1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct...1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).展开更多
Dear Editor,We present the reported case of repetitive bilateral suprachoroidal expulsive hemorrhage(SEH)after anti-glaucoma surgeries.SEH is a rare but potentially devastating complication of intraocular surgery.Long...Dear Editor,We present the reported case of repetitive bilateral suprachoroidal expulsive hemorrhage(SEH)after anti-glaucoma surgeries.SEH is a rare but potentially devastating complication of intraocular surgery.Long-term ocular hypertension,high myopia,older age,arterial sclerosis,and aphakia have been reported as preoperative risk factors for developing SEH^([1]).The prognosis for the visual acuity is poor without proper management.A suggested time for surgical drainage is said to be 10-14d when the hemorrhagic clot begins to liquefy^([2]).展开更多
Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic ep...Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.展开更多
Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a nov...Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.展开更多
Background: In developing countries, charity cleft surgical mission is always operated by sporadic surgical teams without systematic follow up and quality assurance. In the past few decades, many mission projects have...Background: In developing countries, charity cleft surgical mission is always operated by sporadic surgical teams without systematic follow up and quality assurance. In the past few decades, many mission projects have been held regularly in China. The purpose of this audit was a retrospective analysis of a 9-year cleft lip and palate charity project operated in a tertiary hospital in China Shenzhen Area to evaluate perioperative and postoperative complications. Nevertheless, understanding the risk profile is essential for establishing a sustainable in-house cleft service in Shenzhen. Methods: A detailed analysis of hospital centralized record in the The University of Hong Kong-Shenzhen Hospital (HKUSZH) was reviewed since the first charity project held in 2015. The parameters of this audit were focused on perioperative complications including anesthesia related problems, early postoperative complications in patients who underwent primary or secondary cleft surgeries. A total of 430 consecutive admitted cases of 311 non-syndromic cleft lip & palate patients were enrolled into the charity project from June 2015 to July 2024. The main anesthesia related complications that occurred during general anesthesia were respiratory tract problems, while intraoperative complication was excessive bleeding, so as wound local infection and reaction were the main early postoperative complications. Results: In our 9-year clinical audit of 430 cleft lip and palate charity surgeries in Shenzhen, we observed no mortalities and a anesthesia-related complication rate of 1.16%. Specific intraoperative complications included excessive bleeding, while early postoperative issues were dominated by wound infections. The fistula rate of 18.7% post palate repair and the average hospital stay of 3.71 days complete the profile of our surgical outcomes. These data underscore the project’s efficacy and offer a reference for international cleft missions aiming for safe and efficient surgical care. Conclusions: This study provides a thorough data review of the complications in the past 9 years charity missions for cleft lip and palate surgery in a well-structured hospital infrastructure and logistic support by local surgical team. There were no perioperative or postoperative death during the study period and the overall short-term complication rate was low. Therefore, it could be a reference model for other international cleft mission in developing country for a safe and efficient service in future.展开更多
AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between ...AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.展开更多
Background and Objective:Refractive surgery has evolved significantly,with artificial intelligence(AI)offering new possibilities for enhancing patient selection,surgical planning,and postoperative outcome prediction.W...Background and Objective:Refractive surgery has evolved significantly,with artificial intelligence(AI)offering new possibilities for enhancing patient selection,surgical planning,and postoperative outcome prediction.While AI has demonstrated promising applications,its integration into clinical practice remains inconsistent due to challenges in data standardization,model interpretability,and regulatory concerns.This review examines the current applications,limitations,and future directions of AI in refractive surgery,with a focus on its role in laser vision correction(LVC)and phakic intraocular lens(IOL)implantation.Methods:A literature review was conducted using peer-reviewed studies published between January 2010 and October 2024,sourced from databases including Google Scholar,PubMed,Embase,and Web of Science.Studies were selected based on predefined inclusion criteria,covering AI applications in refractive surgery.A total of 33 key studies(16 on LVC and 17 on phakic IOLs)were analyzed,focusing on machine learning and deep learning techniques used for patient selection,surgical optimization,and complication prediction.Only English-language studies were included.Key Content and Findings:AI models utilizing structured tabular data,imaging,and multimodal inputs