Surgery in practice and science最新文献

{"title":"The significance of isolated hyperbilirubinemia in detecting asymptomatic common bile duct stones in patients undergoing laparoscopic cholecystectomy","authors":"A. Aljorfi,&nbsp;M. Abdelkarim,&nbsp;M. Elaraby,&nbsp;A. Kotb,&nbsp;R. Morgan","doi":"10.1016/j.sipas.2023.100223","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100223","url":null,"abstract":"<div><h3>Aim</h3><p>The aim of this study was to evaluate the role of isolated hyperbilirubinemia in the detection of choledocholithiasis.</p></div><div><h3>Methods</h3><p>A retrospective cohort study focused on adult patients diagnosed with gallstone disease, and undergoing intra-operative cholangiogram for suspected choledocholithiasis. Those presenting with isolated hyperbilirubinemia were investigated for their risk of choledocholithiasis, and were compared with those with normal liver function tests.</p></div><div><h3>Results</h3><p>Out of the total 1274 patients undergoing intra-operative cholangiogram in the study period, only 18 exhibited isolated hyperbilirubinemia. Among these, four patients were found to have common bile duct (CBD) stones. This indicates that in approximately 22 % of patients, isolated hyperbilirubinemia may be associated with CBD stones. However, it is essential to note that the number of patients in the study with isolated hyperbilirubinemia was relatively small.</p></div><div><h3>Conclusion</h3><p>Although the incidence of isolated hyperbilirubinemia was limited in our study, the presence of CBD stones in some of these patients suggests a potential association. Isolated hyperbilirubinaemia should not be overlooked as a risk factor for CBD stones. Nonetheless, additional investigations with a larger sample size are needed to establish a more definitive understanding of the relationship between isolated hyperbilirubinemia and choledocholithiasis.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000694/pdfft?md5=569d5e5631807d501cfb0cee5bfb0f7a&pid=1-s2.0-S2666262023000694-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138577735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency laparotomy risk assessment: An audit of South Australian hospitals","authors":"Joseph N. Hewitt ,&nbsp;Thomas J. Milton ,&nbsp;Octavia Tz-Shane Lee ,&nbsp;Joshua Tinnion ,&nbsp;Antonio Barbaro ,&nbsp;Katarina Foley ,&nbsp;Ishraq Murshed ,&nbsp;Nick Georges ,&nbsp;Rippan Shukla ,&nbsp;Cameron Main ,&nbsp;Christopher Dobbins ,&nbsp;Markus I. Trochsler","doi":"10.1016/j.sipas.2023.100225","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100225","url":null,"abstract":"<div><h3>Background</h3><p>Emergency laparotomy (EL) is associated with high mortality rates and is performed on a heterogenous patient population. Pre-operative risk assessment is one tool which can assist with EL patient care. We aimed to characterise rates of pre-operative risk assessment for EL patients in South Australia.</p></div><div><h3>Methods</h3><p>A retrospective audit of all patients undergoing EL over one year in six participating hospitals in South Australia was undertaken. Patient demographics, operation details, risk assessments (e.g. NELA, POSSUM, ACS-NSQIP) and outcomes were recorded.</p></div><div><h3>Results</h3><p>422 ELs were audited. Preoperative risk assessments were recorded for 42 (10 %) operations. The 30-day mortality rate was 9 %. There was no difference in mortality rates for patients with or without a risk assessment documented. Hospital participation in the Australia and New Zealand Emergency Laparotomy Audit (ANZELA) was associated with increased rates of risk assessment. Increasing patient age and then presence of certain comorbidities were also associated with increased rates of risk assessment.</p></div><div><h3>Conclusions</h3><p>This audit shows poor uptake of recommendations for preoperative risk assessment in EL patients in South Australia. Comparable mortality rates to previously published Australian and international data are demonstrated. Factors associated with increased risk assessment rates are identified and are relevant to future quality improvement activities.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000712/pdfft?md5=ae629eeeb12d27d8542747ac0611d36c&pid=1-s2.0-S2666262023000712-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beveled vs. Perpendicular Incisions and The Effects on Wound Healing: A Review","authors":"Joseph De Leon,&nbsp;Mojtaba Wali,&nbsp;Georgios E. Romanos","doi":"10.1016/j.sipas.2023.100226","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100226","url":null,"abstract":"<div><p>Proper surgical technique is crucial for optimizing wound healing and reducing scar tissue formation. There are numerous measures a surgeon can take to improve wound healing; however, the angle of the incision made at the surgical site has been suggested to potentially play a role in wound healing, particularly between beveled and perpendicular incisions.