Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

Objective:To scrutinize the definitions of minimal invasive surgical therapy(MIST)and to investigate urologists’knowledge,attitudes,and practices for benign prostatic obstruction surgeries.Methods:A 36-item survey was developed with a Delphi method.Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included.Urologists were invited globally to complete the online survey.Consensus was achieved when more than or equal to 70%responses were“agree or strongly agree”and less than or equal to 15%responses were“disagree or strongly disagree”(consensus agree),or when more than or equal to 70%responses were“disagree or strongly disagree”and less than or equal to 15%responses were“agree or strongly agree”(consensus disagree).Results:The top three qualities for defining MIST were minimal blood loss(n=466,80.3%),fast post-operative recovery(n=431,74.3%),and short hospital stay(n=425,73.3%).The top three surgeries that were regarded as MIST were Urolift®(n=361,62.2%),Rezum®(n=351,60.5%),and endoscopic enucleation of the prostate(EEP)(n=332,57.2%).Consensus in the knowledge section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,day surgery feasibility,and post-operative continence.Consensus in the attitudes section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,and day surgery feasibility.Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement,lower retreatment rate,and better suitable for prostate more than 80 mL.Conclusion:Minimal blood loss,fast post-operative recovery,and short hospital stay were the most important qualities for defining MIST.Urolift®,Rezum®,and EEP were regarded as MIST by most urologists.

Incidence of surgical site infection in minimally invasive colorectal surgery

BACKGROUND Surgical site infection(SSI)is a common complication of colorectal surgery.Minimally invasive surgery notably reduces the incidence of SSI.This study aimed to compare the incidences of SSI after robot-assisted colorectal surgery(RACS)vs that after laparoscopic assisted colorectal surgery(LACS)and to analyze associated risk factors for SSI in minimally invasive colorectal surgery.AIM To compare the incidences of SSI after RACS and LACS,and to analyze the risk factors associated with SSI after minimally invasive colorectal surgery.METHODS Clinical data derived from patients who underwent minimally invasive colorectal surgery between October 2020 and October 2022 at the First Affiliated Hospital of Soochow University were collated.Differences in clinical characteristics and surgeryrelated information associated with RACS and LACS were compared,and possible risk factors for SSI were identified.RESULTS A total of 246 patients(112 LACS and 134 RACS)were included in the study.Fortythree(17.5%)developed SSI.The proportions of patients who developed SSI were similar in the two groups(17.9%vs 17.2%,P=0.887).Diabetes mellitus,intraoperative blood loss≥100 mL,and incision length were independent risk factors for SSI.Possible additional risk factors included neoadjuvant therapy,lesion site,and operation time.CONCLUSION There was no difference in SSI incidence in the RACS and LACS groups.Diabetes mellitus,intraoperative blood loss≥100 mL,and incision length were independent risk factors for postoperative SSI.

Usefulness of the Surgical Apgar Score to Predict the Occurrence of Major Complications in the Early Post-Operative Period of Major Surgeries: Experience of Two Second-Category Hospitals in Cameroon

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.

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Robotic surgical systems in maxillofacial surgery:a review

Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery

AIMTo determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS).

Combining robot-assisted surgical system and 3D visualization system for teaching minimally invasive vitreoretinal surgery

AIM:To investigate the feasibility of teaching minimally invasive vitreoretinal surgery with a robot-assisted surgical system and a three-dimensional(3D) visualization system.METHODS:Enucleated porcine eyes were established as an animal model for removing foreign bodies.Forty medical students were recruited to remove foreign bodies to compare the traditional microscope and the 3D system.One junior resident performed the surgical task with manual and robot-assisted operations on 20 porcine eyes for each group.One senior surgeon evaluated the retinal invasion by a graded injury degree.The learning curve for minimally invasive vitreoretinal surgery was described.RESULTS:Compared with the robot-assisted group,the injury degree was higher in the manual group.For the first ten surgeries,the manual and robot-assisted groups had injuries of 2.60±1.35(4 to 0) and 1.80±1.62(4 to 0),respectively.For the last ten surgeries,the injury degrees were 1.90±1.20(3 to 0) and 0.80±0.42(1 to 0).Considering the manual and robot-assisted groups together,95%,75% and 60% of the students considered surgical manipulation with the 3D visualization system to be more comfortable,easier and clearer,respectively.CONCLUSION:The robot-assisted surgical system and 3D visualization system may have value in teaching minimally invasive vitreoretinal surgery.