have demonstrated superior performance in predicting surgical outcomes and refining patient selection compared to traditional methods.Machine learning approaches such as random forests,extreme gradient boosting,and ensemble techniques,alongside deep learning architectures like convolutional neural networks and generative models,have improved risk assessment and surgical planning.In LVC,AI enhances ectasia risk assessment,keratoconus detection,and myopic regression prediction.In phakic IOL implantation,AI improves postoperative vault prediction,lens sizing,and refractive error estimation.Multimodal AI systems integrating imaging,textual data,and clinical parameters hold promise for more comprehensive patient evaluations.However,challenges such as data heterogeneity,limited external validation,and regulatory barriers hinder widespread clinical adoption.Conclusions:AI is transforming refractive surgery by enhancing precision,personalization,and patient safety.Its integration into clinical workflows has the potential to improve surgical outcomes and patient satisfaction.Future efforts should focus on advancing multimodal AI,improving model generalizability,and addressing ethical and regulatory challenges to fully harness AI’s potential in refractive surgery.展开更多
1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Nota...1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.展开更多
Background: Surgical site infection (SSI) is a dreaded nightmare for the Orthopaedic surgeon. Preoperative skin cleaning with antiseptics has been shown to reduce the microbial burden of the skin and results in reduce...Background: Surgical site infection (SSI) is a dreaded nightmare for the Orthopaedic surgeon. Preoperative skin cleaning with antiseptics has been shown to reduce the microbial burden of the skin and results in reduced incidence of SSI. However, the ideal skin cleaning agent remains to be established. Aim: To compare the efficacy of Povidone-Iodine/Povidone-Iodine (PI-PI) combination with that of Chlorhexidine-Gluconate/Alcohol (CG-A) combination in re-ducing SSI in Orthopaedic surgeries. Methods: This was a prospective, randomized, double-blinded, controlled study. Subjects that met the selection criteria and gave consent were randomized into PI-PI group (test group) and the CG-A group (control group). Both the patients and the assessors for SSI were blinded to the group a participant belongs. Blocking was done on the type of surgery to cancel the confounding effect of surgery type on SSI. Standard perioperative protocols were applied to both groups. Assessment for features of SSI was done on the 3rd day, 7th day, 14th day, 6th week and 12th-week postoperative period. The diagnosis of SSI was made based on the Centers for Disease and Control (CDC) guidelines. Results: We recruited 124 patients for this study, 62 males and 54 females. The mean age of the subjects was 37.5 years (SD = 14.7 years). Sixty-two subjects were randomized into each group. There was no significant difference in the distribution of the genders in the study arms. Other possible confounders such as duration of hospital stay, use of drains, the surgeon involved and age were evenly distributed in the two groups. Eight patients did not complete the study. The overall incidence of SSI in the study was 2.6%. Subjects in the control group had an SSI of 3.4% while those in the PI-PI group had a rate of 1.8%;however, this was not significant, p = 0.579. Conclusion: Both CG-A and PI-PI combinations are equally efficacious as preoperative skin antiseptic in Orthopaedic implant surgeries.展开更多
Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA ...Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.展开更多
A controlled intervention study was to promote rational antibiotic prophylaxis in clean surgeries in Chinese tertiary hospitals from 2008 to 2009. The effect of the intervention was measured and compared before and af...A controlled intervention study was to promote rational antibiotic prophylaxis in clean surgeries in Chinese tertiary hospitals from 2008 to 2009. The effect of the intervention was measured and compared before and after intervention (intervention group, IG, including twelve hospitals), and compared with the control group (CG, including 164 tertiary hospitals distributed in 31 provinces). There were a total of 3961 and 657 cases identified in IG & CG for the study. Comparing the changes of IG with CG following the 3rd intervention, the proportion of antibiotics use without indication decreased from 61.9% (IG) & 84.4% (CG) (χ2 test, P χ2 test, P > 0.05);the rationality scores increased from 55.4 (IG) & 57.6 (CG) (t test, P > 0.05) to 77.0 (IG) & 64.3 (CG) (t test,展开更多
Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categ...Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.展开更多
BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provide...BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.AIM To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.METHODS A retrospective chart review of 12 consecutive cases within the same year(2016)of cataract surgeries employing I-ring pupil expansion ring(Beaver-Visitec,International)by a single surgeon at the same ambulatory surgical center was conducted.Demographic,pre-op,intra-op,and post-op data were recorded.Total number of cataract cases performed was also recorded.RESULTS 8 of 12 cases were planned I-ring cases.1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink.The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small.7 patients had IFIS from Flomax use.2 patients had pseudoexfoliation syndrome as the cause of small pupil.2 patients had narrow angles with brunescent cataracts.2 patients had pre-op partial zonular dehiscence.1 patient had 360o of posterior synechiae.2 cases had ruptured posterior capsule that required anterior vitrectomy.No complications were attributed to the pupil expansion ring.A total of 296 cataract surgeries were performed that year by the surgeon,making the rate of pupil ring use 4.1%.CONCLUSION Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges,such as brunescent cataract,zonular weakness,and posterior synechiae in this series.I-ring helped to reduce at least one challenge in these difficult cases.展开更多
AIM: To determine the efficacy of multislice CT for gastroenteric and hepatic surgery.METHODS: Dual-phase helical computed tomography was performed in 50 of 51 patients who underwent gastroenteric and hepatic surgerie...AIM: To determine the efficacy of multislice CT for gastroenteric and hepatic surgery.METHODS: Dual-phase helical computed tomography was performed in 50 of 51 patients who underwent gastroenteric and hepatic surgeries. Twenty-eight, eighteen and four patients suffering from colorectal cancer, gastric cancer,and liver cancer respectively underwent colorectal surgery (laparoscopic surgery: 6 cases), gastrectomy, and hepatectomy. Three-dimensional computed tomography imaging of the inferior mesenteric artery, celiac artery and hepatic artery was performed. And in the follow-up examination of postoperative patients, multiplanar reconstruction image was made in case of need.RESULTS: Scans in 50 patients were technically satisfactory and included in the analysis. Depiction of major visceral arteries, which were important for surgery and other treatments, could be done in all patients.Preoperative visualization of the left colic artery and sigmoidal arteries, the celiac artery and its branches, and hepatic artery was very useful to lymph node dissection,the planning of a reservoir and hepatectomy. And multiplanar reconstruction image was helpful to diagnosis for the postoperative follow-up of patients.CONCLUSION: Three-dimensional volume rendering or multiplanar reconstruction imaging performed by multislice computed tomography was very useful for gastroenteric and hepatic surgeries.展开更多
Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods:...Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.展开更多
A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） ...A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.展开更多
Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This w...Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.展开更多
In the past few years, 9 unique laser platforms have been brought to the market. As femtosecond(FS) laserassisted ophthalmic surgery potentially improves patient safety and visual outcomes, this new technology indeed ...In the past few years, 9 unique laser platforms have been brought to the market. As femtosecond(FS) laserassisted ophthalmic surgery potentially improves patient safety and visual outcomes, this new technology indeed provides ophthalmologists a reliable new option. But this new technology also poses a range of new clinical and financial challenges for surgeons. We provide an overview of the evolution of FS laser technology for use in refractive and cataract surgeries. This review describes the available laser platforms and mainly focuses on discussing the development of ophthalmic surgery technologies.展开更多
AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had ...AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.展开更多
Objective: To analyze the management of urological complications of gynecologic and obstetric surgeries. Material and Methods: We retrospectively studied 39 patients hospitalized in the Department of Urology of the Co...Objective: To analyze the management of urological complications of gynecologic and obstetric surgeries. Material and Methods: We retrospectively studied 39 patients hospitalized in the Department of Urology of the Conakry Teaching Hospital for urological complications of gynecological surgery, during 9 years. The epidemiological, diagnostic, surgical and outcome parameters have been analyzed. Results: The urological complications of gynecologic surgery represent 0.29% of admissions in the Department of Urology. The mean age was 31 years with extremes of 18 and 47 years. Etiological factors were dominated by caesarean section with 74.36% of cases. The main lesions observed were vesico-vaginal and uretero-vaginal fistulas respectively 43.6% and 41.2% of cases. The mean delay of diagnosis was 5 months (extreme: 7 days to 3 years). Urine leakage from the vagina was the main symptom. The surgical treatment consisted in 17 surgeries for vesico-vaginal fistulas, 16 surgeries for uretero-vesical reimplantation, 2 surgeries for termino terminal ureterorraphia, 2 surgeries for vesico-uterine fistulas and 1 surgery for hysterectomy. Healing was obtained in all ureteral injuries and we noted two cases of failure in vesico-vaginal fistula. Conclusion: urological complications of gynecologic surgery remain frequent. They are dominated by the vesico-vaginal and uretero-vaginal fistulas and the main etiology is caesarean section. The treatment is surgical in our context.展开更多
文摘1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).
