mine; Kiral, Hakan; Akyil, Mustafa; Dogruyol, Talha; Tezel, Cagatay; Baysungur, Volkan; Yalcinkaya, Irfan

2016-01-01

Video-assisted thoracoscopic surgery is a widespread used procedure for treatment of primary spontaneous pneumothorax patients. In this study, the adaptation of single-port video-assisted thoracoscopic surgery approach to primary spontaneous pneumothorax patients necessitating surgical treatment, with its pros and cons over the traditional two- or three-port approaches are examined. Between January 2011 and August 2013, 146 primary spontaneous pneumothorax patients suitable for surgical treatment are evaluated prospectively. Indications for surgery included prolonged air leak, recurrent pneumothorax, or abnormal findings on radiological examinations. Visual analog scale and patient satisfaction scale score were utilized. Forty triple-port, 69 double-port, and 37 single-port operations were performed. Mean age of 146 (126 male, 20 female) patients was 27.1 ± 16.4 (range 15-42). Mean operation duration was 63.59 ± 26 min; 61.7 for single, 64.2 for double, and 63.8 min for triple-port approaches. Total drainage was lower in the single-port group than the multi-port groups (P = 0.001). No conversion to open thoracotomy or 30-day hospital mortality was seen in our group. No recurrence was seen in single-port group on follow-up period. Visual analog scale scores on postoperative 24th, 48th, and 72nd hours were 3.42 ± 0.94, 2.46 ± 0.81, 1.96 ± 0.59 in the single-port group; significantly lower than the other groups (P = 0.011, P = 0.014, and P = 0.042, respectively). Patient satisfaction scale scores of patients in the single-port group on 24th and 48th hours were 1.90 ± 0.71 and 2.36 ± 0.62, respectively, indicating a significantly better score than the other two groups (P = 0.038 and P = 0.046). This study confirms the competency of single-port procedure in first-line surgical treatment of primary spontaneous pneumothorax.

Single port VATS: recent developments in Asia.

Science.gov (United States)

Yu, Peter S Y; Capili, Freddie; Ng, Calvin S H

2016-03-01

Single port video-assisted thoracic surgery (VATS) is the most recent evolution in minimally invasive thoracic surgery. With increasing global popularity, the single port VATS approach has been adopted by experienced thoracic surgeons in many Asian countries. From initial experience of single port VATS lobectomy to the more complex sleeve resection procedures now forming part of daily practice in some Asia institutes, the region has been the proving ground for single port VATS approaches' feasibility and safety. In addition, certain technical refinements in single port VATS lung resection and lymph node dissection have also sprung from Asia. Novel equipment designed to facilitate single port VATS allowing further reduce access trauma are being realized by the partnership between surgeons and the industries. Advanced thoracoscopes and staplers that are narrower and more maneuverable are particularly important in the smaller habitus of patients from Asia. These and similar new generation equipment are being applied to single port VATS in novel ways. As dedicated thoracic surgeons in the region continue to striving for excellence, innovative ideas in single incision access including subxiphoid and embryonic natural-orifice transluminal endoscopic surgery (e-NOTES) have been explored. Adjunct techniques and technology used in association with single port VATS such as non-intubated surgery, hybrid operating room image guidance and electromagnetic navigational bronchoscopy are all in rapid development in Asia.

Single-port laparoscopic rectal surgery - a systematic review

DEFF Research Database (Denmark)

Lolle, Ida; Rosenstock, Steffen; Bulut, Orhan

2014-01-01

INTRODUCTION: Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS: A systematic literature search...

Global Web Accessibility Analysis of National Government Portals and Ministry Web Sites

DEFF Research Database (Denmark)

Goodwin, Morten; Susar, Deniz; Nietzio, Annika

2011-01-01

Equal access to public information and services for all is an essential part of the United Nations (UN) Declaration of Human Rights. Today, the Web plays an important role in providing information and services to citizens. Unfortunately, many government Web sites are poorly designed and have...... accessibility barriers that prevent people with disabilities from using them. This article combines current Web accessibility benchmarking methodologies with a sound strategy for comparing Web accessibility among countries and continents. Furthermore, the article presents the first global analysis of the Web...... accessibility of 192 United Nation Member States made publically available. The article also identifies common properties of Member States that have accessible and inaccessible Web sites and shows that implementing antidisability discrimination laws is highly beneficial for the accessibility of Web sites, while...

Challenges in Obtaining Property Access: The FUSRAP Maywood Site Experience - 13433

Energy Technology Data Exchange (ETDEWEB)

Kollar, William [Shaw Environmental, Inc., 100 West Hunter Avenue, Maywood, NJ 07607 (United States)

2013-07-01

The Formerly Utilized Sites Remedial Action Program (FUSRAP) is the US government program started in 1974 to identify, investigate and clean up or control sites that became contaminated as a result of the nation's early atomic programs. Many of these sites are not owned by the federal government and therefore require owner permission to enter. The experience in pursuing such access at the FUSRAP Maywood Superfund Site (the Maywood Site or the Site) in Bergen County, New Jersey, is extensive. Since the US Army Corps of Engineers (the Corps) assumed responsibility for the Maywood Site from the US Department of Energy in 1997, at least 186 separate property access agreements (known in FUSRAP as a Real Estate Right-of- Entry or ROE) have been executed between the Corps and approximately 55 different land owners and tenant occupants at the Maywood Site (agreement renewals with the same owners over time account for the difference). Maywood's experience during the Corps' tenure, reflected here in three case studies of representative property access efforts, offers some lessons and best practices that may apply to other remedial programs. While the Site Community Relations Manager (the author of this paper) managed the property access task, multi-disciplinary support from across the project was also critical to success in this endeavor. (authors)

Limited-Access Heart Surgery

Science.gov (United States)

... on the side of the chest. With traditional open heart surgery, the incision is usually 6 to 8 ... attached to a heart-lung machine. In traditional open heart surgery, patients would be connected to the heart- ...

Future of uniportal video-assisted thoracoscopic surgery-emerging technology.

Science.gov (United States)

Li, Zheng; Ng, Calvin S H

2016-03-01

Uniportal VATS poses unique difficulties to the surgeon, mainly as a consequence of operating through a small single incision. The instruments in uniportal VATS have limited movement through the small incision. In addition, the approach to the surgical operating site is unidirectional, which may restrict vision and retraction, and unavoidably suffers from instrument fencing. Recent thoracoscopic technology in the form of a wide variable angled lens has to some extent improved these shortcomings. The development of an extendable flexible thoracoscope and wireless steerable endoscope (WSE) systems can further improve the visualization for surgery and reduce or even remove fencing between endoscope and instruments. New single incision access platforms both derived from Natural orifice transluminal endoscopic surgery (NOTES) and robotic surgery approaches are on the horizon. These may allow uniportal VATS to be performed through an even smaller ultra-minimally invasive incision, with improved vision, more freedom of movement of the instruments and greater precision. However, a number of problems remain to be resolved, including provision of a stable platform and payload, applied force limitations and equipment sterilization. Advances in uniportal VATS major lung resection techniques have not only challenged the surgeon to acquire new skills and knowledge, but at the same time have rekindled the collaborative spirit between industry and clinician in developing novel equipment and technology to push the boundaries of minimally invasive surgery. These technological improvements and innovations may improve operating efficiency and safety during uniportal VATS surgery.

Single visit surgery for pediatric ambulatory surgical procedures: a satisfaction and cost analysis.

Science.gov (United States)

Olson, Jacob K; Deming, Lisa A; King, Denis R; Rager, Terrence M; Gartner, Sarah; Huibregtse, Natalie; Moss, R Lawrence; Besner, Gail E

2017-10-10

Single visit surgery (SVS) consists of same-day pre-operative assessment and operation with telephone post-operative follow-up. This reduces family time commitment to 1 hospital trip rather than 2-3. We began SVS for ambulatory patients with clear surgical indications in 2013. We sought to determine family satisfaction, cost savings to families, and institutional financial feasibility of SVS. SVS patients were compared to age/case matched conventional surgery (CS) patients. Satisfaction was assessed by post-operative telephone survey. Family costs were calculated as the sum of lost revenue (based on median income) and transportation costs ($0.50/mile). Satisfaction was high in both groups (98% for SVS vs. 93% for CS; p=0.27). 40% of CS families indicated that they would have preferred SVS, whereas no SVS families indicated preference for the CS option (p<0.001). Distance from the hospital did not correlate with satisfaction. Estimated cost savings for an SVS family was $188. Reimbursement, hospital and physician charges, and day-of-surgery cancellation rates were similar. SVS provides substantial cost savings to families while maintaining patient satisfaction and equivalent institutional reimbursement. SVS is an effective approach to low-risk ambulatory surgical procedures that is less disruptive to families, facilitates access to pediatric surgical care, and reduces resource utilization. Cost Effectiveness Study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.

SPIDER ® sleeve gastrectomy--a new concept in single-trocar bariatric surgery: initial experience and technical details.

Science.gov (United States)

Noel, P; Nedelcu, M; Gagner, M

2014-04-01

Single port instrument delivery extended reach (SPIDER(®)) surgical system is a revolutionary surgical platform that allows triangulation of the surgical instruments while eliminating the crossing of instruments, the problematic characteristic of single access laparoscopic surgery. The purpose of this study was to analyze our initial experience with SPIDER(®) sleeve gastrectomy and to present the technical details of this new minimally invasive approach, performed in ten patients at the La Casamance Private Hospital between November 2012 and April 2013. All patients were reviewed at scheduled post-operative consultations at 1, 3 and 6 months. In addition to clinical examination, the post-operative consultation at one month also included a satisfaction survey using the Moorehead-Ardelt questionnaire. An initial series of ten sleeve gastrectomies were performed in female patients with a mean age of 41.5 years (range: 2-52). The mean BMI was 40.11 (range: 37.25-44.3). The intervention was performed through a single trocar in all patients with no "conversion" to classic laparoscopy or open surgery. The mean operative time was 61 ± 15.22 minutes (SD=standard deviation) (range: 43-96 min). The mean BMI at one month was 35.5 (SD:± 3.58, SEM: ± 1.13) (SEM=standard error of mean) with an average percentage of excess weight loss (%EWL) of 32.9% (SD:± 8.56%, SEM:± 2.71%). The mean BMI at three months was 32.4 (SD: ± 2.78, SEM: ± 0.88) with an average %EWL of 52.7% (SD: ± 8.64%, SEM: ± 2.73%). The mean BMI at six months was 29.9 (SD:± 2.60, SEM: ± 0.98) with a mean %EWL of 68.8% (SD: ± 8.38%, SEM:± 3.17%). Complete remission of co-morbid conditions was observed in four patients, improvement in three others, and no change in a single patient. The mean duration of hospitalization was 3.1 days. The mean follow-up period was 161 days (SD:± 57.4 days, range: 90-243 days). There was no mortality and no intra-operative and post-operative complications were noted. The

Laparoendoscopic Single-Site Surgery (LESS for a Large Ovarian Tumour: First Clinical Case Report

Directory of Open Access Journals (Sweden)

Yao Dong Chua

2011-01-01

Main Outcome Measure(s. Conversion to standard laparoscopic technique or laparotomy, estimated blood loss, operative time , extent of scarring, occurrence of intra- and perioperative surgical complications, technical adequacy, and clinical outcome. Result(s. No conversion to standard laparoscopic technique or laparotomy, and no intraoperative or postoperative complications were observed. Total operative time was 99 minutes. The patient was discharged home on postoperative day one. Conclusion(s. Laparoendoscopic single-site bilateral salpingo-oophorectomy of a large ovarian tumour is feasible with standard laparoscopic instruments. It is safe and effective, with good results in terms of excellent cosmesis and minimal postoperative pain.

Changes in racial disparities in access to coronary artery bypass grafting surgery between the late 1990s and early 2000s.

Science.gov (United States)

Mukamel, Dana B; Weimer, David L; Buchmueller, Thomas C; Ladd, Heather; Mushlin, Alvin I

2007-07-01

Racial disparities in medical care in the United States are pervasive and persistent. Minorities, African American patients in particular, have lower utilization rates for coronary artery bypass graft surgery (CABG) and, compared with white patients, they receive care from surgeons with worse records of performance. We sought to examine the persistence of disparities in CABG care (overall access to surgery and access to high-quality surgeons) in recent years and the potential causes for declining disparities. We undertook a retrospective analysis of data comparing access to CABG surgery and access to high-quality cardiac surgeons for white and black patients in the late 1990s and the early 2000s. Data used included the Medicare inpatient and physician part B claims and the New York State Cardiac Surgery Reports. A total of 24,087 Medicare fee-for-service patients undergoing CABG surgery between the years 1997-1999 and 23,048 patients undergoing CABG surgery between the years of 2001-2003 in New York State were studied. We measured the number of patients undergoing surgery by race and quality of surgeons measured by the surgeons' risk-adjusted mortality rates. Disparities have declined between the 2 periods. The decline seems to be associated with freed surgical capacity among all surgeons, although other factors may also present barriers, especially in terms of overall access to surgery. Despite the decline in disparities, gaps in care received by white and black patients remain.

Assessing the model transferability for prediction of transcription factor binding sites based on chromatin accessibility.

Science.gov (United States)

Liu, Sheng; Zibetti, Cristina; Wan, Jun; Wang, Guohua; Blackshaw, Seth; Qian, Jiang

2017-07-27

Computational prediction of transcription factor (TF) binding sites in different cell types is challenging. Recent technology development allows us to determine the genome-wide chromatin accessibility in various cellular and developmental contexts. The chromatin accessibility profiles provide useful information in prediction of TF binding events in various physiological conditions. Furthermore, ChIP-Seq analysis was used to determine genome-wide binding sites for a range of different TFs in multiple cell types. Integration of these two types of genomic information can improve the prediction of TF binding events. We assessed to what extent a model built upon on other TFs and/or other cell types could be used to predict the binding sites of TFs of interest. A random forest model was built using a set of cell type-independent features such as specific sequences recognized by the TFs and evolutionary conservation, as well as cell type-specific features derived from chromatin accessibility data. Our analysis suggested that the models learned from other TFs and/or cell lines performed almost as well as the model learned from the target TF in the cell type of interest. Interestingly, models based on multiple TFs performed better than single-TF models. Finally, we proposed a universal model, BPAC, which was generated using ChIP-Seq data from multiple TFs in various cell types. Integrating chromatin accessibility information with sequence information improves prediction of TF binding.The prediction of TF binding is transferable across TFs and/or cell lines suggesting there are a set of universal "rules". A computational tool was developed to predict TF binding sites based on the universal "rules".

Results of single-event multilevel orthopedic surgery in children with cerebral palsy

Directory of Open Access Journals (Sweden)

Akhmed Tomov

2015-11-01

Full Text Available Background: Single-event multilevel orthopedic surgery is a modern approach in the operative treatment of children with cerebral palsy. Methods: Single-event multilevel orthopedic surgery was carried out in 108 patients with cerebral palsy. Patients’ average age was 11.3±1.7 years. Surgical results were analyzed at follow-up after 18 to 24 months, by way of detailed physical examination, functional assessment, imaging, the Edinburgh Visual Gait Score and Gillette Functional Assessment Questionnaire. Results: In our series, 647 procedures were performed during 141 surgeries. Patients had an average of 4.59 procedures per surgery. Observational gait analysis showed an improvement in stance and swing gait phases in ambulatory children. According to the Gillette Functional Assessment Questionnaire, an increase of functional level was noted in 50 patients but did not change in 32 patients. Conclusions: For children with cerebral palsy, single-event multilevel surgery is defined as two or more surgical procedures of the soft tissue or bone at two or more anatomical levels during one operative procedure. In cases where a large volume of surgery is required, two separate operations with a short break in between, but requiring only one hospital admission and one rehabilitation period, are also included. This approach requires adapted methods of surgical intervention, and appropriate methods of anesthesia and pain control in the postoperative period to the start of rehabilitation. Compliance with the above principles allowed the necessary correction of orthopedic complications to be achieved in all cases.

Terminal illness and access to Phase 1 experimental agents, surgeries and devices: reviewing the ethical arguments.

Science.gov (United States)

Schüklenk, Udo; Lowry, Christopher

2009-01-01

The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended--at the time--on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Existing ethics and health policy literature on the topic of access to experimental drugs. The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients--the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to Phase 1 agents for terminally ill patients. Finding a compromise between providing free or no access to Phase 1 drugs for terminally ill patients. We ought to investigate means to increase access to experimental drugs for terminally ill patients without sacrificing necessary clinical trials' sounds scientific methods.

Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis.

Directory of Open Access Journals (Sweden)

André L Mihaljevic

Full Text Available Surgical site infections remain one of the most frequent complications following abdominal surgery and cause substantial costs, morbidity and mortality.To assess the effectiveness of wound edge protectors in open abdominal surgery in reducing surgical site infections.A systematic literature search was conducted according to a prespecified review protocol in a variety of data-bases combined with hand-searches for randomized controlled trials on wound edge protectors in patients undergoing laparotomy. A qualitative and quantitative analysis of included trials was conducted.We identified 16 randomized controlled trials including 3695 patients investigating wound edge protectors published between 1972 and 2014. Critical appraisal uncovered a number of methodological flaws, predominantly in the older trials. Wound edge protectors significantly reduced the rate of surgical site infections (risk ratio 0.65; 95%CI, 0.51-0.83; p = 0.0007; I2 = 52%. The results were robust in a number of sensitivity analyses. A similar effect size was found in the subgroup of patients undergoing colorectal surgery (risk ratio 0.65; 95%CI, 0.44-0.97; p = 0.04; I2 = 56%. Of the two common types of wound protectors double ring devices were found to exhibit a greater protective effect (risk ratio 0.29; 95%CI, 0.15-0.55 than single-ring devices (risk ratio 0.71; 95%CI, 0.54-0.92, but this might largely be due to the lower quality of available data for double-ring devices. Exploratory subgroup analyses for the degree of contamination showed a larger protective effect in contaminated cases (0.44; 95%CI, 0.28-0.67; p = 0.0002, I2 = 23% than in clean-contaminated surgeries (0.72, 95%CI, 0.57-0.91; p = 0.005; I2 = 46% and a strong effect on the reduction of superficial surgical site infections (risk ratio 0.45; 95%CI, 0.24-0.82; p = 0.001; I2 = 72%.Wound edge protectors significantly reduce the rate of surgical site infections in open abdominal surgery. Further trials are needed to

Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

DEFF Research Database (Denmark)

Mynster, Tommie; Wille-Jørgensen, Peer

2013-01-01

of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

Minimal access surgery of pediatric inguinal hernias: a review.

Science.gov (United States)

Saranga Bharathi, Ramanathan; Arora, Manu; Baskaran, Vasudevan

2008-08-01

Inguinal hernia is a common problem among children, and herniotomy has been its standard of care. Laparoscopy, which gained a toehold initially in the management of pediatric inguinal hernia (PIH), has managed to steer world opinion against routine contralateral groin exploration by precise detection of contralateral patencies. Besides detection, its ability to repair simultaneously all forms of inguinal hernias (indirect, direct, combined, recurrent, and incarcerated) together with contralateral patencies has cemented its role as a viable alternative to conventional repair. Numerous minimally invasive techniques for addressing PIH have mushroomed in the past two decades. These techniques vary considerably in their approaches to the internal ring (intraperitoneal, extraperitoneal), use of ports (three, two, one), endoscopic instruments (two, one, or none), sutures (absorbable, nonabsorbable), and techniques of knotting (intracorporeal, extracorporeal). In addition to the surgeons' experience and the merits/limitations of individual techniques, it is the nature of the defect that should govern the choice of technique. The emerging techniques show a trend toward increasing use of extracorporeal knotting and diminishing use of working ports and endoscopic instruments. These favor wider adoption of minimal access surgery in addressing PIH by surgeons, irrespective of their laparoscopic skills and experience. Growing experience, wider adoption, decreasing complications, and increasing advantages favor emergence of minimal access surgery as the gold standard for the treatment of PIH in the future. This article comprehensively reviews the laparoscopic techniques of addressing PIH.

Advantages of robotics in benign gynecologic surgery.

Science.gov (United States)

Truong, Mireille; Kim, Jin Hee; Scheib, Stacey; Patzkowsky, Kristin

2016-08-01

The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy. Robotics was developed to overcome challenges of laparoscopy and has led to technological advantages such as improved ergonomics, visualization with three-dimensional capabilities, dexterity and range of motion with instrument articulation, and tremor filtration. To date, applications of robotics in benign gynecology include hysterectomy, myomectomy, endometriosis surgery, sacrocolpopexy, adnexal surgery, tubal reanastomosis, and cerclage. Though further data are needed, robotics may provide additional benefits over other approaches in the obese patient population and in higher complexity cases. Challenges that arose in the earlier adoption stage such as the steep learning curve, costs, and operative times are becoming more optimized with greater experience, with implementation of robotics in high-volume centers and with improved training of surgeons and robotic teams. Robotic laparoendoscopic single-site surgery, albeit still in its infancy where technical advantages compared with laparoscopic single-site surgery are still unclear, may provide a cost-reducing option compared with multiport robotics. The cost may even approach that of laparoscopy while still conferring similar perioperative outcomes. Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign

The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery.

NARCIS (Netherlands)

Pull ter Gunne, A.F.; Mohamed, A.S.; Skolasky, R.L.; Laarhoven, C.J.H.M. van; Cohen, D.B.

2010-01-01

STUDY DESIGN: Descriptive, retrospective cohort analysis. OBJECTIVE: To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA: SSI after spine surgery is frequently seen. Small case control studies have been published

Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience.

Science.gov (United States)

Holman, Nathan; Wallace, Kristin; Moore, J Matthew; Brock, Andrew S

2015-12-01

To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access procedures were compared in terms of diagnostic and therapeutic yield, adverse events, and procedural success. A total of 125 SBEs were performed on 125 patients. The mean age was 63.1 (53% men) years. In all, 43 procedures were performed open access and 82 after face-to-face consultation. Indications included anemia/gastrointestinal bleeding (110), abdominal pain (8), and other (7). Diagnostic yield for open- and closed-access procedures was 53% and 60%, respectively (P = 0.501) and therapeutic yield was 37% and 52%, respectively (P = 0.11). Overall technical success was 91% with no difference between the groups (P = 0.27). There were no major adverse events in either group. SBE can be performed as an open-access procedure without compromise to safety or diagnostic yield.

Design of a box trainer for objective assessment of technical skills in single-port surgery

NARCIS (Netherlands)

Horeman, Tim; Sun, Siyu; Tuijthof, Gabrielle J. M.; Jansen, Frank William; Meijerink, Jeroen W. J. H. J.; Dankelman, Jenny

2015-01-01

Laparoscopic single-port (SP) surgery uses only a single entry point for all instruments. The approach of SP has been applied in multiple laparoscopic disciplines owing to its improved cosmetic result. However, in SP surgery, instrument movements are further restricted, resulting in increased

New trends in minimally invasive urological surgery: what is beyond the robot?

Science.gov (United States)

Micali, Salvatore; Pini, Giovannalberto; Teber, Dogu; Sighinolfi, Maria Chiara; De Stefani, Stefano; Bianchi, Giampaolo; Rassweiler, Jens

2013-06-01

To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS). A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content. Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology. LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future.

Ramifications of single-port laparoscopic surgery: measuring differences in task performance using simulation.

Science.gov (United States)

Conway, Nathan E; Romanelli, John R; Bush, Ron W; Seymour, Neal E

2014-02-01

Single-port laparoscopic surgery imposes unique psychomotor challenges. We used surgical simulation to define performance differences between surgeons with and without single-port clinical experience and examined whether a short course of training resulted in improved performance. Study participants were assigned to 3 groups: resident group (RES), experienced laparoscopic surgeons with (SP) and without (LAP) prior single-port laparoscopic experience. Participants performed the Fundamentals of Laparoscopic Surgery precision cutting task on a ProMIS trainer through conventional ports or with articulating instruments via a SILS Port (Covidien, Inc). Two iterations of each method were performed. Then, 6 residents performed 10 successive single-port iterations to assess the effect of practice on task performance. The SP group had faster task times for both laparoscopic (P = .0486) and single-port (P = .0238) methods. The LAP group had longer path lengths for the single-port task than for the laparoscopic task (P = .03). The RES group was slower (P = .0019), with longer path length (P = .0010) but with greater smoothness (P = .0186) on the single-port task than the conventional laparoscopic task. Resident performance task time (P = .005) and smoothness (P = .045) improved with successive iterations. Our data show that surgeons with clinical single-port surgery experience perform a simulated single-port surgical task better than inexperienced single-port surgeons. Furthermore, this performance is comparable to that achieved with conventional laparoscopic techniques. Performance of residents declined dramatically when confronted with the challenges of the single-port task but improved with practice. These results suggest a role for lab-based single-port training.

Minimal access surgery in children: An initial experience of 28 months

Directory of Open Access Journals (Sweden)

Gupta Abhaya

2009-01-01

Full Text Available Background : This study reports our 28 months experience with minimal access surgery (MAS in children. Materials and Methods : This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC and King Edward the VII Memorial (KEM Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibilty of MAS in neonates, in the appropriate operative groups. Results : A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years. One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. Conclusion : We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.

Accessibility and content of individualized adult reconstructive hip and knee/musculoskeletal oncology fellowship web sites.

Science.gov (United States)

Young, Bradley L; Cantrell, Colin K; Patt, Joshua C; Ponce, Brent A

2018-06-01

Accessible, adequate online information is important to fellowship applicants. Program web sites can affect which programs applicants apply to, subsequently altering interview costs incurred by both parties and ultimately impacting rank lists. Web site analyses have been performed for all orthopaedic subspecialties other than those involved in the combined adult reconstruction and musculoskeletal (MSK) oncology fellowship match. A complete list of active programs was obtained from the official adult reconstruction and MSK oncology society web sites. Web site accessibility was assessed using a structured Google search. Accessible web sites were evaluated based on 21 previously reported content criteria. Seventy-four adult reconstruction programs and 11 MSK oncology programs were listed on the official society web sites. Web sites were identified and accessible for 58 (78%) adult reconstruction and 9 (82%) MSK oncology fellowship programs. No web site contained all content criteria and more than half of both adult reconstruction and MSK oncology web sites failed to include 12 of the 21 criteria. Several programs participating in the combined Adult Reconstructive Hip and Knee/Musculoskeletal Oncology Fellowship Match did not have accessible web sites. Of the web sites that were accessible, none contained comprehensive information and the majority lacked information that has been previously identified as being important to perspective applicants.

Ionic Exchange of Metal-Organic Frameworks to Access Single Nickel Sites for Efficient Electroreduction of CO2.

Science.gov (United States)

Zhao, Changming; Dai, Xinyao; Yao, Tao; Chen, Wenxing; Wang, Xiaoqian; Wang, Jing; Yang, Jian; Wei, Shiqiang; Wu, Yuen; Li, Yadong

2017-06-21

Single-atom catalysts often exhibit unexpected catalytic activity for many important chemical reactions because of their unique electronic and geometric structures with respect to their bulk counterparts. Herein we adopt metal-organic frameworks (MOFs) to assist the preparation of a catalyst containing single Ni sites for efficient electroreduction of CO 2 . The synthesis is based on ionic exchange between Zn nodes and adsorbed Ni ions within the cavities of the MOF. This single-atom catalyst exhibited an excellent turnover frequency for electroreduction of CO 2 (5273 h -1 ), with a Faradaic efficiency for CO production of over 71.9% and a current density of 10.48 mA cm -2 at an overpotential of 0.89 V. Our findings present some guidelines for the rational design and accurate modulation of nanostructured catalysts at the atomic scale.

Method of localization and implantation of the lumpectomy site for high dose rate brachytherapy after conservative surgery for T1 and T2 breast cancer

International Nuclear Information System (INIS)

Perera, F.; Chisela, F.; Engel, J.; Venkatesan, V.

1995-01-01

Purpose: This article describes our technique of localization and implantation of the lumpectomy site of patients with T1 and T2 breast cancer. Our method was developed as part of our Phase I/II pilot study of high dose rate (HDR) brachytherapy alone after conservative surgery for early breast cancer. Methods and Materials: In March 1992, we started a pilot study of HDR brachytherapy to the lumpectomy site as the sole radiotherapy after conservative surgery for clinical T1 or T2 invasive breast cancer. Initially, the protocol required intraoperative placement of the interstitial needles at the time of definitive surgery to the breast. The protocol was then generalized to allow the implantation of the lumpectomy site after definitive surgery to the breast, either at the time of subsequent axillary nodal dissection or postoperatively. To date, five patients have been implanted intraoperatively at the time of definitive breast surgery. Twelve patients were implanted after definitive breast surgery, with 7 patients being done at the time of axillary nodal dissection and 5 patients postoperatively. We devised a method of accurately localizing and implanting the lumpectomy site after definitive breast surgery. The method relies on the previous placement of surgical clips by the referring surgeon to mark the lumpectomy site. For each patient, a breast mold is made with radio-opaque angiocatheters taped onto the mold in the supero-inferior direction. A planning CT scan is then obtained through the lumpectomy site. The volume of the lumpectomy site, the number of implant planes necessary, and the orientation of the implants are then determined from the CT scan. The angiocatheters provide a reference grid on the CT films to locate the entry and exit points of the interstitial needles on the plastic mold. The entry and exit points for reference needles are then transferred onto the patient's skin enabling implantation of the lumpectomy site. Needle positions with respect to

Effect of Unshaven Hair with Absorbable Sutures and Early Postoperative Shampoo on Cranial Surgery Site Infection.

Science.gov (United States)

Oh, Won-Oak; Yeom, Insun; Kim, Dong-Seok; Park, Eun-Kyung; Shim, Kyu-Won

2018-01-01

Cranial surgical site infection is a significant cause of morbidity and mortality in hospitals. Preoperative hair shaving for cranial neurosurgical procedures is performed traditionally in an attempt to protect patients against complications from infections at cranial surgical sites. However, preoperative shaving of surgical incision sites using traditional surgical blades without properly washing the head after surgery can cause infections at surgical sites. Therefore, a rapid protocol in which the scalp remains unshaven and absorbable sutures are used for scalp closure with early postoperative shampooing is examined in this study. A retrospective comparative study was conducted from January 2008 to December 2012. A total of 2,641 patients who underwent unshaven cranial surgery with absorbable sutures for scalp closure were enrolled in this study. Data of 1,882 patients who underwent surgery with the traditional protocol from January 2005 to December 2007 were also analyzed for comparison. Of 2,641 patients who underwent cranial surgery with the rapid protocol, all but 2 (0.07%) patients experienced satisfactory wound healing. Of 1,882 patients who underwent cranial surgery with the traditional protocol, 3 patients (0.15%) had infections. Each infection occurred at the superficial incisional surgical site. Unshaven cranial surgery using absorbable sutures for scalp closure with early postoperative shampooing is safe and effective in the cranial neurosurgery setting. This protocol has a positive psychological effect. It can help patients accept neurosurgical procedures and improve their self-image after the operation. © 2017 S. Karger AG, Basel.

Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study.

Science.gov (United States)

Su, Jian; Zhu, Qingyi; Yuan, Lin; Zhang, Yang; Zhang, Qingling; Wei, Yunfei

2018-01-01

To describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site (LESS) radical prostatectomy (RP) and LESS radical cystectomy (RC) in a single institution. Between December 2014 and March 2016, a total of 114 LESS RPs and RCs were performed, comprising 68 LESS RPs, 38 LESS RCs with cutaneous ureterostomy (CU) and eight LESS RCs with orthotopic ileal neobladder (OIN). Access was achieved via a single-port, with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port ('Zhu's port') was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The peri-operative and postoperative data were collected and analysed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects. All the procedures were completed successfully. No conversion to conventional laparoscopic surgery was necessary. For LESS RP, the average operating time was 152 min. Estimated blood loss was 117 mL. The mean hospital stay was 16.4 days after surgery. For LESS RC with CU and LESS RC with OIN, the mean operating times were 215 and 328 min, mean estimated blood loss was 175 and 252 mL, and mean hospital stay was 9.4 and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intra-operative complications occurred in two patients (1.75%), and postoperative complications in nine (7.89%). Fourteen out of 68 (20.6%) patients who underwent LESS RP had positive surgical margins. Follow-up ranged from 10 to 30.6 months. In the prostate cancer cases, good urinary control was observed in 35.3%, 97.1% and 100% of patients at 1, 6 and 12 months after the operation, respectively, while biochemical recurrence was observed in 11.8% patients. In the bladder cancer cases, two patients had local recurrence and two patients had distant metastasis. Our results showed that LESS RP and LESS RC

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Science.gov (United States)

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

Surgical site infections are the most common complications of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Cataract Surgery with Foldable Single Piece IOLs in Congenital Cataract-Microcornea Syndrome

Directory of Open Access Journals (Sweden)

Niphon Chirapapaisan, M.D.

2017-11-01

Full Text Available Objective: To present the visual outcomes and intraocular lens (IOLs stability after cataract surgery with foldable single piece IOLs in a patient with congenital cataract-microcornea syndrome (CCMC. Case presentation: A 28-year-old woman presented with bilateral microcornea and posterior polar cataract. Her uncorrected (UDVA and corrected (CDVA distance visual acuities were 20/100, 20/160 and 20/80, 20/80, respectively. The horizontal cornea diameter was 9.0 mm in both eyes. Anterior chamber angle assessment (ACAA with Scheie classification showed grade 3 on the superior, inferior, and temporal site and grade 2 on the nasal site in both eyes. On ultrasound biomicroscopy (UBM, the anterior chamber depths were 2.35 mm. OD and 2.41 mm. OS. The axial lengths were 23.28 mm., OD and 22.50 mm. OS with the A-scan ultrasound biometry. The IOLs power calculation with SRK/T formulas was +25.00 diopter OD and +22.50 diopter OS (A-constant 118.4. Phacoemulsification was performed on both eyes. After lens aspiration, ruptured posterior capsule, a common complication occurred. Then anterior vitrectomy was performed. A foldable single piece IOLs without haptic trimming was implanted in the sulcus in each eye. CDVA was 20/63 equally in both eyes. The intraocular pressure was 12 and 14 mmHg. ACAA showed grade 2 and no pigment dispersion. The IOLs had no tilt or decentration. UBM showed the IOLs were in the proper position and were not rubbing the iris. Conclusion: The foldable single piece IOLs without haptic trimming in the sulcus were safely implanted in both eyes with microcornea in CCMC.