</p></div><div><h3>Objectives</h3><p>The goal of this study was to analyze the literature and observe whether a discrepancy exists between using beveled vs perpendicular incisions in surgical procedures, as well as to understand the relationship between incision angles and physiologic wound healing.</p></div><div><h3>Methods</h3><p>Google Scholar, Pubmed, and MEDLINE searches regarding incision techniques were made to find relevant articles in the fields of plastic surgery, dermatologic surgery, periodontal surgery, and ophthalmic surgery which included studies from 2004 to 2023. The exclusion criteria consisted of studies that did not have a comparative design and/or were not revolved around incision angle.</p></div><div><h3>Results</h3><p>After filtering out irrelevant studies, we selected six studies that addressed the dichotomy between beveled and perpendicular incisions. Out of the six studies, four were in favor of beveled incisions, and the remaining studies either found no significant difference or reported benefits to some degree of using perpendicular cuts.</p></div><div><h3>Discussion</h3><p>The literature seems to suggest that beveled incisions have an advantage over perpendicular incisions in wound healing, particularly in the aspects of esthetic and accelerated wound healing. This is potentially due to the increased surface area of the dermis, preservation of hair follicles, and decreased incidence of infection.</p></div><div><h3>Conclusion</h3><p>Although the literature seems to favor beveled incisions, a definitive conclusion cannot be made as there is not sufficient evidence to support the superiority of one incision type over the other.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000724/pdfft?md5=d319c8fd396f0ad8eb53342ff0e47683&pid=1-s2.0-S2666262023000724-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138558572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-course instructional videos and home-based laparoscopic suturing simulation enhances the educational impact of a laparoscopic training course","authors":"Hansraj Mangray ,&nbsp;Sanele Madziba ,&nbsp;Shamaman Harilal ,&nbsp;Yashlin Govender ,&nbsp;Amanda Ngobese ,&nbsp;Damian L Clarke","doi":"10.1016/j.sipas.2023.100229","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100229","url":null,"abstract":"<div><h3>Introduction</h3><p>We developed a home-based laparoscopic suturing simulation (HBLSS) technique, which is intended to improve the impact of a structured laparoscopic training course.</p></div><div><h3>Method</h3><p>A group of sixteen students were provided with the educational video, and after two weeks, all students were observed and timed performing a laparoscopic reef knot. The students were then randomized into two cohorts. The exclusive video group continued using the video for a further two weeks. The second group were shown the HBLSS technique and told to use this in conjunction with the video for a further two weeks.</p></div><div><h3>Results</h3><p>The entire cohort had an initial median time to form an intracorporeal reef knot of 190 s (range 459, IQR 128). After two additional weeks of using the educational video exclusively, the median time was reduced to 85 s (range 282, IQR 125), whereas the HBLSS and educational video group had a median post-training time of 28.5 s (range 36, IQR 18.5). There was a clear statistical difference between the exclusive video group and the HBLSS and video group (<em>P</em> = 0.008). There was also an improvement from the movement of both instruments to one instrument, reduced crossing of instruments and reduced transverse movement in the HBLSS and video group.</p></div><div><h3>Conclusion</h3><p>A combination of video-based teaching and HBLSS was associated with improved laparoscopic intra-corporeal knot-tying skills in comparison to the exclusive video-based teaching. This reflects the importance of imparting both cognitive and psychomotor skills to students practising laparoscopic surgery.