基金Supported by National Natural Science Foundation of China(No.82171087No.82201228)+1 种基金Natural Science Foundation of Hunan Province(No.2024JJ6570)the Scientific Research Launch Project for new employees of the Second Xiangya Hospital of Central South University.
文摘Dear Editor,We present the reported case of repetitive bilateral suprachoroidal expulsive hemorrhage(SEH)after anti-glaucoma surgeries.SEH is a rare but potentially devastating complication of intraocular surgery.Long-term ocular hypertension,high myopia,older age,arterial sclerosis,and aphakia have been reported as preoperative risk factors for developing SEH^([1]).The prognosis for the visual acuity is poor without proper management.A suggested time for surgical drainage is said to be 10-14d when the hemorrhagic clot begins to liquefy^([2]).
文摘Objective: Erector spinae plane block is a novel regional anaesthetic intervention that is said to have an effective analgesic profile in the upper abdominal region. We compared its analgesic efficacy with thoracic epidural block for upper abdominal cancer surgeries. Methods: This prospective study included 60 patients, 18 to 65 years old with ASA class II who underwent gastrectomy and Whipple’s procedures under general anesthesia. Patients were assigned into two groups: Thoracic epidural group, with injection of 0.1 ml/kg of bupivacaine 0.25% in epidural catheter followed by 0.1 ml/kg/h of 0.125% bupivacaine infusion for 48 hrs., and Erector spinae group, with insertion of bilateral erector spinae catheters to inject 0.1 ml/kg of bupivacaine 0.25% followed by bilateral infusion of 0.1 ml/kg/h of bupivacaine 0.125% for 48 hrs. The primary endpoint was postoperative VAS scores at rest and movement. Secondary endpoint included postoperative total opioid consumption, 1st request for analgesia, hemodynamic changes and satisfaction scores. Results: Pain scores and needed rescue analgesia in both groups were comparable. However, 1st request for opioid was significantly longer in TEPI compared to ESI group. Hemodynamics were significantly lower in TEPI group with no differences in the incidence of postoperative complications except for hypotension. Patient satisfaction scores were arbitrarily higher in ESI group without significance. Conclusion: Erector spinae infusion is a highly promising regional technique with comparable effects to thoracic epidural blockade in reducing pain and opioid needs while causing minimal hemodynamic consequences.
文摘Laparoscopic imaging has advanced significantly,with higher resolutions like 4K,and innovative light modes such as narrow band imaging and near-infrared imaging.Recently,yellow enhancement(YE)mode has emerged as a novel tool that enhances the pale-yellow colour of fat into a fluorescent yellow-green,improving contrast without the need for injected dyes.It can be toggled on and off easily during surgery.YE is still under evaluation,but early experience suggests it helps surgeons differentiate anatomical planes and key intraabdominal structures from surrounding adipose tissue.This is particularly useful in:(1)Dissecting structures surrounded or covered by fat;and(2)operating on patients with obesity,where excess intra-abdominal fat limits visualisation and retraction.By enhancing the visibility of vascular pedicles,ureters,and nerves,YE enables more precise dissections and may reduce the risk of accidental injury.It can also assist less experienced surgeons in identifying important structures,potentially improving efficiency and surgical outcomes.As a training tool,YE may shorten the learning curve,though further study is needed.Overall,YE offers potential benefits in fat-dense surgical fields by improving visualisation,reducing complications,and enhancing patient safety.