Development of an in vivo visual robot system with a magnetic anchoring mechanism and a lens cleaning mechanism for laparoendoscopic single-site surgery (LESS).

Science.gov (United States)

Feng, Haibo; Dong, Dinghui; Ma, Tengfei; Zhuang, Jinlei; Fu, Yili; Lv, Yi; Li, Liyi

2017-12-01

Surgical robot systems which can significantly improve surgical procedures have been widely used in laparoendoscopic single-site surgery (LESS). For a relative complex surgical procedure, the development of an in vivo visual robot system for LESS can effectively improve the visualization for surgical robot systems. In this work, an in vivo visual robot system with a new mechanism for LESS was investigated. A finite element method (FEM) analysis was carried out to ensure the safety of the in vivo visual robot during the movement, which was the most important concern for surgical purposes. A master-slave control strategy was adopted, in which the control model was established by off-line experiments. The in vivo visual robot system was verified by using a phantom box. The experiment results show that the robot system can successfully realize the expected functionalities and meet the demands of LESS. The experiment results indicate that the in vivo visual robot with high manipulability has great potential in clinical application. Copyright © 2017 John Wiley & Sons, Ltd.

Factors contributing to migraine headache surgery failure and success.

Science.gov (United States)

Larson, Kelsey; Lee, Michelle; Davis, Janine; Guyuron, Bahman

2011-11-01

The purpose of this study was to identify factors that contribute to migraine headache surgery failure and success. A retrospective chart review was conducted of patients who underwent surgery for migraine headaches performed by the senior author (B.G.) and had at least 11 months of follow-up. The study population included three groups: migraine surgery success, improvement, and failure. Thirty-six unique data points were collected for each patient. A total of 169 patients met inclusion criteria. Of these, 66 patients comprised the migraine surgery success group (S, complete elimination of migraine headaches); 67 comprised the migraine surgery improvement group (I, >50 percent reduction in migraine frequency, intensity, or duration); and 36 comprised the migraine surgery failure group (F, I, p=0.02), migraine frequency (SI, p=0.003; S>F, p=0.04), history of head or neck injury (SI, p=0.02), increased intraoperative bleeding (SF, p=0.0006; I>F, p=0.0004), site II (S>F, p=0.015), single operative site (SI, p=0.05; S>F, p=0.04). Factors associated with migraine surgery failure include increased intraoperative bleeding and surgery on fewer trigger sites. Factors associated with migraine surgery success are older age of migraine onset, higher rate of visual symptoms versus improvement group, surgery at site I or II, and deactivating all four operative sites. Risk, III.

FIRST SINGLE-PORT LAPAROSCOPIC PANCREATECTOMY IN BRAZIL

Directory of Open Access Journals (Sweden)

Marcel Autran Cesar MACHADO

2013-12-01

Full Text Available Context Pancreatic surgery is an extremely challenging field, and the management of pancreatic diseases continues to evolve. In the past decade, minimal access surgery is moving towards minimizing the surgical trauma by reducing numbers and size of the port. In the last few years, a novel technique with a single-incision laparoscopic approach has been described for several laparoscopic procedures. Objectives We present a single-port laparoscopic spleen-preserving distal pancreatectomy. To our knowledge, this is the first single-port pancreatic resection in Brazil and Latin America. Methods A 33-year-old woman with neuroendocrine tumor underwent spleen-preserving distal pancreatectomy via single-port approach. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector was used. Results Operative time was 174 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions Single-port laparoscopic spleen-preserving distal pancreatectomy is feasible and can be safely performed in specialized centers by skilled laparoscopic surgeons.

Usability and Accessibility of Air Force Intranet Web Sites

National Research Council Canada - National Science Library

Bentley, Richard S

2006-01-01

.... This research effort seeks to establish an understanding of how well common practice usability design principles and government mandated accessibility guidelines are followed by Air Force intranet web sites...

The contribution of atom accessibility to site of metabolism models for cytochromes P450

DEFF Research Database (Denmark)

Rydberg, Patrik; Rostkowski, M.; Gloriam, D.E.

2013-01-01

Three different types of atom accessibility descriptors are investigated in relation to site of metabolism predictions. To enable the integration of local accessibility we have constructed 2DSASA, a method for the calculation of the atomic solvent accessible surface area that is independent of 3D...... coordinates. The method was implemented in the SMARTCyp site of metabolism prediction models and improved the results by up to 4 percentage points for nine cytochrome P450 isoforms. The final models are made available at http://www.farma.ku.dk/smartcyp.......Three different types of atom accessibility descriptors are investigated in relation to site of metabolism predictions. To enable the integration of local accessibility we have constructed 2DSASA, a method for the calculation of the atomic solvent accessible surface area that is independent of 3D...

A smartphone-optimized web site for conveniently viewing otolaryngology journal abstracts.

Science.gov (United States)

Golub, Justin S; Sharma, Arun; Samy, Ravi N

2014-12-01

Access to the medical literature has not kept pace with the mobile revolution. We aimed to (1) gauge interest in a smartphone-optimized Web site for conveniently accessing otolaryngology literature and (2) create an easy-to-access and convenient Web site that displays otolaryngology journal abstracts in a format optimized for smartphones. A survey was sent to physicians of a major US academic otolaryngology-head and neck surgery department. Demographics, literature-browsing habits, and barriers to staying updated were assessed. The response rate was 87%. Ninety-one percent of respondents used a smartphone, and 85% wished they could stay more up to date with the otolaryngology literature. Most respondents believed a convenient smartphone-optimized Web site could help them achieve this goal. A Web site was then developed in collaboration with a university creative department as a proof of concept. The site uses a simple RSS aggregator to display journal abstracts formatted for smartphone-sized screens (www.otosurg.com). © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Improving Surveillance and Prevention of Surgical Site Infection in Pediatric Cardiac Surgery.

Science.gov (United States)

Cannon, Melissa; Hersey, Diane; Harrison, Sheilah; Joy, Brian; Naguib, Aymen; Galantowicz, Mark; Simsic, Janet

2016-03-01

Postoperative cardiovascular surgical site infections are preventable events that may lead to increased morbidity, mortality, and health care costs. To improve surgical wound surveillance and reduce the incidence of surgical site infections. An institutional review of surgical site infections led to implementation of 8 surveillance and process measures: appropriate preparation the night before surgery and the day of surgery, use of appropriate preparation solution in the operating room, appropriate timing of preoperative antibiotic administration, placement of a photograph of the surgical site in the patient's chart at discharge, sending a photograph of the surgical site to the patient's primary care physician, 30-day follow-up of the surgical site by an advanced nurse practitioner, and placing a photograph of the surgical site obtained on postoperative day 30 in the patient's chart. Mean overall compliance with the 8 measures from March 2013 through February 2014 was 88%. Infections occurred in 10 of 417 total operative cases (2%) in 2012, in 8 of 437 total operative cases (2%) in 2013, and in 7 of 452 total operative cases (1.5%) in 2014. Institution of the surveillance process has resulted in improved identification of suspected surgical site infections via direct rather than indirect measures, accurate identification of all surgical site infections based on definitions of the National Healthcare Safety Network, collaboration with all persons involved, and enhanced communication with patients' family members and referring physicians. ©2016 American Association of Critical-Care Nurses.

Colorectal surgery and surgical site infection: is a change of attitude necessary?

Science.gov (United States)

Elia-Guedea, Manuela; Cordoba-Diaz de Laspra, Elena; Echazarreta-Gallego, Estibaliz; Valero-Lazaro, María Isabel; Ramirez-Rodriguez, Jose Manuel; Aguilella-Diago, Vicente

2017-07-01

Surgical site infection (SSI) can be as high as 30% in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality. The aim of this study is to evaluate the impact of a set of simple preventive measures that have resulted in a reduction in surgical site infection in colorectal surgery. Prospective study with two groups of patients treated in the colorectal unit of the "Clinico Universitario Lozano Blesa" hospital in Zaragoza. One group was subject to our measures from February to May 2015. The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented. One hundred forty-nine patients underwent a major colorectal surgical procedure. Seventy (47%) belonged to the control group and were compared to the remaining 79 patients (53% of the total), who were subject to our treatment bundle in the period tested. Comparing the two groups revealed that our set of measures led to a general reduction in SSI (31.4 vs. 13.6%, p = 0.010) and in superficial site infection (17.1 vs. 2.5%, p = 0.002). As a consequence, the postoperative hospital stay was shortened (10.0 vs. 8.0 days, p = 0.048). However, it did not, the number of readmissions nor the re-operation rate. SSI was clearly related to open surgery. The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.

Brain Magnetic Resonance Immediately Prior To Surgery In Single Ventricles and Surgical Postponement

Science.gov (United States)

Fogel, Mark A.; Pawlowski, Tom; Schwab, Peter J.; Nicolson, Susan C.; Montenegro, Lisa M.; Berenstein, Laura Diaz; Spray, Thomas L.; Gaynor, J William; Fuller, Stephanie; Keller, Marc S.; Harris, Matthew A.; Whitehead, Kevin K.; Vossough, Arastoo; Licht, Daniel J.

2014-01-01

Background Single ventricle patients undergoing surgical reconstruction experience a high rate of brain injury; incidental findings on pre-operative brain scans may result in safety considerations involving hemorrhage extension during cardiopulmonary bypass that result in surgical postponement. Methods Single ventricle patients were studied with brain scans immediately preoperatively as part of a National Institute of Health study and were reviewed by neuroradiology immediately prior to cardiopulmonary bypass. Results One hundred and thirty four consecutive subjects recruited into the project were studied: 33 prior to stage I (3.7±1.8 days), 34 prior to bidirectional Glenn (5.8±3.5 months) and 67 prior to Fontan (3.3±1.1 years). Six (4.5%) surgeries were postponed because of concerning imaging findings on brain MRI; 2 prior to stage I, 3 prior to bidirectional Glenn and 1 prior to Fontan. Five were due to unexpected incidental findings of acute intracranial hemorrhage and one due to diffuse cerebellar cytotoxic edema; none who proceeded to surgery had these lesions. Prematurity as well as genetic syndromes were not present in any with postponed surgery. Four of 4 prior to bidirectional Glenn/Fontan with surgical delays had hypoplastic left heart syndrome compared with 44/97 who did not (P=0.048). After observation and follow up, all eventually had successful surgeries with bypass. Conclusion Preoperative brain MRI performed in children with single ventricles disclosed injuries in 4.5% leading to surgical delay; hemorrhagic lesions were most common and raised concerns for extension during surgery. The true risk of progression and need for delay of surgery due to heparinization associated with these lesions remains uncertain. PMID:25149046

40 CFR 1400.8 - Access to off-site consequence analysis information by Federal government officials.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Access to off-site consequence... MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION 112(r)(7); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Access to Off-Site Consequence Analysis...

The quality and accessibility of Australian depression sites on the World Wide Web.

Science.gov (United States)

Griffiths, Kathleen M; Christensen, Helen

2002-05-20

To provide information about Australian depression sites and the quality of their content; to identify possible indicators of the quality of site content; and determine the accessibility of Australian depression web sites. Cross-sectional survey of 15 Australian depression web sites. (i) Quality of treatment content (concordance of site information with evidence-based guidelines, number of evidence-based treatments recommended, discussion of other relevant issues, subjective rating of treatment content); (ii) potential quality indicators (conformity with DISCERN criteria, citation of scientific evidence); (iii) accessibility (search engine rank). Mean content quality scores were not high and site accessibility was poor. There was a consistent association between the quality-of-content measures and the DISCERN and scientific accountability scores. Search engine rank was not associated with content quality. The quality of information about depression on Australian websites could be improved. DISCERN may be a useful indicator of website quality, as may scientific accountability. The sites that received the highest quality-of-content ratings were beyondblue, BluePages, CRUfAD and InfraPsych.

Laparoscopic single port surgery in children using Triport: our early experience.

Science.gov (United States)

de Armas, Ismael A Salas; Garcia, Isabella; Pimpalwar, Ashwin

2011-09-01

Laparoscopy has become the gold standard technique for appendectomy and cholecystectomy. With the emergence of newer laparoscopic instruments which are roticulating and provide 7 degrees of freedom it is now possible to perform these operations through a single umbilical incision rather than the standard 3-4 incisions and thus lead to more desirable cosmetic results and less postoperative pain. The newer reticulating telescopes provide excellent exposure of the operating field and allow the operations to proceed routinely. Recently, ports [Triports (Olympus surgery)/SILS ports] especially designed for single incision laparoscopic surgery (SILS) have been developed. We herein describe our experience with laparoscopic single port appendectomies and cholecystectomies in children using the Triport. This is a retrospective cohort study of children who underwent single incision laparoscopic surgery between May 2009 and August 2010 at Texas Children's Hospital and Ben Taub General Hospital in Houston Texas by a single surgeon. Charts were reviewed for demographics, type of procedure, operative time, early or late complications, outcome and cosmetic results. Fifty-four patients underwent SILS. A total of 50 appendectomies (early or perforated) and 4 cholecystectomies were performed using this new minimally invasive approach. The average operative time for SILS/LESS appendectomy was 54 min with a range between 25 and 205 min, while operative time for SILS cholecystectomy was 156 min with a range of 75-196 min. Only small percentage (4%) of appendectomies (mostly complicated) were converted to standard laparoscopy, but none were converted to open procedure. All patients were followed up in the clinic after 3-4 weeks. No complications were noted and all patients had excellent cosmetic results. Parents were extremely satisfied with the cosmetic results. SILS/LESS is a safe, minimally invasive approach for appendectomy and cholecystectomy in children. This new approach is

Single-port laparoscopic approach of the left liver: initial experience.

Science.gov (United States)

Camps Lasa, Judith; Cugat Andorrà, Esteban; Herrero Fonollosa, Eric; García Domingo, María Isabel; Sánchez Martínez, Raquel; Vargas Pierola, Harold; Rodríguez Campos, Aurora

2014-11-01

New technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. Between May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5 cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed. Median operative time was 135 min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18 h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days. Single-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach. Copyright © 2014 AEC. Published by Elsevier Espana. All rights reserved.

Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

DEFF Research Database (Denmark)

Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg

2012-01-01

Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefi...

40 CFR 1400.9 - Access to off-site consequence analysis information by State and local government officials.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Access to off-site consequence... CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Access to Off-Site Consequence Analysis Information by Government Officials. § 1400.9 Access to off-site consequence analysis...

The benefit of non contrast-enhanced magnetic resonance angiography for predicting vascular access surgery outcome : a coomputer model perspective

NARCIS (Netherlands)

Merkx, M.A.G.; Huberts, W.; Bosboom, E.M.H.; Bode, A.S.; Bescos, J.O.; Tordoir, J.H.M.; Breeuwer, M.; Vosse, van de F.N.

2013-01-01

Introduction Vascular access (VA) surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD) patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative

40 CFR 1400.3 - Public access to paper copies of off-site consequence analysis information.

Science.gov (United States)

2010-07-01

...-site consequence analysis information. 1400.3 Section 1400.3 Protection of Environment ENVIRONMENTAL... PROGRAMS UNDER THE CLEAN AIR ACT SECTION 112(r)(7); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Public Access § 1400.3 Public access to...

The short-term outcomes of conventional and single-port laparoscopic surgery for rectal cancer

DEFF Research Database (Denmark)

Levic, Katarina; Bulut, Orhan

2014-01-01

BACKGROUND: Single-port laparoscopic surgery (SPLS) has evolved as an alternative method to conventional laparoscopic surgery (CLS). The aim of this study is to evaluate the results of SPLS compared to CLS in the treatment of rectal cancer. MATERIAL AND METHODS: Prospectively collected data...

Validation of virtual reality simulators: Key to the successful integration of a novel teaching technology into minimal access surgery

NARCIS (Netherlands)

Schijven, Marlies P.; Jakimowicz, Jack J.

2005-01-01

Minimal access surgery (MAS) requires additional training in the surgical curriculum, as skills needed to perform MAS are quite different from those used in open surgery. Moreover, residents do not seem to experience ample opportunity to gain such skills in the current surgical curriculum. Virtual

Open Access Publishing: A Study of Current Practice in Oral and Maxillofacial Surgery Research.

Science.gov (United States)

Tahim, Arpan; Bansal, Hitesh; Goodson, Alexander M C; Payne, Karl F B; Sabharwal, Sanjeeve

2016-12-01

Open access (OA) publication has become an increasingly common route for dissemination of scientific research findings. However, it remains a contentious issue with continued debate as to its impact on the peer-review process and a potential change in the quality of subsequent evidence published. There is little research that looks into OA in oral and maxillofacial surgery. We investigated the OA policy in the 30 relevant journals listed in the Institute for Scientific Information Web of Knowledge journal citation report, comparing bibliometric data and quality of evidence produced in journals offering OA and those with subscription-only policies. 3474 articles were graded for evidence level and the results correlated to journal OA status. 76.7 % of journals offered authors OA services. There was no difference between impact factor, self-citation rate, total citations or quality of evidence between OA and subscription journals. These findings should send clear messages to both clinicians and researchers and should re- assure readers that scientific findings that are disseminated in open access form do not differ in quality to those in subscription-only format. It should reinforce that open access formats are a credible way to display research findings in oral and maxillofacial surgery.

Web 2.0 Sites for Collaborative Self-Access: The Learning Advisor vs. Google®

Directory of Open Access Journals (Sweden)

Craig D. Howard

2011-09-01

Full Text Available While Web 2.0 technologies provide motivated, self-access learners with unprecedented opportunities for language learning, Web 2.0 designs are not of universally equal value for learning. This article reports on research carried out at Indiana University Bloomington using an empirical method to select websites for self-access language learning. Two questions related to Web 2.0 recommendations were asked: (1 How do recommended Web 2.0 sites rank in terms of interactivity features? (2 How likely is a learner to find highly interactive sites on their own? A list of 20 sites used for supplemental and self-access activities in language programs at five universities was compiled and provided the initial data set. Purposive sampling criteria revealed 10 sites truly represented Web 2.0 design. To address the first question, a feature analysis was applied (Herring, The international handbook of internet research. Berlin: Springer, 2008. An interactivity framework was developed from previous research to identify Web 2.0 design features, and sites were ranked according to feature quantity. The method used to address the second question was an interconnectivity analysis that measured direct and indirect interconnectivity within Google results. Highly interactive Web 2.0 sites were not prominent in Google search results, nor were they often linked via third party sites. It was determined that, using typical keywords or searching via blogs and recommendation sites, self-access learners were highly unlikely to find the most promising Web 2.0 sites for language learning. A discussion of the role of the learning advisor in guiding Web 2.0 collaborative self-access, as well as some strategic short cuts to quick analysis, conclude the article.

[The LESS (Laparo-endoscopic Single-Site) procedure in urology. Technical and clinical aspects].

Science.gov (United States)

Neri, F; Cindolo, L; Gidaro, S; Schips, L

2010-01-01

Minimally invasive urology is rapidly advancing, and single-site laparoscopic surgery is being explored clinically. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument clashing. In the last years several surgeons all over the world have explored the feasibility and safety of LESS using several and different ports, approaches and devices. Hundreds of procedures have been described with overall favorable intraoperative and postoperative outcomes. Our experience consists of more than 30 procedures successfully completed for adrenal, kidney disease and varicocele. To date, LESS could be considered feasible and effective using currently available devices, however it is to be considered as an initial status technique requiring further confirmatory studies and advanced laparoscopic skills.

Single-incision thoracoscopic surgery for spontaneous ...

African Journals Online (AJOL)

aDivision of Pediatric Surgery, bDepartment of Surgery, National Defense Medical. College ... Correspondence to Akinari Hinoki, MD, PhD, Department of Surgery, Division of. Pediatric ... (Echelon60; Ethicon Endo-Surgery, Ethicon, NJ, USA).

Catalysis on singly dispersed bimetallic sites

Science.gov (United States)

Zhang, Shiran; Nguyen, Luan; Liang, Jin-Xia; Shan, Junjun; Liu, Jingyue; Frenkel, Anatoly I.; Patlolla, Anitha; Huang, Weixin; Li, Jun; Tao, Franklin

2015-08-01

A catalytic site typically consists of one or more atoms of a catalyst surface that arrange into a configuration offering a specific electronic structure for adsorbing or dissociating reactant molecules. The catalytic activity of adjacent bimetallic sites of metallic nanoparticles has been studied previously. An isolated bimetallic site supported on a non-metallic surface could exhibit a distinctly different catalytic performance owing to the cationic state of the singly dispersed bimetallic site and the minimized choices of binding configurations of a reactant molecule compared with continuously packed bimetallic sites. Here we report that isolated Rh1Co3 bimetallic sites exhibit a distinctly different catalytic performance in reduction of nitric oxide with carbon monoxide at low temperature, resulting from strong adsorption of two nitric oxide molecules and a nitrous oxide intermediate on Rh1Co3 sites and following a low-barrier pathway dissociation to dinitrogen and an oxygen atom. This observation suggests a method to develop catalysts with high selectivity.

40 CFR 1400.5 - Internet access to certain off-site consequence analysis data elements.

Science.gov (United States)

2010-07-01

... consequence analysis data elements. 1400.5 Section 1400.5 Protection of Environment ENVIRONMENTAL PROTECTION... UNDER THE CLEAN AIR ACT SECTION 112(r)(7); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION Public Access § 1400.5 Internet access to certain off...

Risk Factors for Surgical Site Infections in Dermatological Surgery

Directory of Open Access Journals (Sweden)

Xiaomeng Liu

2017-11-01

Full Text Available Current literature on risk factors for surgical site infection (SSI in dermatological surgery in the absence of antibiotic prophylaxis is limited. The aim of this study was to retrospectively evaluate patients presenting for dermatological surgery. A total of 1,977 procedures were reviewed. SSI was clinically suspected in 79 (4.0% patients and confirmed by culture in 38 (1.9%. Using the strictest definition of SSI (clinical symptoms with positive culture significantly higher risk of SSI was found for location on the ear (odds ratio (OR 6.03, 95% confidence interval (95% CI 2.12–17.15, larger defects (OR 1.08 per cm2 increase, 95% CI 1.03–1.14, closure with flaps (OR 6.35, 95% CI 1.33–30.28 and secondary intention (OR 3.01, 95% CI 1.11–8.13. These characteristics were also associated with higher risk of clinically suspected SSI regardless of culture results with slightly lower ORs. In conclusion, the risk of acquiring a SSI is increased in surgeries performed on the ear, in larger wounds and in defects closed with flaps or healed by secondary intention.

Innovations in robotic surgery.

Science.gov (United States)

Gettman, Matthew; Rivera, Marcelino

2016-05-01

Developments in robotic surgery have continued to advance care throughout the field of urology. The purpose of this review is to evaluate innovations in robotic surgery over the past 18 months. The release of the da Vinci Xi system heralded an improvement on the Si system with improved docking, the ability to further manipulate robotic arms without clashing, and an autofocus universal endoscope. Robotic simulation continues to evolve with improvements in simulation training design to include augmented reality in robotic surgical education. Robotic-assisted laparoendoscopic single-site surgery continues to evolve with improvements on technique that allow for tackling previously complex pathologic surgical anatomy including urologic oncology and reconstruction. Last, innovations of new surgical platforms with robotic systems to improve surgeon ergonomics and efficiency in ureteral and renal surgery are being applied in the clinical setting. Urologic surgery continues to be at the forefront of the revolution of robotic surgery with advancements in not only existing technology but also creation of entirely novel surgical systems.

SINGLE-DOSE VERSUS 3-DAY PROPHYLAXIS WITH CIPROFLOXACIN IN TRANSURETHRAL SURGERY - A CLINICAL-TRIAL

NARCIS (Netherlands)

BIJL, W; JANKNEGT, RA

1993-01-01

in 235 patients who underwent transurethral surgery, perioperative oral ciprofloxacin prophylaxis was given as a single dose 500 mg versus a 3-day regimen. Out of 180 evaluable patients, 84 received a single dose and 96 received a 3-day course. In the single dose prophylaxis group there were 5

Evolution of segmental anesthesia for Laparo-Endoscopic Single Site (LESS) cholecystectomy.

Science.gov (United States)

Ross, S B; Mangar, D; Karlnoski, R; Patel, R S; Camporesi, E M; Barry, L K; Luberice, K; Sprenker, C J; Rosemurgy, A S

2012-06-01

Transumbilical Laparo-Endoscopic Single Site (LESS) surgery promises improved cosmesis, quick recovery, reduced postoperative pain and shorter length of hospital stay. Since only a simple umbilical incision is used, LESS surgery can be completed with segmental epidural anesthesia. This study describes the evolution of our technique of LESS cholecystectomy from a combination of spinal and epidural anesthesia to thoracic epidural alone and presents our experience with its safety, the observed morbidity, and the reported patient satisfaction. In August 2009, a prospective evaluation of LESS cholecystectomy with regional anesthesia was undertaken. We recruited patients with chronic cholecystitis or symptomatic cholelithasis. Blood loss, operative time, complications, and length of hospital stay were measured. Preoperatively and 14 days postoperatively, outcome and symptom resolution were scored. Fifteen consecutive patients underwent LESS cholecystectomy; first with combined spinal-epidural (CSE), and then with thoracic epidural anesthesia alone. Immediate postoperative pain and discomfort were well tolerated. VAS scores upon admission to PACU were 0.4 (1.7±2.2). At postoperative day 14, the patients scored high values for "Satisfaction", 10 (10±1.0) and "Cosmesis", 10 (9.3±1.5). LESS cholecystectomy with epidural anesthesia can be undertaken safely. Patient satisfaction and cosmesis are particularly prominent amongst our patients. Our experience supports further utilization of epidural anesthesia for selected patients undergoing LESS cholecystectomy.

Supplemental Perioperative Oxygen to Reduce Surgical Site Infection after High Energy Fracture Surgery

Science.gov (United States)

2017-10-01

AWARD NUMBER: W81XWH-12-1-0588 TITLE: Supplemental Perioperative Oxygen to Reduce Surgical Site Infection after High- Energy Fracture Surgery...High- Energy Fracture Surgery 5a. CONTRACT NUMBER W81XWH-12-1-0588 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Robert V. O’Toole, MD...14 4 1. INTRODUCTION: The overall scope of this project is to address the treatment of high- energy military fractures, which has

The concept, reality and utility of single-site heterogeneous catalysts (SSHCs).

Science.gov (United States)

Thomas, John Meurig

2014-05-07

Very substantial advances have recently been made in the design and construction of solid catalysts and in elucidating both their mode of operation and the factors that determine their selectivity and longevity. This Perspective explains how and why such progress has been made. One important factor, the deployment of single-site heterogeneous and enzymatic catalysts, used either alone or in conjunction with other strategies, including metabolic engineering, enables a multitude of new products (for example, environmentally clean jet fuel) to be readily manufactured. In a practical sense SSHCs enable the advantages of homogeneous and to a lesser degree enzymatic catalysts to be united with those of heterogeneous ones. With the aid of the vastly increasing families of nanoporous solids, desired catalytically active sites may be engineered in atomic detail on their inner, accessible surfaces, thereby opening up new possibilities in synthetic organic chemistry - as in the smooth formation of C-C and C[double bond, length as m-dash]N bonds in a number of intermolecular reactions - as well as in photocatalysts and in fluidized catalytic cracking of hydrocarbons.

Risk factors for surgical site infection and urinary tract infection after spine surgery.

Science.gov (United States)

Tominaga, Hiroyuki; Setoguchi, Takao; Ishidou, Yasuhiro; Nagano, Satoshi; Yamamoto, Takuya; Komiya, Setsuro

2016-12-01

This study aimed to identify and compare risk factors for surgical site infection (SSI) and non-surgical site infections (non-SSIs), particularly urinary tract infection (UTI), after spine surgery. We retrospectively reviewed 825 patients (median age 59.0 years (range 33-70 years); 442 males) who underwent spine surgery at Kagoshima University Hospital from January 2009 to December 2014. Patient parameters were compared using the Mann-Whitney U and Fisher's exact tests. Risk factors associated with SSI and UTI were analyzed via the multiple logistic regression analysis. P operation time (P = 0.0019 and 0.0162, respectively) and ASA classification 3 (P = 0.0132 and 0.0356, respectively). The 1 week post-operative C-reactive protein (CRP) level was a risk factor for UTI (P = 0.0299), but not for SSI (P = 0.4996). There was no relationship between SSI and symptomatic UTI after spine surgery. Risk factors for post-operative SSI and UTI were operative time and ASA classification 3; 1 week post-operative CRP was a risk factor for UTI only.

Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects.

Science.gov (United States)

Mota Filho, Francisco Hidelbrando Alves; Sávio, Luis Felipe; Sakata, Rafael Eiji; Ivanovic, Renato Fidelis; da Silva, Marco Antonio Nunes; Maia, Ronaldo; Passerotti, Carlo

2018-01-01

Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1-3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using na 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology. Copyright® by the International Brazilian Journal of Urology.

Robot-assisted single port radical nephrectomy and cholecystectomy: description and technical aspects

Directory of Open Access Journals (Sweden)

Francisco Hidelbrando Alves Mota Filho

Full Text Available ABSTRACT Introduction Robot-Assisted Single Site Radical Nephrectomy (RASS-RN has been reported by surgeons in Europe and United States (1–3. To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America. Case A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected. Results Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3 cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using an 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis. Discussion Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2. Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision. Conclusion RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.

Implementation of laparoscopic approach in colorectal surgery - a single center's experience.

Science.gov (United States)

Kwiatkowski, Andrzej P; Stępińska, Gabriela; Stanowski, Edward; Paśnik, Krzysztof

2018-03-01

Implementation of the laparoscopic approach in colorectal surgery has not happened as rapidly as in cholecystectomy, because of concerns about oncological safety. The results of controlled trials in multiple centers showed the method to be safe. Consequently, surgeons decided to try the approach with colorectal surgery. This process, in our clinic, began in earnest about four years ago. To analyze and present the clinical outcomes of applying the laparoscopic approach to colorectal surgery in a single center. We retrospectively identified patients from a hospital database who underwent colorectal surgery - laparoscopic and open - between 2013 and 2016. Our focus was on laparoscopic cases. Study points included operative time, duration of the hospital stay, postoperative mortality and rates of complications, conversion, reoperation and readmission. Of 534 cases considered, the results showed that the relation between open and laparoscopic procedures had reversed, in favor of the latter method (2013: open: 82% vs. laparoscopic: 18%; 2016: open: 22.4% vs. laparoscopic: 77.6%). The most commonly performed procedure was right hemicolectomy. The total complication rate was 22%. The total rate of conversion to open surgery was 9.3%. The postoperative mortality rate was 3%. Use of the laparoscopic approach in colorectal surgery has increased in recent years world-wide - including in Poland - but the technique is still underused. Rapid implementation of the miniinvasive method in colorectal surgery, in centers with previous laparoscopic experience, is not only safe and feasible, but also highly recommended.

Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands, 2002-2007

NARCIS (Netherlands)

Manniën, Judith; Wille, Jan C.; Kloek, Jaap J.; van Benthem, Birgit H. B.

2011-01-01

Surgical site infections after cardiothoracic surgery substantially increase the risk for illness, mortality, and costs. Surveillance of surgical site infections might assist in the prevention of these infections. This study describes the Dutch surveillance methods and results of data collected

Internet Presentation of Departments of Pediatric Surgery in Germany and Their Compliance with Recommended Criteria for Promoting Services and Offering Professional Information for Patients.

Science.gov (United States)

Farhat, Naim; Zoeller, Christoph; Petersen, Claus; Ure, Benno

2016-08-01

Introduction The presentation of health institutions in the internet is highly variable concerning marketing features and medical information. We aimed to investigate the structure and the kind of information provided on the Web sites of all departments of pediatric surgery in Germany. Furthermore, we aimed to identify the degree to which these Web sites comply with internet marketing recommendations for generating business. Method The Web sites of all pediatric surgery units referred to as departments on the official Web site of the German Society of Pediatric Surgery (GSPS) were assessed. The search engine Google was used by entering the terms "pediatric surgery" and the name of the city. Besides general data eight content characteristics focusing on ranking, accessibility, use of social media, multilingual sites, navigation options, selected images, contact details, and medical information were evaluated according to published recommendations. Results A total of 85 departments of pediatric surgery were included. On Google search results 44 (52%) ranked number one and 34 (40%) of the department's homepages were accessible directly through the homepage link of the GSPS. A link to own digital and/or social media was offered on 11 (13%) homepages. Nine sites were multilingual. The most common navigation bar item was clinical services on 74 (87%) homepages. Overall, 76 (89%) departments presented their doctors and 17 (20%) presented other staff members with images of doctors on 53 (62%) and contact data access from the homepage on 68 (80%) Web sites. On 25 (29%) Web sites information on the medical conditions treated were presented, on 17 (20%) details of treating concepts, and on 4 (5%) numbers of patients with specific conditions treated in the own department per year. Conclusion We conclude that numerous of the investigated online presentations do not comply with recommended criteria for offering professional information for patients and for promoting

The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions.

Science.gov (United States)

Sorokin, Igor; Canvasser, Noah E; Irwin, Brian; Autorino, Riccardo; Liatsikos, Evangelos N; Cadeddu, Jeffrey A; Rane, Abhay

2017-10-01

To analyze the most recent temporal trends in the adoption of urologic laparoendoscopic single-site (LESS), to identify the perceived limitations associated with its decline, and to determine factors that might revive the role of LESS in the field of minimally invasive urologic surgery. A 15 question survey was created and sent to members of the Endourological Society in September 2016. Only members who performed LESS procedures in practice were asked to respond. In total, 106 urologists responded to the survey. Most of the respondents were from the United States (35%) and worked in an academic hospital (84.9%). Standard LESS was the most popular approach (78.1%), while 14.3% used robotics, and 7.6% used both. 2009 marked the most popular year to perform the initial (27.6%) and the majority (20%) of LESS procedures. The most common LESS procedure was a radical/simple nephrectomy (51%) followed by pyeloplasty (17.3%). In the past 12 months, 60% of respondents had performed no LESS procedures. Compared to conventional laparoscopy, respondents only believed cosmesis to be better, however, this enthusiasm waned over time. Worsening shifts in enthusiasm for LESS also occurred with patient desire, marketability, cost, safety, and robotic adaptability. The highest rated factor to help LESS regain popularity was a new robotic platform. The decline of LESS is apparent, with few urologists continuing to perform procedures attributed to multiple factors. The availability of a purpose-built robotic platform and better instrumentation might translate into a renewed future interest of LESS.