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100229"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266626202300075X/pdfft?md5=ab625f78fc3cb93faa841a5380d281df&pid=1-s2.0-S266626202300075X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138549923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of frozen section in sentinel lymph node biopsy in early breast cancer – An Australian single-centre experience","authors":"Elan Novis ,&nbsp;Tae Jun Kim ,&nbsp;Chahaya Gauci ,&nbsp;Jasmine Mui ,&nbsp;Yijun Gao ,&nbsp;Natalia Garibotto","doi":"10.1016/j.sipas.2023.100224","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100224","url":null,"abstract":"<div><h3>Introduction</h3><p>Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in patients with clinically lymph node negative early breast cancer, reducing the need for axillary lymph node dissection (ALND) and its associated risks. Intra-operative frozen section is a method of rapid pathological assessment of the sentinel node to identify the presence of metastatic disease and potentially avoid the need for a second operation in patient who will require an axillary lymph node dissection.</p></div><div><h3>Methods</h3><p>A retrospective review of a prospectively collected breast cancer database was performed. All patients with breast cancer who underwent SLNB and/or ALND at our institution, between May 1st 2017 to June 1st 2022 were identified. There were 565 patients who were included in the study.</p></div><div><h3>Results</h3><p>Intra-operative frozen section was able to accurately identify 71% of patients who had macrometastasis in their sentinel lymph node, thus allowing them to immediately proceed to ALND and avoid a second operation. In patient who had a false negative frozen section result, only 6.5% required ALND. The majority of false negative results were due to isolated tumour cells or micrometastasis, and therefore would not have required further intervention.</p></div><div><h3>Conclusion</h3><p>Intra-operative frozen section of sentinel lymph node biopsy in breast cancer is useful in reducing the need for a second operation, allowing staging of the axilla to occur more efficiently and with high diagnostic accuracy.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000700/pdfft?md5=9d21e195f341f7eecb0e6cf234ac2084&pid=1-s2.0-S2666262023000700-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138430300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of work hour restrictions on the operative experience of general surgical residents: A systematic review","authors":"Hamza Ashraf ,&nbsp;Deepika Gunda ,&nbsp;F. Hamish Morgan ,&nbsp;Gizem Ashraf ,&nbsp;Alexander R. Cortez ,&nbsp;Vijayaragavan Muralidharan ,&nbsp;Sean Stevens","doi":"10.1016/j.sipas.2023.100222","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100222","url":null,"abstract":"<div><h3>Introduction</h3><p>Work hour restrictions (WHR) have been implemented globally to improve resident safety and welfare, but many in the surgical community have raised concerns regarding the impact on resident education and operative experience. This systematic review aims to investigate the impact of WHR on general surgical resident operative caseload.</p></div><div><h3>Materials and methods</h3><p>Medline and Embase databases were systematically searched according to PRISMA guidelines to identify articles published between 2003 and 2022 assessing the impact of WHR on the operative experience of general surgical residents. Articles were only included if they reported on quantitative measures of operative experience and examined operative caseload after the introduction of WHR.</p></div><div><h3>Results</h3><p>Of 1,266 studies identified, 26 studies were included, with the majority from US literature. Total major cases underwent a 0.6 % decrease after the introduction of WHR, with surgeon chief cases undergoing a 3.3 % decrease and surgeon junior cases undergoing a 3.7 % increase. Operative trauma underwent the greatest decrease at 18.4 %. Skin &amp; soft tissue cases underwent the greatest increase at 67.6 %.</p></div><div><h3>Discussion</h3><p>While WHR were often associated with reduced operative caseload in the early years following implementation, the majority of studies found a significant reduction was avoided in the long-term as training programs likely adapted to the new environment. These findings are of particular significance to countries considering the introduction of WHR for surgical residents and may guide future policy and decision-making.</p></div><div><h3>Conclusions</h3><p>This review demonstrated no significant change in total major cases and an increased caseload for most operative subcategories after the introduction of WHR for general surgical residents. These findings are in keeping with a previous review published in 2011.