文摘Background: In developing countries, charity cleft surgical mission is always operated by sporadic surgical teams without systematic follow up and quality assurance. In the past few decades, many mission projects have been held regularly in China. The purpose of this audit was a retrospective analysis of a 9-year cleft lip and palate charity project operated in a tertiary hospital in China Shenzhen Area to evaluate perioperative and postoperative complications. Nevertheless, understanding the risk profile is essential for establishing a sustainable in-house cleft service in Shenzhen. Methods: A detailed analysis of hospital centralized record in the The University of Hong Kong-Shenzhen Hospital (HKUSZH) was reviewed since the first charity project held in 2015. The parameters of this audit were focused on perioperative complications including anesthesia related problems, early postoperative complications in patients who underwent primary or secondary cleft surgeries. A total of 430 consecutive admitted cases of 311 non-syndromic cleft lip & palate patients were enrolled into the charity project from June 2015 to July 2024. The main anesthesia related complications that occurred during general anesthesia were respiratory tract problems, while intraoperative complication was excessive bleeding, so as wound local infection and reaction were the main early postoperative complications. Results: In our 9-year clinical audit of 430 cleft lip and palate charity surgeries in Shenzhen, we observed no mortalities and a anesthesia-related complication rate of 1.16%. Specific intraoperative complications included excessive bleeding, while early postoperative issues were dominated by wound infections. The fistula rate of 18.7% post palate repair and the average hospital stay of 3.71 days complete the profile of our surgical outcomes. These data underscore the project’s efficacy and offer a reference for international cleft missions aiming for safe and efficient surgical care. Conclusions: This study provides a thorough data review of the complications in the past 9 years charity missions for cleft lip and palate surgery in a well-structured hospital infrastructure and logistic support by local surgical team. There were no perioperative or postoperative death during the study period and the overall short-term complication rate was low. Therefore, it could be a reference model for other international cleft mission in developing country for a safe and efficient service in future.
文摘AIM:To compare analysis of the impact of high altitude on corneal endothelial cells,and the prognosis in patients with cataract surgeries.METHODS:Totally 265 plateau patients with cataract surgeries performed between January 2019 and July 2022(average altitude=3000 m),and 524 plain patients with cataract surgeries performed between January 2020 and July 2022 were included.The propensity score matching(PSM)method was applied to match the basic information of patients in both regions on a 1:1 basis.Corneal endothelial cell density(ECD),coefficient of variation(CV),hexagonal cell ratio(HEX),duration of surgery,and pre-and postoperative visual acuity(VA)were compared retrospectively,and correlation tests were done.RESULTS:Totally 223 pairs have been matched successfully.The HEX in the plateau group was higher than that in the plain group(61.95%±6.191%vs 44.91%±6.829%,P<0.001).For ECD and CV,no significant differences were observed between both groups(P>0.1).The pre-and postoperative VA of patients with cataract surgeries in the plateau group were lower(1.40±0.610 vs 0.71±0.514,P<0.001&0.68±0.479 vs 0.18±0.259,P<0.001),and the duration of surgery was longer than those in the plain group(27.06±14.900 min vs 16.03±8.033 min,P<0.001).No significant associations were found between the post-operative VA and the corneal endothelial parameters(P>0.05),while the post-operative VA was significantly related to the pre-operative VA and the duration of surgery(P<0.05).CONCLUSION:The relative hypoxic environment of the plateau does not promote the apoptosis of corneal endothelial cells,but may lead to the compensatory increase of their functions.In plateau patients,no significant associations are found between the poor VA and the corneal endothelial functions early after cataract surgeries.
文摘Background and Objective:Refractive surgery has evolved significantly,with artificial intelligence(AI)offering new possibilities for enhancing patient selection,surgical planning,and postoperative outcome prediction.While AI has demonstrated promising applications,its integration into clinical practice remains inconsistent due to challenges in data standardization,model interpretability,and regulatory concerns.This review examines the current applications,limitations,and future directions of AI in refractive surgery,with a focus on its role in laser vision correction(LVC)and phakic intraocular lens(IOL)implantation.Methods:A literature review was conducted using peer-reviewed studies published between January 2010 and October 2024,sourced from databases including Google Scholar,PubMed,Embase,and Web of Science.Studies were selected based on predefined inclusion criteria,covering AI applications in refractive surgery.A total of 33 key studies(16 on LVC and 17 on phakic IOLs)were analyzed,focusing on machine learning and deep learning techniques used for patient selection,surgical optimization,and complication prediction.Only English-language studies were included.Key Content and Findings:AI models utilizing structured tabular data,imaging,and multimodal inputs have demonstrated superior performance in predicting surgical outcomes and refining patient selection compared to traditional methods.Machine learning approaches such as random forests,extreme gradient boosting,and ensemble techniques,alongside deep learning architectures like convolutional neural networks and generative models,have improved risk assessment and surgical planning.In LVC,AI enhances ectasia risk assessment,keratoconus detection,and myopic regression prediction.In phakic IOL implantation,AI improves postoperative vault prediction,lens sizing,and refractive error estimation.Multimodal AI systems integrating imaging,textual data,and clinical parameters hold promise for more comprehensive patient evaluations.However,challenges such as data heterogeneity,limited external validation,and regulatory barriers hinder widespread clinical adoption.Conclusions:AI is transforming refractive surgery by enhancing precision,personalization,and patient safety.Its integration into clinical workflows has the potential to improve surgical outcomes and patient satisfaction.Future efforts should focus on advancing multimodal AI,improving model generalizability,and addressing ethical and regulatory challenges to fully harness AI’s potential in refractive surgery.