Preoperative stoma site marking in the general surgery population.

Science.gov (United States)

Zimnicki, Katherine M

2013-01-01

Preoperative teaching and stoma site marking are supported by research and professional organizations as interventions that can reduce the incidence of problematic stomas and improve patient outcomes. This study investigated the translation of this research into practice in the acute care surgery population. A retrospective chart review using convenience sampling was conducted at a large urban hospital in the Midwestern United States. Thirty patients underwent a surgical procedure that resulted in the creation of a fecal ostomy over a 5-month period. Descriptive statistical analysis examined the reason for surgery, preoperative length of stay (LOS), the percentage of patients who received preoperative teaching and stoma marking and the relationship between preoperative LOS and the use of preoperative teaching and stoma marking. Twenty-one of 30 patients were admitted to hospital 24 hours or more before surgery. No participants were admitted urgently. Three (14%) of those admitted for more than 24 hours received preoperative marking or teaching. There was no significant relationship between preoperative LOS and preoperative teaching and stoma marking. The opportunity exists to promote successful adaptation in this surgical population through the implementation of the evidence-based interventions of preoperative teaching and stoma marking. Additional study is needed to determine barriers to their use as well as to develop effective implementation strategies.

A systematic review of laparoscopic port site hernias in gastrointestinal surgery.

LENUS (Irish Health Repository)

Owens, M

2011-08-01

Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it.

66 Accessibility Constraints of Patronage of Tourist Sites in Ondo ...

African Journals Online (AJOL)

Choice-Academy

, ... The problem of inadequate accessibility to social facilities in developing ... The study concluded that for the tourist sites to attract patronage and to realize the .... international networks. ..... for a Sustainable Built Environment: A Case. Study ...

Low anastomotic leak rate after colorectal surgery: a single-centre study.

Science.gov (United States)

Jones, O M; John, S K P; Horseman, N; Lawrance, R J; Fozard, J B J

2007-10-01

Anastomotic leak after colorectal surgery is a serious event associated with significant morbidity and mortality. There is little consensus regarding 'acceptable' rates of leakage, however. This study describes the experience of anastomotic leakage after both elective and emergency colorectal surgery in a district general hospital. A prospectively collected database of all patients with a diagnosis of colorectal cancer in a single hospital formed the basis of the study. Leak was defined as breakdown of the anastomosis contributing to death or requiring reoperation or reintervention. A total of 949 patients underwent surgery with an anastomosis between 1996 and 2004, including 331 patients treated with anterior resection. Anastomotic leaks requiring reoperation occurred in eight patients (0.8%). Thirty-day and in-hospital mortality was 4%. A very low rate of anastomotic leakage after colorectal surgery is possible in a district general hospital setting. Given the impact of anastomotic leakage on function, tumour recurrence and long-term survival, it should be considered as a marker of surgical quality when evaluating surgical performance.

Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis

OpenAIRE

Yassa, Rafik RD; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

2017-01-01

Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of ...

Energy consumption during simulated minimal access surgery with and without using an armrest.

Science.gov (United States)

Jafri, Mansoor; Brown, Stuart; Arnold, Graham; Abboud, Rami; Wang, Weijie

2013-03-01

Minimal access surgery (MAS) can be a lengthy procedure when compared to open surgery and therefore surgeon fatigue becomes an important issue and surgeons may expose themselves to chronic injuries and making errors. There have been few studies on this topic and they have used only questionnaires and electromyography rather than direct measurement of energy expenditure (EE). The aim of this study was to investigate whether the use of an armrest could reduce the EE of surgeons during MAS. Sixteen surgeons performed simulated MAS with and without using an armrest. They were required to perform the time-consuming task of using scissors to cut a rubber glove through its top layer in a triangular fashion with the help of a laparoscopic camera. Energy consumptions were measured using the Oxycon Mobile system during all the procedures. Error rate and duration time for simulated surgery were recorded. After performing the simulated surgery, subjects scored how comfortable they felt using the armrest. It was found that O(2) uptake (VO(2)) was 5 % less when surgeons used the armrest. The error rate when performing the procedure with the armrest was 35 % compared with 42.29 % without the armrest. Additionally, comfort levels with the armrest were higher than without the armrest. 75 % of surgeons indicated a preference for using the armrest during the simulated surgery. The armrest provides support for surgeons and cuts energy consumption during simulated MAS.

Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

Science.gov (United States)

Palanivelu, Praveenraj; Patil, Kedar Pratap; Parthasarathi, Ramakrishnan; Viswambharan, Jaiganesh K; Senthilnathan, Palanisami; Palanivelu, Chinnusamy

2015-01-01

The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

Robotic surgery update.

Science.gov (United States)

Jacobsen, G; Elli, F; Horgan, S

2004-08-01

Minimally invasive surgical techniques have revolutionized the field of surgery. Telesurgical manipulators (robots) and new information technologies strive to improve upon currently available minimally invasive techniques and create new possibilities. A retrospective review of all robotic cases at a single academic medical center from August 2000 until November 2002 was conducted. A comprehensive literature evaluation on robotic surgical technology was also performed. Robotic technology is safely and effectively being applied at our institution. Robotic and information technologies have improved upon minimally invasive surgical techniques and created new opportunities not attainable in open surgery. Robotic technology offers many benefits over traditional minimal access techniques and has been proven safe and effective. Further research is needed to better define the optimal application of this technology. Credentialing and educational requirements also need to be delineated.

Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

Science.gov (United States)

Goh, Brian K P; Low, Tze-Yi; Lee, Ser-Yee; Chan, Chung-Yip; Chung, Alexander Y F; Ooi, London L P J

2018-05-24

Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy. © 2018 Royal Australasian College of Surgeons.

Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

Science.gov (United States)

Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

2009-08-01

Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

Accessibility and content of individualized adult reconstructive hip and knee/musculoskeletal oncology fellowship web sites

Directory of Open Access Journals (Sweden)

Bradley L. Young, MD

2018-06-01

Conclusions: Several programs participating in the combined Adult Reconstructive Hip and Knee/Musculoskeletal Oncology Fellowship Match did not have accessible web sites. Of the web sites that were accessible, none contained comprehensive information and the majority lacked information that has been previously identified as being important to perspective applicants.

The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria.

Science.gov (United States)

Nwosu, Arinze

2015-01-01

Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame. This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit. There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.

Single-word multiple-bit upsets in static random access devices

International Nuclear Information System (INIS)

Koga, R.; Pinkerton, S.D.; Lie, T.J.; Crawford, K.B.

1993-01-01

Energetic ions and protons can cause single event upsets (SEUs) in static random access memory (SRAM) cells. In some cases multiple bits may be upset as the result of a single event. Space-borne electronics systems incorporating high-density SRAM are vulnerable to single-word multiple-bit upsets (SMUs). The authors review here recent observations of SMU, present the results of a systematic investigation of the physical cell arrangements employed in several currently available SRAM device types, and discuss implications for the occurrence and mitigation of SMU

Single Incision Laparoscopic Surgery for a Large Endometriotic Cyst

African Journals Online (AJOL)

In the last decade, laparoscopy has become the standard treatment for many gynecological conditions.[1,2] Today, laparoscopy is hailed as the standard approach in the surgical treatment of benign adnexal pathology.[1,2] Attempts to minimize access-related injuries and complications resulted in development of single port ...

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

Science.gov (United States)

Hempel, Susanne; Maggard-Gibbons, Melinda; Nguyen, David K; Dawes, Aaron J; Miake-Lye, Isomi; Beroes, Jessica M; Booth, Marika J; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G

2015-08-01

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per

Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

Directory of Open Access Journals (Sweden)

Praveenraj Palanivelu

2015-01-01

Full Text Available Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. Material and Methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11 and with corrugated drain (2.09 needlescopic method (1.2, Umbilical tape sling (1.95, crural stitch method (2.5. Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

Chronological changes in lung cancer surgery in a single Japanese institution

Directory of Open Access Journals (Sweden)

Nakamura H

2017-03-01

Full Text Available Haruhiko Nakamura, Hiroki Sakai, Hiroyuki Kimura, Tomoyuki Miyazawa, Hideki Marushima, Hisashi Saji Department of Chest Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan Background: The aim of this study was to evaluate the chronological changes in epidemiological factors and surgical outcomes in patients with lung cancer who underwent surgery in a single Japanese institution.Patients and methods: A clinicopathological database of patients with lung cancer who underwent surgery with curative intent from January 1974 to December 2014 was reviewed. The chronological changes in various factors, including patient’s age, sex, histological type, tumor size, pathological stage (p-stage, surgical method, operative time, intraoperative blood loss, 30-day mortality, and postoperative overall survival (OS, were evaluated.Results: A total of 1,616 patients were included. The numbers of resected patients, females, adenocarcinomas, p-stage IA patients, and age at the time of surgery increased with time, but tumor size decreased (all P<0.0001. Concerning surgical methods, the number of sublobar resections increased, but that of pneumonectomies decreased (P<0.0001. The mean operative time, intraoperative blood loss, and the postoperative 30-day mortality rate decreased (all P<0.0001. When the patients were divided into two groups (1974–2004 and 2005–2014, the 5-year OS rates for all patients and for p-stage IA patients improved from 44% to 79% and from 73% to 89%, respectively (all P<0.0001. The best 5-year OS rate was obtained for sublobar resection (73%, followed by lobectomy (60%, combined resection (22%, and pneumonectomy (21%; P<0.0001.Conclusion: Changes in epidemiological factors, a trend toward less invasive surgery, and a remarkably improved postoperative OS were confirmed, which demonstrated the increasingly important role of surgery in therapeutic strategies for lung cancer. Keywords: lung cancer, surgery, sublobar

Reusable single-port access device shortens operative time and reduces operative costs.

Science.gov (United States)

Shussman, Noam; Kedar, Asaf; Elazary, Ram; Abu Gazala, Mahmoud; Rivkind, Avraham I; Mintz, Yoav

2014-06-01

In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy. We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis. SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy. Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.

Site-Selection in Single-Molecule Junction for Highly Reproducible Molecular Electronics.

Science.gov (United States)

Kaneko, Satoshi; Murai, Daigo; Marqués-González, Santiago; Nakamura, Hisao; Komoto, Yuki; Fujii, Shintaro; Nishino, Tomoaki; Ikeda, Katsuyoshi; Tsukagoshi, Kazuhito; Kiguchi, Manabu

2016-02-03

Adsorption sites of molecules critically determine the electric/photonic properties and the stability of heterogeneous molecule-metal interfaces. Then, selectivity of adsorption site is essential for development of the fields including organic electronics, catalysis, and biology. However, due to current technical limitations, site-selectivity, i.e., precise determination of the molecular adsorption site, remains a major challenge because of difficulty in precise selection of meaningful one among the sites. We have succeeded the single site-selection at a single-molecule junction by performing newly developed hybrid technique: simultaneous characterization of surface enhanced Raman scattering (SERS) and current-voltage (I-V) measurements. The I-V response of 1,4-benzenedithiol junctions reveals the existence of three metastable states arising from different adsorption sites. Notably, correlated SERS measurements show selectivity toward one of the adsorption sites: "bridge sites". This site-selectivity represents an essential step toward the reliable integration of individual molecules on metallic surfaces. Furthermore, the hybrid spectro-electric technique reveals the dependence of the SERS intensity on the strength of the molecule-metal interaction, showing the interdependence between the optical and electronic properties in single-molecule junctions.

Two-port access versus four-port access laparoscopic ovarian cystectomy.

Science.gov (United States)

Choi, Won-Kyu; Kim, Jang-Kew; Yang, Jung-Bo; Ko, Young-Bok; Nam, Sang-Lyun; Lee, Ki-Hwan

2014-09-01

This study was conducted to compare the surgical outcomes between two-port access and four-port access laparoscopic ovarian cystectomy. Four hundred and eighty nine patients who had received two-port access laparoscopic ovarian cystectomy (n=175) and four-port access laparoscopic ovarian cystectomy (n=314) in Chungnam National University Hospital from January 2009 to August 2012 were analyzed retrospectively. The data were compared between the bilaterality of the cysts and cyst diameter of less than 6 cm and 6 cm or more. There were no significant differences in patient's age, parity, body weight, body mass index and history of previous surgery between the two-port and four-port access laparoscopy group. Bilaterality of ovarian cysts was more in fourport access laparoscopy group (13.7% vs. 32.5%, P=0.000). There were no significant differences in operation time, hemoglobin change, hospital stay, adhesiolysis, transfusion, and insertion of hemo-vac between the two-port and four-port access laparoscopy group for size matched compare. However additional analgesics were more in four-port access laparoscopy group for unilateral ovarian cystectomy. Two-port access laparoscopic surgery was feasible and safe for unilateral and bilateral ovarian cystectomy compare with four-port access laparoscopic surgery.

Patient Factors But Not the Use of Novel Anticoagulants or Warfarin Are Associated With Internal Jugular Vein Access-Site Hematoma After Right Heart Catheterization.

Science.gov (United States)

Dasa, Osama; Shafiq, Qaiser; Ruzieh, Mohammed; Alhazmi, Luai; Al-Dabbas, Maen; Ammari, Zaid; Khouri, Samer; Moukarbel, George

2017-12-01

Right heart catheterization (RHC) is routinely performed to assess hemodynamics. Generally, anticoagulants are held prior to the procedure. At our center, anticoagulants are continued and ultrasound guidance is always used for internal jugular vein access. A micropuncture access kit is used to place a 5 or 6 Fr sheath using the modified Seldinger technique. Manual compression is applied for 10-15 min and the patient is observed for at least 2 hours after the procedure. In a retrospective analysis, we investigated the risk of bleeding complications associated with RHC via the internal jugular vein in patients with and without full anticoagulation. Our catheterization laboratory database was searched for adult patients who underwent RHC by a single operator between January 2012 and December 2015. A total of 571 patients were included in the analysis. Baseline characteristics, labs, relevant invasive hemodynamics, co-morbid conditions, and incidence of access-site hematoma are presented. Multivariable binary logistic regression was performed using IBM SPSS v. 23.0 software. Statistically significant associations with access-site hematoma were observed with body mass index (P=.02; 95% confidence interval [CI], 1.0-1.1), right atrial pressure (P=.03; 95% CI, 0.7-0.9), and dialysis dependence (P.99). The incidence of internal jugular vein access-site hematoma is small when using careful access techniques for RHC even with the continued use of novel oral anticoagulants and warfarin. Patient characteristics and co-morbid conditions are related to bleeding complications.

Nutrition adequacy in enhanced recovery after surgery: a single academic center experience.

Science.gov (United States)

Gillis, Chelsia; Nguyen, Thi Haiyen; Liberman, A Sender; Carli, Francesco

2015-06-01

A prospective observational study was initiated to determine the prevalence of nutrition risk before surgery and assess nutrition adequacy of food choices after elective colorectal surgery. Patient-Generated Subjective Global Assessment was used to screen all preoperative clinic patients (n = 70) scheduled for elective colorectal surgery. Adequacy of dietary intake (n = 40) was determined for the first 3 postoperative days by estimating total energy and protein intake from leftover food at each meal based on standard hospital portions with food composition tables. Food access questionnaire provided a rationale for observed food intake. All patients received Enhanced Recovery After Surgery (ERAS) and room service system care. Before surgery, 63% of patients were considered well-nourished, 29% suspected or moderately undernourished, and 8% severely undernourished. Fifty-one percent of patients scored > 4 on the Patient-Generated Subjective Global Assessment, indicating requirement for dietary intervention or symptom management. On average, 77% ± 27%, 63% ± 28%, and 92% ± 39% of energy requirements were met on postoperative days 1, 2, and 3, respectively; conversely, 55% ± 24%, 43% ± 16%, and 45% ± 12% of protein requirements were met. Most common reasons for missed meals included loss of appetite and feelings of fatigue or worry. Preoperative nutrition risk tended to result in a greater 30-day hospital readmission rate compared to well-nourished patients (P = .07). A third of patients scheduled for elective colorectal surgery were at nutrition risk. An acceptable intake of dietary protein was not achieved during the first 3 days of hospitalization. Preoperative nutrition education, as part of Enhanced Recovery Programs, may be useful to optimize nutrition status before surgery to mitigate clinical consequences associated with undernutrition and empower patients to make adequate food choices for recovery. NCT 01727570. © 2014 American Society for Parenteral and

Endoscopic Transsphenoidal Surgery Outcomes in 331 Nonfunctioning Pituitary Adenoma Cases After a Single Surgeon Learning Curve.

Science.gov (United States)

Kim, Jung Hee; Lee, Jung Hyun; Lee, Ji Hyun; Hong, A Ram; Kim, Yoon Ji; Kim, Yong Hwy

2018-01-01

The outcomes of recent endoscopic surgery of nonfunctioning pituitary adenomas (NFPAs) are controversial when compared with traditional microscopic surgery. We aimed to assess the outcomes of endoscopic transsphenoidal surgeries performed by 1 surgeon with 7 years of experience and elucidate the predictive factors for surgical outcomes for NFPAs. We included 331 patients (155 men and 176 women) with clinical NFPAs who underwent transsphenoidal surgery because of visual symptoms by a single surgeon in Seoul National University Hospital from March 2010 to May 2016. We assessed the tumor removal rate, hormonal outcomes, visual outcomes, and complications. The gross total resection rate of endoscopic transsphenoidal surgery for NFPAs by a single surgeon was 74.9%. Cavernous sinus invasion, a high Knosp grade, large tumor size, previous surgery, and lack of surgical experience in the neurosurgeon elevated the risk for residual tumors. Visual deficits were improved in 73.4% of the patients, which was associated with tumor size, preoperative visual impairment score, previous radiation, and surgical experience. Hormonal status was improved in 15.4% and aggravated in 32.9% after surgery. There were no predictors for hormonal recovery. Transient diabetes insipidus (DI) was the most common complication (9.1%), and among these patients, 3.0% had persistent DI. Endoscopic transsphenoidal surgery by a well-experienced surgeon was an effective and safe treatment for NFPAs, but the hormonal outcomes were not changed compared with previous reports of microscopic surgery. Large tumor size and cavernous sinus invasion were still the barriers for achieving total resection. Copyright © 2017 Elsevier Inc. All rights reserved.

Single-site neural tube closure in human embryos revisited.

Science.gov (United States)

de Bakker, Bernadette S; Driessen, Stan; Boukens, Bastiaan J D; van den Hoff, Maurice J B; Oostra, Roelof-Jan

2017-10-01

Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Oophorectomy by natural orifice transluminal endoscopic surgery: feasibility study in dogs.

Science.gov (United States)

Freeman, Lynetta J; Rahmani, Emad Y; Sherman, Stuart; Chiorean, Michael V; Selzer, Don J; Constable, Peter D; Snyder, Paul W

2009-06-01

Natural orifice transluminal endoscopic surgery (NOTES) represents a potentially less-invasive alternative to conventional or laparoscopic surgery. Our purpose was to develop a canine oophorectomy model for prospective evaluation of intraoperative complications, surgical stress, and postoperative pain and recovery with NOTES. Feasibility study. Academic preclinical research. Ten healthy female dogs. NOTES procedures were performed through gastric access with an electrocautery snare to resect and retrieve the ovaries. The gastrotomy was closed with prototype T-fasteners. Operative time; complications; postoperative pain scores, and nociceptive threshold; surgical stress markers (interleukin-6 [IL-6], C-reactive protein); systemic stress parameters (cortisol, glucose); necropsy evaluation at 10 to 14 days. The mean operative time was 154 minutes (SD +/- 58 minutes) and no animals died as a result of complications from the procedure. The primary difficulty was incomplete ovarian excision and conversion to an open procedure in 1 dog. Serum glucose concentrations increased after surgery and remained elevated for at least 36 hours. The serum cortisol concentration was transiently increased from baseline at 2 hours after surgery. The serum IL-6 concentration peaked at 2 hours after surgery and returned to the baseline value by 18 hours. The serum C-reactive protein concentration increased significantly from baseline, peaked at 12 hours after surgery, and then slowly declined toward baseline but remained elevated at 72 hours after surgery. Nociceptive threshold measurements indicated increased sensitivity to pain for 2 to 24 hours after surgery. At necropsy, surgical sites were healing uneventfully with no significant damage to surrounding organs, no significant growth on bacterial cultures, and no evidence of peritonitis. Small number of animals, single center. The NOTES approach to oophorectomy in dogs appears to be a reasonable alternative to traditional surgery

Pre-bent instruments used in single-port laparoscopic surgery versus conventional laparoscopic surgery: comparative study of performance in a dry lab.

Science.gov (United States)

Miernik, Arkadiusz; Schoenthaler, Martin; Lilienthal, Kerstin; Frankenschmidt, Alexander; Karcz, Wojciech Konrad; Kuesters, Simon

2012-07-01

Different types of single-incision laparoscopic surgery (SILS) have become increasingly popular. Although SILS is technically even more challenging than conventional laparoscopy, published data of first clinical series seem to demonstrate the feasibility of these approaches. Various attempts have been made to overcome restrictions due to loss of triangulation in SILS by specially designed SILS-specific instruments. This study involving novices in a dry lab compared task performances between conventional laparoscopic surgery (CLS) and single-port laparoscopic surgery (SPLS) using newly designed pre-bent instruments. In this study, 90 medical students without previous experience in laparoscopic techniques were randomly assigned to undergo one of three procedures: CLS, SPLS using two pre-bent instruments (SPLS-pp), or SPLS using one pre-bent and one straight laparoscopic instrument (SPLS-ps). In the dry lab, the participants performed four typical laparoscopic tasks of increasing difficulty. Evaluation included performance times or number of completed tasks within a given time frame. All performances were videotaped and evaluated for unsuccessful attempts and unwanted interactions of instruments. Using subjective questionnaires, the participants rated difficulties with two-dimensional vision and coordination of instruments. Task performances were significantly better in the CLS group than in either SPLS group. The SPLS-ps group showed a tendency toward better performances than the SPLS-pp group, but the difference was not significant. Video sequences and participants` questionnaires showed instrument interaction as the major problem in the single-incision surgery groups. Although SILS is feasible, as shown in clinical series published by laparoscopically experienced experts, SILS techniques are demanding due to restrictions that come with the loss of triangulation. These can be compensated only partially by currently available SILS-designed instruments. The future of

The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery

OpenAIRE

Toomey, Paul G.; Ross, Sharona B.; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael; Rosemurgy, Alexander S.

2015-01-01

Background and Objectives: As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. Methods: LESS surgery courses th...

Technical and instrumental prerequisites for single-port laparoscopic solo surgery: state of art.

Science.gov (United States)

Kim, Say-June; Lee, Sang Chul

2015-04-21

With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator's eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder.

Innovation in Pediatric Surgical Education for General Surgery Residents: A Mobile Web Resource.

Science.gov (United States)

Rouch, Joshua D; Wagner, Justin P; Scott, Andrew; Sullins, Veronica F; Chen, David C; DeUgarte, Daniel A; Shew, Stephen B; Tillou, Areti; Dunn, James C Y; Lee, Steven L

2015-01-01

General surgery residents lack a standardized educational experience in pediatric surgery. We hypothesized that the development of a mobile educational interface would provide general surgery residents broader access to pediatric surgical education materials. We created an educational mobile website for general surgery residents rotating on pediatric surgery, which included a curriculum, multimedia resources, the Operative Performance Rating Scale (OPRS), and Twitter functionality. Residents were instructed to consult the curriculum. Residents and faculty posted media using the Twitter hashtag, #UCLAPedSurg, and following each surgical procedure reviewed performance via the OPRS. Site visits, Twitter posts, and OPRS submissions were quantified from September 2013 to July 2014. The pediatric surgery mobile website received 257 hits; 108 to the homepage, 107 to multimedia, 28 to the syllabus, and 19 to the OPRS. All eligible residents accessed the content. The Twitter hashtag, #UCLAPedSurg, was assigned to 20 posts; the overall audience reach was 85 individuals. Participants in the mobile OPRS included 11 general surgery residents and 4 pediatric surgery faculty. Pediatric surgical education resources and operative performance evaluations are effectively administered to general surgery residents via a structured mobile platform. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Compliance with Operational Circular No. 2 on conditions of access to the fenced CERN sites

CERN Multimedia

Relations with the Host States Service

2004-01-01

The purpose of Operational Circular No. 2 is to contribute to the protection of people and property by defining the conditions of access to the Organization's fenced sites. However, recently, the services concerned have noted a significant increase in the instances of non-compliance with those conditions that cannot be tolerated, for example: use of CERN access cards by people, other than the cardholders themselves, in order to gain access to facilities without having attended the required safety course; speeding, particularly on Route Gregory and Route Weisskopf; driving in and out of the site on the wrong side of the road; parking on spaces set aside for the disabled; nuisance parking, especially in the proximity of the Restaurants; the dumping of wrecked vehicles. As the aforementioned instances of non-compliance can lead to dangerous situations, the Organization reserves the right to apply the penalties provided for under paragraph 26 of Operational Circular No. 2, namely to refuse access to the site...

A novel robotic platform for single-port abdominal surgery

Science.gov (United States)

Singh, Satwinder; Cheung, Jo L. K.; Sreedhar, Biji; Hoa, Xuyen Dai; Ng, Hoi Pang; Yeung, Chung Kwong

2018-03-01

In this paper, a novel robot-assisted platform for single-port minimally invasive surgery is presented. A miniaturized seven degrees of freedom (dof) fully internalized in-vivo actuated robotic arm is designed. Due to in-vivo actuation, the system has a smaller footprint and can generate 20 N of gripping force. The complete work envelop of the robotic arms is 252 mm × 192 mm × 322 m. With the assistance of the cannula-swivel system, the robotic arms can also be re-positioned and have multi-quadrant reachability without any additional incision. Surgical tasks, such as lifting, gripping suturing and knot tying that are commonly used in a standard surgical procedure, were performed to verify the dexterity of the robotic arms. A single-port trans-abdominal cholecystectomy in a porcine model was successfully performed to further validate its functionality.

A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial.

Science.gov (United States)

Weltert, Luca; Rondinelli, Beatrice; Bello, Ricardo; Falco, Mauro; Bellisario, Alessandro; Maselli, Daniele; Turani, Franco; De Paulis, Ruggero; Pierelli, Luca

2015-07-01

We conducted a prospective single-blind randomized study to assess whether a single 80,000 IU dose of human recombinant erythropoietin (HRE), given just 2 days before cardiac surgery, could be effective in reducing perioperative allogeneic red blood cell transfusion (aRBCt). Six-hundred patients presenting with preoperative hemoglobin (Hb) level of not more than 14.5 g/dL were randomly assigned to either HRE or control. The primary endpoint was the incidence of perioperative aRBCt. The secondary endpoints were mortality and the incidence of adverse events in the first 45 days after surgery, Hb level on Postoperative Day 4, and number of units of RBC transfusions in the first 4 days after surgery. A total of 17% (HRE) versus 39% (control) required transfusion (relative risk, 0.436; pHRE (0%) and control (3.5%) among the patients with baseline Hb of 13.0 g/dL or more, which included the nonanemic fraction of the study population. The mean (range) Hb level on Postoperative Day 4 was 10.2 (9.9-10.6) g/dL (HRE) versus 8.7 (8.5-9.2) g/dL (control; pHRE (pHRE) versus 3.33% (control). The 45-day adverse event rate was 4.33% (HRE) versus 5.67% (control; both p=NS). In anemic patients (HbHRE administered 2 days before cardiac surgery is effective in reducing the incidence of aRBCt without increasing adverse events. © 2015 AABB.

[Vacuum-assisted closure as a treatment modality for surgical site infection in cardiac surgery].

Science.gov (United States)

Simek, M; Nemec, P; Zálesák, B; Hájek, R; Kaláb, M; Fluger, I; Kolár, M; Jecmínková, L; Gráfová, P

2007-08-01

The vacuum-asssited closure has represented an encouraging treatment modality in treatment of surgical site infection in cardiac surgery, providing superior results compared with conventional treatment strategies, particularly in the treatment of deep sternal wound infection. From November 2004 to January 2007, 40 patients, undergoing VAC therapy (VAC system, KCI, Austria, Hartmann-Rico Inc., Czech Republic) for surgical site infection following cardiac surgery, were prospectively evaluated. Four patients (10%) were treated for extensive leg-wound infection, 10 (25%) were treated for superficial sternal wound infection and 26 (65%) for deep sternal wound infection. The median age was 69.9 +/- 9.7 years and the median BMI was 33.2 +/- 5.0 kg/m2. Twenty-three patients (57%) were women and diabetes was present in 22 patients (55%). The VAC was employed after the previous failure of the conventional treatment strategy in 7 patients (18%). Thirty-eight patients (95%) were successfully healed. Two patients (5%) died, both of deep sternal infetion consequences. The overall length of hospitalization was 36.4 +/- 22.6 days. The median number of dressing changes was 4.6 +/- 1.8. The median VAC treatment time until surgical closure was 9.7 +/- 3.9 days. The VAC therapy was solely used as a bridge to the definite wound closure. Four patients (10%) with a chronic fistula were re-admitted with the range of 1 to 12 months after the VAC therapy. The VAC therapy is a safe and reliable option in the treatment of surgical site infection in the field of cardiac surgery. The VAC therapy can be considered as an effective adjunct to convetional treatment modalities for the therapy of extensive and life-threatening wound infection following cardiac surgery, particurlarly in the group of high-risk patients.

Totally extraperitoneal (TEP) bilateral hernioplasty using the Single Site® robotic da Vinci platform (DV-SS TEP): description of the technique and preliminary results.

Science.gov (United States)

Cestari, A; Galli, A C; Sangalli, M N; Zanoni, M; Ferrari, M; Roviaro, G

2017-06-01

Laparoendoscopic single site totally extraperitoneal (TEP) hernia repair showed to be a feasible alternative to conventional laparoscopic hernia repair; nevertheless single site surgery, with the loss of instruments triangulation can be a demanding procedure. To overcome those hurdles, the Single Site® (SS) platform of the da Vinci (DV) Si robotic system enables to perform surgical procedures through a 25-mm skin incision, with a stable 3D vision and restoring an adequate triangulation of the surgical instruments. We present in details the technique and the preliminary results of DV-SS TEP, to our knowledge the first cases reported in literature. In March 2016, three consecutive male patients (mean age 46.6 years-mean BMI 25.3) with bilateral symptomatic inguinal hernia were submitted to DV-SS TEP in our institutions. Feasibility, codification of the technique, operative time and perioperative outcomes were recorded. All the procedures were completed as scheduled, with no conversion to other techniques. Mean operative time was 98.6 min, ranging between 155 and 55 min, reflecting the learning curve of the operating room team on this new procedure. No intraoperative or postoperative complications were experienced and all the patients were discharged within 24 h after surgery. Patients reported satisfactory postoperative course, with no recurrence of inguinal hernia and satisfaction in cosmetic result at 6-month follow-up. DV-SS TEP inguinal hernia repair showed to be feasible and effective surgical option for bilateral groin hernia repair. Patients' outcome was uneventful, with optimal cosmetic results. Further studies comparing this innovative technique to TEP or LESS TEP should be promoted.

Endovascular Revascularization of Chronically Thrombosed Arteriovenous Fistulas and Grafts for Hemodialysis: A Retrospective Study in 15 Patients With 18 Access Sites

International Nuclear Information System (INIS)

Weng Meijui; Chen, Matt Chiung-Yu; Chi Wenche; Liu Yichun; Liang, Huei-Lung; Pan, Huay-Ben

2011-01-01

The current study retrospectively evaluated whether endovascular revascularization of chronically thrombosed and long-discarded vascular access sites for hemodialysis was feasible. Technical and clinical success rates, postintervention primary and secondary patency rates, and complications were reported. During a 1-year period, we reviewed a total of 924 interventions performed for dysfunction and/or failed hemodialysis vascular access sites and permanent catheters in 881 patients. In patients whose vascular access-site problems were considered untreatable or were considered treatable with a high risk of failure and access-site abandonment, we attempted to revascularize (resurrect) the chronically occluded and long-discarded (mummy) vascular access sites. We attempted to resurrect a total of 18 mummy access sites (mean age 46.6 ± 38.7 months; range 5–144) in 15 patients (8 women and 7 men; mean age 66.2 ± 11.5 years; age range 50–85) and had an overall technical success rate of 77.8%. Resurrection failure occurred in 3 fistulas and in 1 straight graft. The clinical success rate was 100% at 2 months after resurrection. In the 14 resurrected vascular access sites, 6 balloon-assisted maturation procedures were required in 5 fistulas; after access-site maturation, a total of 22 interventions were performed to maintain access-site patency. The mean go-through time for successful resurrection procedures was 146.6 ± 34.3 min (range 74–193). Postmaturation primary patency rates were 71.4 ± 12.1% at 30 days, 57.1 ± 13.2% at 60 days, 28.6 ± 13.4% at 90 days, and 19 ± 11.8% at 180 days. Postmaturation secondary patency rates were 100% at 30, 60, and 90 days and 81.8 ± 11.6% at 180 days. There were 2 major complications consisting of massive venous ruptures in 2 mummy access sites during balloon dilation; in both cases, prolonged balloon inflation failed to achieve hemostasis, but percutaneous N-butyl cyanoacrylate glue seal-off was performed successfully

Hysterectomy and Bilateral Salpingoovariectomy in a Transsexual Subject without Visible Scaring

OpenAIRE

Perrone, Anna Myriam; Scifo, Maria Cristina; Martelli, Valentina; Casadio, Paolo; Morselli, Paolo Giovanni; Pelusi, Giuseppe; Meriggiola, Maria Cristina

2010-01-01

Objective. To report on the use of laparoendoscopic single-site surgery (LESS) for the management of total hysterectomy (TH) with bilateral salpingoovariectomy (BSO) in a subject affected by gender identity disorder. Design. Case report. Setting. University Hospital. Patient(s). A 27-year-old affected by Gender Identity Disorder underwent a hysterectomy and BSO as part of surgical sex reassignment. Intervention(s). Laparoendoscopic single-site surgery access for TH and BSO. Main Outcome ...

