Application of Nursing Cooperation Path in Operating Room and Analysis of Complication Rate During Laparoscopic Hysterectomy

Objective:To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy.Methods:64 laparoscopic hysterectomy cases were divided into groups according to the order of admission.The control group received routine perioperative care.The observation group implemented the nursing cooperation path in the operating room on the same basis as the control group.The two groups’physiological responses,stimulus indicators,anxiety,and complication rates were compared.Results:The heart rate,blood pressure 0.5 hours after surgery,anxiety scores 1 day before and 3 days after surgery,and the total number of complications in the observation group were all lower than those in the control group(P<0.05).Conclusion:The development of a nursing cooperation path in the operating room can help patients undergoing laparoscopic hysterectomy reduce heart rate,blood pressure,stress responses,and the risk of complications,and is worthy of promotion.

Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy

BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.

Effect of simulating training of the fundamentals of laparoscopic surgery on the attitude of operating room nurses students:an intervention study

Objective:Clinical education plays a key role in preparing students for patient care.Laparoscopy is one of the most important minimally invasive surgeries(MISs)wherein surgical technologists are responsible for camera navigation and assistant surgeons are responsible for peg transfer.Therefore,it is necessary to improve the attitude of the operating room students toward these skills during their study period.The present study was conducted to determine the effect of simulating training in the fundamentals of laparoscopic surgery(FLS)on the attitude of the operating room students.Methods:This interventional study was conducted on 28 operating room students of Iran University of Medical Sciences in 2019.The census sampling method was used.The data-collection tool included the“Intrinsic motivation inventory(IMI)questionnaire.”The educational intervention was carried out in theoretical(booklet design)and practical(simulation)sections.Data analysis was carried out using descriptive and inferential analyses including the paired t-test,Mann–Whitney U test,and independent t-test.The collected data were analyzed using R and SPSS software.P-value<0.05 was considered as the significant level.Results:The mean±SD of the participants'age was 22.93±2.14 years,and the majority of them were women(67.9%).There was a significant difference in the mean scores of students'attitudes toward the FLS before and after the educational intervention(P<0.001)in all dimensions(interest,perceived competence,perceived choice,and tension).There was also a significant correlation between gender and interest dimension(P=0.005).Conclusions:The results of the present study showed that simulating the training FLS curriculum positively affects students'attitudes.Therefore,the researchers suggest that for creating a positive attitude,increasing students'interest in laparoscopic surgery,and ensuring a more effective presence in the operating room,this training should be considered in the operating room curriculum.

Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer

BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic cavities.Therefore,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical difficulties.AIM To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal cancer.METHODS We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for rectal cancer.Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)scans.Operative difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a nomogram.RESULTS Out of 162 patients,21(13.0%)were classified in the high surgical difficulty group,while 141(87.0%)were in the low surgical difficulty group.Multivariate logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection,intraoperative preventive ostomy,and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer(P<0.05).Conversely,the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was identified as a protective factor(P<0.05).A nomogram was subsequently constructed,demonstrating good predictive accuracy(C-index=0.834).CONCLUSION The surgical approach,intraoperative preventive ostomy,the sacrococcygeal distance,and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.

Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients

BACKGROUND Anastomotic leakage(AL)is one of the severest complications after laparoscopic surgery for middle/low rectal cancer,significantly impacting patient outcomes.Identifying reliable predictive factors for AL remains a clinical challenge.Serum nutritional biomarkers have been implicated in surgical outcomes but are un-derexplored as predictive tools for AL in this setting.Our study hypothesizes that preoperative serum levels of prealbumin(PA),albumin(ALB),and transferrin(TRF),along with surgical factors,can accurately predict AL risk.AIM To determine the predictive value of preoperative serum nutritional biomarkers for rectal cancer AL following laparoscopic surgery.METHODS In the retrospective cohort study carried out at a tertiary cancer center,we examined 560 individuals who underwent laparoscopic procedures for rectal cancer from 2018 to 2022.Preoperative serum levels of PA,ALB,and TRF were measured.We employed multivariate logistic regression to determine the independent risk factors for AL,and a predictive model was constructed and evaluated using receiver operating characteristic curve analysis.RESULTS AL occurred in 11.96%of cases,affecting 67 out of 560 patients.Multivariate analysis identified PA,ALB,and TRF as the independent risk factor,each with an odds ratio of 2.621[95%confidence interval(CI):1.582-3.812,P=0.012],3.982(95%CI:1.927-4.887,P=0.024),and 2.109(95%CI:1.162-2.981,P=0.031),respectively.Tumor location(<7 cm from anal verge)and intraoperative bleeding≥300 mL also increased AL risk.The predictive model demonstrated an excellent accuracy,achieving an area under the receiver operating characteristic curve of 0.942,a sensitivity of 0.844,and a specificity of 0.922,demonstrating an excellent ability to discriminate.CONCLUSION Preoperative serum nutritional biomarkers,combined with surgical factors,reliably predict anastomotic leakage risk after rectal cancer surgery,highlighting their importance in preoperative assessment.