基金supported by grants from the National Natural Science Foundation of China(No.82172741 to Ye D)Shanghai Municipal Health Bureau(No.2020CXJQ03 to Ye D)Xuhui District Hospital Local Cooperation Project(No.23XHYD-14 to Ye D).
文摘1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.
文摘Background: Surgical site infection (SSI) is a dreaded nightmare for the Orthopaedic surgeon. Preoperative skin cleaning with antiseptics has been shown to reduce the microbial burden of the skin and results in reduced incidence of SSI. However, the ideal skin cleaning agent remains to be established. Aim: To compare the efficacy of Povidone-Iodine/Povidone-Iodine (PI-PI) combination with that of Chlorhexidine-Gluconate/Alcohol (CG-A) combination in re-ducing SSI in Orthopaedic surgeries. Methods: This was a prospective, randomized, double-blinded, controlled study. Subjects that met the selection criteria and gave consent were randomized into PI-PI group (test group) and the CG-A group (control group). Both the patients and the assessors for SSI were blinded to the group a participant belongs. Blocking was done on the type of surgery to cancel the confounding effect of surgery type on SSI. Standard perioperative protocols were applied to both groups. Assessment for features of SSI was done on the 3rd day, 7th day, 14th day, 6th week and 12th-week postoperative period. The diagnosis of SSI was made based on the Centers for Disease and Control (CDC) guidelines. Results: We recruited 124 patients for this study, 62 males and 54 females. The mean age of the subjects was 37.5 years (SD = 14.7 years). Sixty-two subjects were randomized into each group. There was no significant difference in the distribution of the genders in the study arms. Other possible confounders such as duration of hospital stay, use of drains, the surgeon involved and age were evenly distributed in the two groups. Eight patients did not complete the study. The overall incidence of SSI in the study was 2.6%. Subjects in the control group had an SSI of 3.4% while those in the PI-PI group had a rate of 1.8%;however, this was not significant, p = 0.579. Conclusion: Both CG-A and PI-PI combinations are equally efficacious as preoperative skin antiseptic in Orthopaedic implant surgeries.
文摘Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.
文摘A controlled intervention study was to promote rational antibiotic prophylaxis in clean surgeries in Chinese tertiary hospitals from 2008 to 2009. The effect of the intervention was measured and compared before and after intervention (intervention group, IG, including twelve hospitals), and compared with the control group (CG, including 164 tertiary hospitals distributed in 31 provinces). There were a total of 3961 and 657 cases identified in IG & CG for the study. Comparing the changes of IG with CG following the 3rd intervention, the proportion of antibiotics use without indication decreased from 61.9% (IG) & 84.4% (CG) (χ2 test, P χ2 test, P > 0.05);the rationality scores increased from 55.4 (IG) & 57.6 (CG) (t test, P > 0.05) to 77.0 (IG) & 64.3 (CG) (t test,
文摘Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.
基金Supported by a research grant from Beaver-Visited International,the manufacturer of the I-ring
文摘BACKGROUND The retrospective review of I-ring pupil expansion ring use is designed to examine the patient characteristics and associated surgical challenges in a clinical practice.The hypothesis is that I-ring provides a necessary additive tool in dealing with challenging cataract surgeries with small pupils.AIM To document the safety profile and use of I-ring pupil expansion ring in a clinical practice.METHODS A retrospective chart review of 12 consecutive cases within the same year(2016)of cataract surgeries employing I-ring pupil expansion ring(Beaver-Visitec,International)by a single surgeon at the same ambulatory surgical center was conducted.Demographic,pre-op,intra-op,and post-op data were recorded.Total number of cataract cases performed was also recorded.RESULTS 8 of 12 cases were planned I-ring cases.1 case was decided intraoperatively when femtosecond laser caused the pupil to shrink.The other 3 cases were also decided upon intraoperatively when pupil was deemed to be small.7 patients had IFIS from Flomax use.2 patients had pseudoexfoliation syndrome as the cause of small pupil.2 patients had narrow angles with brunescent cataracts.2 patients had pre-op partial zonular dehiscence.1 patient had 360o of posterior synechiae.2 cases had ruptured posterior capsule that required anterior vitrectomy.No complications were attributed to the pupil expansion ring.A total of 296 cataract surgeries were performed that year by the surgeon,making the rate of pupil ring use 4.1%.CONCLUSION Small pupil requiring pupil expansion ring during cataract surgery is often associated with other challenges,such as brunescent cataract,zonular weakness,and posterior synechiae in this series.I-ring helped to reduce at least one challenge in these difficult cases.