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000682/pdfft?md5=25185167e2fc11708f5ef8e09a80ef3f&pid=1-s2.0-S2666262023000682-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92073802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of trauma patients on chronic antithrombotic therapies in a trauma center in a rural state","authors":"Benjamin Moore ,&nbsp;Hanna Jensen MD PhD ,&nbsp;Karan Patel ,&nbsp;Zeel Modi ,&nbsp;Rebecca J Reif ,&nbsp;Shibani Lal ,&nbsp;Stephen M Bowman ,&nbsp;Melissa Kost ,&nbsp;Kyle J. Kalkwarf ,&nbsp;Joseph Margolick ,&nbsp;Avi Bhavaraju ,&nbsp;Howard L. Corwin","doi":"10.1016/j.sipas.2023.100221","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100221","url":null,"abstract":"<div><h3>Objective</h3><p>The number of trauma patients presenting with chronic antithrombotic therapy is on the rise. The risk of hemorrhage, the leading cause of death in trauma patients, increases for those on such therapy. This study sought to compare the clinical outcomes of patients on warfarin, direct oral anticoagulants (DOAC), or antiplatelet agents.</p></div><div><h3>Methods</h3><p>A retrospective cohort analysis was conducted on adult patients admitted to a Level 1 trauma center with pre-admission antithrombotic therapy. Patients were divided into those on warfarin, DOACs, and antiplatelet agents. The primary outcomes measured were hospital mortality, total blood products received, hospital length of stay (LOS), and ICU LOS.</p></div><div><h3>Results</h3><p>738 patients were included in the study: 191 (26 %) warfarin, 260 (35 %) DOACs, and 287 (39 %) antiplatelet. There were no differences in the demographic variables between study groups. The Injury Severity Score (ISS) was similar across the three groups as well as blood product usage, reversal agent usage, and mean hospital stay. Multivariable regression showed patients with pre-admission antiplatelet usage were more likely to have a shorter ICU LOS than those on warfarin (<em>p</em> = 0.048).</p></div><div><h3>Conclusion</h3><p>Blood product and reversal agent use was similar between patients on warfarin, DOACs, or antiplatelet agents. Patients on antiplatelet agents had a shorter ICU stay than the warfarin group, the only significant difference observed. Our results indicate similar safety profiles of antithrombotic medications in a generic trauma population, likely due to institutional protocols to increase responsiveness and immediate availability of resources when the patient has known anticoagulation.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49883839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worsening preoperative functional status increases morbidity and mortality in patients undergoing coronary artery bypass grafting: A propensity matched study of the ACS-NSQIP database","authors":"Renxi Li ,&nbsp;SeungEun Lee ,&nbsp;William Rienas ,&nbsp;Qianyun Luo ,&nbsp;Daniel Rinewalt","doi":"10.1016/j.sipas.2023.100220","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100220","url":null,"abstract":"<div><h3>Introduction</h3><p>Dependent functional status is correlated with increased mortality in patient undergoing coronary artery bypass grafting (CABG). However, patients who are partially dependent and totally dependent may have different peri‑operative outcome profiles. This study aims to retrospectively examine the effect of different levels of functional dependency on post-CABG morbidity and mortality.</p></div><div><h3>Methods</h3><p>Patients who underwent a CABG from 2005 to 2021 were identified in the ACS-NSQIP database. Subjects were stratified into independent (IFS), partially dependent (PDFS), and totally dependent functional status (TDFS). A 5:1 propensity matching between IFS and each functional dependent group was performed, respectively. The 30-day peri‑operative outcomes of PDFS and TDFS were compared to that of IFS. Peri-operative outcomes between PDFS and TDFS were compared using multivariable logistic regression, adjusted for demographics and co-morbidities.</p></div><div><h3>Results</h3><p>There were 968 PDFS with 4779 matched IFS and 247 TDFS with 1202 matched IFS. Compared to IFS, PDFS and TDFS had higher mortality, sepsis, bleeding, and length of stay&gt;7 days. TDFS have higher MACE, cardiac/pulmonary/renal complications, and OR return than IFS. Compared to PDFS, TDFS had higher mortality (aOR 1.68, <em>p</em> = 0.03), higher risk of MACE (aOR 1.88, <em>p</em>&lt;0.01), cardiac events (aOR 2.74, <em>p</em>&lt;0.01), perioperative sepsis (aOR 1.73, <em>p</em> = 0.03), pulmonary complications (aOR 2.16, <em>p</em>&lt;0.01), and returning to OR (aOR 1.68, <em>p</em> = 0.02).