Surgical Techniques - Science topic

Endoscopic middle meatal surgery is commonly associated with post-op adhesions. I my self use different techniqs.

Perhaps surgical techniques have changed and some are allowed but a good proportion are not allowed to weightbear. May I know the reasons or indications to keep a patient non-weightbearing? Noted a previous discussion on load bearing and sharing differences a few years back. Noted for IM Nailing, which is load sharing, patients are allowed to weight-bear early. Noted also that a dynamic hip screw is load bearing but weight bearing is allowed since stability is achieved. Thanks!

The subject of operative technique of caesarean section is quite dear and relevant to most obstetricians. I hope you will find the articles below thought stimulating. I will greatly appreciate any comments or suggestions regarding these articles.

Dear all,

For some time, we have been working with Stata metaprop in order to analyse our results from our review on two surgical techniques (for now A and B).

Through the metaprop command (Metaprop: a Stata command to perform meta-analysis of binomial data, by Nyaga et al.) we were able to perform a meta-analysis of our data.

However, where the 'normal' Stata program for meta-analysis has a test for group differences ( Qb with corresponding p value) to compare overall effect sizes of the two groups.

Metaprop gives a significance test with hypothesis effect size = 0 (ES = 0).

This results in tree Z values and their p values, one for each group and one overall outcome.

Eg. outcome A : z= 7.68, p=0.00

outcome B: z= 8.77, p=0.00

Overall: z =9.79, p=0.00

Is there a way of telling or calculating the group difference between the effect sizes of group A versus group B?

Thanks in advance,

Regards,

Iris Hochstenbach

If there are two surgeons in two different institutions and both are mastered in two different surgical techniques, can we compare the outcome of their patients to understand the value of each intervention? Let me also put this; when I mean "mastered" learning curve for the intervention is suggested as 100 cases and each had done that intervention for more than 500. I am asking this question as we have a study like this and it has been rejected for this limitation. However, I have encountered similar studies in the literature and would like to know how to respond or how to make a revision in our study.

Looking for any approaches, SOPs or anatomical landmarks people use to conduct a gonadectomy of immature male rats (this is for epigenetic analysis of reproductive cells as young as 10 days). Looking for a method to minimize the time and damage to the area while removing the immature testes.

I am considering the surgical technique during thoracic surgery concerning phrenic nerve and laryngeal recurrent nerve injury.

What's the outcome after the reconstruction of these nerves?

Do any endeavors have related experience?

HelIo everyone, Currently I am working on systematic review and meta-analysis of a surgical technique ( Posterior Scleral Reinforcement in high myopia and complications of high myopia ) to observe its effect. As there is no comparator in my study. So my question is,which type of study model I should apply and which software is most reliable for Meta-analysis?

Regards.

Can anyone recommend any recent research that supports or disproves standard precautions such as double gloving and PPE in surgery?

My study has 2 components:

1)

I have 10 organ and I want to find how accurate surgeons are using 2 seperate measurement techniques for measuring an angle on the organ compared to a gold standard.

4 surgeons each generate 1 measurement per organ per technique.

I want to pool the surgeons data together, making the asumption that they are representive, and then get some sort of value on the accuracy of the 2 techniques compared to gold standard.

Would a Lin's Concordance Correlation Coefficient for each technique be appropriate? Would that tell me how "good" each technique is in some sense?

Then, would it be appropriate to run ICC to see what the inter-observer agreement is for each of the 2 measurement techniques?

2)

I also have 1010 organs that were operated on by each surgeon 3 times using 3 different techniques.

After each "surgery" I measured the change in angle from pre to post surgery (if surgery was perfect, change would be 0)

I want to find some way of estimating the "accuracy" or "effectiveness" in some way of each of the 3 surgical techiques, pooling the data from the 4 surgeons.

could I do some sort of regression analysis to see overall how each technique performed in terms of having the smallest overall change in angle?

Could I also run an ICC to get a sense of the inter-observer variability for each surgical technique?

Thanks for reading

Nasalisation is a french surgical technique for massive excision of sinus polyposis, aiming to make all sinuses & nostrils as one cavity. Majority of sinus surgeons prefer FESS. Of my gathered experience during working with different sinus surgeons, I noted that FESS is lesser aggressive than Nasalisation but followed by recurrence of polyposis requiring multiple revision FESS which gave finally a sinus condition resembling that of post-Nasalisation.  Would you give your own experience, if possible with research study. 

From time to time, I meet cases of bilateral choanal adenoids causing mouth breathing, snoring +/- disturbed sleep according to severity. I found that both x-ray of postnasal space and flexible fibreoptic nasal scope can preoperatively diagnose this unusual type of adenoids. Surgical technique varies according to size & extension of this adenoid. If it is limited at choana but bulged intranasally, then I use an endonasal approach to remove it by depriding (preferable to me) or by suction diathermy (vallylab). If it is limited at choana but bulged into nasopharynx, then it can be removed through nasopharynx under mirror vision using suction diathermy (vallylab). If it is prominent intranasal & into nasopharynx, then combined approach can be used. I found that choanal adenoids is preoperatively misdiagnosed by geniors as classic nasopharyngeal adenoids hypertrophy if they depends on endoscope alone. Also, x-ray alone when revealed empty nasopharynx does not mean absent choanal adenoids in case of presence of symptoms (mouth breathing, snoring +/- disturbed sleep). Also, choanal adenoids is perioperatively misdiagnosed by geniors as inferior turbinate tail hypertrophy. So, to diagnose choanal adenoids, you would put it in your consideration & you would request x-ray with endoscopic examination. This is my own experience regarding choanal adenoids management. Would you add your experience?

what is your experience with sternal cable system for sternal closure? is it better than ordinary stainless steel wire? is it cost effective? 