文摘AIM: To determine the efficacy of multislice CT for gastroenteric and hepatic surgery.METHODS: Dual-phase helical computed tomography was performed in 50 of 51 patients who underwent gastroenteric and hepatic surgeries. Twenty-eight, eighteen and four patients suffering from colorectal cancer, gastric cancer,and liver cancer respectively underwent colorectal surgery (laparoscopic surgery: 6 cases), gastrectomy, and hepatectomy. Three-dimensional computed tomography imaging of the inferior mesenteric artery, celiac artery and hepatic artery was performed. And in the follow-up examination of postoperative patients, multiplanar reconstruction image was made in case of need.RESULTS: Scans in 50 patients were technically satisfactory and included in the analysis. Depiction of major visceral arteries, which were important for surgery and other treatments, could be done in all patients.Preoperative visualization of the left colic artery and sigmoidal arteries, the celiac artery and its branches, and hepatic artery was very useful to lymph node dissection,the planning of a reservoir and hepatectomy. And multiplanar reconstruction image was helpful to diagnosis for the postoperative follow-up of patients.CONCLUSION: Three-dimensional volume rendering or multiplanar reconstruction imaging performed by multislice computed tomography was very useful for gastroenteric and hepatic surgeries.
基金supported by college medical journal clinicalspecial funds(11321587)
文摘Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.
文摘A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.
文摘Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.
文摘In the past few years, 9 unique laser platforms have been brought to the market. As femtosecond(FS) laserassisted ophthalmic surgery potentially improves patient safety and visual outcomes, this new technology indeed provides ophthalmologists a reliable new option. But this new technology also poses a range of new clinical and financial challenges for surgeons. We provide an overview of the evolution of FS laser technology for use in refractive and cataract surgeries. This review describes the available laser platforms and mainly focuses on discussing the development of ophthalmic surgery technologies.
基金Supported by the National Key Research and Development Project of China(No.2020YFC2008200)the Program for Zhejiang Leading Talent of S&T Innovation(No.2021R52012)+1 种基金Key Research and Development Projects of Zhejiang Province(No.2022C03112)the Zhejiang Provincial Program for the Cultivation of Leading Talents in Colleges and Universities(No.2020099)。
文摘AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.
文摘Objective: To analyze the management of urological complications of gynecologic and obstetric surgeries. Material and Methods: We retrospectively studied 39 patients hospitalized in the Department of Urology of the Conakry Teaching Hospital for urological complications of gynecological surgery, during 9 years. The epidemiological, diagnostic, surgical and outcome parameters have been analyzed. Results: The urological complications of gynecologic surgery represent 0.29% of admissions in the Department of Urology. The mean age was 31 years with extremes of 18 and 47 years. Etiological factors were dominated by caesarean section with 74.36% of cases. The main lesions observed were vesico-vaginal and uretero-vaginal fistulas respectively 43.6% and 41.2% of cases. The mean delay of diagnosis was 5 months (extreme: 7 days to 3 years). Urine leakage from the vagina was the main symptom. The surgical treatment consisted in 17 surgeries for vesico-vaginal fistulas, 16 surgeries for uretero-vesical reimplantation, 2 surgeries for termino terminal ureterorraphia, 2 surgeries for vesico-uterine fistulas and 1 surgery for hysterectomy. Healing was obtained in all ureteral injuries and we noted two cases of failure in vesico-vaginal fistula. Conclusion: urological complications of gynecologic surgery remain frequent. They are dominated by the vesico-vaginal and uretero-vaginal fistulas and the main etiology is caesarean section. The treatment is surgical in our context.