Hybrid Single-Incision Laparoscopic Colon Cancer Surgery Using One Additional 5 mm Trocar.

Science.gov (United States)

Kim, Hyung Ook; Choi, Dae Jin; Lee, Donghyoun; Lee, Sung Ryol; Jung, Kyung Uk; Kim, Hungdai; Chun, Ho-Kyung

2018-02-01

Single-incision laparoscopic surgery (SILS) is a feasible and safe procedure for colorectal cancer. However, SILS has some technical limitations such as collision between instruments and inadequate countertraction. We present a hybrid single-incision laparoscopic surgery (hybrid SILS) technique for colon cancer that involves use of one additional 5 mm trocar. Hybrid SILS for colon cancer was attempted in 70 consecutive patients by a single surgeon between August 2014 and July 2016 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine. Using prospectively collected data, an observational study was performed on an intention-to-treat basis. Hybrid SILS was technically completed in 66 patients, with a failure rate of 5.7% (4/70). One patient was converted to open surgery for para-aortic lymph node dissection. Another was converted to open surgery due to severe peritoneal adhesion. An additional trocar was inserted for adhesiolysis in the other two cases. Median lengths of proximal and distal margins were 12.8 cm (interquartile range [IQR], 10.0-18.6), and 8.2 cm (IQR, 5.5-18.3), respectively. Median total number of lymph nodes harvested was 24 (IQR, 18-33). Overall rate of postoperative morbidity was 12.9%, but there were no Clavien-Dindo grade III or IV complications. There was no postoperative mortality or reoperation. Median postoperative hospital stay was 6 days (IQR, 5-7). Hybrid SILS using one additional 5 mm trocar is a safe and effective minimally invasive surgical technique for colon cancer. Experienced laparoscopic surgeons can perform hybrid SILS without a learning curve based on the formulaic surgical techniques presented in this article.

New trends in minimally invasive urological surgery

Directory of Open Access Journals (Sweden)

Prabhakar Rajan

2009-10-01

Full Text Available Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures

NARCIS (Netherlands)

Zwaan, E.M.; Koopman, A.G.M.M.; Holtzer, C.A.J.; Zijlstra, F.; Ritt, M.J.P.F.; Amoroso, G.; Moerman, E.; Kofflard, M.J.M.; Ijsselmuiden, A.J.J.

2015-01-01

Objectives Little is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity

Craniofacial Surgery Fellowship Websites.

Science.gov (United States)

Silvestre, Jason; Agarwal, Divyansh; Taylor, Jesse A

2016-06-01

Applicants for craniofacial surgery fellowships utilize Internet-based resources like the San Francisco (SF) Match to manage applications. The purpose of this study was to evaluate the accessibility and content of craniofacial surgery fellowship websites (CSFWs). A list of available craniofacial surgery fellowships was compiled from directories of the American Society of Craniofacial Surgery (ACSFS) and SF Match. Accessibility of CSFWs was assessed via links from these directories and a Google search. Craniofacial surgery fellowship websites were evaluated on education and recruitment content and compared via program characteristics. Twenty-four of the 28 US-based craniofacial surgery fellowship programs had a CSFW (86%). The ACSFS and SF Match databases had limited CSFW accessibility, but a Google search revealed most CSFWs had the top search result (76%). In total, CSFWs provided an average of 39% of education and recruitment variables. While most programs provided fellowship program descriptions (96%), application links (96%), and faculty listings (83%), relatively few provided rotation schedules (13%), fellow selection process information (13%), or interview dates (8%). CSFW content did not vary by program location, faculty size, accreditation status, or institutional affiliations (P > 0.05). Craniofacial surgery fellowships often lack readily accessible websites from national program lists and have limited information for interested applicants. The consistent lack of online information across programs suggests future opportunities exist to improve these educational resources.

Sealed Orifice Laparoscopic or Endoscopic (SOLE) Surgery: technology and technique convergence for next-step colorectal surgery.

LENUS (Irish Health Repository)

Cahill, R A

2012-02-01

The new avenue of minimally invasive surgery, referred to as single-incision\\/access laparoscopy, is often presented as an alternative to standard multiport approaches, whereas in fact it is more usefully perceived as a complementary modality. The emergence of the technique can be of greater use both to patients and to the colorectal specialty if its principles can be merged into next-stage evolution by synergy with more conventional practice. In particular, rather than device specificity, what is needed is convergence of capability that can be applied by the same surgeon in differing scenarios depending on the individualized patient and disease characteristics. We detail here the global applicability of a simple access device construct that allows the provision of simple and complex single-port laparoscopy as well as contributing to multiport laparoscopic and transanal resections in a manner that is reliable, reproducible, ergonomical and economical.

Evaluation of the content and accessibility of web sites for accredited orthopaedic sports medicine fellowships.

Science.gov (United States)

Mulcahey, Mary K; Gosselin, Michelle M; Fadale, Paul D

2013-06-19

The Internet is a common source of information for orthopaedic residents applying for sports medicine fellowships, with the web sites of the American Orthopaedic Society for Sports Medicine (AOSSM) and the San Francisco Match serving as central databases. We sought to evaluate the web sites for accredited orthopaedic sports medicine fellowships with regard to content and accessibility. We reviewed the existing web sites of the ninety-five accredited orthopaedic sports medicine fellowships included in the AOSSM and San Francisco Match databases from February to March 2012. A Google search was performed to determine the overall accessibility of program web sites and to supplement information obtained from the AOSSM and San Francisco Match web sites. The study sample consisted of the eighty-seven programs whose web sites connected to information about the fellowship. Each web site was evaluated for its informational value. Of the ninety-five programs, fifty-one (54%) had links listed in the AOSSM database. Three (3%) of all accredited programs had web sites that were linked directly to information about the fellowship. Eighty-eight (93%) had links listed in the San Francisco Match database; however, only five (5%) had links that connected directly to information about the fellowship. Of the eighty-seven programs analyzed in our study, all eighty-seven web sites (100%) provided a description of the program and seventy-six web sites (87%) included information about the application process. Twenty-one web sites (24%) included a list of current fellows. Fifty-six web sites (64%) described the didactic instruction, seventy (80%) described team coverage responsibilities, forty-seven (54%) included a description of cases routinely performed by fellows, forty-one (47%) described the role of the fellow in seeing patients in the office, eleven (13%) included call responsibilities, and seventeen (20%) described a rotation schedule. Two Google searches identified direct links for

Information available on the internet about pain after orthognathic surgery: a careful review.

Science.gov (United States)

Pithon, Matheus Melo; dos Santos, Elinailton Silva

2014-01-01

Investigate the quality of data available on the internet with respect to pain after orthognathic surgery. A careful search was conducted on the Internet in December, 2012. The most accessed websites browsers were employed for research using the terms: "pain" and "orthognathic surgery" together. The first 30 results of each portal were examined, and after applying the exclusion criteria, 29 sites remained. All remaining websites went through an evaluation process with online tools that investigated the quality, level of reading, accessibility, usability and reliability. Assessment criteria outcomes were considered unfavorable. Texts were considered difficult to read with inappropriate language for the general public. The mean global validation for the 29 websites of the LIDA instrument was 65.10, thereby indicating a structure of medium quality. Information about post-orthognathic surgery pain available on the internet is poorly written and unreliable. Therefore, candidates for orthognathic surgery must seek information from specialists who, in turn, should indicate reliable sources.

Single incision pediatric endoscopic surgery: advantages of relatively large incision

International Nuclear Information System (INIS)

Yilmaz, E.; Afsarlar, E.; Karaman, I.

2015-01-01

To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages. Study Design: An observational case series. Place and Duration of Study: Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014. Methodology: A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed. Results: SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO/sub 2/ could be ensured. All of the patients/parents were satisfied with the cosmesis. Conclusion: SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO/sub 2/, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision. (author)

Evaluation of single-stage adjustable strabismus surgery under conscious sedation

Directory of Open Access Journals (Sweden)

Sharma Pradeep

2009-01-01

Full Text Available Purpose: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS performed under topical anesthesia. Materials and Methods: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients′ experience of the surgery (by questionnaire were also compared. Results: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd ±9.0, -38.93 pd ±11.05 and -41.87 pd ±8.91 ( P =0.6 respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I ( P =0.03. Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5 in all groups. Intraoperative pain ( P < 0.001 and time taken for surgery ( P < 0.001 was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5. Conclusions: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.

Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery

Directory of Open Access Journals (Sweden)

Aina Gomila

2017-04-01

Full Text Available Abstract Background Organ-space surgical site infections (SSI are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. Methods A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. Results Of 3,701 patients, 2,518 (68% underwent colon surgery and 1,183 (32% rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001. Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14–2.15 and ostomy creation (OR: 2.65, 95% CI: 1.8–3.92 while laparoscopy (OR: 0.5, 95% CI: 0.38–0.69 and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51–0.97 were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34–3.31 and longer surgery (OR: 1.49, 95% CI: 1.03–2.15, whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32–0.73 was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04. Conclusions Organ-space SSI in colon and rectal surgery has some

Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

Directory of Open Access Journals (Sweden)

Wolfram Malter

2014-01-01

Full Text Available Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer.

Transradial access for coronary angiography: a single operator's experience of 500 cases

International Nuclear Information System (INIS)

Ali, J.; Aziz, S.; Javed, A.; Kayani, A.M.

2011-01-01

Objective: The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for diagnostic coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) over a period of ten months from June 2009 to March 2010. Patients and Methods: We collected data of 500 consecutive patients who underwent coronary catheterization by the transradial approach. Transradial access was performed only if the Allen's test was normal (positive). Patients with previous CABG or requiring right heart catheterization were excluded from this study. Study endpoints included procedure success rate, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization. Results: Mean age of the patients was 52 years (range 33-77 yrs) and 72.8% (n= 364) were men and 27.2% (n=136) were females. The vast majority of cases (98.4%) were elective. The right radial artery was used in 98% of cases. Procedural success was achieved in 90.6% cases (453/500). No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Conclusion: Transradial access for coronary angiography is a safe, effective and elegant alternative to trans femoral access. (author)

Training for single port video assisted thoracoscopic surgery lung resections.

Science.gov (United States)

McElnay, Philip J; Lim, Eric

2015-11-01

With many surgical training programmes providing less time for training it can be challenging for trainees to acquire the necessary surgical skills to perform complex video assisted thoracoscopic surgery (VATS) lung resections. Indeed as the utilization of single port operations increases the need to approach the operating theatre with already-existing excellent hand-eye coordination skills increases. We suggest that there are a number of ways that trainees can begin to develop these necessary skills. Firstly, using computer games that involve changing horizons and orientations. Secondly, utilizing box-trainers to practice using the thoracoscopic instruments. Thirdly, learning how essential tools such as the stapler work. Trainees will then be able to progress to meaningfully assisting in theatre and indeed learning how to perform the operation themselves. At this stage is useful to observe expert surgeons whilst they operate-to watch both their technical and non-technical skills. Ultimately, surgery is a learned skill and requires implementation of these techniques over a sustained period of time.

Cosmic and terrestrial single-event radiation effects in dynamic random access memories

International Nuclear Information System (INIS)

Massengill, L.W.

1996-01-01

A review of the literature on single-event radiation effects (SEE) on MOS integrated-circuit dynamic random access memories (DRAM's) is presented. The sources of single-event (SE) radiation particles, causes of circuit information loss, experimental observations of SE information upset, technological developments for error mitigation, and relationships of developmental trends to SE vulnerability are discussed

Wound management with vacuum assisted closure in surgical site infection after ankle surgery.

Science.gov (United States)

Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

2015-05-01

The aim of this study was to compare the efficacy of vacuum assisted closure (VAC) with standard moist wound care (SMWC) in surgical site infection after ankle surgery. A prospective cohort was performed among patients with surgical site infection after ankle surgery between 2012 and 2013. The follow-up period was three month, and the efficacy end point was complete wound closure rate. Ninety-four patients were analyzed, with 61 patients in the VAC group and 33 in the SMWC group. The complete wound closure rate in the VAC group was higher than that in the SMWC group at 3 month follow up (90.2% Vs. 72.7%, p = 0.028). The median time to complete wound closure was 31 days (95% CI 20.2-41.8) for VAC, and 63 days (95% CI 46.9-79.1) for SMWC (χ(2) = 4.023, p = 0.045). In the superficial infection subgroup, the median times to complete wound closure were 20 days (95% CI 14.2-35.1) in the VAC group and 42 days (95% CI 35.4-69.4) in SMWC group (χ(2) = 4.331, p = 0.041). In the deep subgroup, the median times to complete wound closure were 46 days (95% CI 28.2-65.9) in the VAC group and 75 days (95% CI 43.2-79.6) in SMWC group (χ(2) = 6.475, p = 0.026). Our result showed that vacuum assisted closure was more effective than standard moist wound care in surgical site infection after ankle surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

REMINDER - Compliance with Operational Circular No. 2 on conditions of access to the fenced CERN sites

CERN Multimedia

Relations with the Host States Service

2004-01-01

The purpose of Operational Circular No. 2 is to contribute to the protection of people and property by defining the conditions of access to the Organization's fenced sites. However, recently, the services concerned have noted a significant increase in the instances of non-compliance with those conditions that cannot be tolerated, for example: use of CERN access cards by people, other than the cardholders themselves, in order to gain access to facilities without having attended the required safety course; speeding, particularly on Route Gregory and Route Weisskopf; driving in and out of the site on the wrong side of the road; parking on spaces set aside for the disabled; nuisance parking, especially in the proximity of the Restaurants; the dumping of wrecked vehicles. As the aforementioned instances of non-compliance can lead to dangerous situations, the Organization reserves the right to apply the penalties provided for under paragraph 26 of Operational Circular No. 2, namely to refuse access to the site ...

Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins.

Science.gov (United States)

Honda, Tsuyoshi; Fujimoto, Kazuteru; Miyao, Yuji; Koga, Hidenobu; Hirata, Yoshihiro

2012-09-01

The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P strategy that could prevent radial artery occlusion after transradial procedures.

Hanford Site Welding Program Successfully Providing A Single Site Function For Use By Multiple Contractors

International Nuclear Information System (INIS)

Cannell, G.R.

2009-01-01

The Department of Energy, Richland Operations (DOE-RL) recently restructured its Hanford work scope, awarding two new contracts over the past several months for a total of three contracts to manage the sites cleanup efforts. DOE-RL met with key contractor personnel prior to and during contract transition to ensure site welding activities had appropriate oversight and maintained code compliance. The transition also provided an opportunity to establish a single site-wide function that would provide welding and materials engineering services to the Hanford site contractors: CH2M HILL Plateau Remediation Company (CHPRC); Mission Support Alliance (MSA); Washington River Protection Solutions (WRPS); and Washington Closure Hanford (WCH). Over the years, multiple and separate welding programs (amongst the several contractors) existed at the Hanford site leading to inefficiencies resulting from duplication of administrative efforts, maintenance of welding procedures, welder performance certifications, etc. The new, single program eliminates these inefficiencies. The new program, co-managed by two of the sites' new contractors, the CHPRC ('owner' of the program and responsible for construction welding services) and the MSA (provides maintenance welding services), provides more than just the traditional construction and maintenance welding services. Also provided, are welding engineering, specialty welding development/qualification for the closure of radioactive materials containers and materials evaluation/failure analysis. The following describes the new Hanford site welding program.

Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients.

Science.gov (United States)

Do, Minh; Liatsikos, Evangelos; Beatty, John; Haefner, Tim; Dunn, Ian; Kallidonis, Panagiotis; Stolzenburg, Jens-Uwe

2011-06-01

Recent technical advances and a trend toward laparoscopic single incision surgery have led us to explore the feasibility of laparoendoscopic single-site (LESS) hernia repair. We present our technique and initial experience with LESS extraperitoneal inguinal hernia repair in 10 consecutive men with unilateral inguinal hernias. Age range was 43.7 (28-64) years. Mean body mass index was 28 (range 24-30). Six were left inguinal hernias. There were six indirect and four direct hernias. Three patients had undergone previous open appendectomy. Incarcerated or bilateral hernias were excluded from our initial series. All cases were performed by three surgeons who were experienced in conventional totally extraperitoneal laparoscopic hernia repair as well as experienced in LESS. A literature review of current single-port inguinal hernia repair data is also presented. The mean operative time was 53 minutes (range 45-65  min). The average length of skin incision was 2.8  cm (range 2.3-3.2  cm). No drain was necessary in any of the patients, while no recordable bleeding was observed. There were no intraoperative or immediate postoperative complications. Hospitalization period was 2 days for all patients. After a limited follow-up of 1 month, there have been no recurrences and no complaints of testicular pain. The results of the current series compare favorably with those found in a literature review. LESS extraperitoneal inguinal hernia repair is both feasible and safe, although more technically demanding than its conventional laparoscopic counterpart. Although the cosmetic result with the former approach may prove superior, there are standing questions regarding the complications and long-term outcome. Randomized and if possible blinded trials that compare conventional and single-incision laparoscopic hernia repair may help to distinguish the most advantageous technique.

Nuclear tourists: the challenge of EDF's production sites accessibility, 1974-1991

International Nuclear Information System (INIS)

Lopez, Fanny

2014-01-01

This article focuses on the evolution of accessibility of Electricite de France (EDF) production sites when the country chose energy independence in 1974. If the nuclear program seems to be at the origins of French industrial tourism, which process made these energy plants a touristic attraction?

A high lymph node yield in colon cancer is associated with age, tumour stage, tumour sub-site and priority of surgery

DEFF Research Database (Denmark)

Lykke, Jakob; Jess, Per; Roikjær, Ole

2016-01-01

by curative resection of stage I-III colon cancer in the period 2003-2011. The association between a LNY ≥ 12 and age, sex, body mass index, open vs. laparoscopic surgery, acute vs. elective surgery, pT stage, tumour sub-site and year of diagnosis was analysed. RESULTS: A total of 13,766 patients were...... eligible for the analysis. In total, 71.4 % of the patients had a LNY ≥ 12. In multivariate analysis, age, pT stage, tumour sub-site and priority of surgery were independently associated with the probability of a LNY ≥ 12. Odds ratios (ORs) were as follows: age ... of a LNY ≥ 12: OR 1.480 (CI 1.445-1.516) for each increasing year in the study period. CONCLUSION: A LNY ≥ 12 is significantly associated with age, pT stage, tumour sub-site and priority of surgery. A significant increase in the LNY over the period of the study was observed, probably reflecting the effect...

Optically-controlled platforms for transfection and single- and sub-cellular surgery

DEFF Research Database (Denmark)

Villangca, Mark Jayson; Casey, Duncan; Glückstad, Jesper

2015-01-01

and specificity of optical trapping in conjunction with other modalities to perform single and sub-cellular surgery. These tools form highly tuneable platforms for the delivery or removal of material from cells of interest, but can simultaneously excite fluorescent probes for imaging purposes or plasmonic...... structures for very local heating. We discuss both the history and recent applications of the field, highlighting the key findings and developments over the last 40 years of biophotonics research....

Single-site robotic cholecystectomy and robotics training: should we start in the junior years?

Science.gov (United States)

Ayabe, Reed I; Parrish, Aaron B; Dauphine, Christine E; Hari, Danielle M; Ozao-Choy, Junko J

2018-04-01

It has become increasingly important to expose surgical residents to robotic surgery as its applications continue to expand. Single-site robotic cholecystectomy (SSRC) is an excellent introductory case to robotics. Resident involvement in SSRC is known to be feasible. Here, we sought to determine whether it is safe to introduce SSRC to junior residents. A total of 98 SSRC cases were performed by general surgery residents between August 2015 and August 2016. Cases were divided into groups based on resident level: second- and third-years (juniors) versus fourth- and fifth-years (seniors). Patient age, gender, race, body mass index, and comorbidities were recorded. The number of prior laparoscopic cholecystectomies completed by participating residents was noted. Outcomes including operative time, console time, rate of conversion to open cholecystectomy, and complication rate were compared between groups. Juniors performed 54 SSRC cases, whereas seniors performed 44. There were no significant differences in patient age, gender, race, body mass index, or comorbidities between the two groups. Juniors had less experience with laparoscopic cholecystectomy. There was no significant difference in mean operative time (92.7 min versus 98.0 min, P = 0.254), console time (48.7 min versus 50.8 min, P = 0.639), or complication rate (3.7% versus 2.3%, P = 0.68) between juniors and seniors. SSRC is an excellent way to introduce general surgery residents to robotics. This study shows that with attending supervision, SSRC is feasible and safe for both junior and senior residents with very low complication rates and no adverse effect on operative time. Copyright © 2017 Elsevier Inc. All rights reserved.

"Converting a bi-jaw surgery to a single-jaw surgery:" Posterior maxillary dentoalveolar intrusion with microimplants to avoid the need of a maxillary surgery in the surgical management of skeletal Class III vertical malocclusion

Directory of Open Access Journals (Sweden)

Abhisek Ghosh

2016-01-01

Full Text Available The management of a vertical skeletal Class III malocclusion with mandibular prognathism revolves around the protocol of bi-jaw surgery (maxillary LeFort I impaction and mandibular bilateral sagittal split osteotomy with setback. The maxillary surgery not only provides increased stability to the ultimate surgical outcome but also increases the amount by which the mandibular set back can be done, therefore aiding in greater profile improvement. With the need of maxillary surgery almost inevitable in treating such situations, the complexity and the increased discomfort associated with such surgery can never be ignored. Is it at all possible to convert a bi-jaw surgery into a single-jaw surgery with the aid of microimplants? With increasing number of patients being treated with microimplants for anterior openbite and gummy smiles, our idea was to incorporate this novel protocol in treating Class III vertical situations and therefore avoid the need of a maxillary surgery in treating such a situation, together with achieving optimum treatment outcome.

Chronological changes in lung cancer surgery in a single Japanese institution

Science.gov (United States)

Nakamura, Haruhiko; Sakai, Hiroki; Kimura, Hiroyuki; Miyazawa, Tomoyuki; Marushima, Hideki; Saji, Hisashi

2017-01-01

Background The aim of this study was to evaluate the chronological changes in epidemiological factors and surgical outcomes in patients with lung cancer who underwent surgery in a single Japanese institution. Patients and methods A clinicopathological database of patients with lung cancer who underwent surgery with curative intent from January 1974 to December 2014 was reviewed. The chronological changes in various factors, including patient’s age, sex, histological type, tumor size, pathological stage (p-stage), surgical method, operative time, intraoperative blood loss, 30-day mortality, and postoperative overall survival (OS), were evaluated. Results A total of 1,616 patients were included. The numbers of resected patients, females, adenocarcinomas, p-stage IA patients, and age at the time of surgery increased with time, but tumor size decreased (all P<0.0001). Concerning surgical methods, the number of sublobar resections increased, but that of pneumonectomies decreased (P<0.0001). The mean operative time, intraoperative blood loss, and the postoperative 30-day mortality rate decreased (all P<0.0001). When the patients were divided into two groups (1974–2004 and 2005–2014), the 5-year OS rates for all patients and for p-stage IA patients improved from 44% to 79% and from 73% to 89%, respectively (all P<0.0001). The best 5-year OS rate was obtained for sublobar resection (73%), followed by lobectomy (60%), combined resection (22%), and pneumonectomy (21%; P<0.0001). Conclusion Changes in epidemiological factors, a trend toward less invasive surgery, and a remarkably improved postoperative OS were confirmed, which demonstrated the increasingly important role of surgery in therapeutic strategies for lung cancer. PMID:28331339

The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery.

Science.gov (United States)

Koullouros, Michalis; Khan, Nadir; Aly, Emad H

2017-01-01

Surgical site infection (SSI) continues to be a challenge in colorectal surgery. Over the years, various modalities have been used in an attempt to reduce SSI risk in elective colorectal surgery, which include mechanical bowel preparation before surgery, oral antibiotics and intravenous antibiotic prophylaxis at induction of surgery. Even though IV antibiotics have become standard practice, there has been a debate on the exact role of oral antibiotics. The primary aim was to identify the role of oral antibiotics in reduction of SSI in elective colorectal surgery. The secondary aim was to explore any potential benefit in the use of mechanical bowel preparation (MBP) in relation to SSI in elective colorectal surgery. Medline, Embase and the Cochrane Library were searched. Any randomised controlled trials (RCTs) or cohort studies after 1980, which investigated the effectiveness of oral antibiotic prophylaxis and/or MBP in preventing SSIs in elective colorectal surgery were included. Twenty-three RCTs and eight cohorts were included. The results indicate a statistically significant advantage in preventing SSIs with the combined usage of oral and systemic antibiotic prophylaxis. Furthermore, our analysis of the cohort studies shows no benefits in the use of MBP in prevention of SSIs. The addition of oral antibiotics to systemic antibiotics could potentially reduce the risk of SSIs in elective colorectal surgery. Additionally, MBP does not seem to provide a clear benefit with regard to SSI prevention.

Locally advanced cervix cancer: chemotherapy prior to definitive surgery or radiotherapy. A single institutional experience

International Nuclear Information System (INIS)

MacLeod, C.; O'Donnell, A.; Tattersall, M.H.N.; Dalrymple, C.; Firth, I.

2001-01-01

Primary or neoadjuvant chemotherapy prior to definitive local therapy has potential advantages for locally advanced cervix cancer. It can down stage a cancer and allow definitive local therapy to be technically possible (surgery), or potentially more effective (radiotherapy). It can also eradicate subclinical systemic metastases. This report reviews a single institution's experience of neoadjuvant chemotherapy prior to definitive local therapy for cervix cancer over a 13-year period. One hundred and six patients were treated with this intent. The patients were analysed for their response to chemotherapy, treatment received, survival, relapse and toxicity. The chemotherapy was feasible and the majority of patients had a complete or partial response (58.5%). Eight patients did not proceed to local treatment. Forty-six patients had definitive surgery and 52 had definitive radiotherapy. The 5-year overall survival was 27% and the majority of patients died with disease. The first site of relapse was usually in the pelvis (46.2%). Late complications that required ongoing medical therapy (n = 6) or surgical intervention (n = 2) were recorded in eight patients (7.5%). On univariate analysis stage (P= 0.04), tumour size (P = 0.01), lymph node status (P=0.003), response to chemotherapy (P = 0.045) and treatment (P = 0.003) were all significant predictors of survival. On multivariate analysis, tumour size (P < 0.0001) and nodal status (P = 0.02) were significant predictors of survival. Despite the impressive responses to chemotherapy of advanced cervix cancer, there is evidence from randomized trials that it does not improve or compromise survival prior to radiotherapy. As its role prior to surgery remains unclear, it should not be used in this setting outside a prospective randomized trial. Copyright (2001) Blackwell Science Pty Ltd

Stress-induced enhancement of leukocyte trafficking into sites of surgery or immune activation

Science.gov (United States)

Viswanathan, Kavitha; Dhabhar, Firdaus S.

2005-04-01

Effective immunoprotection requires rapid recruitment of leukocytes into sites of surgery, wounding, infection, or vaccination. In contrast to immunosuppressive chronic stressors, short-term acute stressors have immunoenhancing effects. Here, we quantify leukocyte infiltration within a surgical sponge to elucidate the kinetics, magnitude, subpopulation, and chemoattractant specificity of an acute stress-induced increase in leukocyte trafficking to a site of immune activation. Mice acutely stressed before sponge implantation showed 200-300% higher neutrophil, macrophage, natural killer cell, and T cell infiltration than did nonstressed animals. We also quantified the effects of acute stress on lymphotactin- (LTN; a predominantly lymphocyte-specific chemokine), and TNF-- (a proinflammatory cytokine) stimulated leukocyte infiltration. An additional stress-induced increase in infiltration was observed for neutrophils, in response to TNF-, macrophages, in response to TNF- and LTN, and natural killer cells and T cells in response to LTN. These results show that acute stress initially increases trafficking of all major leukocyte subpopulations to a site of immune activation. Tissue damage-, antigen-, or pathogen-driven chemoattractants subsequently determine which subpopulations are recruited more vigorously. Such stress-induced increases in leukocyte trafficking may enhance immunoprotection during surgery, vaccination, or infection, but may also exacerbate immunopathology during inflammatory (cardiovascular disease or gingivitis) or autoimmune (psoriasis, arthritis, or multiple sclerosis) diseases. chemokine | psychophysiological stress | surgical sponge | wound healing | lymphotactin

Pulse patterning effect in optical pulse division multiplexing for flexible single wavelength multiple access optical network

Science.gov (United States)

Jung, Sun-Young; Kim, Chang-Hun; Han, Sang-Kook

2018-05-01

A demand for high spectral efficiency requires multiple access within a single wavelength, but the uplink signals are significantly degraded because of optical beat interference (OBI) in intensity modulation/direct detection system. An optical pulse division multiplexing (OPDM) technique was proposed that could effectively reduce the OBI via a simple method as long as near-orthogonality is satisfied, but the condition was strict, and thus, the number of multiplexing units was very limited. We propose pulse pattern enhanced OPDM (e-OPDM) to reduce the OBI and improve the flexibility in multiple access within a single wavelength. The performance of the e-OPDM and patterning effect are experimentally verified after 23-km single mode fiber transmission. By employing pulse patterning in OPDM, the tight requirement was relaxed by extending the optical delay dynamic range. This could support more number of access with reduced OBI, which could eventually enhance a multiple access function.

Does stoma site specimen extraction increase postoperative ileostomy complication rates?

Science.gov (United States)

Li, Wanglin; Benlice, Cigdem; Stocchi, Luca; Kessler, Hermann; Gorgun, Emre; Costedio, Meagan

2017-09-01

Minimizing incisions has the potential to decrease hernia formation and wound complications following laparoscopic surgery. It is currently unknown if using the stoma site for specimen extraction affects outcomes. This study aims to evaluate the impact of stoma site extraction on postoperative complication rates in laparoscopic colorectal surgery. After IRB approval, a retrospective comparative review of 738 consecutive patients (405 M) who underwent laparoscopic colorectal surgery with ileostomy between January 2008 and December 2014 was performed. Patients who had a minimally invasive surgery that required an ileostomy were included. Patients were classified into two groups: stoma site extraction (SSE) or non-stoma site extraction (NSSE) and compared by body mass index (BMI), age, comorbidities, American Society of Anesthesiologists score, length of stay, estimated blood loss, parastomal complications, and hernia rate. The parastomal hernia rate was 10.1% for the SSE group (n = 14) and 4.2% for the NSSE group (n = 25) (p = 0.007). The need for additional surgeries was 7/139 (5.0%) for the SSE group and 27/599 (4.5%) for the NSSE group (p = 0.79). There was no difference in the hernia rate after stoma closure in either group. There was no difference in single incision laparoscopic surgery versus conventional laparoscopy or robotic-assisted laparoscopy on stoma site complications in patients with SSE. SSE, transfusion, and BMI >30 were found to be independent factors associated with increased stoma site complications. SSE does increase stoma site complications. SSE should be used with caution, or in conjunction with other techniques to reduce hernias in patients requiring a permanent stoma or with an elevated BMI. The increase in stoma site complications does not translate into additional surgeries or postoperative sequelae following stoma reversal and is a reasonable option in patients requiring a temporary stoma.

Perioperative and short-term oncological outcomes of single-port surgery for transverse colon cancer.

Science.gov (United States)

Tei, Mitsuyoshi; Suzuki, Yozo; Wakasugi, Masaki; Akamatsu, Hiroki

2017-06-01

To compare the perioperative and short-term oncological outcomes of patients who underwent single-port surgery (SPS) with those of patients who underwent multi-port surgery (MPS) for transverse colon cancer. The records of consecutive patients who underwent SPS (n = 75) or MPS (n = 41) for transverse colon cancer in our department between January, 2008 and December, 2015 were analyzed retrospectively. Operative times were significantly shorter in the SPS group than in the MPS group (185 vs. 195 min, respectively; P = 0.043). There were no significant differences in operative procedures, blood loss, or extent of lymph node dissection. The rate of postoperative complications was similar in both groups, but the length of hospital stay was significantly shorter in the single-port group than in the multi-port group (8 vs. 11 days, respectively; P transverse colon cancer.

Telemedicine and Plastic Surgery: A Pilot Study

Directory of Open Access Journals (Sweden)

Denis Souto Valente

2015-01-01

Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

Is hospital information system relevant to detect surgical site infection? Findings from a prospective surveillance study in posterior instrumented spinal surgery.

Science.gov (United States)

Boetto, J; Chan-Seng, E; Lonjon, G; Pech, J; Lotthé, A; Lonjon, N

2015-11-01

Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system. This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12 months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS). One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI. Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Impact of Arterial Access Site on Outcomes After Primary Percutaneous Coronary Intervention

DEFF Research Database (Denmark)

Hamon, Martial; Coste, Pierre; Van't Hof, Arnoud

2015-01-01

BACKGROUND: In European Ambulance Acute Coronary Syndrome Angiography (EUROMAX), bivalirudin improved 30-day clinical outcomes with reduced major bleeding compared with heparins plus optional glycoprotein IIb/IIIa inhibitors. We assessed whether choice of access site (radial or femoral) had an im...

Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry.

Science.gov (United States)

Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

2014-09-01

The impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of SSI after spine surgery. This study performs a multivariate analysis of SSI after spine surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after spine surgery. The patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data. An SSI that required return to the operating room for surgical debridement. Using a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis. The final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com. We present a validated model for predicting SSI after spine surgery. The value in this model is that it gives

Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbar spinal surgery in adults.