32 year old women with a BMI of 60 presented with severe Gallstone disease.ERCP was performed to clear the Bile duct 2days prior to her admission.GallBladder was gangrenous and full of pus.Lap chole was difficult but no adverse events.Her temperature was swinging at 101 which is settling.She has no other comorbidities.

I am conducting meta-analysis on complication outcomes related to a rather new surgical technique. Hence, published studies contain rather small study samples. Is there a minimum to the number of participants in a study for it to be eligible for inclusion in meta-analysis?

Thank you

40 years old female patient with a 3,5 cm solitary nodule on left thyroid lobe.fine needle aspiration biopys confirmed atypia with undetermined significance. Which type of surgery do you prefer? Total thyroidectomy? Left lobectomy or frozen section biopsy directed surgery?

Can anyone suggest me any article highlighting steps in costotransversectomy?

Dear Colleagues,

Good day. Laparoscopic PIRS is a procedure that closes the patent deep inguinal ring mainly in paediatric indirect hernia without posterior wall weakness. No mesh is used in this procedure. 

Upon my brief literature review, patients that have underwent Lap PIRS ranges 4 weeks old to 17 years old have been reported.

May I know anyone has any experience on performing Lap PIRS on older teenage or young adult?

Is there a limit to the size of the deep ring defect? How do we check for posterior wall weakness in laparoscopy?

Many thanks in advance.

Assuming H.pylori eradicated and NSAIDs/antiplatelet risk factor withdrawn

Is it 6 weeks, the same duration recommended as for non perforated ulcer healing?

Do we routinely perform gastroduodenoscopy to confirm ulcer healing?

It is known that Hippocrates had developed a "surgical" technique to stabilise the commonly presented anterior dislocation of the shoulder. In the modern medical era we have developed and abandoned many procedures. Which of them do you think imitates the original Hippocratic technique?

Does anyone use Definity contrast agent as a continuous infusion? We have had to manually continuously rotate the syringe pump during use to keep the solution mixed. Any ideas on a better method of mixing during infusion? Thanks in advance.

Literature is rife with many surgical techniques for obese diabetics. Is duodeno-jejunal bypass + sleeve gastrectomy superior to Roux-en-Y gastric bypass regarding T2DM control ?

One of the commonly performed minimal access procedure is Lap mesh ventral hernia repair.we started with plain polypropylene grafts and now we are using composite mesh grafts.The market is flooded with variety of expensive grafts.Most of them are good. It is always a difficult task to choose.One such is symbotex which has been recently introduced in India.

Acid burns of upper gastrointestinal tract produce a complex combination of lesions which can be grouped into five types, and existing surgical techniques have proved inadequate in treating some of these lesions. Over the past 25 years 72 patients have needed operative treatment since they could not be managed by more conservative measures; the anatomical lesions in the five types and their surgical management are described.

the safest  and reproducible technique

A 55 year old obese female patient has undergone Open Mesh Repair for Ventral Hernia (Onlay Technique) about 45 days back. It was a large hernia with defect size of about 20 x 15 cm. Mesh was placed and vacuum suction placed over it. Even after 45 days drain output is about 100 ml per day. There is no evidence of infection and the suture line has healed well. Do i have to wait till output comes to less than 30 ml per day or remove it now and use compression dressing?

I need to know which cyanoacrylate tissue adhesive is better to use in oral and maxillofacial surgical procedure instead of suturing?

[email removed by admin]

long surgery

cancer surgery

 hepatic surgery

We are planning some studies assaying tissue collected by a minimally invasive muscle biopsy method. We have two scientists and a clinician working on this project. The clinician is not in a position to perform these biospsies on our patients. We are unclear as to the relevant regultion surrounding the ability of non-clinically trained scientific personnel to peform these tasks as ideally the two scientists would perform the biopsies. Further what are the costs involved in this proceedure (per patient) and what other consumables are needed?

Often comparisons between different surgical techniques for assessing the effectiveness of a method are performed. That experience is with the use of the same technique as Tector today?

Intraoperatively, what is the best surgical technique to fin intramyocardial LAD

The therapy involves the use of stem cells derived from the patient’s own fat (adipose tissue) obtained using liposuction.

I've not been able to locate any evidence for or against warming patients intraoperatively as a prevention measure for postoperative delirium in elderly patients. 

In trans abdominal proproteinial hernioplasty, is it important to fix the mesh??

Have you any experience in , not fixing the mesh??