Efficacy of subcutaneous penrose drains for surgical site infections in colorectal surgery

AIM: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. METHODS: This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue.RESULTS: There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242).CONCLUSION: Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.

Guidelines and consensus:Jejunoileostomy for diabetes mellitussurgical norms and expert consensus(2023 version)

Diabetes mellitus(DM)is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin.Once diagnosed,patients need long-term treatment with hypoglycemic drugs.Currently,the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications.In the past,the first generation and the second generation of weight loss surgery,such as gastric bypass and sleeve gastric surgery,had strict body mass index requirements.Moreover,post-surgery,patients are prone to fluctuating hypoglycemia,gastroesophageal reflux,and dumping syndrome.Hence,the curative effect of this type of surgery was compromised to a certain extent.Jejunoileostomy is a third-generation surgery for patients with DM,which has been shown to improve glucose and lipid metabolism,without changing the original gastrointestinal tract structure.Different from previous weight loss surgeries,jejunoileostomy has been clinically observed to delay the development of DM-related complications.Additionally,the postoperative complications are mild and do not affect the patient’s quality of life.Based on our clinical observations from multi-center large samples,our team developed a consensus on the operative period and perioperative management of jejunoileostomy as a reference for clinical researchers.

Effect of high-protein peptide-based formula compared with isocaloric isonitrogenous polymeric formula in critically ill surgical patient

BACKGROUND Malnutrition is common in critically ill patients,and it is associated with an increased risk of complications.Early enteral nutrition with adequate caloric and protein intake is critical nevertheless it is difficult to achieve.Peptide-based formulas have been shown to be beneficial in patients with feeding intolerance.However,there are limited studies showing the efficacy and safety of high-protein peptide-based formula in critically ill surgical patients.AIM To determine the effects of a high-protein peptide formulation on gastrointestinal tolerance,nutritional status,biochemical changes,and adverse events in patients in the surgery intensive care unit(SICU)compared to an isocaloric isonitrogenous standard polymeric formulation.METHODS This study was a multi-center double-blind,randomized controlled trial.We enrolled adult patients in the surgical intensive care unit,age≥15 years and expected to receive enteral feeding for at least 5-14 d post-operation.They were randomly assigned to receive either the high-protein peptide-based formula or the isocaloric isonitrogenous standard formula for 14 d.Gastric residual volume(GRV),nutritional status,body composition and biochemical parameters were assessed at baseline and on days 3,5,7,9,11,and 14.RESULTS A total of 19 patients were enrolled,9 patients in the peptide-based formula group and 10 patients in the standard formula group.During the study period,there were no differences of the average GRV,body weight,body composition,nutritional status and biochemical parameters in the patients receiving peptide-based formula,compared to the standard regimen.However,participants in the standard formula lost their body weight,body mass index(BMI)and skeletal muscle mass significantly.While body weight,BMI and muscle mass were maintained in the peptide-based formula,from baseline to day 14.Moreover,the participants in the peptide-based formula tended to reach their caloric target faster than the standard formula.CONCLUSION The study emphasizes the importance of early nutritional support in the SICU and showed the efficacy and safety of a high-protein,peptide-based formula in meeting caloric and protein intake targets while maintaining body weight and muscle mass.

Incidences and Risk Factors for Surgical Site Infections in Koutiala, Mali

Purpose: This paper aims to assess the incidences and risk factors for surgical site (ISO) infections in the general surgery department of the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study from August 1, 2017 to October 31, 2020 involving all patients who underwent laparotomy in the general surgery department of the Koutiala District Hospital. Patients who were not operated on and who did not have a laparotomy were not included. Age, sex, frequency, patient history, National Nosocomial Infections Surveillance (NNIS) index, time to occur, bacteriological test results and course of infection were analyzed. Results: Fifty patients were registered. The average age was 34.2 ± 21.2 years old. Eleven patients were 60 years old or older. The hospital incidence rate was 4.3% and the community incidence rate was 6.1 cases per 100,000 population. The concept of smoking was noted in 15 patients. Patients were operated on in emergency 84% of cases. Peritonitis was the most common initial lesion with 32% of cases. Our patients had an NNIS index greater than 0 in 84% of cases. The time to develop infection from the surgical site was less than 3 days in 8 patients (16% of cases). Depending on the depth of the infection, it was superficial (cutaneous) in 39 patients (78%) and deep (subcutaneous and organic) in 11 patients (22%). Escherichia coli was the most common germ with 72% followed by staphylococcus aureus at 24%. We noted 22% morbidity. The median length of hospitalization was 9 ± 2.2 days. Conclusion: ISO is common in our service. Prevention and mastery require knowledge of risk factors.