Science.gov (United States)

Ogihara, Satoshi; Yamazaki, Takashi; Maruyama, Toru; Oka, Hiroyuki; Miyoshi, Kota; Azuma, Seiichi; Yamada, Takashi; Murakami, Motoaki; Kawamura, Naohiro; Hara, Nobuhiro; Terayama, Sei; Morii, Jiro; Kato, So; Tanaka, Sakae

2015-01-01

Surgical site infection is a serious and significant complication after spinal surgery and is associated with high morbidity rates, high healthcare costs and poor patient outcomes. Accurate identification of risk factors is essential for developing strategies to prevent devastating infections. The purpose of this study was to identify independent risk factors for surgical site infection among posterior thoracic and/or lumbar spinal surgery in adult patients using a prospective multicenter surveillance research method. From July 2010 to June 2012, we performed a prospective surveillance study in adult patients who had developed surgical site infection after undergoing thoracic and/or lumbar posterior spinal surgery at 11 participating hospitals. Detailed preoperative and operative patient characteristics were prospectively recorded using a standardized data collection format. Surgical site infection was based on the definition established by the Centers for Disease Control and Prevention. A total of 2,736 consecutive adult patients were enrolled, of which 24 (0.9%) developed postoperative deep surgical site infection. Multivariate regression analysis indicated four independent risk factors. Preoperative steroid therapy (P = 0.001), spinal trauma (P = 0.048) and gender (male) (P = 0.02) were statistically significant independent patient-related risk factors, whereas an operating time ≥3 h (P operating time ≥3 h were independent risk factors for deep surgical site infection after thoracic and/or lumbar spinal surgery in adult patients. Identification of these risk factors can be used to develop protocols aimed at decreasing the risk of surgical site infection.

The responsibility of business enterprises to restore access to essential public service at resettlement sites

NARCIS (Netherlands)

van der Ploeg, Lidewij; Vanclay, Francis; Lourenço, Ivo; Hesselman, Marlies; Hallo de Wolf, Antenor; Toebes, Brigit

2017-01-01

This chapter examines the provision of essential public services in resettlement sites associated with project induced displacement. Restoring and improving access to essential public services in resettlement sites is an important aspect of livelihood restoration of affected peoples. Project

The learning curve of laparoendoscopic single-site (LESS) cholecystectomy: definable, short, and safe.

Science.gov (United States)

Hernandez, Jonathan; Ross, Sharona; Morton, Connor; McFarlin, Kellie; Dahal, Sujat; Golkar, Farhaad; Albrink, Michael; Rosemurgy, Alexander

2010-11-01

The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety. We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications. One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts. For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Over grafting donor site | Rogers | East and Central African Journal ...

African Journals Online (AJOL)

East and Central African Journal of Surgery. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 14, No 2 (2009) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Over grafting donor site. AD Rogers, AK ...

The Influence of Age at Single-Event Multilevel Surgery on Outcome in Children with Cerebral Palsy Who Walk with Flexed Knee Gait

Science.gov (United States)

Svehlik, Martin; Steinwender, Gerhard; Kraus, Tanja; Saraph, Vinay; Lehmann, Thomas; Linhart, Wolfgang E.; Zwick, Ernst B.

2011-01-01

Aim: Information on the timing and long-term outcome of single-event multilevel surgery in children with bilateral spastic cerebral palsy (CP) walking with flexed knee gait is limited. Based on our clinical experience, we hypothesized that older children with bilateral spastic CP would benefit more from single-event multilevel surgery than younger…

Single incision laparoscopic-assisted intestinal surgery (SILAIS) in 7 dogs and 1 cat.

Science.gov (United States)

Case, J Brad; Ellison, Gary

2013-06-01

To describe the clinical findings and short-term outcome in 7 dogs and 1 cat undergoing single-incision laparoscopic-assisted intestinal surgery (SILAIS) using an SILS™ or EndoCone™ port. Prospective case series. Dogs (n = 7) and cat (n = 1). An SILS™ port using three 5-mm instrument cannulas or EndoCone™ port was used to perform an initial limited laparoscopic abdominal exploration. The stomach and descending duodenum were explored intracorporeally and the jejunum through orad descending colon was explored extracorporeally. All intestinal procedures (enterotomy, biopsy, resection, and anastomosis) were performed extracorporeally. Omentalization of affected bowel was accomplished either intracorporeally or extracorporeally. Short-term outcome was determined. SILAIS was completed successfully in all but 1 dog and all animals had a good short-term outcome. Most (n = 5) animals were discharged the day after surgery. SILAIS was performed in a median of 120 minutes (interquartile range; 82-148 minutes) and was associated with a moderate level of difficulty. No major complications occurred but conversion to celiotomy (n = 1) and enlargement of the incision (n = 3) was required because of inability to exteriorize the affected bowel. SILAIS using an SILS™ or EndoCone™ port in dogs and cats is feasible and appears effective in selected cases. Single portal laparoscopic-assisted intestinal surgery might be an effective method of minimizing morbidity in dogs and cats with uncomplicated intestinal disease. © Copyright 2013 by The American College of Veterinary Surgeons.

INITIAL SINGLE-SHELL TANK (SST) SYSTEM PERFORMANCE ASSESSMENT OF THE HANFORD SITE

International Nuclear Information System (INIS)

JARAYSI, M.N.

2007-01-01

The ''Initial Single-Shell Tank System Performance Assessment for the Hanford Site [1] (SST PA) presents the analysis of the long-term impacts of residual wastes assumed to remain after retrieval of tank waste and closure of the SST farms at the US Department of Energy (DOE) Hanford Site. The SST PA supports key elements of the closure process agreed upon in 2004 by DOE, the Washington State Department of Ecology (Ecology), and the US Environmental Protection Agency (EPA). The SST PA element is defined in Appendix I of the ''Hanford Federal Facility Agreement and Consent Order'' (HFFACO) (Ecology et al. 1989) [2], the document that establishes the overall closure process for the SST and double-shell tank (DST) systems. The approach incorporated in the SST PA integrates substantive features of both hazardous and radioactive waste management regulations into a single analysis. The defense-in-depth approach used in this analysis defined two major engineering barriers (a surface barrier and the grouted tank structure) and one natural barrier (the vadose zone) that will be relied on to control waste release into the accessible environment and attain expected performance metrics. The analysis evaluates specific barrier characteristics and other site features that influence contaminant migration by the various pathways. A ''reference'' case and a suite of sensitivity/uncertainty cases are considered. The ''reference case'' evaluates environmental impacts assuming central tendency estimates of site conditions. ''Reference'' case analysis results show residual tank waste impacts on nearby groundwater, air resources; or inadvertent intruders to be well below most important performance objectives. Conversely, past releases to the soil, from previous tank farm operations, are shown to have groundwater impacts that re significantly above most performance objectives. Sensitivity/uncertainty cases examine single and multiple parameter variability along with plausible alternatives

Effects of surgical side and site on psychological symptoms following epilepsy surgery in adults.

Science.gov (United States)

Prayson, Brigid E; Floden, Darlene P; Ferguson, Lisa; Kim, Kevin H; Jehi, Lara; Busch, Robyn M

2017-03-01

This retrospective study examined the potential role of side and site of surgery in psychological symptom change after epilepsy surgery and determined the base rate of psychological change at the individual level. Two-hundred twenty-eight adults completed the Personality Assessment Inventory (PAI) before and after temporal (TLR; n=190) or frontal lobe resection (FLR; n=38). Repeated measures ANOVAs with bootstrapping examined differences in psychological outcome as a function of surgical site separately in patients who underwent left- versus right-sided resections. Individual's PAI score changes were then used to determine the prevalence of clinically meaningful postoperative symptom change. Following left-sided resections, there were significant group-by-time interactions on Somatic Complaints, Anxiety, and Anxiety Related Disorders. There was also a trend in this direction on the Depression scale. TLR patients endorsed greater preoperative symptoms than FLR patients on all of these scales, except the Somatic Complaints scale. After surgery, TLR patients reported symptom improvement on all four scales, while scores of FLR patients remained relatively stable over time. Endorsement of Mania-related symptoms increased in both TLR and FLR groups from pre-to post-surgical testing. Following right-sided resections, both groups endorsed symptom improvements on Somatic Complaints, Anxiety, and Depression scales following surgery. In addition, the TLR group endorsed more Mania-related symptoms than the FLR group regardless of time. Patterns of meaningful change in individual patients were generally consistent with group findings, with the most frequent improvements observed following TLR. However, there were a small subset of patients who reported symptom exacerbation after surgery. Our results suggest that surgical lateralization and localization are important factors in postoperative psychological outcome and highlight the importance of considering psychological change

An evaluation of the availability, accessibility, and quality of online content of vascular surgery training program websites for residency and fellowship applicants.

Science.gov (United States)

Huang, Bryant Y; Hicks, Taylor D; Haidar, Georges M; Pounds, Lori L; Davies, Mark G

2017-12-01

Vascular surgery residency and fellowship applicants commonly seek information about programs from the Internet. Lack of an effective web presence curtails the ability of programs to attract applicants, and in turn applicants may be unable to ascertain which programs are the best fit for their career aspirations. This study was designed to evaluate the presence, accessibility, comprehensiveness, and quality of vascular surgery training websites (VSTW). A list of accredited vascular surgery training programs (integrated residencies and fellowships) was obtained from four databases for vascular surgery education: the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, Fellowship and Residency Electronic Interactive Database, and Society for Vascular Surgery. Programs participating in the 2016 National Resident Matching Program were eligible for study inclusion. Accessibility of VSTW was determined by surveying the Accreditation Council for Graduate Medical Education, Electronic Residency Application Service, and Fellowship and Residency Electronic Interactive Database for the total number of programs listed and for the presence or absence of website links. VSTW were analyzed for the availability of recruitment and education content items. The quality of VSTW was determined as a composite of four dimensions: content, design, organization, and user friendliness. Percent agreements and kappa statistics were calculated for inter-rater reliability. Eighty-nine of the 94 fellowship (95%) and 45 of the 48 integrated residencies (94%) programs participating in the 2016 Match had a VSTW. For program recruitment, evaluators found an average of 12 of 32 content items (35.0%) for fellowship programs and an average of 12 of 32 (37%) for integrated residencies. Only 47.1% of fellowship programs (53% integrated residencies) specified the number of positions available for the 2016 Match, 20% (13% integrated residencies) indicated alumni

Simple Enough--Even for Web Virgins: Lisa Mitten's Access to Native American Web Sites. Web Site Review Essay.

Science.gov (United States)

Belgarde, Mary Jiron

1998-01-01

A mixed-blood Mohawk urban Indian and university librarian, Lisa Mitten provides access to Web sites with solid information about American Indians. Links are provided to 10 categories--Native nations, Native organizations, Indian education, Native media, powwows and festivals, Indian music, Native arts, Native businesses, and Indian-oriented home…

South African Journal of Surgery

African Journals Online (AJOL)

The South African Journal of Surgery is published by the South African Medical Association and publishes papers related to surgery. Other websites related to this journal: http://www.sajs.org.za/index.php/sajs. Vol 56, No 1 (2018). DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT Subscription or Fee Access ...

Beyond Section 508: The Spectrum of Legal Requirements for Accessible e-Government Web Sites in the United States

Science.gov (United States)

Jaeger, Paul T.

2004-01-01

In the United States, a number of federal laws establish requirements that electronic government (e-government) information and services be accessible to individuals with disabilities. These laws affect e-government Web sites at the federal, state, and local levels. To this point, research about the accessibility of e-government Web sites has…

Past and present in abdominal surgery management for Cushing's syndrome.

Science.gov (United States)

Vilallonga, Ramon; Zafon, Carles; Fort, José Manuel; Mesa, Jordi; Armengol, Manel

2014-01-01

Data on specific abdominal surgery and Cushing's syndrome are infrequent and are usually included in the adrenalectomy reports. Current literature suggests the feasibility and reproducibility of the surgical adrenalectomies for patients diagnosed with non-functioning tumours and functioning adrenal tumours including pheochromocytoma, Conn's syndrome and Cushing's syndrome. Medical treatment for Cushing's syndrome is feasible but follow-up or clinical situations force the patient to undergo a surgical procedure. Laparoscopic surgery has become a gold standard nowadays in a broad spectrum of pathologies. Laparoscopic adrenalectomies are also standard procedures nowadays. However, despite the different characteristics and clinical disorders related to the laparoscopically removed adrenal tumours, the intraoperative and postoperative outcomes do not significantly differ in most cases between the different groups of patients, techniques and types of tumours. Tumour size, hormonal type and surgeon's experience could be different factors that predict intraoperative and postoperative complications. Transabdominal and retroperitoneal approaches can be considered. Outcomes for Cushing's syndrome do not differ depending on the surgical approach. Novel technologies and approaches such as single-port surgery or robotic surgery have proven to be safe and feasible. Laparoscopic adrenalectomy is a safe and feasible approach to adrenal pathology, providing the patients with all the benefits of minimally invasive surgery. Single-port access and robotic surgery can be performed but more data are required to identify their correct role between the different surgical approaches. Factors such as surgeon's experience, tumour size and optimal technique can affect the outcomes of this surgery.

Operational Circular No. 2 (Rev. 3) - Conditions of access to the fenced parts of the CERN site

CERN Multimedia

HR Department

2015-01-01

Operational Circular No. 2 (Rev. 3) entitled "Conditions of access to the fenced parts of the CERN site", approved by the Director-General following discussion in the Standing Concertation Committee meeting on 24 September 2015, is now available via this link.   This revised circular cancels and replaces Operational Circular No. 2 (Rev. 2) also entitled "Conditions of access to the fenced parts of the CERN site", of September 2014. The circular was revised predominantly in order to specify that access to the CERN site is granted to CERN Pension Fund beneficiaries only provided that they are actually in receipt of payments from the Fund; and to allow the Director-General to permit special types of vehicles on site, such as trailers. It also includes a certain number of text improvements and an updated version of the implementation measures, in particular with regard to vehicle identification, road traffic and parking.  

Surgical site infection in posterior spine surgery

African Journals Online (AJOL)

2016-03-20

Mar 20, 2016 ... Methodology: All consecutive patients who had posterior spine surgeries between January 2012 ... However, spinal instrumentation, surgery on cervical region and wound inspection on or ... While advances have been made in infection control ... costs, due to loss of productivity, patient dissatisfaction and.

Investigation of prototypal MOFs consisting of polyhedral cages with accessible Lewis-acid sites for quinoline synthesis.

Science.gov (United States)

Gao, Wen-Yang; Leng, Kunyue; Cash, Lindsay; Chrzanowski, Matthew; Stackhouse, Chavis A; Sun, Yinyong; Ma, Shengqian

2015-03-21

A series of prototypal metal-organic frameworks (MOFs) consisting of polyhedral cages with accessible Lewis-acid sites, have been systematically investigated for Friedländer annulation reaction, a straightforward approach to synthesizing quinoline and its derivatives. Amongst them MMCF-2 demonstrates significantly enhanced catalytic activity compared with the benchmark MOFs, HKUST-1 and MOF-505, as a result of a high-density of accessible Cu(II) Lewis acid sites and large window size in the cuboctahedral cage-based nanoreactor of MMCF-2.

Development and Validation of a Preprocedural Risk Score to Predict Access Site Complications After Peripheral Vascular Interventions Based on the Vascular Quality Initiative Database

Directory of Open Access Journals (Sweden)

Daniel Ortiz

2016-01-01

Full Text Available Purpose: Access site complications following peripheral vascular intervention (PVI are associated with prolonged hospitalization and increased mortality. Prediction of access site complication risk may optimize PVI care; however, there is no tool designed for this. We aimed to create a clinical scoring tool to stratify patients according to their risk of developing access site complications after PVI. Methods: The Society for Vascular Surgery’s Vascular Quality Initiative database yielded 27,997 patients who had undergone PVI at 131 North American centers. Clinically and statistically significant preprocedural risk factors associated with in-hospital, post-PVI access site complications were included in a multivariate logistic regression model, with access site complications as the outcome variable. A predictive model was developed with a random sample of 19,683 (70% PVI procedures and validated in 8,314 (30%. Results: Access site complications occurred in 939 (3.4% patients. The risk tool predictors are female gender, age > 70 years, white race, bedridden ambulatory status, insulin-treated diabetes mellitus, prior minor amputation, procedural indication of claudication, and nonfemoral arterial access site (model c-statistic = 0.638. Of these predictors, insulin-treated diabetes mellitus and prior minor amputation were protective of access site complications. The discriminatory power of the risk model was confirmed by the validation dataset (c-statistic = 0.6139. Higher risk scores correlated with increased frequency of access site complications: 1.9% for low risk, 3.4% for moderate risk and 5.1% for high risk. Conclusions: The proposed clinical risk score based on eight preprocedural characteristics is a tool to stratify patients at risk for post-PVI access site complications. The risk score may assist physicians in identifying patients at risk for access site complications and selection of patients who may benefit from bleeding avoidance

Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis: a randomized, prospective, controlled trial.

Science.gov (United States)

Bickel, Amitai; Gurevits, Michael; Vamos, Ronny; Ivry, Simon; Eitan, Arieh

2011-04-01

To assess the influence of hyperoxygenation on surgical site infection by using the most homogeneous study population. A randomized, prospective, controlled trial. Department of surgery in a government hospital. A total of 210 patients who underwent open surgery for acute appendicitis. In the study group, patients received 80% oxygen during anesthesia, followed by high-flow oxygen for 2 hours in the recovery room. The control group received 30% oxygen, as usual. Open appendectomy via incision in the right lower quadrant of the abdomen. Surgical site infection, mainly assessed by the ASEPSIS (additional treatment, serous discharge, erythema, purulent discharge, separation of deep tissues, isolation of bacteria, and stay in hospital prolonged >14 days) system score. Surgical site infections were recorded in 6 of 107 patients (5.6%) in the study group vs 14 of 103 patients (13.6%) in the control group (P = .04). Significant differences in the ASEPSIS score were also found. The mean hospital stay was longer in the control group (2.92 days) compared with the study group (2.51 days) (P = .01). The use of supplemental oxygen is advantageous in operations for acute appendicitis by reducing surgical site infection rate and hospital stay. clinicaltrials.gov Identifier: NCT01002365.

Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

Directory of Open Access Journals (Sweden)

Jad eChahoud

2014-03-01

Full Text Available Surgical site infection (SSI following spine surgery is a dreaded complication with significant morbidity and economic burden. SSIs following spine surgery can be superficial, characterized by obvious wound drainage, or deep-seated with a healed wound. Staphylococcus aureus remains the principal causal agent. There are certain pre-operative risk factors that increase the risk of SSI, mainly diabetes, smoking, steroids, and peri-operative transfusions. Additionally, intra-operative risk factors include surgical invasiveness, type of fusion, implant use, and traditional instead of minimally invasive approach. A high level of suspicion is crucial to attaining an early definitive diagnosis and initiating appropriate management. The most common presenting symptom is back pain, usually manifesting 2 to 4 weeks and up to 3 months after a spinal procedure. Scheduling a follow-up visit between weeks 2 to 4 after surgery is therefore necessary for early detection. Inflammatory markers are important diagnostic tools, and comparing pre-operative with post-operative levels should be done when suspecting SSIs following spine surgery. Particularly, Serum Amyloid A (SAA is a novel inflammatory marker that can expedite the diagnosis of SSIs. Magnetic resonance imaging remains the diagnostic modality of choice when suspecting a SSI following spine surgery. While 18F-fluorodeoxyglucose-positron emission tomography is not widely used, it may be useful in challenging cases. Despite their low yield, blood cultures should be collected before initiating antibiotic therapy. Samples from wound drainage should be sent for Gram stain and cultures. When there is a high clinical suspicion of SSI and in the absence of superficial wound drainage, CT guided aspiration of paraspinal collections is warranted. Unless the patient is hemodynamically compromised, antibiotics should be deferred until proper specimens for culture are secured.

Totally Transanal Laparo-Endoscopic Single-Site ProctoColectomy-Ileoanal J-Pouch (TLPC-J: An Experimental Study of a Novel Approach

Directory of Open Access Journals (Sweden)

Mohammad Reza Vahdad

2015-09-01

Full Text Available Background: The natural orifice transluminal endoscopic surgery (NOTES has become a commonly considered novel approach in the surgical field. The NOTES provide possibility of operation through the natural orifice and decreases the intentional puncture of the systemic organ and subsequent complications. Totally transanal laparo-endoscopic single-site proctoColectomy-Ileoanal J-Pouch (TLPC-J is a novel method in minimally invasive surgery for total colectomy. The main goal of this study is to perform this new method on an animal model, to assess probable complication and to resolve probable issues by using patients that are candidate for total colectomy. Method: Five dogs were prepared in lithotomy position. The TLPC-I procedure consists of endorectal technique with full thickness rectal dissection starting 1 cm orally from the dentate line above the peritoneal reflection and the proximal bowel was replaced into the abdominal cavity. Afterwards, the TriPort system was inserted in the anal canal and mesentrial resection of the total colon, mobilization of a distal ileal segment and intracorporeal suture of an ileal J-loop was accomplished by this system. An incision in the J-loop was conducted transanally. The J-pouch was created with an Endo-GIA® and sutured to the rectal wall. Results: All animals survived and passed stool with clear post operation situation. There was no infection in site of anastomosis. Conclusion: The TLPC-I provides the possibility of surgery without abdominal wall incision and decreases post operation complication such as pain, abdominal wound infection and wound dehiscence. This technique increases the quality of life and surgeons can discharge the patients early.

Laparoendoscopic single-site myomectomy and the use of fibrin sealant (Tisseel

Directory of Open Access Journals (Sweden)

Angelito Magno

2015-11-01

Full Text Available Myomectomy remains the standard surgical treatment for women with uterine myoma, who wish to preserve their fertility. However, it is often associated with increased blood loss and adhesion formation. Laparoscopic myomectomy has multiple advantages over open myomectomy1. A newer approach, laparoendoscopic single-site surgery, also known as LESS, has been developed and applied in gynecologic field.2 This is a case of a 41-year-old G2P1 patient, with the complaints of irregular menstrual cycles and lower abdominal pain for 6 months. Transvaginal ultrasound showed uterine myoma at the anterior corpus, measuring 6 × 5 cm2. The procedure is started by grasping the bilateral edges of the umbilicus with Allis forceps. A vertical incision, 1.5–2 cm, is made from the superficial skin of the umbilicus to the ventral peritoneum. A wound retractor of appropriate size is inserted and adjusted. A multiple instrument access port (LagisEndosurgical, Taichung, Taiwan is placed over the wound retractor (Figure 1. Prior to the procedure, inspection of the pelvic organs is performed to determine the pathology. Vasopressin is injected over the area of the myoma to decrease blood loss. Location of the myoma is then identified. Uterine incision is made on the serosa over the area of the myoma using the monopolar scissors. Using a bipolar instrument LigaSure®, ValleyLab, Inc., Boulder, Colorado, the incision is extended until the myoma is exposed. The myoma is grasped gently using the tenaculum forcep, and dissected bluntly along with it's pseudocapsule using the tip of suction irrigation gear. At the base of the myoma where feeding vessels may be located, coagulation by the advanced bipolar, is performed to prevent bleeding. The specimen is removed through the umbilicus. A sliding knot is made at the tail of one zero monofilament suture to fasten the anchor of the first knot. The uterus is then repaired with a continuous non-locking method. Hemostasis is

Accessibility Trends among Academic Library and Library School Web Sites in the USA and Canada

Science.gov (United States)

Schmetzke, Axel; Comeaux, David

2009-01-01

This paper focuses on the accessibility of North American library and library school Web sites for all users, including those with disabilities. Web accessibility data collected in 2006 are compared to those of 2000 and 2002. The findings of this follow-up study continue to give cause for concern: Despite improvements since 2002, library and…

Case scheduling preferences of one Surgeon's cataract surgery patients.

Science.gov (United States)

Dexter, Franklin; Birchansky, Lee; Bernstein, James M; Wachtel, Ruth E

2009-02-01

The increase in the number of operating rooms nationwide in the United States may reflect preferences of patients for scheduling of outpatient surgery. Yet, little is known of the importance that patients place on scheduling convenience and flexibility. Fifty cataract surgery patients seen by a surgeon at his main office during a 6-mo period responded to a marketing survey. All the patients had Medicare insurance and supplemental insurance permitting surgery at any facility. A telephone questionnaire included four vignettes describing different choices in the scheduling of cataract surgery. Respondents were asked how far they would be willing to travel for one option instead of another. For example, "Your surgery will be on Thursday in three weeks at 2 pm. You can drink water until 9 am. You arrive at 10 am, because your surgery might start early. If you travel farther, you would arrive at 8 am for 9 am surgery." The median (50th percentile) additional travel time was 60 min (lower 95% confidence bound >or=52 min) for each of four options: to receive care on a day chosen by the patient instead of assigned by the physician, to receive care at a single site instead of both the surgeon's office and a surgery center at a different location, to combine the examination and the surgery into a single visit instead of two visits, and to have surgery in the morning instead of the afternoon. The patients of this ophthalmologist placed a high value on convenience and flexibility in scheduling their surgery. In general, this would be achievable only if many operating rooms were available each morning.

HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files

Data.gov (United States)

U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

[The role of antiarrhythmic surgery in 2004].

Science.gov (United States)

Guiraudon, G M

2004-11-01

In 2004, surgery for cardiac arrhythmias addresses essentially atrial fibrillation. Surgery is only a rare alternative for other cardiac arrhythmias in center that still have the surgical skill. Surgery for atrial fibrillation has the definite advantage of concomitant exclusion of the left atrial appendage which is the predominant site of intra-atrial thrombi with the associated risk of severe thrombo-embolic events. Our experience with surgery for lone atrial fibrillation, using the Corridor III operation, shows that surgery is associated with high efficacy and long term control of arrhythmia when the surgical technique is well performed. Failures were associated with incomplete line of block or exclusion. This experience shows the necessity of postoperative EP testing. Initially performed using open heart technique, surger for atrial fibrillation is now performed using mini-invasive technique. Indications for surgery for lone atrial fibrillation will decreased while other strategies are developing. To remain competitive surgery must have high efficacy and use mini-invasive techniques. i.e.: closed off pump beating heart via port access. Surgery for atrial fibrillation concomitant with other cardiac surgical repairs yields remarkable results, without increased surgical risk. Their indications go beyond mitral valve pathology. Future developments imply the following conditions: atrial surgery must not increase morbidity, and its cost-effectiveness must be documented. Combined surgery must be testable and tested to gain valid pathophysiological data to improve surgical rationales. Its impact in terms of survival, prevention of thrombo-embolic events and quality of life will be documented by clinical trials.

Vascular access in critical limb ischemia.

Science.gov (United States)

Kang, Won Yu; Campia, Umberto; Ota, Hideaki; Didier, Romain J; Negi, Smita I; Kiramijyan, Sarkis; Koifman, Edward; Baker, Nevin C; Magalhaes, Marco A; Lipinski, Michael J; Escarcega, Ricardo O; Torguson, Rebecca; Waksman, Ron; Bernardo, Nelson L

2016-01-01

Currently, percutaneous endovascular intervention is considered a first line of therapy for treating patients with critical limb ischemia. As the result of remarkable development of techniques and technologies, percutaneous endovascular intervention has led to rates of limb salvage comparable to those achieved with bypass surgery, with fewer complications, even in the presence of lower rates of long-term patency. Currently, interventionalists have a multiplicity of access routes including smaller arteries, with both antegrade and retrograde approaches. Therefore, the choice of the optimal access site has become an integral part of the success of the percutaneous intervention. By understanding the technical aspects, as well as the advantages and limitations of each approach, the interventionalists can improve clinical outcomes in patients with severe peripheral arterial disease. This article reviews the access routes in critical limb ischemia, their advantages and disadvantages, and the clinical outcomes of each. Copyright © 2016 Elsevier Inc. All rights reserved.

Site-controlled InGaN/GaN single-photon-emitting diode

Energy Technology Data Exchange (ETDEWEB)

Zhang, Lei; Deng, Hui, E-mail: dengh@umich.edu [Department of Physics, University of Michigan, 450 Church St., Ann Arbor, Michigan 48109 (United States); Teng, Chu-Hsiang; Ku, Pei-Cheng, E-mail: peicheng@umich.edu [Department of Electrical Engineering and Computer Science, University of Michigan, 1301 Beal Ave., Ann Arbor, Michigan 48109 (United States)

2016-04-11

We report single-photon emission from electrically driven site-controlled InGaN/GaN quantum dots. The device is fabricated from a planar light-emitting diode structure containing a single InGaN quantum well, using a top-down approach. The location, dimension, and height of each single-photon-emitting diode are controlled lithographically, providing great flexibility for chip-scale integration.

Umbilical Microflora, Antiseptic Skin Preparation, and Surgical Site Infection in Abdominal Surgery.

Science.gov (United States)

Kleeff, Jörg; Erkan, Mert; Jäger, Carsten; Menacher, Maximilian; Gebhardt, Friedemann; Hartel, Mark

2015-08-01

Surgical site infections (SSI) following abdominal surgery are frequent and a major cause of postoperative morbidity and prolonged hospital stay. Besides antibiotic prophylaxis, antiseptic skin preparation is an important measure to prevent SSI. Here we prospectively analyzed the effectiveness of antiseptic skin preparation in a cohort of 93 patients undergoing laparotomy, with special emphasis on the umbilical region. The microflora of the umbilicus contained a large number of resident (mostly staphylococci species and corynebacteria) and transient germs (including enterococci species). Following antiseptic skin preparation, bacteria could still be cultured from 24.7% of the patients' umbilici. In case of postoperative SSI, only one of seven SSI was caused by the microorganism that was present in the umbilicus before and after skin preparation. Antiseptic skin preparation fails to completely eradicate the microflora of the umbilical region in one quarter of the patients. However, at least in abdominal surgery, the vast majority of SSI are caused by intra-abdominal contamination rather than the skin microflora.

Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases.

Science.gov (United States)

Mamelak, Adam N; Carmichael, John; Bonert, Vivien H; Cooper, Odelia; Melmed, Shlomo

2013-09-01

The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke's cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke's cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92% concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73%) for GH-secreting, 12/12 (100%) for ACTH-secreting, and 8/17 (47%) for prolactin-secreting tumors. Post-operative complications included transient (11%) and permanent (1.4%) diabetes insipidus, hyponatremia (13%), and new anterior pituitary hormonal deficits (1.4%). CSF leak occurred in 42 cases (15%), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10% of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes

Development of rail access to the proposed repository site at Yucca Mountain

International Nuclear Information System (INIS)

Standish, P.N.; Seidler, P.E.; Andrews, W.B.; Shearin, G.

1991-01-01

In accordance with the Nuclear Waste Policy Amendment Act of 1987, Yucca Mountain was designated as the initial site to be investigated as a potential repository for the disposal of high-level radioactive waste. The Yucca Mountain site is an undeveloped area located on the southwestern edge of the Nevada Test Site (NTS), about 100 miles northwest of Las Vegas. The site currently lacks rail service or an existing right-of-way. If the Yucca Mountain site is found suitable for the repository, rail service is considered desirable by the Office of Civilian Radioactive Waste Management (OCRWM) program because of the potential of rail transportation to reduce (1) costs and (2) number of shipments, relative to highway transportation. Therefore, it is necessary to conduct a study to determine (1) that there are alignments for a potential rail line from existing mainline railroads to Yucca Mountain and (2) that these are consistent with present rail design standards and are acceptable relative to environmental and land access considerations

Is double-gloving really protective? A comparison between the glove perforation rate among perioperative nurses with single and double gloves during surgery.

Science.gov (United States)

Guo, Yue Ping; Wong, Po Ming; Li, Yi; Or, Peggy Pui Lai

2012-08-01

Surgical teams rely on surgical gloves as a barrier to protect themselves against blood-borne pathogenic infections during surgery. Double-gloving is adopted by surgeons to tackle the problem of glove perforation. Nevertheless, double-gloving is not practiced commonly by operating room nurses and there are only limited studies about double-gloving that targets only perioperative nurses. The aim of this research was to assess the effectiveness of double-gloving in protecting perioperative nurses by comparing the frequency of glove perforation between single-gloving and double-gloving groups. A prospective and randomized study was performed. Nurses were assigned randomly to single-gloved and double-gloved groups for comparison of the glove perforation rate. Water-leakage and air-inflation tests were used to detect glove perforation. Glove perforations was detected in 10 of 112 sets of single-gloves (8.9%) and 12 of 106 sets of outer gloves in the double-gloved group (11.3%). There was no inner double-glove perforation (0%). Glove perforations were found in 6 and 4 of the 112 sets of single-gloves for the first assistants (5.36%) and the scrub nurses (3.57%), and 5 and 7 of 106 sets of outer gloves in the double-gloved group for the first assistants (4.72%) and the scrub nurses (6.60%), respectively. The average occurrence of perforation was 69.8 minutes (range, 20-110 min) after the beginning of surgery. The sites of perforation were localized mostly on the left middle finger (42%) and the left ring finger (33.3%). Based on the findings of the study, double-gloving is indeed effective in protecting operating room nurses against blood-borne pathogen exposure. It should be introduced as a routine practice. Copyright © 2012 Elsevier Inc. All rights reserved.

Laparoscopic single-port ovariectomy and gastropexy in dogs.

Science.gov (United States)

Gandini, M; Giusto, G

2016-11-01

In this study single-port percutaneous laparoscopic gastropexy in dogs using barbed suture material in combination with ovariectomy is described. A single port preventive gastropexy was performed in 6 female German shepherds in combination with ovariectomy using a laparoscope. Surgery time, intraoperative, postoperative and follow up complications were recorded. In this study median surgery time in clinical cases was 73 minutes (range 66-79). The only difficulty reported was visualization of a proper site for gastropexy on the stomach. No complications and/or episodes of gastric volvulus were detected at a 3-month minimum follow-up. The proposed technique provides an effective and minimally invasive approach to ovariectomy and preventive gastropexy in dogs.

Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

Science.gov (United States)

Yassa, Rafik Rd; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

2017-03-01

The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. UK University Teaching Hospital. All patients ( n  = 460) presenting across a single year study period with a confirmed hip fracture. The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection ( p -value: 0.0005). The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients.