Efficacy of Bispectral index-monitored closed-loop targeted-controlled infusion of propofol for laparoscopic radical operation for gastric cancer

Objective:To discuss the efficacy of Bispectral index (BIS)-monitored closed-loop targeted-controlled infusion of propofol for laparoscopic radical operation for gastric cancer.Methods:A total of 106 patients with primary gastric cancer who underwent laparoscopic radical operation for gastric cancer in our hospital between August 2015 and February 2018 were chosen as the research subjects and divided into the control group (n=53) and the observation group (n=53) according to the different anesthesia methods. Control group of patients received BIS-monitored manually adjusted targeted-controlled infusion concentration of propofol, and observation group of patients received BIS-monitored closed-loop targeted-controlled infusion of propofol. The differences in hemodynamic index levels as well as serum contents of inflammatory factors and stress hormones were compared between the two groups of patients before anesthesia (T0), 30 min after surgery started (T1) and 30 min before surgery ended (T2).Results:At T0, the differences in hemodynamic index levels as well as serum contents of inflammatory factors and stress hormones were not statistically significant between the two groups. At T1 and T2, hemodynamic indexes MAP and HR levels of observation group were lower than those of control group at the corresponding time points;serum inflammatory factors sICAM-1, IL-1β, IL-8 and TNF-α contents were lower than those of control group at the corresponding time points;serum stress hormones Cor, T4 and glucagon contents were lower than those of control group at the corresponding time points.Conclusion: BIS-monitored closed-loop targeted-controlled infusion of propofol can effectively stabilize the intraoperative hemodynamics and inhibit the systemic inflammatory stress response in patients with laparoscopic radical operation for gastric cancer.

Prevention and Management of Related Complication due to Laparoscopic Operation: Pneumothorax, Pneumomediastinum and Subcutaneous Emphysema

Essential prerequisite of laparoscopic operation is establishing and maintaining pneumoperitoneum with a certain pressure. But under certain circumstances CO2-gas insuffiating could induce pneumothorax , pneumomediastinum and subcutaneous emphysema during the operation. to probe the mechanism of the above complications. 2 typical cases were reported with attempt to probe the mechanism of the development of such applications. We believe that high intraabdominal pressure during operation is the primary cause of the complications. The essentials of prevention and management of such complications were proposed.

Effect of body mass index on the operation time and postoperative hospital stay of retroperitoneal laparoscopic renal cyst decortication

Objective:To investigate the effect of body mass index(BMI)on the operation time and postoperative hospital stay for patients who underwent retroperitoneal laparoscopic decortication for a single simple renal cyst.Methods:A retrospective cohort study was conducted among 81 patients with single simple renal cyst who had undergone retroperitoneal laparoscopic cyst decortication from January 2017 to December 2019 in Wuxi Xishan People's Hospital.All patients were divided into three groups according to BMI:normal group(BMI<25 kg/m^(2),n=44),overweight group(BMI=25-30 kg/m^(2),n=21),and obese group(BMI>30 kg/m^(2),n=16).Multiple linear regression was conducted to investigate the correlation.Results:The three groups were comparable in terms of age,gender,maximum diameter of cyst,and cyst location.In the aspect of operation time,only the patients in obese group had longer duration when compared with those in the normal group(59.1±15.7 min vs.45.2±12.8 min,p=0.001).And the patients in the obese group had significantly longer hospital stay compared with those in the normal group(6.2±1.9 d vs.5.2±0.5 d,p=0.002)and overweight group(6.2±1.9 d vs.5.0±1.0d,p=0.001).In the analysis of multiple linear regression,it was found that operation time is significantly affected by BMI and location 2,with coefficients of 1.299 and -8.646 respectively.The influence of BMI was greater than location 2(0.335 vs.-0.289).For hospital stay,only BMI had an effect on it,with a coefficient of 0.110.Conclusion:BMI was a major factor that associated with longer operation time and hospital stay in patients with retroperitoneal laparoscopic renal cyst decortication.