</p></div><div><h3>Conclusion</h3><p>Our study shows that dependent functional status is associated with increased morbidity and mortality after CABG. Additional post-CABG complication monitoring and care may be required for TDFS.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49883838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in COVID-19 patients undergoing laparoscopic cholecystectomy/appendectomy in the pre-vaccine era","authors":"Steven K.M. Vuu ,&nbsp;Huazhi Liu ,&nbsp;Darwin N. Ang","doi":"10.1016/j.sipas.2023.100219","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100219","url":null,"abstract":"<div><h3>Background</h3><p>We hypothesized that COVID-19 positive patients requiring laparoscopic cholecystectomy (lap chole) or appendectomy (lap appy) would have increased inpatient mortality rates compared to all COVID-19 patients.</p></div><div><h3>Methods</h3><p>Retrospective cohort analysis including COVID-19 patients from 1/1/20 to 9/30/20. 82,574 cases identified. Patients excluded if &lt;18 years old or underwent surgery other than lap chole or lap appy. Control groups were patients without surgery (<em>N</em> = 82,145). Exposure groups underwent lap chole (<em>N</em> = 323) or lap appy (<em>N</em> = 106). Primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS) and complications such as bacterial pneumonia, deep venous thrombosis (DVT), pulmonary embolism (PE), urinary tract infection (UTI), acute myocardial infarction (MI), acute respiratory distress syndrome (ARDS), and respiratory failure (RF).</p></div><div><h3>Results</h3><p>Overall inpatient mortality rate was 32.8% in COVID-19 patients undergoing lap chole (p-value &lt;0.0001), 2.8 % lap appy (p-value 0.93), and 1.2 % in control group. ARDS complication rate was 11.2 % in lap chole (p-value &lt;0.0001), 1.9 % lap appy (p-value 0.71), and 0.2 % in control.</p></div><div><h3>Conclusion</h3><p>COVID-19 patients during the initial wave of the pandemic who underwent lap chole during hospital admission had significantly higher risk of mortality and ARDS while lap appy did not.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49883837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of perivascular tissue on lateral thermal expansion during bipolar vessel sealing","authors":"Andreas Kirschbaum ,&nbsp;Paula Sauer ,&nbsp;Anika Pehl ,&nbsp;Nikolas Mirow","doi":"10.1016/j.sipas.2023.100218","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100218","url":null,"abstract":"<div><h3>Background</h3><p>Lateral heat propagation has been an unavoidable effect of bipolar sealing with the risk of damage to surrounding structures. It is presently unknown whether leaving the perivascular tissue in situ may be advantageous in the sense of an isolation effect.</p></div><div><h3>Material and methods</h3><p>Two groups were formed from ex vivo carotid specimens. Group A (<em>n</em> = 10) consisted of carotid artery with the perivascular connective tissue in place (mean preparation diameter: 10.57 ± 0.16 mm) and group B (<em>n</em> = 10) of skeletonized carotids (mean vessel diameter: 5.21 ± 0.12 mm). All specimens were fixed on a plastic plate and mounted vertically in a holder. Sealing was performed perpendicular to the axis of the specimens. The temperature during the sealing process was recorded by a thermal camera. Group comparison was performed by a nonparametric test and significance was set at <em>p</em> &lt; 0.05.</p></div><div><h3>Results</h3><p>Mean sealing time in group A was 3.71 ± 0.37 s compared to 3.42 ± 0.37 s (<em>p</em> = 0.009) in group B. The maximum temperature in the middle of the jaws was significantly different. Group A had a temperature of 71.4 ± 3.9 °C and group B had a temperature of 91.4 ± 7.4 °C (<em>p</em> &lt; 0.0001). RILATE risk scores (percent of necrotic zone in relation to potential area of necrosis) at both upper and lower sides of instrumental jaws were significantly different. For group A, it was 14.9 ± 1.6 at the upper side of jaws, 20.4 ± 2.63 at the lower side of jaws and for group B, it was 21.9 ± 3.5 at the upper side of jaws, 30.2 ± 6.2 at the lower side of jaws.</p></div><div><h3>Conclusion</h3><p>Perivascular connective tissue acts as an insulator with respect to lateral heat propagation. Peak temperature between instrument jaws is significantly reduced with perivascular tissue in situ. This may result in a negative impact on sealing quality.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"15 ","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49883836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}