Science.gov (United States)

Danan, Eleanor; Smith, Janessa; Kruer, Rachel M; Avdic, Edina; Lipsett, Pamela; Curless, Melanie S; Jarrell, Andrew S

2018-04-24

Current practice guidelines for antimicrobial prophylaxis in surgery recommend a cephamycin or cefazolin plus metronidazole for various abdominal surgeries. In February 2016, cephamycin drug shortages resulted in a change in The Johns Hopkins Hospital's (JHH) recommendation for peri-operative antibiotic prophylaxis in abdominal surgeries from cefotetan to cefazolin plus metronidazole. The primary objective of this study was to quantify the percentage of abdominal surgeries adherent to JHH peri-operative antibiotic prophylaxis guidelines. A sub-group analysis investigated whether prophylaxis with cefazolin plus metronidazole was associated with a lower rate of surgical site infections (SSIs) versus cefotetan. This retrospective cohort study included adult inpatients who underwent an abdominal surgery at JHH in September 2015 (Study Period I: cefotetan) or February to March 2016 (Study Period II: cefazolin plus metronidazole). Two hundred abdominal surgery cases were included in the primary analysis. A subset of 156 surgical cases were included in the sub-group analysis. The overall adherence rate to JHH guidelines was 75% in Study Period I versus 17% in Study Period II (p operative administration time (87% vs. 23%, p site infections occurred in 14% (12/83) of surgeries with cefotetan versus 8.2% (6/73) with cefazolin plus metronidazole for prophylaxis (p = 0.19). Adherence to an institution-specific peri-operative antibiotic prophylaxis guideline for abdominal surgeries was limited primarily by the longer infusion time required for pre-operative metronidazole. A higher percentage of SSIs occurred among abdominal surgeries with cefotetan versus cefazolin plus metronidazole for prophylaxis.

Robotic surgery for rectal cancer: a single center experience of 100 consecutive cases.

Science.gov (United States)

Stănciulea, O; Eftimie, M; David, L; Tomulescu, V; Vasilescu, C; Popescu, I

2013-01-01

Minimally invasive techniques have revolutionized the field of general surgery over the few last decades. Despite its advantages, in complex procedures such as rectal surgery, laparoscopy has not achieved a high penetration rate because of its steep learning curve, its relatively high conversion rate and technical challenges. The aim of this study was to present a single center experience with robotic surgery for rectal cancer focusing mainly on early and mid-term postoperative outcome. A series of 100 consecutive patients who underwent robotic rectal surgery between January 2008 and June 2012 was analyzed retrospectively in terms of demographics, pathological data, surgical and oncological outcomes. Seventy-seven patients underwent robotic sphincter-saving resection, and 23 patients underwent robotic abdominoperineal resection. There were 4 conversions. The median operative time for sphincter-saving procedures was 180 min. The median time for robotic abdominoperineal resection was 160 min. The median distal resection margin of the operative specimen was 3 cm. The median number of retrieved lymph nodes was 14. The median hospital stay was 10 days. In-hospital mortality was nil. The overall morbidity was 30%. Four patients presented transitory postoperative urinary dysfunction. Severe erectile dysfunction was reported by 3 patients. The median length of follow-up was 24 months. The 3-year overall survival rate was 90%. Robotic surgery is advantageous for both surgeons (in that it facilitates dissection in a narrow pelvis) and patients (in that it affords a very good quality of life via the preservation of sexual and urinary function in the vast majority of patients and it has low morbidity and good midterm oncological outcomes). In rectal cancer surgery, the robotic approach is a promising alternative and is expected to overcome the low penetration rate of laparoscopy in this field. Celsius.

Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery.

Science.gov (United States)

Siddiqui, Zohaib A; Husain, Fahd; Siddiqui, Zain; Siddiqui, Midhat

2017-06-18

Endometriomas are a rare cause of abdominal wall pain. We report a case of a port site endometrioma presenting with an umbilical swelling. The patient underwent a laparoscopy for pelvic endometriosis 6 months previously and presented with a swelling around her umbilical port site scar associated with cyclical pain during menses. Ultrasound scan reported a well-defined lesion in the umbilicus and MRI scanning excluded other pathology. As she was symptomatic, she underwent an exploration of the scar and excision of the endometrioma with resolution of her symptoms. Precautions should be taken to reduce the risk of endometrial seeding during laparoscopic surgery. All tissues should be removed in an appropriate retrieval bag and the pneumoperitoneum should be deflated completely before removing ports to reduce the chimney effect of tissue being forced through the port site. The diagnosis should be considered in all women of reproductive age presenting with a painful port site scar. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Drainage of amoebic liver abscess by single incision laparoscopic surgery. Report of a case].

Science.gov (United States)

Telich-Tarriba, José Eduardo; Parrao-Alcántara, Iris Jocelyn; Montes-Hernández, Jesús Manuel; Vega-Pérez, Jesús

2015-01-01

Single incision laparoscopic surgery has increased recently due to successful results, achieved in several procedures. The aim of the present work is to present the first case in which single incision laparoscopy is used for the drainage of an amoebic liver abscess. A 44-year-old man presented with intense right upper quadrant pain, generalised jaundice, tachycardia, fever, hepatomegaly and a positive Murphy's sign. Laboratory results revealed an increased plasma bilirubin, elevated alkaline phosphatase and transaminases, leucocytosis, negative viral panel for hepatitis, and positive antibodies against Entamoeba histolytica. On an abdominal computed tomography a 15 × 12.1 cm hypodense lesion was observed in the patient's liver, identified as an amoebic liver abscess. Analgesics and antibiotics were started and subsequently the patient was submitted to laparoscopic drainage of the abscess using a single port approach. Drainage and irrigation of the abscess was performed. Four days later the patient was discharged without complications. Management of amoebic liver abscess is focused on the elimination of the infectious agent and obliteration of the abscess cavity in order to prevent its complications, especially rupture. Laparoscopic surgery has proved to be a safe and effective way to manage this entity. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes.

Science.gov (United States)

Angioni, Stefano; Pontis, Alessandro; Sedda, Federica; Zampetoglou, Theodoros; Cela, Vito; Mereu, Liliana; Litta, Pietro

2015-01-01

Bilateral salpingo-oophorectomy (BSO) in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy-BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy.

Port insertion for minimally invasive surgery: a report of practices in the Irish Republic.

Science.gov (United States)

Harrington, Cuan M; Kavanagh, Dara O; Tierney, Sean; Deane, Richard; Hehir, Dermot

2018-02-06

With rapidly evolving surgical technologies, minimally invasive surgery (MIS) has become the mainstay approach for many surgeons worldwide. As laparoscopic surgery was introduced in Ireland over two decades ago, we may be encountering a higher prevalence of related complications. This study aimed to gather data pertaining to risk factors for port-site herniation in MIS. A 14-point anonymous questionnaire was distributed electronically between January and May 2017 to consultant and trainee laparoscopists in the Republic of Ireland. This survey related to laparoscopic volume and surgical approaches to laparoscopic port-sites. There were 172 eligible responses nationally. Approaches to peritoneal access included Hasson, veress (blind puncture) and SILS were 66.3, 32.6 and 1.2%, respectively. Senior surgeons and specialists in Obstetrics and Gynaecology (OBGYN) reported significantly higher utilisations of closed peritoneal access (p ports using absorbable suture in 76.7%, non-absorbable suture in 14.5% and port closure devices in 8.7%. Perceptions of risk factors for PSH were not congruent with significant variations in responses between levels of expertise. This study demonstrates significant variations in laparoscopic port-site practices amongst surgeons nationally. The new era of practitioners may benefit from evidence-based technical workshops and guidelines to increase awareness and reduce potential complications.

Post site metastasis of breast cancer after video-assisted thoracic surgery for pulmonary metastasis of breast cancer: A case report

Energy Technology Data Exchange (ETDEWEB)

Park, Mee Hyun; Hwang, Ji Young; Hyun, Su Jeong; Lee, Yul; Woo, Ji Young; Yang, Ik; Hong, Hye Sook; Kim, Han Myun [Dept. of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)

2016-05-15

We reported a case of port site metastasis in a 57-year-old patient who underwent video-assisted thoracic surgery (VATS) resection of pulmonary metastasis from breast cancer. Port site metastasis after VATS is very rare in patients with breast cancer. However, when suspicious lesions are detected near the port site in patients who have undergone VATS for pulmonary metastasis, port site metastasis should be considered in the differential diagnosis.

The Effects of Noncontingent Access to Single-versus Multiple-Stimulus Sets on Self-Injurious Behavior.

Science.gov (United States)

DeLeon, Iser G.; Anders, Bonita M.; Rodriguez-Catter, Vanessa; Neidert, Pamela L.

2000-01-01

The automatically reinforced self-injury of a girl (age 11) with autism was treated by providing noncontingent access to a single set of preferred toys during 30-minute sessions. Rotating toy sets after 10 minutes or providing access to multiple toy sets resulted in reductions that lasted the entire 30 minutes. (Contains four references.)…

Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study.

Science.gov (United States)

Yamada, Shozo; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Ito, Junko

2018-03-30

OBJECTIVE The aim of this study was to analyze the outcomes of transsphenoidal surgery (TSS) in a single-center clinical series of pediatric craniopharyngioma patients treated with gross-total resection (GTR). METHODS The authors retrospectively reviewed the surgical outcomes for 65 consecutive patients with childhood craniopharyngiomas (28 girls and 37 boys, mean age 9.6 years) treated with TSS (45 primary and 20 repeat surgeries) between 1990 and 2015. Tumors were classified as subdiaphragmatic or supradiaphragmatic. Demographic and clinical characteristics, including extent of resection, complications, incidence of recurrence, pre- and postoperative visual disturbance, pituitary function, and incidence of diabetes insipidus (DI), as well as new-onset obesity, were analyzed and compared between the primary surgery and repeat surgery groups. RESULTS Of the 45 patients in the primary surgery group, 26 (58%) had subdiaphragmatic tumors and 19 had supradiaphragmatic tumors. Of the 20 patients in the repeat surgery group, 9 (45%) had subdiaphragmatic tumors and 11 had supradiaphragmatic tumors. The only statistically significant difference between the 2 surgical groups was in tumor size; tumors were larger (mean maximum diameter 30 mm) in the primary surgery group than in the repeat surgery group (25 mm) (p = 0.008). GTR was accomplished in 59 (91%) of the 65 cases; the GTR rate was higher in the primary surgery group than in the repeat surgery group (98% vs 75%, p = 0.009). Among the patients who underwent GTR, 12% experienced tumor recurrence, with a median follow-up of 7.8 years, and recurrence tended to occur less frequently in primary than in repeat surgery patients (7% vs 27%, p = 0.06). Of the 45 primary surgery patients, 80% had deteriorated pituitary function and 83% developed DI, whereas 100% of the repeat surgery patients developed these conditions. Among patients with preoperative visual disturbance, vision improved in 62% but worsened in 11%. Visual

Robotic Applications in Cardiac Surgery

Directory of Open Access Journals (Sweden)

Alan P. Kypson

2008-11-01

Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

Chapter 12: Surgery for sinonasal disease.

Science.gov (United States)

Higgins, Thomas S; Lane, Andrew P

2013-01-01

Surgery for chronic rhinosinusitis is an effective complement to a well-designed medical regimen. Functional endoscopic sinus surgery is among the most common surgeries performed for sinonasal disease refractory to maximal medical therapy. Nasal surgery techniques, such as septoplasty and inferior turbinate surgery, may assist in both relieving the symptom of nasal obstruction and providing access for sinus surgery. Although rare, open sinus techniques are occasionally required.

Digital Accessible Knowledge and well-inventoried sites for birds in Mexico: baseline sites for measuring faunistic change

OpenAIRE

Peterson, A. Townsend; Navarro-Sig?enza, Adolfo G.; Mart?nez-Meyer, Enrique

2016-01-01

Background Faunal change is a basic and fundamental element in ecology, biogeography, and conservation biology, yet vanishingly few detailed studies have documented such changes rigorously over decadal time scales. This study responds to that gap in knowledge, providing a detailed analysis of Digital Accessible Knowledge of the birds of Mexico, designed to marshal DAK to identify sites that were sampled and inventoried rigorously prior to the beginning of major global climate change (1980). M...

Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

LENUS (Irish Health Repository)

Salah, Nazar

2009-12-01

Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.

Patients undergoing PCI from the femoral route by default radial operators are at high risk of vascular access-site complications.

Science.gov (United States)

Rafie, Ihsan M; Uddin, Muez M; Ossei-Gerning, Nicholas; Anderson, Richard A; Kinnaird, Timothy D

2014-02-01

Radial artery (RA) access for PCI has a lower incidence of vascular access-site (VAS) complications than the femoral artery (FA) approach. However, even for default radial operators certain patients are intervened upon from the FA. We examined the demographics and incidence of VAS complications when default radial operators resort to the FA for PCI. The demographics and VAS complications were compared by access site retrospectively for all PCI cases performed by default radial operators (n=1,392). A modified ACUITY trial definition of major VAS complication was used. FA puncture occurred in 25.2% (351/1,392) of cases. Patients were more likely to be female, older and weigh less than patients undergoing PCI from the RA. The FA procedure was likely to be more complex with larger sheaths, more left main stem, graft and multivessel intervention, and there was a greater proportion of emergency cases. Despite increased case complexity, glycoprotein inhibitors were used less frequently in femoral cases (26.5% vs. 36.8%, prisk factors for access-site bleeding are disproportionately high in the population requiring FA puncture by default radial operators, and as a result such patients have a high rate of vascular access-site complications.

A novel robotic system for single-port urologic surgery: first clinical investigation.

Science.gov (United States)

Kaouk, Jihad H; Haber, Georges-Pascal; Autorino, Riccardo; Crouzet, Sebastien; Ouzzane, Adil; Flamand, Vincent; Villers, Arnauld

2014-12-01

The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. This was a prospective institutional review board-approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38 min. At 3-yr follow-up all

Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study.

Science.gov (United States)

Ellis, Scott Michael; Varley, Martin; Howell, Stuart; Trochsler, Markus; Maddern, Guy; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

2016-08-01

Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills. Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion. 92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A-C) (P skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

Single-site catalyst promoters accelerate metal-catalyzed nitroarene hydrogenation

KAUST Repository

Wang, Liang

2018-04-04

Atomically dispersed supported metal catalysts are drawing wide attention because of the opportunities they offer for new catalytic properties combined with efficient use of the metals. We extend this class of materials to catalysts that incorporate atomically dispersed metal atoms as promoters. The catalysts are used for the challenging nitroarene hydrogenation and found to have both high activity and selectivity. The promoters are single-site Sn on TiO2 supports that incorporate metal nanoparticle catalysts. Represented as M/Sn-TiO2 (M = Au, Ru, Pt, Ni), these catalysts decidedly outperform the unpromoted supported metals, even for hydrogenation of nitroarenes substituted with various reducible groups. The high activity and selectivity of these catalysts result from the creation of oxygen vacancies on the TiO2 surface by single-site Sn, which leads to efficient, selective activation of the nitro group coupled with a reaction involving hydrogen atoms activated on metal nanoparticles.

Single-site catalyst promoters accelerate metal-catalyzed nitroarene hydrogenation

KAUST Repository

Wang, Liang; Guan, Erjia; Zhang, Jian; Yang, Junhao; Zhu, Yihan; Han, Yu; Yang, Ming; Cen, Cheng; Fu, Gang; Gates, Bruce C.; Xiao, Feng-Shou

2018-01-01

Atomically dispersed supported metal catalysts are drawing wide attention because of the opportunities they offer for new catalytic properties combined with efficient use of the metals. We extend this class of materials to catalysts that incorporate atomically dispersed metal atoms as promoters. The catalysts are used for the challenging nitroarene hydrogenation and found to have both high activity and selectivity. The promoters are single-site Sn on TiO2 supports that incorporate metal nanoparticle catalysts. Represented as M/Sn-TiO2 (M = Au, Ru, Pt, Ni), these catalysts decidedly outperform the unpromoted supported metals, even for hydrogenation of nitroarenes substituted with various reducible groups. The high activity and selectivity of these catalysts result from the creation of oxygen vacancies on the TiO2 surface by single-site Sn, which leads to efficient, selective activation of the nitro group coupled with a reaction involving hydrogen atoms activated on metal nanoparticles.

Comparative Performance in Single-Port Versus Multiport Minimally Invasive Surgery, and Small Versus Large Operative Working Spaces: A Preclinical Randomized Crossover Trial.

Science.gov (United States)

Marcus, Hani J; Seneci, Carlo A; Hughes-Hallett, Archie; Cundy, Thomas P; Nandi, Dipankar; Yang, Guang-Zhong; Darzi, Ara

2016-04-01

Surgical approaches such as transanal endoscopic microsurgery, which utilize small operative working spaces, and are necessarily single-port, are particularly demanding with standard instruments and have not been widely adopted. The aim of this study was to compare simultaneously surgical performance in single-port versus multiport approaches, and small versus large working spaces. Ten novice, 4 intermediate, and 1 expert surgeons were recruited from a university hospital. A preclinical randomized crossover study design was implemented, comparing performance under the following conditions: (1) multiport approach and large working space, (2) multiport approach and intermediate working space, (3) single-port approach and large working space, (4) single-port approach and intermediate working space, and (5) single-port approach and small working space. In each case, participants performed a peg transfer and pattern cutting tasks, and each task repetition was scored. Intermediate and expert surgeons performed significantly better than novices in all conditions (P Performance in single-port surgery was significantly worse than multiport surgery (P performance in the intermediate versus large working space. In single-port surgery, there was a converse trend; performances in the intermediate and small working spaces were significantly better than in the large working space. Single-port approaches were significantly more technically challenging than multiport approaches, possibly reflecting loss of instrument triangulation. Surprisingly, in single-port approaches, in which triangulation was no longer a factor, performance in large working spaces was worse than in intermediate and small working spaces. © The Author(s) 2015.

First 101 Robotic General Surgery Cases in a Community Hospital

Science.gov (United States)

Robertson, Jarrod C.; Alrajhi, Sharifah

2016-01-01

Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

Next-generation robotic surgery--from the aspect of surgical robots developed by industry.

Science.gov (United States)

Nakadate, Ryu; Arata, Jumpei; Hashizume, Makoto

2015-02-01

At present, much of the research conducted worldwide focuses on extending the ability of surgical robots. One approach is to extend robotic dexterity. For instance, accessibility and dexterity of the surgical instruments remains the largest issue for reduced port surgery such as single port surgery or natural orifice surgery. To solve this problem, a great deal of research is currently conducted in the field of robotics. Enhancing the surgeon's perception is an approach that uses advanced sensor technology. The real-time data acquired through the robotic system combined with the data stored in the robot (such as the robot's location) provide a major advantage. This paper aims at introducing state-of-the-art products and pre-market products in this technological advancement, namely the robotic challenge in extending dexterity and hopefully providing the path to robotic surgery in the near future.

Low-energy neutron-induced single-event upsets in static random access memory

International Nuclear Information System (INIS)

Guo Xiaoqiang; Guo Hongxia; Wang Guizhen; Ling Dongsheng; Chen Wei; Bai Xiaoyan; Yang Shanchao; Liu Yan

2009-01-01

The visual analysis method of data process was provided for neutron-induced single-event upset(SEU) in static random access memory(SRAM). The SEU effects of six CMOS SRAMs with different feature size(from 0.13 μm to 1.50 μm) were studied. The SEU experiments were performed using the neutron radiation environment at Xi'an pulsed reactor. And the dependence of low-energy neutron-induced SEU cross section on SRAM's feature size was given. The results indicate that the decreased critical charge is the dominant factor for the increase of single event effect sensitivity of SRAM devices with decreased feature size. Small-sized SRAM devices are more sensitive than large-sized ones to single event effect induced by low-energy neutrons. (authors)

Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

Science.gov (United States)

Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

2017-11-15

MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

Patient access in plastic surgery: an operational and financial analysis of service-based interventions to improve ambulatory throughput in an academic surgery practice.

Science.gov (United States)

Hultman, Charles Scott; Gilland, Wendell G; Weir, Samuel

2015-06-01

Inefficient patient throughput in a surgery practice can result in extended new patient backlogs, excessively long cycle times in the outpatient clinics, poor patient satisfaction, decreased physician productivity, and loss of potential revenue. This project assesses the efficacy of multiple throughput interventions in an academic, plastic surgery practice at a public university. We implemented a Patient Access and Efficiency (PAcE) initiative, funded and sponsored by our health care system, to improve patient throughput in the outpatient surgery clinic. Interventions included: (1) creation of a multidisciplinary team, led by a project redesign manager, that met weekly; (2) definition of goals, metrics, and target outcomes; 3) revision of clinic templates to reflect actual demand; 4) working down patient backlog through group visits; 5) booking new patients across entire practice; 6) assigning a physician's assistant to the preoperative clinic; and 7) designating a central scheduler to coordinate flow of information. Main outcome measures included: patient satisfaction using Press-Ganey surveys; complaints reported to patient relations; time to third available appointment; size of patient backlog; monthly clinic volumes with utilization rates and supply/demand curves; "chaos" rate (cancellations plus reschedules, divided by supply, within 48 hours of booked clinic date); patient cycle times with bottleneck analysis; physician productivity measured by work Relative Value Units (wRVUs); and downstream financial effects on billing, collection, accounts receivable (A/R), and payer mix. We collected, managed, and analyzed the data prospectively, comparing the pre-PAcE period (6 months) with the PAcE period (6 months). The PAcE initiative resulted in multiple improvements across the entire plastic surgery practice. Patient satisfaction increased only slightly from 88.5% to 90.0%, but the quarterly number of complaints notably declined from 17 to 9. Time to third

LNS users primer for accessing government sites on the ARPA network. [MIT. -->. ANL, BNL, LBL, and New York Univ. Courant Inst

Energy Technology Data Exchange (ETDEWEB)

Kannel, M.

1979-06-01

This primer was developed as part of the study conducted by the Laboratory for Nuclear Science (LNS) on the feasibility of networks for computer resource sharing. The primer is an instructinal guide for the LNS user who would like to access and use computers at other government sites on the ARPA network. The format is a series of scenarios of actual recorded on-line terminal sessions' showing the novice user how to access the foreign site, obtain help documentation, run a simple program, and transfer files to and from the foreign site. Access to the ARPA network in these scenarios is via Multics or the Massachusetts Institute of Technology Terminal Interface Processor. The foreign government sites accessed are the computing facilities at Argonne National Laboratory, Brookhaven National Laboratory, Lawrence Livermore Laboratory, and New York University Courant Institute. This technique of auditing actual terminal sessions as a teaching aid can be extended to include other computing facilities as well as other networks.

78 FR 67881 - Nondiscrimination on the Basis of Disability in Air Travel: Accessibility of Web Sites and...

Science.gov (United States)

2013-11-12

... ticket agents are providing schedule and fare information and marketing covered air transportation... corresponding accessible pages on a mobile Web site by one year after the final rule's effective date; and (3... criteria) as the required accessibility standard for all public-facing Web pages involved in marketing air...

Preliminary access routes and cost study analyses for seven potentially acceptable salt sites: Final report, October 1984

International Nuclear Information System (INIS)

1987-02-01

This report analyzes highway and railroad access to seven potentially acceptable salt repository sites: Richton Dome and Cypress Creek Dome in Mississippi, Vacherie Dome in Louisiana, Swisher County and Deaf Smith County in Texas, and Davis Canyon and Lavender Canyon in utah. The objectives of the study were to investigate the routing of reasonable access corridors to the sites, describe major characteristics of each route, and estimate the costs for constructing or upgrading highways and railroads. The routes used in the analysis are not necessarily recommended or preferred over other routes, nor do they represent an implied final selection. Detailed engineering studies must be performed for the Davis Canyon and Lavender Canyon highway access before the analyzed routes can be considered to be viable. 20 refs., 7 figs., 3 tabs

Surgical site infection rates following laparoscopic urological procedures.

Science.gov (United States)

George, Arvin K; Srinivasan, Arun K; Cho, Jane; Sadek, Mostafa A; Kavoussi, Louis R

2011-04-01

Surgical site infections have been categorized by the Centers for Medicare and Medicaid Services as "never events". The incidence of surgical site infection following laparoscopic urological surgery and its risk factors are poorly defined. We evaluated surgical site infection following urological laparoscopic surgery and identified possible factors that may influence occurrence. Patients who underwent transperitoneal laparoscopic procedures during a 4-year period by a single laparoscopic surgeon were retrospectively reviewed. Surgical site infections were identified postoperatively and defined using the Centers for Disease Control criteria. Clinical parameters, comorbidities, smoking history, preoperative urinalysis and culture results as well as operative data were analyzed. Nonparametric testing using the Mann-Whitney U test, multivariable logistic regression and Spearman's rank correlation coefficient were used for data analysis. In 556 patients undergoing urological laparoscopic procedures 14 surgical site infections (2.5%) were identified at mean postoperative day 21.5. Of the 14 surgical site infections 10 (71.4%) were located at a specimen extraction site. Operative time, procedure type and increasing body mass index were significantly associated with the occurrence of surgical site infections (p = 0.007, p = 0.019, p = 0.038, respectively), whereas history of diabetes mellitus (p = 0.071) and intraoperative transfusion (p = 0.053) were found to trend toward significance. Age, gender, positive urine culture, steroid use, procedure type and smoking history were not significantly associated with surgical site infection. Body mass index and operative time remained significant predictors of surgical site infection on multivariate logistic regression analysis. Surgical site infection is an infrequent complication following laparoscopic surgery with the majority occurring at the specimen extraction site. Infection is associated with prolonged operative time and

Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial.

Science.gov (United States)

Ishibashi, Keiichiro; Ishida, Hideyuki; Kuwabara, Kouki; Ohsawa, Tomonori; Okada, Norimichi; Yokoyama, Masaru; Kumamoto, Kensuke

2014-04-01

To investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study. Patients undergoing elective surgery for rectal cancer were randomized to receive a single intravenous injection of flomoxef (group 1) or five additional doses (group 2) of flomoxef after the surgery. All the patients had received preoperative oral antibiotic prophylaxis (kanamycin and erythromycin) after mechanical cleansing within 24 h prior to surgery, and had received intravenous flomoxef during surgery. A total of 279 patients (including 139 patients in group 1 and 140 in group 2) were enrolled in the study. The incidence of SSIs was 13.7% in group 1 and 13.6% in group 2 (difference [95% confidence interval]: -0.2% [-0.9 to 0.7%]). The incidence of SSIs was not significantly different in patients undergoing elective rectal surgery who were treated using a single dose of postoperative antibiotics compared to those treated using multiple-dose antibiotics when preoperative mechanical and chemical bowel preparations were employed.

GENERAL SURGERY

African Journals Online (AJOL)

mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

Italian Society of Surgery and Association of Stoma Care Nurses Joint Position Statement on Preoperative Stoma Siting.

Science.gov (United States)

Roveron, Gabriele; De Toma, Giorgio; Barbierato, Maria

2016-01-01

Drawing on the existing position statements approved by the Wound, Ostomy and Continence Nursing Society in collaboration with the American Society of Colon & Rectal Surgeons and the American Urological Association, the Italian Association of Stoma care Nurses and the Italian Society of Surgery jointly developed and approved this document on July 27, 2013. Its purpose was to provide a formal recommendation for preoperative stoma siting and associated counseling for all patients undergoing enterostomy or urostomy surgery, with the goals of preventing complications, enhancing health-related quality of life, improving care, achieving better health outcomes, and reducing health care costs.

Minimal Access Surgery Educational Needs of Trainees from Africa: Perspectives from an Asian Training Institution.

Science.gov (United States)

Ahmad, J I; Mishra, R K

2015-01-01

The establishment of minimal access surgery (MAS) in the last three decades brought new dimensions to surgical training. The sole role of traditional apprenticeship training model was challenged and adjunctive surgical simulation models were introduced. Knowledge of the trainees' educational needs is important in designing MAS training curriculum. To study the MAS educational needs of trainees from Africa, review MAS training models and offer recommendations for MAS training. Data was obtained from questionnaires filled by trainees from Africa who attended the monthly MAS training at the World Laparoscopy Hospital, India from October 2013 to May 2014 about their MAS educational needs. There were 38 trainees from different parts of Africa (Central, East, North, South and West Africa) with average age of 41.92 ± 8.67 years (minimum-28 years and maximum 63 years) and majority were males (92%). General surgeons constituted 57% while Gynaecologists were 41%. Only a quarter have MAS training integrated in their training curriculum. Box trainers, Animal models, live human surgeries and virtual reality simulation were the commonest models used in previous trainings and favoured in the educational needs for MAS training. Using cadaveric models and self sponsorship were deemphasised. Widespread application of MAS, globalisation and trainees educational needs call for establishing training programmes. Box trainers, animal models, live human surgeries and virtual reality simulators should be adopted and a synergy between Postgraduate surgical programmes, biomedical industry, universities and trainees will facilitate the setting of MAS skills laboratories and programmes.

Digital Accessible Knowledge and well-inventoried sites for birds in Mexico: baseline sites for measuring faunistic change.

Science.gov (United States)

Peterson, A Townsend; Navarro-Sigüenza, Adolfo G; Martínez-Meyer, Enrique

2016-01-01

Faunal change is a basic and fundamental element in ecology, biogeography, and conservation biology, yet vanishingly few detailed studies have documented such changes rigorously over decadal time scales. This study responds to that gap in knowledge, providing a detailed analysis of Digital Accessible Knowledge of the birds of Mexico, designed to marshal DAK to identify sites that were sampled and inventoried rigorously prior to the beginning of major global climate change (1980). We accumulated DAK records for Mexican birds from all relevant online biodiversity data portals. After extensive cleaning steps, we calculated completeness indices for each 0.05° pixel across the country; we also detected 'hotspots' of sampling, and calculated completeness indices for these broader areas as well. Sites were designated as well-sampled if they had completeness indices above 80% and >200 associated DAK records. We identified 100 individual pixels and 20 broader 'hotspots' of sampling that were demonstrably well-inventoried prior to 1980. These sites are catalogued and documented to promote and enable resurvey efforts that can document events of avifaunal change (and non-change) across the country on decadal time scales. Development of repeated surveys for many sites across Mexico, and particularly for sites for which historical surveys document their avifaunas prior to major climate change processes, would pay rich rewards in information about distributional dynamics of Mexican birds.

Performing surgery: commonalities with performers outside medicine

Directory of Open Access Journals (Sweden)

Roger Lister Kneebone

2016-08-01

Full Text Available This paper argues for the inclusion of surgery within the canon of performance science. The world of medicine presents rich, complex but relatively under-researched sites of performance. Performative aspects of clinical practice are overshadowed by a focus on the processes and outcomes of medical care, such as diagnostic accuracy and the results of treatment. The primacy of this ‘clinical’ viewpoint - framed by clinical professionals as the application of medical knowledge - hides resonances with performance in other domains. Yet the language of performance is embedded in the culture of surgery - surgeons ‘perform’ operations, work in an operating ‘theatre’ and use ‘instruments’. This paper asks what might come into view if we take this performative language at face value and interrogate surgery from the perspective of performance science. It addresses the following questions: 1.To what extent and in what ways can surgical practice (both consultation and operation be considered as performance?2.How does comparison with two domains domains of non-surgical performance (close-up magic and puppetry illuminate understanding of surgical practice as performance?3.In what ways might including surgery within the canon of performance studies enrich the field of performance science?Two detailed case studies over 5 years with magicians (71.5 hours contact time and puppeteers (50.5 hours contact time identified performative aspects of surgical practice from the perspectives of professionals (as individuals or in groups and audiences. Physical simulation provided a means for non-clinicians to access and experience elements of the surgical world, acting as a prompt for discussion. Thematic analysis was used to establish themes and sub-themes.Key themes were: 1 clinical consultation can be viewed as ‘close-up live performance with a very small audience’ and 2 operative surgery can be viewed as ‘reading bodies within a dextrous team�

Single site porphyrine-like structures advantages over metals for selective electrochemical CO2 reduction

DEFF Research Database (Denmark)

Bagger, Alexander; Ju, Wen; Varela, Ana Sofia

2017-01-01

Currently, no catalysts are completely selective for the electrochemical CO2 Reduction Reaction (CO2RR). Based on trends in density functional theory calculations of reaction intermediates we find that the single metal site in a porphyrine-like structure has a simple advantage of limiting...... the competing Hydrogen Evolution Reaction (HER). The single metal site in a porphyrine-like structure requires an ontop site binding of hydrogen, compared to the hollow site binding of hydrogen on a metal catalyst surface. The difference in binding site structure gives a fundamental energy-shift in the scaling...... relation of ∼0.3eV between the COOH* vs. H* intermediate (CO2RR vs. HER). As a result, porphyrine-like catalysts have the advantage over metal catalyst of suppressing HER and enhancing CO2RR selectivity....

Shape memory alloy fixator system for suturing tissue in minimal access surgery.

Science.gov (United States)

Xu, W; Frank, T G; Stockham, G; Cuschieri, A

1999-01-01

A new technique for suturing human tissue is described in which tissue closure is achieved by means of small fixators made from shape memory alloy. The aim of the development is to provide an alternative to thread suturing in minimal access surgery, which is quicker and requires less skill to achieve the required suturing quality. The design of the fixators is described in terms of the thermal shape recovery of shape memory alloy and a novel form of finite element analysis, which uses a nonlinear elastic element for the material property. Thermal analysis of the fixators and surrounding tissue is used to predict the temperature distribution during and after the application of electric current heating. This was checked in an in vitro experiment, which confirmed that deployment caused no detectable collateral damage to surrounding tissue. In vivo animal studies on the use of the shape memory alloy fixator for suturing tissue are ongoing to establish safety and healing effects.

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences.

Science.gov (United States)

Damani, Zaheed; MacKean, Gail; Bohm, Eric; Noseworthy, Tom; Wang, Jenney Meng Han; DeMone, Brie; Wright, Brock; Marshall, Deborah A

2018-02-01

Single-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system's design/implementation; successes, challenges, and unanticipated consequences. On two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings. Respondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons' offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams. Although successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care. Copyright © 2017 Elsevier B.V. All rights reserved.

Single-Blinded Prospective Implementation of a Preoperative Imaging Checklist for Endoscopic Sinus Surgery.

Science.gov (United States)

Error, Marc; Ashby, Shaelene; Orlandi, Richard R; Alt, Jeremiah A

2018-01-01

Objective To determine if the introduction of a systematic preoperative sinus computed tomography (CT) checklist improves identification of critical anatomic variations in sinus anatomy among patients undergoing endoscopic sinus surgery. Study Design Single-blinded prospective cohort study. Setting Tertiary care hospital. Subjects and Methods Otolaryngology residents were asked to identify critical surgical sinus anatomy on preoperative CT scans before and after introduction of a systematic approach to reviewing sinus CT scans. The percentage of correctly identified structures was documented and compared with a 2-sample t test. Results A total of 57 scans were reviewed: 28 preimplementation and 29 postimplementation. Implementation of the sinus CT checklist improved identification of critical sinus anatomy from 24% to 84% correct ( P identification of sinus anatomic variants, including those not directly included in the systematic review implemented. Conclusion The implementation of a preoperative endoscopic sinus surgery radiographic checklist improves identification of critical anatomic sinus variations in a training population.