Although most surgeons may claim to master all current hernia surgery techniques, a recent analysis show that outcomes of hernia surgery in different hospitals show a large variability. Additionally to two major problems of groin hernia surgery (chronic pain and hernia recurrence) remain a continuous challenge. A few networks (e.g. Denmark, Germany) have come up with a hernia database to monitor surgical quality and set benchmarks. 

Do you think we need more quality management in hernia surgery?

what education medication can cut down on ileostomy output

Inguinal seems to be safer but less effective. Is this true?

Madelung's deformity is a rare disease of the wrist which affects mainly females during the adolescence growth spurt. Clinical presentation: radial deviation of the hand with prominence of distal end of ulna and a volar subluxation of the carpus. Various techniques for surgical management have been described until now, but still clear evidence to support the use of any single approach is lacking. 

Elective orthopeadics, OA , post op athroplasty.

the indication is cardiac arrest usually or tamponade which is not giving us time enough to shift the patient back to theater. but when exactly should we say lets re-open the patient and stop defibrillating etc any more.? 

SILS cholecystectomy concept is not popular in the UK,most Lap.Chole operations are performed by traditional 4,or 3 ports lap.chole. One study from the UK showed comparable results for SILS cholecystectomy but the time is longer.(.Chow A, et al.)

Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience.Surg Innov. 2009 .

The review showed comparable safety (Markar SR, Karthikesalingam A,et al.Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis.Surg Endosc. 2012.

I am trying to perform a surgery for 2k1c method. Does the kidney size gets reduced after clipping it or does it remains same. Can we use some other thing to occlude renal artery other them silver clip and do we need to partially or completely block the artery.

We're planning a trial on patients choosing CAM from aversion to surgery due to fear-avoidance beliefs and catastrophizing, and we are looking for fear-specific psychiatric assessment tools for treatment interventions (esp. surgery). Any ideas would be most welcome, Thank you :)

Is this necessary? What is the rationale? Is not the spacer another foreign body that could maintain the infection?

Traditionally, we use a 11 x 6cm in open hernia repair. In laparoscopic repair, most surgeons use one of these sizes: 15 x 10cm, 15 x 12cm or 15 x 7.5cm. The recommendation is to adequately cover the myopectineal orifice of Fruchaud, so what size mesh will do this?

Is there a consensus?

I remember during my training days, how difficult it is to inject local anesthetic for corn excision. Where the local spilt all over.

We usually enter the saphenous vein below the knee level and place in upwards to the saphenofemoral junction. In 2 cases of mine, who were morbid obese, I tried this method and I thought it may be helpful in some cases. Especially in patients who can not be cannulated from below the knee level due to various reasons.

After disconnecting the uterus, I think suturing is faster and easier if its done transvaginally. Laparoscopy & CO2 insufflation times can be reduced as well. Is there any specific advantage of suturing intracorporeally?

I think the opening for organ extraction should be mede at the beginning in the umbilicus.

There seems to be a lot of doubt and confusion as to whether anything works at all, and which option is the most effective. If anyone can answer one or both parts of my question, that would be quite helpful.

What are your opinions and suggestion about treatment? VAC therapy? Total Parenteral Nutrition? Wait and watch? Planned delayed new laparotomy?

The motion capture data is needed to train classification models which could basically help surgical trainees to improve their body posture and manual techniques applying motion capture technology. The data would be recorded during exercises on surgery training system like CAST (see attached link) or similar systems. After classifiers have been trained using different algorithms and different sets of extracted features, their performance and reliability will be evaluated in order to find the best combination of classification algorithm and feature extraction. The final goal is a reliable classifier which tells trainees what exactly they have to improve in their movements and maybe even how to. Of course that's easier said than done though - and there are many intermediate steps to accomplish prior to that.

There are concerns regarding mesh infection during emergency hernia repair especially if a segment of bowel has compromised blood supply requiring resection. On the other hand, anatomical repair of these hernias will lead to a high recurrence rate. In these circumstances, what is your preferred technique of repair?

...

Nowadays it's possible to achieve real time control of surgical resections, like in neuro and orthopedic surgery. In liver surgery this new technology is still experimental. The question is if we will gain clinical application of such a technology and more important if we really need it.

Despite the impressive scientific and technological progress of modern surgery, many general surgeons, whether community- or academic-based, continue to follow some of the traditional surgical myths (changing the scalpel blade after the skin incision to limit contamination, drainage as an attribute of operations, antibiotics in irrigation solution, midline incisions are the best, wound dressings should be changed under sterile conditions etc.). Everyone of us has heard them before - they have been trusted for years. Some of these myths are actually based on fact, but most of them are based on archaic or obsolete scientific concepts. What do we do with these myths: not notice and continue to live with them or to try to verify or disprove them?

I wrote two articles (a meta-analysis and a systematic review) on two different topics regarding the surgical technique of open appendicectomy. I'm finding it difficult to publish them because the Editors of various journals claim that nowadays open appendicectomy is a procedure almost abandoned in "developed" countries which favour laparoscopic appendicectomy. What do you think about this statement? Can you also suggest any journal that could possibly be interested?