Surgical Technique and Efficacy Analysis of Extra-pseudocapsular Transnasal Transsphenoidal Surgery for Pituitary Microprolactinoma

Objective To elucidate the role of transsphenoidal surgery in the treatment of pituitary microprolactinoma.Methods The clinical data of 107 prolactinoma cases treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS)for different indications in our department since 2011 was retrospectively analyzed.Results The most common indication was the ineffectiveness of oral medication(41.1%),followed by the personal willingness of the patient(35.5%),and 20.6%of the patients were young women with clear tumor boundaries.The pseudocapsule was not observed in 63 cases(58.9%),incomplete pseudocapsule was observed in 26 cases(24.3%),and complete pseudocapsule in 18 cases(16.8%).A total of 97 patients(90.7%)obtained 1-year post-operation remission.According to the relative location of the adenoma and pituitary gland on the MRI scan,46 patients were classified into a central type,59 a lateral type,and 2 a supra-pituitary type.Two patients developed hypogonadism,one patient developed hypocortisolism,and one patient developed post-operative hypothyroidism.Two patients were administrated with hormone replacement treatment,and the treatment was stopped within one week.There was no permanent hypopituitarism.Further investigation demonstrated that the adenoma types could affect the remission rates of hyperprolactinemia and gross total resection rate in microprolactinoma.Conclusion ETTS was an effective treatment for pituitary microprolactinomas.This could be the first choice for patients who presented enclosed adenoma on the MRI and were potentially curable in a preoperative evaluation.Maximal safe removal of the adenoma by ETTS with the aim to increase the sensitivity of the drugs was also recommended for patients with invasive dopamine agonist resistant prolactinomas and patients with difficulty in childbirth.

Neurosurgical and pharmacological management of dystonia

Dystonia characterizes a group of neurological movement disorders characterized by abnormal muscle movements,often with repetitive or sustained contraction resulting in abnormal posturing.Different types of dystonia present based on the affected body regions and play a prominent role in determining the potential efficacy of a given intervention.For most patients afflicted with these disorders,an exact cause is rarely identified,so treatment mainly focuses on symptomatic alleviation.Pharmacological agents,such as oral anticholinergic administration and botulinum toxin injection,play a major role in the initial treatment of patients.In more severe and/or refractory cases,focal areas for neurosurgical intervention are identified and targeted to improve quality of life.Deep brain stimulation(DBS)targets these anatomical locations to minimize dystonia symptoms.Surgical ablation procedures and peripheral denervation surgeries also offer potential treatment to patients who do not respond to DBS.These management options grant providers and patients the ability to weigh the benefits and risks for each individual patient profile.This review article explores these pharmacological and neurosurgical management modalities for dystonia,providing a comprehensive assessment of each of their benefits and shortcomings.

Optimizing postsurgical recovery for elderly patients with gastric cancer

Based on a recent study by Li et al,this editorial examines the significance of enhanced recovery after surgery(ERAS)protocols for elderly patients with gastric cancer.Cancer-related mortality,which is overwhelmingly caused by gastric cancer,calls for effective treatment strategies.Despite advances in the field of oncology,conventional postoperative care often results in prolonged hospital stays and increased complications.The aim of ERAS is to expedite recovery,reduce surgical stress,and improve patient satisfaction.The study of Li et al showed that,compared to traditional care,ERAS significantly reduces mortality risk,shortens hospital stays,and decreases postoperative complications.These findings support the widespread implementation of ERAS protocols in surgical practice to enhance patient outcomes and healthcare value.

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery:Four case reports

BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

Risk factors and prediction model for inpatient surgical site infection after elective abdominal surgery