Robotic single port cholecystectomy (R-LESS-C): experience in 36 patients.

Science.gov (United States)

Uras, Cihan; Böler, Deniz Eren; Ergüner, Ilknur; Hamzaoğlu, Ismail

2014-07-01

Laparoendoscopic single-site surgery (LESS) has emerged as a result of a search for "pain-less" and "scar-less" surgery. Laparoendoscopic single-site cholecystectomy (LESS-C) is probably the most common application in general surgery, although it harbors certain limitations. It was proposed that the da Vinci Single-Site (Si) robotic system may overcome some of the difficulties experienced during LESS, providing three dimensional views and the ability to work in a right-handed fashion. Thirty-six robotic single port cholecystectomies (R-LESS-C) performed with the da Vinci Si robotic system are evaluated in this paper R-LESS-C performed in 36 patients were reviewed. The data related to the perioperative period (i.e., anesthesia time, operation time, docking time, and console time) was recorded prospectively, whereas the hospitalization period, postoperative visual analogue scale (VAS) pain scores were collected retrospectively. A total number of 36 patients, with a mean age of 40.1 years (21-64 years), underwent R-LESS-C. There were five men and 31 women. The mean anesthesia and operation times were 79.3 minutes (45-130 minutes) and 61.8 minutes (34-110 minutes), respectively. The mean docking time was 9.8 minutes (4-30 minutes) and the mean console time was 24.9 minutes (7-60 minutes). The mean hospital stay was 1.05 days (1-2 days) and the mean pain score (VAS) was 3.6 (2-8) in the first 24 hours. Incisional hernia was recorded in one patient. R-LESS-C can be performed reliably with acceptable operative times and safety. The da Vinci Si robotic system may ease LESS-C. Two issues should be considered for routine use: expensive resources are needed and the incidence of incisional hernia may increase. Copyright © 2013. Published by Elsevier B.V.

A new modified speculum guided single nostril technique for endoscopic transnasal transsphenoidal surgery: an analysis of nasal complications.

Science.gov (United States)

Waran, Vicknes; Tang, Ing Ping; Karuppiah, Ravindran; Abd Kadir, Khairul Azmi; Chandran, Hari; Muthusamy, Kalai Arasu; Prepageran, Narayanan

2013-12-01

Abstract The endoscopic transnasal, transsphenoidal surgical technique for pituitary tumour excision has generally been regarded as a less invasive technique, ranging from single nostril to dual nostril techniques. We propose a single nostril technique using a modified nasal speculum as a preferred technique. We initially reviewed 25 patients who underwent pituitary tumour excision, via endoscopic transnasal transsphenoidal surgery, using this new modified speculum-guided single nostril technique. The results show shorter operation time with reduced intra- and post-operative nasal soft tissue injuries and complications.

Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

Science.gov (United States)

Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

2017-01-01

To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Digital Accessible Knowledge and well-inventoried sites for birds in Mexico: baseline sites for measuring faunistic change

Directory of Open Access Journals (Sweden)

A. Townsend Peterson

2016-09-01

Full Text Available Background Faunal change is a basic and fundamental element in ecology, biogeography, and conservation biology, yet vanishingly few detailed studies have documented such changes rigorously over decadal time scales. This study responds to that gap in knowledge, providing a detailed analysis of Digital Accessible Knowledge of the birds of Mexico, designed to marshal DAK to identify sites that were sampled and inventoried rigorously prior to the beginning of major global climate change (1980. Methods We accumulated DAK records for Mexican birds from all relevant online biodiversity data portals. After extensive cleaning steps, we calculated completeness indices for each 0.05° pixel across the country; we also detected ‘hotspots’ of sampling, and calculated completeness indices for these broader areas as well. Sites were designated as well-sampled if they had completeness indices above 80% and >200 associated DAK records. Results We identified 100 individual pixels and 20 broader ‘hotspots’ of sampling that were demonstrably well-inventoried prior to 1980. These sites are catalogued and documented to promote and enable resurvey efforts that can document events of avifaunal change (and non-change across the country on decadal time scales. Conclusions Development of repeated surveys for many sites across Mexico, and particularly for sites for which historical surveys document their avifaunas prior to major climate change processes, would pay rich rewards in information about distributional dynamics of Mexican birds.

Vascular access site complication in transfemoral coronary angiography between uninterrupted warfarin and heparin bridging.

Science.gov (United States)

Wongcharoen, Wanwarang; Pinyosamosorn, Kittipong; Gunaparn, Siriluck; Boonnayhun, Suchada; Thonghong, Tasalak; Suwannasom, Pannipa; Phrommintikul, Arintaya

2017-08-01

Warfarin discontinuation with heparin bridging is a common practice in patients receiving warfarin prior to elective coronary angiography (CAG). The uninterrupted warfarin strategy has been suggested to be alternative option for patients with high thromboembolic risk. Therefore, we aimed to assess the safety of elective transfemoral CAG during uninterrupted warfarin therapy compared to heparin bridging. This study was a randomized open-label design with blinded event evaluation. The 110 consecutive patients (age ≥ 18 years) receiving warfarin before the planned transfemoral CAG were randomly assigned to either heparin bridging or uninterrupted warfarin with targeted INR (2.0-3.0). The primary outcome was the incidence of major vascular access site complications. The baseline characteristics were comparable between two groups (mean age was 60.1 ± 7.8 years, 49 males). The mean INR on the day of CAG of heparin bridging and uninterrupted warfarin groups was 1.2 ± 0.3 and 2.2 ± 0.5 (P warfarin patients (P = 0.243). The total vascular access site complications occurred in 6 (10.9%) heparin-bridging and one (1.8%) uninterrupted warfarin patients (P = 0.113). No patient developed either other bleeding or thromboembolic events during 7 days after CAG. We demonstrated that an uninterrupted warfarin strategy did not increase vascular access site complications in patients undergoing transfemoral CAG compared to heparin bridging therapy. Due to the safety and the ease of uninterrupted warfarin strategy, this approach should be encouraged in patients receiving long-term warfarin who undergo elective transfemoral CAG. © 2017, Wiley Periodicals, Inc.

Standardized technique for single port laparoscopic ileostomy and colostomy.

Science.gov (United States)

Shah, A; Moftah, M; Hadi Nahar Al-Furaji, H; Cahill, R A

2014-07-01

Single site laparoscopic techniques and technology exploit maximum usefulness from confined incisions. The formation of an ileostomy or colostomy seems very applicable for this modality as the stoma occupies the solitary incision obviating any additional wounds. Here we detail the principles of our approach to defunctioning loop stoma formation using single port laparoscopic access in a stepwise and standardized fashion along with the salient specifics of five illustrative patients. No specialized instrumentation is required and the single access platform is established table-side using the 'glove port' technique. The approach has the intra-operative advantage of excellent visualization of the correct intestinal segment for exteriorization along with direct visual control of its extraction to avoid twisting. Postoperatively, abdominal wall trauma has been minimal allowing convalescence and stoma care education with only one parietal incision. Single incision stoma siting proves a ready, robust and reliable technique for diversion ileostomy and colostomy with a minimum of operative trauma for the patient. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Manual Control for Medical Instruments in Minimally Invasive Surgery

NARCIS (Netherlands)

Fan, C.

2014-01-01

With the introduction of new technologies, surgical procedures have been varying from free access in open surgery towards limited access in minimal invasive surgery. During such procedures, surgeons have to manoeuver the instruments from outside the patient while looking at the monitor. Long and

Patient-specific surgical simulator for the pre-operative planning of single-incision laparoscopic surgery with bimanual robots.

Science.gov (United States)

Turini, Giuseppe; Moglia, Andrea; Ferrari, Vincenzo; Ferrari, Mauro; Mosca, Franco

2012-01-01

The trend of surgical robotics is to follow the evolution of laparoscopy, which is now moving towards single-incision laparoscopic surgery. The main drawback of this approach is the limited maneuverability of the surgical tools. Promising solutions to improve the surgeon's dexterity are based on bimanual robots. However, since both robot arms are completely inserted into the patient's body, issues related to possible unwanted collisions with structures adjacent to the target organ may arise. This paper presents a simulator based on patient-specific data for the positioning and workspace evaluation of bimanual surgical robots in the pre-operative planning of single-incision laparoscopic surgery. The simulator, designed for the pre-operative planning of robotic laparoscopic interventions, was tested by five expert surgeons who evaluated its main functionalities and provided an overall rating for the system. The proposed system demonstrated good performance and usability, and was designed to integrate both present and future bimanual surgical robots.

Advances in percutaneous stone surgery

OpenAIRE

Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, ...

Micro-analysis of plaque fluid from single-site fasted plaque

International Nuclear Information System (INIS)

Vogel, G.L.; Carey, C.M.; Chow, L.C.; Tatevossian, A.

1990-01-01

Despite the site-specific nature of caries, nearly all data on the concentration of ions relevant to the level of saturation of plaque fluid with respect to calcium phosphate minerals or enamel are from studies that used pooled samples. A procedure is described for the collection and analysis of inorganic ions relevant to these saturation levels in plaque fluid samples collected from a single surface on a single tooth. Various methods for examining data obtained by this procedure are described, and a mathematical procedure employing potential plots is recommended

Stabilization of bacterially expressed erythropoietin by single site-specific introduction of short branched PEG chains at naturally occurring glycosylation sites.

Science.gov (United States)

Hoffmann, E; Streichert, K; Nischan, N; Seitz, C; Brunner, T; Schwagerus, S; Hackenberger, C P R; Rubini, M

2016-05-24

The covalent attachment of polyethylene glycol (PEG) to therapeutic proteins can improve their physicochemical properties. In this work we utilized the non-natural amino acid p-azidophenylalanine (pAzF) in combination with the chemoselective Staudinger-phosphite reaction to install branched PEG chains to recombinant unglycosylated erythropoietin (EPO) at each single naturally occurring glycosylation site. PEGylation with two short 750 or 2000 Da PEG units at positions 24, 38, or 83 significantly decreased unspecific aggregation and proteolytic degradation while biological activity in vitro was preserved or even increased in comparison to full-glycosylated EPO. This site-specific bioconjugation approach permits to analyse the impact of PEGylation at single positions. These results represent an important step towards the engineering of site-specifically modified EPO variants from bacterial expression with increased therapeutic efficacy.

Severe isolated tricuspid insufficiency due to tricuspid papillary muscle rupture after a fall from a horse: treatment with port access minimally invasive cardiac surgery.

Science.gov (United States)

Öz, Kürsad; Mayeran, Yousef; Van Praet, Frank; Codens, Jose; Vanerman, Hugo

2014-04-01

We report on the successful treatment of tricuspid valve insufficiency due to blunt chest injury using port-access minimally invasive cardiac surgery. The optimal surgical treatment of traumatic valvular insufficiency is discussed, including a brief review of the relevant literature.

Women's preference of cosmetic results after gynecologic surgery.

Science.gov (United States)

Goebel, Kathryn; Goldberg, Jeffrey M

2014-01-01

To determine the cosmetic appeal of different incision types used in gynecologic surgery. One hundred women between the ages of 20 and 40 years were shown 4 color photographs of a female abdomen with incision sites marked for Pfannenstiel, minilaparotomy, traditional laparoscopy, and robotic-assisted laparoscopy. The women were asked to rank the photographs on cosmetic appeal alone. An additional photograph depicting single-port laparoscopy was then added, and patients were asked to again rank the photographs. Participants were also asked basic demographic information and prior surgical history. Office practice. One hundred women between the ages of 20 and 40. Participants. Minilaparotomy was ranked as the most appealing incision among the first set of photographs by 74% of the participants, and the remaining 26% preferred traditional laparoscopy. Robotic-assisted laparoscopy was ranked as the least appealing scar type by 42%, and no patient selected it as their first choice. Sixty-four percent preferred the appearance of a single-port laparoscopic scar when that option was added. The only demographic variable that reached statistical significance was the presence of prior abdominal surgery. Patients without prior surgery ranked minilaparotomy as more cosmetically appealing. When several minimally invasive surgical approaches are possible, the patient should be counseled regarding the cosmetic results of each. Patients in this study strongly preferred the appearance of minilaparotomy and single-port incisions over full Pfannenstiel or robotic incisions. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Evaluation of accuracy in implant site preparation performed in single- or multi-step drilling procedures.

Science.gov (United States)

Marheineke, Nadine; Scherer, Uta; Rücker, Martin; von See, Constantin; Rahlf, Björn; Gellrich, Nils-Claudius; Stoetzer, Marcus

2018-06-01

Dental implant failure and insufficient osseointegration are proven results of mechanical and thermal damage during the surgery process. We herein performed a comparative study of a less invasive single-step drilling preparation protocol and a conventional multiple drilling sequence. Accuracy of drilling holes was precisely analyzed and the influence of different levels of expertise of the handlers and additional use of drill template guidance was evaluated. Six experimental groups, deployed in an osseous study model, were representing template-guided and freehanded drilling actions in a stepwise drilling procedure in comparison to a single-drill protocol. Each experimental condition was studied by the drilling actions of respectively three persons without surgical knowledge as well as three highly experienced oral surgeons. Drilling actions were performed and diameters were recorded with a precision measuring instrument. Less experienced operators were able to significantly increase the drilling accuracy using a guiding template, especially when multi-step preparations are performed. Improved accuracy without template guidance was observed when experienced operators were executing single-step versus multi-step technique. Single-step drilling protocols have shown to produce more accurate results than multi-step procedures. The outcome of any protocol can be further improved by use of guiding templates. Operator experience can be a contributing factor. Single-step preparations are less invasive and are promoting osseointegration. Even highly experienced surgeons are achieving higher levels of accuracy by combining this technique with template guidance. Hereby template guidance enables a reduction of hands-on time and side effects during surgery and lead to a more predictable clinical diameter.

Determining the use of prophylactic antibiotics in breast cancer surgeries: a survey of practice

Directory of Open Access Journals (Sweden)

Acuna Sergio A

2012-08-01

Full Text Available Abstract Background Prophylactic antibiotics (PAs are beneficial to breast cancer patients undergoing surgery because they prevent surgical site infection (SSI, but limited information regarding their use has been published. This study aims to determine the use of PAs prior to breast cancer surgery amongst breast surgeons in Colombia. Methods An online survey was distributed amongst the breast surgeon members of the Colombian Association of Mastology, the only breast surgery society of Colombia. The scope of the questions included demographics, clinical practice characteristics, PA prescription characteristics, and the use of PAs in common breast surgical procedures. Results The survey was distributed amongst eighty-eight breast surgeons of whom forty-seven responded (response rate: 53.4%. Forty surgeons (85.1% reported using PAs prior to surgery of which >60% used PAs during mastectomy, axillary lymph node dissection, and/or breast reconstruction. Surgeons reported they targeted the use of PAs in cases in which patients had any of the following SSI risk factors: diabetes mellitus, drains in situ, obesity, and neoadjuvant therapy. The distribution of the self-reported PA dosing regimens was as follows: single pre-operative fixed-dose (27.7%, single preoperative dose followed by a second dose if the surgery was prolonged (44.7%, single preoperative dose followed by one or more postoperative doses for >24 hours (10.6%, and single preoperative weight-adjusted dose (2.1%. Conclusion Although this group of breast surgeons is aware of the importance of PAs in breast cancer surgery there is a discrepancy in how they use it, specifically with regards to prescription and timeliness of drug administration. Our findings call for targeted quality-improvement initiatives, such as standardized national guidelines, which can provide sufficient evidence for all stakeholders and therefore facilitate best practice medicine for breast cancer surgery.

Comparison of ropivacaine and bupivacaine as single-shot epidural anaesthesia for orthopaedic surgery

International Nuclear Information System (INIS)

Riaz, A.; Khan, A.S.

2015-01-01

To compare the efficacy and side-effects of 0.5% ropivacaine with that of 0.5% bupivacaine when used for single-shot epidural anaesthesia for orthopaedic surgery. Design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, over a period of eight months from June 2013 to January 2014. Patients and Methods: The study was carried out in 60 ASA physical status I, II or III patients undergoing elective lower extremity orthopedic surgery. Two groups of 30 patients each received single-shot epidural anaesthesia either with ropivacaine 0.5% (ropivacaine group) or bupivacaine 0.5% (bupivacaine group). Onset, time for maximum height and median height of sensory block was assessed as well as time to two segment recession. Modified Bromage scale was used for motor blockade. Total duration of motor block and common side effects were also recorded. Results: The patients in both groups were similar in age, height, weight, gender and ASA status. There was no significant difference in onset of sensory block and time for maximum height of sensory block. The median heighest level of sensory block was T6 (T5-T8) for ropivacaine group and T5 (T4-T7) for bupivacaine group. Time for two segment regression and duration of sensory block were also comparable for both groups. The total duration of motor block was significantly more in bupivacaine group (159 min vs 134.2 min, p< 0.001). Modified Bromage scale was also significantly higher in bupivacaine group (2.86 vs 1.96 min, p<0.001). Side effects like hypotension, bradycardia, nausea, vomiting and shivering were similar in both groups. Conclusion: Epidural administration of 0.5% ropivacaine provided effective and good quality anaesthesia. Motor blockade was of less duration as compared to equivalent dose of 0.5% bupivacaine, which may offer potential benefit of early patient mobilization after orthopaedic surgery. (author)

Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Yang, Ye; Zeng, Chao; Wei, Jie; Li, Hui; Yang, Tuo; Deng, Zhen-Han; Li, Yu-Sheng; Yang, Tu-Bao; Lei, Guang-Hua

2017-03-01

The purpose of this meta-analysis was to compare the efficacy and safety of single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone for pain management following arthroscopic knee surgery. A comprehensive literature search was conducted to identify randomized controlled trials that used single-dose intra-articular bupivacaine plus morphine and bupivacaine alone for post-operative pain, using MEDLINE (1966-2014), Cochrane Library and EMBASE databases. The weighted mean difference (WMD), relative risk (RR) and their corresponding 95 % confidence intervals (CIs) were calculated using RevMan statistical software. A total of twenty-nine trials (n = 1167) were included. The post-operative visual analog scale (VAS) pain score of the bupivacaine plus morphine group compared with the bupivacaine alone group was significantly lower (WMD -1.15, 95 % CI -1.67 to -0.63, p bupivacaine plus morphine was shown to be significantly better than bupivacaine alone at relieving post-operative pain after arthroscopic knee surgery without increasing the short-term side effects. Routine use of single-dose intra-articular bupivacaine plus morphine is an effective way for pain management after arthroscopic knee surgery. II.

Access road reclamation

International Nuclear Information System (INIS)

Manson, T.; Blok, M.

1997-01-01

A general review of the measures involved in restoring abandoned access road sites in British Columbia was presented. Permits and licences are needed for the use of crown land for roads used by the petroleum and natural gas industry for exploration activities. However, the regulatory framework for road site reclamation is not well developed. The nature of access road reclamation is very site-specific. Some of the issues that are considered for all reclamation projects include slope stability, water control, revegetation, soil rehabilitation, access management and monitoring. The primary objective of reclaiming access road sites is to return the site to conditions that are equal or better than pre-disturbance conditions. Restoration measures must be approved by BC Environment and by the Department of Fisheries and Oceans where federal fisheries responsibilities are involved. 54 refs., 5 tabs., 3 figs

Access control system operation

International Nuclear Information System (INIS)

Barnes, L.D.

1981-06-01

An automated method for the control and monitoring of personnel movement throughout the site was developed under contract to the Department of Energy by Allied-General Nuclear Services (AGNS) at the Barnwell Nuclear Fuel Plant (BNFP). These automated features provide strict enforcement of personnel access policy without routine patrol officer involvement. Identification methods include identification by employee ID number, identification by voice verification and identification by physical security officer verification. The ability to grant each level of access authority is distributed over the organization to prevent any single individual at any level in the organization from being capable of issuing an authorization for entry into sensitive areas. Each access event is recorded. As access events occur, the inventory of both the entered and the exited control area is updated so that a current inventory is always available for display. The system has been operated since 1979 in a development mode and many revisions have been implemented in hardware and software as areas were added to the system. Recent changes have involved the installation of backup systems and other features required to achieve a high reliability. The access control system and recent operating experience are described

Surgery for bilateral large intracranial traumatic hematomas: evacuation in a single session.

Science.gov (United States)

Kompheak, Heng; Hwang, Sun-Chul; Kim, Dong-Sung; Shin, Dong-Sung; Kim, Bum-Tae

2014-06-01

Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia. In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated. The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived. Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

Stretching single fibrin fibers hampers their lysis.

Science.gov (United States)

Li, Wei; Lucioni, Tomas; Li, Rongzhong; Bonin, Keith; Cho, Samuel S; Guthold, Martin

2017-09-15

Blood clots, whose main structural component is a mesh of microscopic fibrin fibers, experience mechanical strain from blood flow, clot retraction and interactions with platelets and other cells. We developed a transparent, striated and highly stretchable substrate made from fugitive glue (a styrenic block copolymer) to investigate how mechanical strain affects lysis of single, suspended fibrin fibers. In this suspended fiber assay, lysis manifested itself by fiber elongation, thickening (disassembly), fraying and collapse. Stretching single fibrin fibers significantly hampered their lysis. This effect was seen in uncrosslinked and crosslinked fibers. Crosslinking (without stretching) also hampered single fiber lysis. Our data suggest that strain is a novel mechanosensitive factor that regulates blood clot dissolution (fibrinolysis) at the single fiber level. At the molecular level of single fibrin molecules, strain may distort, or hinder access to, plasmin cleavage sites and thereby hamper lysis. Fibrin fibers are the major structural component of a blood clot. We developed a highly stretchable substrate made from fugitive glue and a suspended fibrin fiber lysis assay to investigate the effect of stretching on single fibrin fibers lysis. The key findings from our experiments are: 1) Fibers thicken and elongate upon lysis; 2) stretching strongly reduces lysis; 3) this effect is more pronounced for uncrosslinked fibers; and 4) stretching fibers has a similar effect on reducing lysis as crosslinking fibers. At the molecular level, strain may distort plasmin cleavage sites, or restrict access to those sites. Our results suggest that strain may be a novel mechanobiological factor that regulates fibrinolysis. Copyright © 2017 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Development and validation of the Single Item Trait Empathy Scale (SITES).

Science.gov (United States)

Konrath, Sara; Meier, Brian P; Bushman, Brad J

2018-04-01

Empathy involves feeling compassion for others and imagining how they feel. In this article, we develop and validate the Single Item Trait Empathy Scale (SITES), which contains only one item that takes seconds to complete. In seven studies (N=5,724), the SITES was found to be both reliable and valid. It correlated in expected ways with a wide variety of intrapersonal outcomes. For example, it is negatively correlated with narcissism, depression, anxiety, and alexithymia. In contrast, it is positively correlated with other measures of empathy, self-esteem, subjective well-being, and agreeableness. The SITES also correlates with a wide variety of interpersonal outcomes, especially compassion for others and helping others. The SITES is recommended in situations when time or question quantity is constrained.

Single-Site Palladium(II) Catalyst for Oxidative Heck Reaction: Catalytic Performance and Kinetic Investigations

Energy Technology Data Exchange (ETDEWEB)

Duan, Hui; Li, Mengyang; Zhang, Guanghui; Gallagher, James R.; Huang, Zhiliang; Sun, Yu; Luo, Zhong; Chen, Hongzhong; Miller, Jeffrey T.; Zou, Ruqiang; Lei, Aiwen; Zhao, Yanli

2015-01-01

ABSTRACT: The development of organometallic single-site catalysts (SSCs) has inspired the designs of new heterogeneous catalysts with high efficiency. Nevertheless, the application of SSCs in certain modern organic reactions, such as C-C bond formation reactions, has still been less investigated. In this study, a single-site Pd(II) catalyst was developed, where 2,2'-bipyridine-grafted periodic mesoporous organosilica (PMO) was employed as the support of a Pd(II) complex. The overall performance of the single-site Pd(II) catalyst in the oxidative Heck reaction was then investigated. The investigation results show that the catalyst displays over 99% selectivity for the product formation with high reaction yield. Kinetic profiles further confirm its high catalytic efficiency, showing that the rate constant is nearly 40 times higher than that for the free Pd(II) salt. X-ray absorption spectroscopy reveals that the catalyst has remarkable lifetime and recyclability.

ARCAS (ACACIA Regional Climate-data Access System) -- a Web Access System for Climate Model Data Access, Visualization and Comparison

Science.gov (United States)

Hakkarinen, C.; Brown, D.; Callahan, J.; hankin, S.; de Koningh, M.; Middleton-Link, D.; Wigley, T.

2001-05-01

A Web-based access system to climate model output data sets for intercomparison and analysis has been produced, using the NOAA-PMEL developed Live Access Server software as host server and Ferret as the data serving and visualization engine. Called ARCAS ("ACACIA Regional Climate-data Access System"), and publicly accessible at http://dataserver.ucar.edu/arcas, the site currently serves climate model outputs from runs of the NCAR Climate System Model for the 21st century, for Business as Usual and Stabilization of Greenhouse Gas Emission scenarios. Users can select, download, and graphically display single variables or comparisons of two variables from either or both of the CSM model runs, averaged for monthly, seasonal, or annual time resolutions. The time length of the averaging period, and the geographical domain for download and display, are fully selectable by the user. A variety of arithmetic operations on the data variables can be computed "on-the-fly", as defined by the user. Expansions of the user-selectable options for defining analysis options, and for accessing other DOD-compatible ("Distributed Ocean Data System-compatible") data sets, residing at locations other than the NCAR hardware server on which ARCAS operates, are planned for this year. These expansions are designed to allow users quick and easy-to-operate web-based access to the largest possible selection of climate model output data sets available throughout the world.

Laparoscopic surgery for complicated diverticular disease: a single-centre experience.

LENUS (Irish Health Repository)

Royds, J

2012-10-01

The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery.

Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute.

Science.gov (United States)

Novellis, Pierluigi; Bottoni, Edoardo; Voulaz, Emanuele; Cariboni, Umberto; Testori, Alberto; Bertolaccini, Luca; Giordano, Laura; Dieci, Elisa; Granato, Lorenzo; Vanni, Elena; Montorsi, Marco; Alloisio, Marco; Veronesi, Giulia

2018-02-01

Robotic surgery is increasingly used to resect lung cancer. However costs are high. We compared costs and outcomes for robotic surgery, video-assisted thoracic surgery (VATS), and open surgery, to treat non-small cell lung cancer (NSCLC). We retrospectively assessed 103 consecutive patients given lobectomy or segmentectomy for clinical stage I or II NSCLC. Three surgeons could choose VATS or open, the fourth could choose between all three techniques. Between-group differences were assessed by Fisher's exact, two-way analysis of variance (ANOVA), and Wilcoxon-Mann-Whitney test. P values open surgery. Age, physical status, pulmonary function, comorbidities, stage, and perioperative complications did not differ between the groups. Pathological tumor size was greater in the open than VATS and robotic groups (P=0.025). Duration of surgery was 150, 191 and 116 minutes, by robotic, VATS and open approaches, respectively (Popen groups. Estimated costs were 82%, 68% and 69%, respectively, of the regional health service reimbursement for robotic, VATS and open approaches. Robotic surgery for early lung cancer was associated with shorter stay and more extensive lymph node dissection than VATS and open surgery. Duration of surgery was shorter for robotic than VATS. Although the cost of robotic thoracic surgery is high, the hospital makes a profit.

Health care access and utilization among children of single working and nonworking mothers in the United States.

Science.gov (United States)

Clarke, Tainya C; Arheart, Kristopher L; Muennig, Peter; Fleming, Lora E; Caban-Martinez, Alberto J; Dietz, Noella; Lee, David J

2011-01-01

To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.

Adherence to Surgical Site Infection Guidelines in Cardiac Surgery ...

African Journals Online (AJOL)

Purpose: To assess the appropriateness and compliance of antibiotic prophylaxis practices in cardiac surgery in a tertiary hospital in United Arab Emirates (UAE) using three international guidelines. Methods: A retrospective study was performed by reviewing patients' files admitted for cardiac surgery between January 2008 ...

Novel approach of single-port laparoscopic appendectomy as a solo surgery: A prospective cohort study.

Science.gov (United States)

Kim, Say-June; Choi, Byung-Jo; Lee, Sang Chul

2015-09-01

Recent advances in medical equipment and surgical techniques have enabled solo surgery, wherein a surgeon operates alone without the participation of other surgical members. However, the application of solo surgery in single-port laparoscopic surgery (SPLS) has been rarely reported. Prospectively collected databases of 60 patients who underwent solo-SPLS for appendicitis between March 2013 and June 2014 were retrospectively reviewed. Making a transumbilical incision into the peritoneal cavity was facilitated by using a Lone Star self-retaining retractor. After the establishment of a single port through the umbilicus, we installed a mechanical adjustable camera holder (Endoworld®LAP53 Holding Systems). It was anchored to the operating table rail and firmly held the laparoscope with a possibility to adjust the same as required by the operator. The operative method was identical to the SPLS appendectomy, except for the use of these instruments. The median operation time was 50 min (25-120). None of the patients required open conversion, insertion of an additional port or help of a human assistant. The median length of hospital stay for all patients was 1.0 day (range: 1-3 days). The median dosage of required intravenous analgesics (ketorolac, 0.1 mg/kg of body weight) was 0.0 ampoule (0-4). The median interval to initiation of solid diet was 1 day (1-2). The incidence of postoperative complications was 8.3% (5/60). Our results shows that solo-SPLS appendectomy could be performed without increasing operation time or postoperative complications when performed by a surgeon competent in performing SPLS appendectomy. Copyright © 2015. Published by Elsevier Ltd.

Catalysis by Design: Well-Defined Single-Site Heterogeneous Catalysts

KAUST Repository

Pelletier, Jeremie

2016-03-09

ConspectusHeterogeneous catalysis, a field important industrially and scientifically, is increasingly seeking and refining strategies to render itself more predictable. The main issue is due to the nature and the population of catalytically active sites. Their number is generally low to very low, their "acid strengths" or " redox properties" are not homogeneous, and the material may display related yet inactive sites on the same material. In many heterogeneous catalysts, the discovery of a structure-activity reationship is at best challenging. One possible solution is to generate single-site catalysts in which most, if not all, of the sites are structurally identical. Within this context and using the right tools, the catalyst structure can be designed and well-defined, to reach a molecular understanding. It is then feasible to understand the structure-activity relationship and to develop predictable heterogeneous catalysis. Single-site well-defined heterogeneous catalysts can be prepared using concepts and tools of surface organometallic chemistry (SOMC). This approach operates by reacting organometallic compounds with surfaces of highly divided oxides (or of metal nanoparticles). This strategy has a solid track record to reveal structure-activity relationship to the extent that it is becoming now quite predictable. Almost all elements of the periodical table have been grafted on surfaces of oxides (from simple oxides such as silica or alumina to more sophisticated materials regarding composition or porosity).Considering catalytic hydrocarbon transformations, heterogeneous catalysis outcome may now be predicted based on existing mechanistic proposals and the rules of molecular chemistry (organometallic, organic) associated with some concepts of surface sciences. A thorough characterization of the grafted metal centers must be carried out using tools spanning from molecular organometallic or surface chemistry. By selection of the metal, its ligand set, and the

Single-stage multilevel soft-tissue surgery in the lower limbs with spastic cerebral palsy: Experience from a rehabilitation unit

Directory of Open Access Journals (Sweden)

Gupta Anupam

2008-01-01

Full Text Available Background: To assess the effect of single-stage multilevel soft-tissue surgery (Single Event Multiple Level Resections, SEMLR on deformities and locomotion in patients with cerebral palsy (CP with static contracture(s in lower limbs. Patients and Methods: Study included 34 patients (M:F, 23:11 with mean age of 9.53 ± 3.92 years (4-16 years. Among them 22 had diplegia and four each had quadriplegia and right and left hemiplegia. Fourteen patients (41.2% had their intelligence quotient (IQ in the normal range (IQ ≥ 80, while others had mental retardation (MR of varying severity: borderline MR (IQ = 70-79 in 12, mild MR (IQ = 50-69 in 5, and moderate MR (IQ = 35-49 in patients 3. All patients underwent surgery (total number of procedures 153, average 4.5 procedures/patient over a period of 30 months (April 2005 to September 2007. Improvement in functional abilities and locomotion was assessed using Gross Motor Functional Classification Scale (GMFCS scores and by physical examination. Results: Significant improvement in function was observed ( P = 0.000 after surgery when comparing the preoperative and postoperative GMFCS scores. All patients were maintaining ambulation at a mean follow-up duration of 13.12 ± 6.07 months (3-24 months, with five patients using knee-ankle-foot orthoses (KAFO, 22 using ankle-foot orthoses (AFO, and six patients using knee gaiters. Sixteen patients were using walker, and two were using crutches as assistive devices. Conclusion: This study suggests that CP patients with good trunk control and static contractures at multiple joints in the lower limbs can be made ambulant with single-stage multilevel soft-tissue surgery. It has to be a team effort of the surgeon and the rehabilitation team in the postoperative period for the attainment of satisfactory goal.

Overview of robotic colorectal surgery: Current and future practical developments

Science.gov (United States)

Roy, Sudipta; Evans, Charles

2016-01-01

Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete. PMID:26981188

Shape Optimization of the Assisted Bi-directional Glenn surgery for stage-1 single ventricle palliation

Science.gov (United States)

Verma, Aekaansh; Shang, Jessica; Esmaily-Moghadam, Mahdi; Wong, Kwai; Marsden, Alison

2016-11-01

Babies born with a single functional ventricle typically undergo three open-heart surgeries starting as neonates. The first of these stages (BT shunt or Norwood) has the highest mortality rates of the three, approaching 30%. Proceeding directly to a stage-2 Glenn surgery has historically demonstrated inadequate pulmonary flow (PF) & high mortality. Recently, the Assisted Bi-directional Glenn (ABG) was proposed as a promising means to achieve a stable physiology by assisting the PF via an 'ejector pump' from the systemic circulation. We present preliminary parametrization and optimization results for the ABG geometry, with the goal of increasing PF. To limit excessive pressure increases in the Superior Vena Cava (SVC), the SVC pressure is included as a constraint. We use 3-D finite element flow simulations coupled with a single ventricle lumped parameter network to evaluate PF & the pressure constraint. We employ a derivative free optimization method- the Surrogate Management Framework, in conjunction with the OpenDIEL framework to simulate multiple simultaneous evaluations. Results show that nozzle diameter is the most important design parameter affecting ABG performance. The application of these results to patient specific situations will be discussed. This work was supported by an NSF CAREER award (OCI1150184) and by the XSEDE National Computing Resource.