Effects of laparoscopic operation combined neoadjuvant chemotherapy on serum levels of CEA, CA242, CA19-9, CA724, ICAM-1 and VCAM-1 in patients with colorectal carcinoma

Objective: To observe the effects of neoadjuvant chemotherapy on the basis of laparoscopic operation on colorectal carcinoma patients, serum CEA, CA242, CA19-9, CA724, ICAM-1 and VCAM-1 levels. Methods: A total of 120 cases of colorectal carcinoma in our hospital from January 2012 to January 2015 were retrospectively analyzed and divided into control group and observation group, with each group of 60 patients. All patients were given laparoscopic operation, the patients in the observation group were given neoadjuvant chemotherapy (FOLFOX4 regimen) four cycles before laparoscopic surgery, fasting venous blood before and after treatment in the morning was taken and centrifuged, and the serum CA242, CA19-9, ICAM-1 and VCAM-1 levels were measured by ELISA, and the serum CEA levels were measured by MEIA, and the serum CA724 levels were measured by ECLI, and compared with those of the two groups. Results: (1) Before treatment, there was no statistically significant difference in the serum CEA, CA242, CA19-9 and CA724 levels between the two groups. After treatment, compared with the same group before treatment, the serum CEA, CA242, CA19-9 and CA724 levels of the two groups were significantly lower, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups;(2) Before treatment, there was no statistically significant difference in the serum ICAM-1, VCAM-1 levels between the two groups. After treatment, compared with the same group before treatment, the serum ICAM-1, VCAM-1 levels of the two groups were significantly lower, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. Conclusion: The treatment of colorectal cancer patients with neoadjuvant chemotherapy combined with laparoscopic operation can effectively reduce serum CEA, CA242, CA19-9, CA724, ICAM-1 and VCAM-1 levels, indicating that the program can regulate cancer-related tumor markers and the expression of relative factors, to promote the recovery of patients with autoimmune system, ease the patient's condition, safe and reliable, worthy of clinical application.

Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports:Initial experience and perioperative outcomes

AIM:To evaluate the feasibility,safety,and efficacy of laparoscopic pancreaticoduodenectomy(LPD) using a reverse-"V" approach with four ports.METHODS:This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012.The following data were collected and reviewed:patient characteristics,tumor histology,surgical outcome,resection margins,morbidity,and mortality.All patients were thoroughly evaluated preoperatively by complete hematologic investigations,triple-phase helical computed tomography,upper gastrointestinal endoscopy,and biopsy of ampullary lesions(when present).Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions.RESULTS:There was no perioperative mortality.LPD was performed with tumor-free margins in all patients,including patients with pancreatic ductal adenocarcinoma(n = 6),ampullary carcinoma(n = 6),intra-ductal papillary mucinous neoplasm(n = 2),pancreatic cystadenocarcinoma(n = 2),pancreatic head adenocarcinoma(n = 3),and bile duct cancer(n = 2).The mean patient age was 65 years(range,42-75 years).The median blood loss was 240 m L,and the mean operative time was 368 min.CONCLUSION:LPD using a reverse-"V" approach can be performed safely and yields good results in elective patients.Our preliminary experience showed that LDP can be performed via a reverse-"V" approach.This approach can be used to treat localized malignant lesions irrespective of histopathology.

Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

Introduction: Fibroid benign tumour of the uterus can be operated either by laparotomy or laparoscopy. Laparoscopy is not well vulgarised in our settings. Objective: The main objective was to compare the surgical and post-operative outcomes of laparoscopic versus abdominal myomectomy. Methods: We performed a comparative analytical cross sectional study from 1st January 2016 to 31st March 2018 consisted of two groups: group 1 of women who underwent laparoscopic myomectomy (LM) and group 2 of women who underwent abdominal myomectomy (AM). The data collected was entered in Epi Info 7.2 version and exported to IBM SPSS Statistics version 22 for analysis. We used alpha error margin of 5% and confidence interval of 95%. Results: We enrolled 50 cases of myomectomy consisted of 33 (66.0%) files for AM and 17 (34.0%) files for LM. The clinical presentation of fibroid was similar in both groups. The main operation time (H) was (1.27 ± 0.13) for laparoscopy which is much less than (2.05 ± 0.07) for laparotomy group (p = 0.006). In AM group we had 04 post-operatory complications against zero complications in LM group but the difference was not statistically significant (p = 0.387). In the second look laparoscopy, the types of adhesions were not statistically significant (p = 0.471). Conclusion: Laparoscopic offers advantages compared to abdominal myomectomy.

Retroperitoneal laparoscopic partial nephrectomy for unilateral synchronous multifocal renal carcinoma with different pathological types:A case report

BACKGROUND The majority of renal cell carcinomas are single lesions;unilateral synchronous multifocal renal carcinoma(USMRC)is rarely reported and poses a treatment challenge for urological oncologists.CASE SUMMARY A 56-year-old man was hospitalized for pain and discomfort in the right kidney area for 6 d.Contrast-enhanced computed tomography demonstrated cT1a renal tumors at the lower pole of the right kidney and a cT1b renal tumor at the middle dorsal portion of the right kidney.The patient underwent retroperitoneal laparoscopic partial nephrectomy(RLPN).There were no complications peri-operatively.Histopathology revealed a low-grade,pathologic stage T1a(pT1a),clear cell renal cell carcinoma at the lower pole of the right kidney and a pT1b,chromophobe renal cell carcinoma at the middle dorsal portion of the right kidney.No tumor bed recurrence or metastasis was observed on imaging and his renal function remained stable during the 12-mo follow-up period.CONCLUSION RLPN is a safe,effective,and feasible for the management of USMRC,which can obtain equivalent oncological results with optimal renal function preservation.