BACKGROUND Surgical site infections(SSIs) are the commonest healthcare-associated infection. In addition to increasing mortality, it also lengthens the hospital stay and raises healthcare expenses. SSIs are challenging to predict, with most models having poor predictability. Therefore, we developed a prediction model for SSI after elective abdominal surgery by identifying risk factors.AIM To analyse the data on inpatients undergoing elective abdominal surgery to identify risk factors and develop predictive models that will help clinicians assess patients preoperatively.METHODS We retrospectively analysed the inpatient records of Shaanxi Provincial People’s Hospital from January 1, 2018 to January 1, 2021. We included the demographic data of the patients and their haematological test results in our analysis. The attending physicians provided the Nutritional Risk Screening 2002(NRS 2002)scores. The surgeons and anaesthesiologists manually calculated the National Nosocomial Infections Surveillance(NNIS) scores. Inpatient SSI risk factors were evaluated using univariate analysis and multivariate logistic regression. Nomograms were used in the predictive models. The receiver operating characteristic and area under the curve values were used to measure the specificity and accuracy of the model.RESULTS A total of 3018 patients met the inclusion criteria. The surgical sites included the uterus(42.2%), the liver(27.6%), the gastrointestinal tract(19.1%), the appendix(5.9%), the kidney(3.7%), and the groin area(1.4%). SSI occurred in 5% of the patients(n = 150). The risk factors associated with SSI were as follows: Age;gender;marital status;place of residence;history of diabetes;surgical season;surgical site;NRS 2002 score;preoperative white blood cell, procalcitonin(PCT), albumin, and low-density lipoprotein cholesterol(LDL) levels;preoperative antibiotic use;anaesthesia method;incision grade;NNIS score;intraoperative blood loss;intraoperative drainage tube placement;surgical operation items. Multivariate logistic regression revealed the following independent risk factors: A history of diabetes [odds ratio(OR) = 5.698, 95% confidence interval(CI): 3.305-9.825, P = 0.001], antibiotic use(OR = 14.977, 95%CI: 2.865-78.299, P = 0.001), an NRS 2002 score of ≥ 3(OR = 2.426, 95%CI: 1.199-4.909, P = 0.014), general anaesthesia(OR = 3.334, 95%CI: 1.134-9.806, P = 0.029), an NNIS score of ≥ 2(OR = 2.362, 95%CI: 1.019-5.476, P = 0.045), PCT ≥ 0.05 μg/L(OR = 1.687, 95%CI: 1.056-2.695, P = 0.029), LDL < 3.37 mmol/L(OR = 1.719, 95%CI: 1.039-2.842, P = 0.035), intraoperative blood loss ≥ 200 mL(OR = 29.026, 95%CI: 13.751-61.266, P < 0.001), surgical season(P < 0.05), surgical site(P < 0.05), and incision grade I or Ⅲ(P < 0.05). The overall area under the receiver operating characteristic curve of the predictive model was 0.926, which is significantly higher than the NNIS score(0.662).CONCLUSION The patient’s condition and haematological test indicators form the bases of our prediction model. It is a novel, efficient, and highly accurate predictive model for preventing postoperative SSI, thereby improving the prognosis in patients undergoing abdominal surgery.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

Hand-Held Surgical Instrument with the Function of Self-Locking for Minimally Invasive Surgery

In order to improve the flexibility of the surgical instruments, a wire-driven wrist-like structure is proposed in this paper. The instrument has three degrees of freedom (DOFs) of rotation, yaw, opening and closing. Furthermore, we also acknowledge no coupling motion for each DOF. Moreover, the self-locking motion contributes to sustaining joint posture under external force. A static analysis for the end effector was conducted using the ANSYS software. At the end of this paper, a series of experiments for the prototype was performed. The results revealed that for the same surgical task, the proposed instrument had higher flexibility and the completion time of the operation tasks was obviously less than that of the traditional instrument. The results of the self-locking and operating force test showed that the surgical instruments perform well in maintaining joint posture under the force of 8.2N. The proposed surgical instrument meets the requirements of minimally invasive surgery (MIS).

Surgical and non-surgical education practices in female pelvic medicine and reconstructive surgery fellowships within the United States

Data are scarce regarding surgical and non-surgical education in accredited Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowships in theUnited States. We compared surgical and non-surgical and education among training programs and expected surgical comfort level with pelvic reconstructive procedures from the perspective of the fellow and program director. An online survey was distributed to program directors and fellows from the 39 accredited FPMRS fellowships at the time (2010). Domains evaluated in the survey were academic education requirements;surgical approaches to prolapse and to incontinence;other surgical procedures;and research and publication expectations. In total, forty fellows from 21 programs and directors from 27 programs. The most common surgical procedures performed for apical, anterior, and posterior prolapse were uterosacral ligament suspension, native tissue anterior colporrhaphy, and posterior colporrhaphy, respectively. Differences in perceived surgical comfort level were seen for coccygeus suspension, graftreinforced posterior colporrhaphy, rectus fascial sling, urethral bulking agent, cystoscopic ureteral stent placement and bowel repair. A greater proportion of program directors reported that fellows would be comfortable performing these procedures upon graduation than the proportion reported by the fellows themselves. Differences exist in FPMRS training nationwide, however, responding fellows appeared to be trained in multiple approaches to prolapse repair. Differences were seen in surgical comfort level as perceived by fellows and program directors.