Advances in percutaneous stone surgery.

Science.gov (United States)

Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.

Geographic Diffusion and Implementation of Acute Care Surgery: An Uneven Solution to the National Emergency General Surgery Crisis.

Science.gov (United States)

Khubchandani, Jasmine A; Ingraham, Angela M; Daniel, Vijaya T; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

2018-02-01

Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging. A national survey on EGS practices was developed, tested, and administered at all 2811 US acute care hospitals providing EGS to adults between August 2015 and October 2015. Surgeons responsible for EGS coverage at these hospitals were approached. If these surgeons failed to respond to the initial survey implementation, secondary surgeons or chief medical officers at hospitals with only 1 general surgeon were approached. Survey responses on ACS implementation were linked with geocoded hospital data and national census data to determine geographic diffusion of and access to ACS. We measured the distribution of hospitals with ACS models of care vs those without over time (diffusion) and by US counties characterized by sociodemographic characteristics of county residents (access). Survey response rate was 60% (n = 1690); 272 responding hospitals had implemented ACS by 2015, steadily increasing from 34 in 2001 to 125 in 2010. Acute care surgery implementation has not been uniform. Rural regions have limited ACS access, with hospitals in counties with greater than the 75th percentile population having 5.4 times higher odds (95% CI, 1.66-7.35) of implementing ACS than hospitals in counties with less than 25th percentile population. Communities with greater percentages of adults without a college degree also have limited ACS access (OR, 3.43; 95% CI, 1.81-6.48). However, incorporating EGS into ACS models may be a potential equalizer for poor, black, and Hispanic communities. Understanding and

Water Access Sites in Minnesota

Data.gov (United States)

Minnesota Department of Natural Resources — This data shows the approximate locations of boat accesses in the state. This is not a comprehensive list but one that was generated through a cooperative effort....

Warm-up before laparoscopic surgery is not essential.

Science.gov (United States)

Weston, Maree K; Stephens, Jacqueline H; Schafer, Amy; Hewett, Peter J

2014-03-01

Several recent studies have suggested that warming up prior to surgery may improve surgical performance. The purpose of this study was to investigate whether warming up prior to laparoscopic surgery improves surgical performance or reduces surgery duration. Between August 2011 and January 2012, a randomized controlled trial was conducted to compare two warm-up modalities to no warm-up. The study was conducted at a single site, with nine surgeons performing 72 laparoscopic cholecystectomies and 37 laparoscopic appendicectomies. Prior to surgery, surgeons were randomized to either laparoscopic trainer box warm-up, PlayStation 2 warm-up or no warm-up. The activity was performed within 30 min of surgery commencing. Patients provided informed consent for the surgery to be digitally recorded. Digital videodiscs (DVDs) were reviewed by an independent and blinded assessor. Data were collected on duration of surgery, level of training and perceived surgical difficulty. Surgical performance was graded using a validated scoring system. From the 109 operations performed, there were 75 usable DVDs. Overall, there were no statistical differences in the demographics of patients and surgeons in the three treatment groups, nor in the subset that had useable DVDs. There were no statistical differences in the duration of surgery or surgeon's perceived surgical difficulty. There was no statistical difference in surgical performance. This study suggests that warm-up prior to laparoscopic cholecystectomy or appendicectomy is not essential, acknowledging that there are several study limitations that preclude definitive conclusion. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Very late complications of cervical arthroplasty: results of 2 controlled randomized prospective studies from a single investigator site.

Science.gov (United States)

Hacker, Francis M; Babcock, Rebecca M; Hacker, Robert J

2013-12-15

Prospective, single-site, randomized, Food and Drug Administration-approved investigational device exemption clinical trials of 2 cervical arthroplasty (CA) devices. To evaluate complications with CA occurring more than 4 years after the surgical procedure in Food and Drug Administration clinical trials of the Bryan and Prestige LP arthroplasty devices. Reports of several randomized clinical studies have shown CA to be a safe and effective alternative to anterior cervical fusion in the treatment of degenerative cervical disc disorders. A majority include follow-up intervals of 4 years or less. Between 2002 and 2006, 94 patients were enrolled in Food and Drug Administration studies of the Bryan and Prestige LP cervical disc devices. Charts, imaging studies, and hospital records were reviewed for those who underwent arthroplasty and returned more than 4 years after their surgical procedure with neck-related pain or dysfunction. Excluding adjacent segment disease that occurred with a similar rate for patients who underwent fusion and arthroplasty, 5 patients, all treated with arthroplasty, returned for evaluation of neck and arm symptoms between 48 and 72 months after surgery. Four patients had peridevice vertebral body bone loss. One patient had posterior device migration and presented with myelopathy. Three required revision surgery and 2 were observed. Four patients maintained follow-up and reported stabilization or improvement in symptoms. Despite their similarities, CA and fusion are not equivalent procedures in this study in regard to very late complications. Similar to large joint arthroplasty, delayed device-related complications may occur with CA. These complications commenced well beyond the time frame for complications associated with more traditional cervical spine procedures. Both patients and surgeons should be aware of the potential for very late device-related complications occurring with CA and the need for revision surgery. 1.

Differences in risk factors associated with surgical site infections following two types of cardiac surgery in Japanese patients.

Science.gov (United States)

Morikane, K; Honda, H; Yamagishi, T; Suzuki, S

2015-05-01

Differences in the risk factors for surgical site infection (SSI) following open heart surgery and coronary artery bypass graft surgery are not well described. To identify and compare risk factors for SSI following open heart surgery and coronary artery bypass graft surgery. SSI surveillance data on open heart surgery (CARD) and coronary artery bypass graft surgery (CBGB) submitted to the Japan Nosocomial Infection Surveillance (JANIS) system between 2008 and 2010 were analysed. Factors associated with SSI were analysed using univariate modelling analysis followed by multi-variate logistic regression analysis. Non-binary variables were analysed initially to determine the most appropriate category. The cumulative incidence rates of SSI for CARD and CBGB were 2.6% (151/5895) and 4.1% (160/3884), respectively. In both groups, the duration of the operation and a high American Society of Anesthesiologists' (ASA) score were significant in predicting SSI risk in the model. Wound class was independently associated with SSI in CARD but not in CBGB. Implants, multiple procedures and emergency operations predicted SSI in CARD, but none of these factors predicted SSI in CBGB. There was a remarkable difference in the prediction of risk for SSI between the two types of cardiac surgery. Risk stratification in CARD could be improved by incorporating variables currently available in the existing surveillance systems. Risk index stratification in CBGB could be enhanced by collecting additional variables, because only two of the current variables were found to be significant for the prediction of SSI. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

In elective arch surgery with circulatory arrest, does the arterial cannulation site really matter? A propensity score analysis of right axillary and innominate artery cannulation.

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Preventza, Ourania; Price, Matt D; Spiliotopoulos, Konstantinos; Amarasekara, Hiruni S; Cornwell, Lorraine D; Omer, Shuab; de la Cruz, Kim I; Zhang, Qianzi; Green, Susan Y; LeMaire, Scott A; Rosengart, Todd K; Coselli, Joseph S

2018-05-01

The preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery. We reviewed the records of 938 patients who underwent elective hemiarch or total arch surgery with circulatory arrest between 2006 and 2016. Five cannulation sites were used: the right axillary (n = 515; 54.9%), innominate (n = 376; 40.1%), and right common carotid arteries (n = 15; 1.6%), each with a side graft; the ascending aorta (n = 19; 2.0%); and the femoral artery (n = 13; 1.4%). Multivariable logistic regression analysis was used to model the effects of cannulation site on adverse outcomes for the entire cohort and for a subcohort of 891 patients who underwent innominate or axillary artery cannulation. Propensity-matching yielded 564 patients (282 pairs) from the right axillary and innominate artery groups. For the entire cohort, mortality, stroke, and composite adverse outcome (operative death or persistent stroke or renal failure at hospital discharge) rates were 7.0%, 4.1%, and 9.8%. In the multivariable analysis of the axillary/innominate subcohort, cannulation site did not independently predict operative mortality, persistent stroke, or composite adverse event. These results were confirmed with the propensity-matched analysis, where both axillary and innominate artery cannulation provided equivalent composite adverse event rates, operative death rates, and overall stroke rates. During elective arch surgery, right axillary artery cannulation and innominate artery cannulation (both via a side graft) produce excellent results and can be used interchangeably. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: a single center experience in a developing economy.

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Balachandran, Rakhi; Kappanayil, Mahesh; Sen, Amitabh Chanchal; Sudhakar, Abhish; Nair, Suresh G; Sunil, G S; Raj, R Benedict; Kumar, Raman Krishna

2015-01-01

The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance. The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy

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Rakhi Balachandran

2015-01-01

Full Text Available Background: The International Quality Improvement Collaborative (IQIC for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. Objective: We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. Methods: The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU stay, bacterial sepsis and surgical site infection. Results: The 1702 patients included 771(45.3% females. The median age was 8 months (0.03-216 and the median weight was 6.1Kg (1-100. The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001, surgical site infection (11.1% to 2.4%, P < 0.001 and duration of ICU stay from 114(8-999 hours to 72 (18-999 hours (P < 0.001 The decline in mortality from (4.3% to 2.2% did not reach statistical significance. Conclusions: The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

FACTORS ASSOCIATED WITH INFECTIONS IN SPINAL SURGERY

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ANA MARÍA MORALES LÓPEZ

Full Text Available ABSTRACT Objective: To identify the factors associated with postoperative infections in spinal surgery. Methods: Descriptive, retrospective, cross-sectional study conducted in the spine surgery department of the Medical Unit of High Specialty (UMAE at the Hospital of Traumatology and Orthopedics Lomas Verdes, Mexican Institute of Social Security (IMSS between January 01, 2013 and June 30, 2014 through medical records of the service and the records of clinical care. Data were gathered in accordance with the records of patients with infection after spinal surgery. The factors considered were age group, etiologic agent, surgical site, type of treatment, bleeding volume and pharmacotherapy. Frequency and descriptive statistic was conducted. The rank sum test with the Wilcoxon test for a single sample was performed in different measurements; Pearson's correlation was calculated and all p<0.05 values were considered significant. Results: The sample was composed of 14 patients of which 11 were female (78.6% and 3 male (21.4% with predominance of surgical area in the lumbar and dorsolumbar region. There was a significant correlation between the surgical time and the amount of bleeding with p<0.001. Conclusions: It was clear that the infections present in patients after spinal surgery are multifactorial. However, in this study the correlation between time of surgery and bleeding amount had the highest importance and relevance.

Single scrotal incision orchiopexy - a systematic review

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Hugo Fabiano Fernandes Novaes

2013-06-01

Full Text Available Objective To conduct a systematic review on single scrotal incision orchiopexy. Materials and Methods A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. The following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery. Results A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%, there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. Conclusions Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.

Laparoscopic surgery for complicated diverticular disease: a single-centre experience.

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Royds, J; O'Riordan, J M; Eguare, E; O'Riordan, D; Neary, P C

2012-10-01

The role of laparoscopic surgery in the management of patients with diverticular disease is still not universally accepted. The aim of our study was to evaluate the results of laparoscopic surgery for diverticular disease in a centre with a specialist interest in minimally invasive surgery. All diverticular resections carried out between 2006 and 2010 were reviewed. Data recorded included baseline demographics, indication for surgery, operative details, length of hospital stay and complications. Complicated diverticular disease was defined as diverticulitis with associated abscess, phlegmon, fistula, stricture, obstruction, bleeding or perforation. One hundred and two patients (58 men) who had surgery for diverticular disease were identified (median age 59 years, range 49-70 years). Sixty-four patients (64%) had surgery for complicated diverticular disease. The indications were recurrent acute diverticulitis (37%), colovesical fistula (21%), stricture formation (17%) and colonic perforation (16%). Sixty-nine cases (88%) were completed by elective laparoscopy. Postoperative mortality was 0%. For elective cases there was no difference in morbidity rates between patients with complicated and uncomplicated diverticular disease. The overall anastomotic leakage rate was 1% and the wound infection rate 7%. There was a nonsignificant trend to higher conversion to open surgery in the elective group in complicated (11.4%) compared with uncomplicated patients (5.2%) (P=0.67). Electively, the rate of stoma formation was higher in the complicated (31.6%) than the uncomplicated group (5.2%) (Pdiverticular disease is associated with low rates of postoperative morbidity and relatively low conversion rates. Laparoscopic surgery is now the standard of care for complicated and uncomplicated diverticular disease in our institution. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Archives: Annals of Pediatric Surgery

African Journals Online (AJOL)

Items 1 - 32 of 32 ... Archives: Annals of Pediatric Surgery. Journal Home > Archives: Annals of Pediatric Surgery. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 1 - 32 of 32 Items ...

First experience with single incision laparoscopic surgery in Slovakia: concomitant cholecystectomy and splenectomy in an 11-year-old girl with hereditary spherocytosis.

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Cingel, Vladimir; Zabojnikova, Lenka; Kurucova, Patricia; Varga, Ivan

2014-09-01

Hereditary spherocytosis is an autosomal dominant inheritance disorder of the red blood cell membrane characterized by the presence of spherical-shaped erythrocytes (spherocytes) in the peripheral blood. The main clinical features include haemolytic anemia, variable jaundice, splenomegaly and cholelithiasis caused by hyperbilirubinemia from erythrocyte hemolysis. Splenectomy does not solve the congenital genetic defect but it stops pathological hemolysis in the enlarged spleen. If gallstones are present, it is appropriate to perform cholecystectomy at the time of splenectomy, although the patient has symptoms of gall bladder disease. We present the case of single incision laparoscopic surgical (SILS) concomitant splenectomy and cholecystectomy performed with conventional laparoscopic instruments in an 11-year-old girl with the diagnosis of hereditary spherocytosis. A 2-3 cm umbilical incision was used for the placement of two 5 mm trocars and one 10 mm flexible videoscope. Conventional laparoscopic dissector, grasper, Ligasure, Harmonic Ace and hemoclips were the main tools during surgical procedure. We prefer Single Incision Laparoscopic Surgery Foam Port (Covidien) as the single umbilical device for introduction into the abdominal cavity. First, we performed cholecystectomy, then the gallbladder was put aside over the liver and after that we peformed splenectomy. To remove the detached spleen and gallbladder, a nylon extraction bag is introduced through one of the port sites. The spleen is than morcellated in the bag with forceps and removed in fragments. After that we removed them and the umbilical fascial incision was closed. Splenectomy is the only effective therapy for this disorder and often it is performed in combination with cholecystectomy. Conventional surgery requires a wide upper abdominal incision for correct exposure of the gallbladder and spleen. Our experience shows that SILS splenectomy and cholecystectomy is feasible even in young children and

Repair of traumatic tricuspid insufficiency via minimally invasive port access.

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Kasahara, Hirofumi; Kudo, Mikihiko; Kawajiri, Hiroyuki; Yozu, Ryohei

2010-04-01

We report on a successful tricuspid valve plasty using port-access minimally invasive cardiac surgery (MICS) for severe traumatic tricuspid insufficiency caused by blunt chest trauma suffered 15 years previously. A combination repair procedure, consisting of cleft closures, plication of the anteroseptal commissure, and ring annuloplasty, was necessary to achieve valve competence and proved possible via port access without difficulty. Port-access MICS is an alternative approach for tricuspid valve surgery.

Umbilical KeyPort bilateral laparoscopic orchiectomy in patient with complete androgen insensitivity syndrome

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Felipe P. Andrade

2012-10-01

Full Text Available MAIN FINDINGS: A 22-year-old woman with complete androgen insensitivity syndrome (CAIS presenting with primary amenorrhea and normal female external genitalia was referred for laparoscopic gonadectomy. She had been diagnosed several years earlier but was reluctant to undergo surgery. CASE HYPOTHESIS: Diagnosis of this X-linked recessive inherited syndrome characterizes by disturbance of virilization in males with an AR mutation, XY karyotipe, female genitalia and severely undescended testis with risk of malignization. The optimal time to orchidectomy is not settled; neither the real risk of malignancy in these patients. Early surgery impacts development of a complete female phenotype, with enlargement of the breasts. Based on modern diagnostic imaging using DCE-MRI and surgical technology with single port laparoscopic access we hypothesize that the optimum time for gonadectomy is not at the time of diagnosis, but once feminization has completed. PROMISING FUTURE IMPLICATIONS: An umbilical laparoendoscopic single-site access for bilateral gonadectomy appears to be the first choice approach as leaves no visible incision and diminishes the psychological impact of surgery in a patient with CAIS absolutely reassured as female. KeyPort, a single port access with duo-rotate instruments developed by Richard Wolf facilitates this surgery and allows excellent cosmetic results.

Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

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Atakan Sezer

2011-06-01

Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

Conversion to full sternotomy during minimal-access cardiac surgery: reasons and results during a 9.5-year experience.

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Tabata, Minoru; Umakanthan, Ramanan; Khalpey, Zain; Aranki, Sary F; Couper, Gregory S; Cohn, Lawrence H; Shekar, Prem S

2007-07-01

A hemisternotomy approach to minimal-access cardiac surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function. Conversion to a full sternotomy is occasionally required for reasons that remain inadequately reported. Between January 1996 and June 2005, 907 cardiac surgical patients were planned for an upper hemisternotomy and 528 for a lower hemisternotomy. We retrospectively reviewed 45 patients who required conversion to a full sternotomy. Twenty-four (2.6%) of 907 patients required a conversion from upper hemisternotomy because of bleeding (n = 8), ventricular dysfunction (n = 5), refractory ventricular arrhythmia (n = 3), poor exposure (n = 2), and other causes (n = 6). Eight (33.3%) of 24 patients died perioperatively. Of the 883 patients who went on to have an operation through the upper hemisternotomy approach, the mortality was 1.7% (15/883). Twenty-one (4.0%) of 528 patients required conversion from a lower hemisternotomy because of poor exposure (n = 16), bleeding (n = 1), refractory ventricular arrhythmia (n = 3), and a retained venous cannula (n = 1). None of these patients died postoperatively. Of the 507 patients who went on to have an operation through the lower hemisternotomy approach, the mortality was 1.2% (6/507). Conversion to a full sternotomy occurs infrequently during minimal-access cardiac surgery. Upper hemisternotomy conversions are usually urgent after crossclamp removal and are often associated with serious morbidity and mortality. Conversely, lower hemisternotomy conversions are performed electively in the prebypass period because of poor exposure and are not associated with complications.

Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery.

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Sawang, Kamonpun; Chaiyasamut, Teeranut; Kiattavornchareon, Sirichai; Pairuchvej, Verasak; Bhattarai, Bishwa Prakash; Wongsirichat, Natthamet

2017-06-01

There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P molar region can be an alternative anesthetic for LITM surgery.

Incidence of early symptomatic port-site hernia: a case series from a department where laparoscopy is the preferred surgical approach.

LENUS (Irish Health Repository)

Moran, D C

2012-12-01

Potential benefits of laparoscopic surgery include decreased post-operative pain, improved cosmesis and a shorter hospital stay. However as the volume and complexity of laparoscopic procedures increase, there appears to be a simultaneous increase in complications relating to laparoscopic access. Development of a port-site hernia is one such complication.

Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial).

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Arezzo, Alberto; Passera, Roberto; Bullano, Alberto; Mintz, Yoav; Kedar, Asaf; Boni, Luigi; Cassinotti, Elisa; Rosati, Riccardo; Fumagalli Romario, Uberto; Sorrentino, Mario; Brizzolari, Marco; Di Lorenzo, Nicola; Gaspari, Achille Lucio; Andreone, Dario; De Stefani, Elena; Navarra, Giuseppe; Lazzara, Salvatore; Degiuli, Maurizio; Shishin, Kirill; Khatkov, Igor; Kazakov, Ivan; Schrittwieser, Rudolf; Carus, Thomas; Corradi, Alessio; Sitzman, Guenther; Lacy, Antonio; Uranues, Selman; Szold, Amir; Morino, Mario

2017-07-01

Single-port laparoscopic surgery as an alternative to conventional laparoscopic cholecystectomy for benign disease has not yet been accepted as a standard procedure. The aim of the multi-port versus single-port cholecystectomy trial was to compare morbidity rates after single-access (SPC) and standard laparoscopy (MPC). This non-inferiority phase 3 trial was conducted at 20 hospital surgical departments in six countries. At each centre, patients were randomly assigned to undergo either SPC or MPC. The primary outcome was overall morbidity within 60 days after surgery. Analysis was by intention to treat. The study was registered with ClinicalTrials.gov (NCT01104727). The study was conducted between April 2011 and May 2015. A total of 600 patients were randomly assigned to receive either SPC (n = 297) or MPC (n = 303) and were eligible for data analysis. Postsurgical complications within 60 days were recorded in 13 patients (4.7 %) in the SPC group and in 16 (6.1 %) in the MPC group (P = 0.468); however, single-access procedures took longer [70 min (range 25-265) vs. 55 min (range 22-185); P risk of incisional hernia following SPC do not appear to be justified. Patient satisfaction with aesthetic results was greater after SPC than after MPC.

Surgery with cooperative robots.

Science.gov (United States)

Lehman, Amy C; Berg, Kyle A; Dumpert, Jason; Wood, Nathan A; Visty, Abigail Q; Rentschler, Mark E; Platt, Stephen R; Farritor, Shane M; Oleynikov, Dmitry

2008-03-01

Advances in endoscopic techniques for abdominal procedures continue to reduce the invasiveness of surgery. Gaining access to the peritoneal cavity through small incisions prompted the first significant shift in general surgery. The complete elimination of external incisions through natural orifice access is potentially the next step in reducing patient trauma. While minimally invasive techniques offer significant patient advantages, the procedures are surgically challenging. Robotic surgical systems are being developed that address the visualization and manipulation limitations, but many of these systems remain constrained by the entry incisions. Alternatively, miniature in vivo robots are being developed that are completely inserted into the peritoneal cavity for laparoscopic and natural orifice procedures. These robots can provide vision and task assistance without the constraints of the entry incision, and can reduce the number of incisions required for laparoscopic procedures. In this study, a series of minimally invasive animal-model surgeries were performed using multiple miniature in vivo robots in cooperation with existing laparoscopy and endoscopy tools as well as the da Vinci Surgical System. These procedures demonstrate that miniature in vivo robots can address the visualization constraints of minimally invasive surgery by providing video feedback and task assistance from arbitrary orientations within the peritoneal cavity.

Archives: East and Central African Journal of Surgery

African Journals Online (AJOL)

Items 1 - 40 of 40 ... Archives: East and Central African Journal of Surgery. Journal Home > Archives: East and Central African Journal of Surgery. Log in or Register to get access to full text downloads.

Wound Complications Following Laparoscopic Surgery in a ...

African Journals Online (AJOL)

Laparoscopic surgery offers many proven advantages over conventional open surgery for many procedures.[1,2] These advantages have increased the utilization and acceptability of laparoscopy and indeed other forms of .... chemotherapy and had no recurrence at the site after 13 months follow‑up. The extraction site in ...

Identifying the Infection Control Areas Requiring Modifications in Thoracic Surgery Units: Results of a Two-Year Surveillance of Surgical Site Infections in Hospitals in Southern Poland.

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Dubiel, Grzegorz; Rogoziński, Paweł; Żaloudik, Elżbieta; Bruliński, Krzysztof; Różańska, Anna; Wójkowska-Mach, Jadwiga

2017-10-01

Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland. The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room. In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site. The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely

Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates: a single-center experience with 112 cases.

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Son, Tran Ngoc; Kien, Hoang Huu

2017-12-01

A single center study was conducted to compare the short-term clinical outcome between laparoscopic surgery (LS) and open surgery (OS) repair for neonates with congenital duodenal obstruction (CDO). Medical records of all neonates with bodyweight at surgery over 1500g and without other gastrointestinal anomalies that underwent surgery (duodeno-duodenostomy or duodeno-jejunostomy) for CDO at our center between January 2009 and July 2015 were reviewed. The choice of OS or LS was surgeon-dependent. One hundred twelve patients were identified, with a median age and weight at surgery 8.5days and 2500g respectively. Forty-four patients underwent OS and 68 patients LS. There were no significant differences between the two groups regarding patient age, gender, weight at surgery, associated anomalies, and mean operative time. Compared to OS, the LS group had lower postoperative complications (5.9% vs 36.4%, p<0.0001), shorter mean time to initial oral feeding and mean postoperative hospital stay (3.9 vs. 7.1days and 8.6 vs. 12.9days respectively, p<0.0001) and better postoperative cosmesis. LS treatment for neonatal CDO is associated with lower postoperative morbidity, shorter recovery time and postoperative hospital stay and better postoperative cosmesis than OS. Retrospective Comparative Study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection.

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Xu, Sheng-Gen; Mao, Zhao-Guang; Liu, Bin-Sheng; Zhu, Hui-Hua; Pan, Hui-Lin

2015-02-01

Widespread overuse and inappropriate use of antibiotics contribute to increasingly antibiotic-resistant pathogens and higher health care costs. It is not clear whether routine antibiotic prophylaxis can reduce the rate of surgical site infection (SSI) in low-risk patients undergoing orthopaedic surgery. We designed a simple scorecard to grade SSI risk factors and determined whether routine antibiotic prophylaxis affects SSI occurrence during open reduction and internal fixation (ORIF) orthopaedic surgeries in trauma patients at low risk of developing SSI. The SSI risk scorecard (possible total points ranged from 5 to 25) was designed to take into account a patient's general health status, the primary cause of fractures, surgical site tissue condition or wound class, types of devices implanted, and surgical duration. Patients with a low SSI risk score (≤8 points) who were undergoing clean ORIF surgery were divided into control (routine antibiotic treatment, cefuroxime) and evaluation (no antibiotic treatment) groups and followed up for 13-17 months after surgery. The infection rate was much higher in patients with high SSI risk scores (≥9 points) than in patients with low risk scores assigned to the control group (10.7% vs. 2.2%, Prisk score. Implementation of this scoring system could guide the rational use of perioperative antibiotics and ultimately reduce antibiotic resistance, health care costs, and adverse reactions to antibiotics. Copyright © 2014 Elsevier Ltd. All rights reserved.

Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques

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Antonio Marte

2014-01-01

Full Text Available Background: Single-incision laparoscopic surgery (SILS has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V. Patients and Methods: A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V. Results: No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28 in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25. All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V. Conclusion: The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.

Civil Engineering Works Status of the Proton Accelerator Research Center in PEFP - Site and Access Road Earthwork

International Nuclear Information System (INIS)

Nam, Jung Min; Jeon, G. P.; Min, Y. S.; Park, S. S.; Cho, J. S.; Mun, K. J.; Kim, J. Y.

2010-01-01

PEFP(Proton Engineering Frontier Project) was Launched in 2002 as one of the 21st Century Frontier R and D Programs of MOST(Ministry of Science and Technology). Gyeongju city was selected as the project host site in March, 2006, where 'Proton Accelerator Research Center' was going to be constructed. Since 2005, the Architectural and Civil design work has been performing. The Earthwork of the site was started in June, 2009. In this paper, we describe the status of the civil engineering works for the PEFP, focusing on the earthwork of the site and access road

Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment.

Science.gov (United States)

Mohr, Stefan; Siegenthaler, Franziska; Imboden, Sara; Kuhn, Annette; Mueller, Michael D

To show a new technique of using single-incision laparoscopic surgery (SILS) equipment in vaginal surgery to create a "pneumovagina." Explanatory video demonstrating the technique and intraoperative findings. University hospital. The 68-year-old patient was referred with a vaginal mesh erosion that resulted in abscess formation at the vaginal apex. The patient was symptomatic with an increasingly foul-smelling vaginal discharge for about 1 year. She had a laparoscopic sacrocolpopexy in a remote hospital 22 months before the current operation and had a total abdominal hysterectomy 15 years ago. The, patient's history was uneventful without dyspareunia, incontinence or voiding difficulties, and she was otherwise content with the sacrocolpopexy result. The local institutional review board granted exemption for this publication. Frequently, pelvic organ prolapse can only be effectively treated if the surgical procedure comprises support of the central compartment. Laparoscopic sacrocolpopexy shows superior outcomes for this indication, with success rates of up to 96%. However, a rare side effect of laparoscopic sacrocolpopexy is mesh erosion, occurring in up to 2.4% [1]. These erosions are usually treated laparoscopically [2]. In this video we show an alternative route for excision of a symptomatic exposed mesh by using a transvaginal approach: The SILS trocar is used vaginally for abscess irrigation and mesh excision with minimally invasive instruments. For treatment of the abscess and removal of the exposed mesh, the SILS trocar was placed vaginally, and laparoscopic instruments were used. The abscess was incised, cleansed and irrigated, debrided, and the mesh excised. Because no mesh material was exposed after excision, the vagina was not closed to avoid creating a cavity with the risk of promoting reabscess formation, and secondary wound healing was anticipated. Laparoscopy was used to confirm that no intra-abdominal lesion coexisted or occurred. There were

NetOglyc: prediction of mucin type O-glycosylation sites based on sequence context and surface accessibility

DEFF Research Database (Denmark)

Hansen, Jan Erik; Lund, Ole; Tolstrup, Niels

1998-01-01

-glycosylated serine and threonine residues in independent test sets, thus proving more accurate than matrix statistics and vector projection methods. Predicition of O-glycosylation sites in the envelope glycoprotein gp120 from the primate lentiviruses HIV-1, HIV-2 and SIV are presented. The most conserved O...... structure and surface accessibility. The sequence context of glycosylated threonines was found to differ from that of serine, and the sites were found to cluster. Non-clustered sites had a sequence context different from that of clustered sites. charged residues were disfavoured at postition -1 and +3......-glycosylation signals in these evolutionary-related glycoproteins were found in their first hypervariable loop, V1. However, the strain variation for HIV-1 gp120 was significant. A computer server, available through WWW or E-mail, has been developed for prediction of mucin type O-glycosylation sites in proteins based...

Well-defined single-site monohydride silica-supported zirconium from azazirconacyclopropane

KAUST Repository

Hamzaoui, Bilel

2015-01-13

The silica-supported azazirconacyclopropane ≡SiOZr(HNMe2)(η2-NMeCH2)(NMe2) (1) leads exclusively under hydrogenolysis conditions (H2, 150°C) to the single-site monopodal monohydride silica-supported zirconium species ≡SiOZr(HNMe2)(NMe2)2H (2). Reactivity studies by contacting compound 2 with ethylene, hydrogen/ethylene, propene, or hydrogen/propene, at a temperature of 200°C revealed alkene hydrogenation.

Well-defined single-site monohydride silica-supported zirconium from azazirconacyclopropane

KAUST Repository

Hamzaoui, Bilel; El Eter, Mohamad; Abou-Hamad, Edy; Chen, Yin; Pelletier, Jeremie; Basset, Jean-Marie

2015-01-01

The silica-supported azazirconacyclopropane ≡SiOZr(HNMe2)(η2-NMeCH2)(NMe2) (1) leads exclusively under hydrogenolysis conditions (H2, 150°C) to the single-site monopodal monohydride silica-supported zirconium species ≡SiOZr(HNMe2)(NMe2)2H (2). Reactivity studies by contacting compound 2 with ethylene, hydrogen/ethylene, propene, or hydrogen/propene, at a temperature of 200°C revealed alkene hydrogenation.

Laparoendoscopic Single-Site Pyelolithotomy With Use of a Carter-Thomason Needle Grasper

OpenAIRE

Seo, Ill Young; Rim, Joung Sik

2013-01-01

Purpose To study the feasibility and safety of the procedure, we present our early experience with laparoendoscopic single-site (LESS) pyelolithotomy performed by use of a Carter-Thomason needle grasper. Materials and Methods Four patients underwent LESS pyelolithotomy for the removal of renal pelvic stones. The patients' mean age was 57.8 years, and their mean body mass index was 23.01. We used a homemade single-port device made with a surgical glove that was inserted into a 2.5-cm periumbil...

Pictorial essay: Interventional radiology in the management of hemodialysis vascular access - A single-center experience

International Nuclear Information System (INIS)

Mammen, Suraj; Keshava, Shyamkumar N; Moses, Vinu; Babu, Surendra; Varughese, Santhosh

2012-01-01

Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution

Analysis of Surgical Site Infection after Musculoskeletal Tumor Surgery: Risk Assessment Using a New Scoring System

Directory of Open Access Journals (Sweden)

Satoshi Nagano

2014-01-01

Full Text Available Surgical site infection (SSI has not been extensively studied in musculoskeletal tumors (MST owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P=0.0002 and intraoperative blood loss (P=0.0005 was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials. The MOSI index (0–4 points score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points. The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

CO Reduction to CH3OSiMe3: Electrophile-Promoted Hydride Migration at a Single Fe Site.

Science.gov (United States)

Deegan, Meaghan M; Peters, Jonas C

2017-02-22

One of the major challenges associated with developing molecular Fischer-Tropsch catalysts is the design of systems that promote the formation of C-H bonds from H 2 and CO while also facilitating the release of the resulting CO-derived organic products. To this end, we describe the synthesis of reduced iron-hydride/carbonyl complexes that enable an electrophile-promoted hydride migration process, resulting in the reduction of coordinated CO to a siloxymethyl (L n Fe-CH 2 OSiMe 3 ) group. Intramolecular hydride-to-CO migrations are extremely rare, and to our knowledge the system described herein is the first example where such a process can be accessed from a thermally stable M(CO)(H) complex. Further addition of H 2 to L n Fe-CH 2 OSiMe 3 releases CH 3 OSiMe 3 , demonstrating net four-electron reduction of CO to CH 3 OSiMe 3 at a single Fe site.