Benefit of laparoscopic liver resection in high body mass index patients

AIM: To explore the impact of body mass index(BMI) on surgical outcomes in patients undergoing laparoscopic liver resection(LLR).METHODS: From January 2010 to February 2015, sixty-eight patients who underwent primary partial liver resection in our institute were retrospectively reviewed. Surgical outcomes of LLR were compared with those of open liver resection(OLR). In addition, we analyzed associations with BMI and surgical outcomes.RESULTS: Among 68 patients, thirty-nine patients underwent LLR and 29 were performed OLR. Significant difference in operation time, blood loss, and postoperative hospital stay was observed. There were no signi ficant di fferences in mortali ty and morbidity in two groups. Twenty-two patients(32.4%) were classified as obese(BMI ≥ 25). A statistically significant correlation was observed between BMI and operation time, between BMI and blood loss in OLR, but not in LLR. The operation time and blood loss of OLR were significantly higher than that of LLR in obese patients. Open liver resection and BMI were independent predictors for prolonged operation time and increased blood loss in multivariate analysis.CONCLUSION: The present study demonstrated that BMI had influenced to surgical outcomes of OLR. LLR was less influenced by BMI and had great benefit in obese patients.

Gao's double-way approach for laparoscopic D2 radical surgery for gastric cancer

Laparoscopic D2 radical surgery for gastric cancer is minimally invasive but complex.In this path:(1) Repeated operation of lesser curvature side;(2) The gastrohepatic ligament is relatively fixed.Hence,it is not easy to expose the suprapancreatic area;and(3) It is not easy to dissect No.1,12 lymph nodes.This area may not be sufficiently cleaned or surrounding vessels may be injured during a resection.So it is critical to choose position fixing,and a clear,fast and convenient operation path.The author,based on his experience,has established a set of procedural steps called "Gao's double-way",lesser omentum approach and traditional greater omentum approach,which are described in detail in this article.The path of this first approach is described as a "W" type of dissection.The second way is the traditional greater omentum approach,whose path is described as a "M" type of dissection.This will enable laparoscopic surgeons to select a suitable path.This new approach not only simplifies the surgery but also provides more space for the subsequent operation,thereby making the surgery more simple,safe and easy.

Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery

Sister Mary Joseph’s nodule(SMJN)is a rare umbilical nodule that develops secondary to metastatic cancer.Primary malignancies are located in the abdomen or pelvis.Patients with SMJN have a poor prognosis.An 83-year-old woman presented to our hospital with a1-month history of a rapidly enlarging umbilical mass.Endoscopic findings revealed advanced transverse colon cancer.computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon,umbilicus,right inguinal lymph nodes,and left lung.The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels.Imaging findings of the left lung tumor allowed for identification of the primary lung cancer,and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made.The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection.Intra-abdominal dissemination to the mesocolon was confirmed during surgery.Histopathologically,the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma.We suspect that SMJN may occur via a hematogenous pathway.Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled,the patient and her family desired home hospice.Seven months after surgery,she died of rapidly growing lung cancer.

Improved laparoscopic transanal pull-through technique for low-rectal cancer resection

Objective： We described the applicability and evaluated the advantages of improved laparoscopic transanal pull-through （ILTPT） for low-rectal cancer resection. Materials： ILTPT was performed in 4 patients. Five or 4 ports were used. After isolation and section of the inferior mesenteric vessels, the rectum and sigmoid colon was mobilized. Total mesorectal excision and dissection of the distal rectum from the puborectalis muscle was carried out under laparoscopic guidance. The sigmoid colon and rectum were exteriorized via the anus. The rectum was divided proximally. Next, a purse-string suture was placed in the proximal segment, and the distal end of the sigmoid colon was returned to the pelvic cavity. The distal rectum was divided with Curved cutter staplermade by Jonson-Jonson company. Dislodging specimen, the continuity of the intestinal tract was restored using PROXIMATE ILS Curved and Straight Intraluminal Staplers CDH29/33 （Ethicon） through the rectum. Results： None of the cases were converted to open surgery. Average operation time was 180 min （range, 160-210 min）. No blood loss or any other complications were noted. Average postoperative stay was 9 days. Complications such as necrosis, anastomotic leakage and stricture, and genitoudnary disorders were not found in any of the patients at the 1 m follow-up. Conclusion： This report suggests that ILTPT is feasible and safe in Anus-Conserving Operation for low Rectal Cancer without auxiliary incision. If only we hold the applicability of ILTPT less trauma, more beautiful.

MODIFIED LAPAROSCOPIC CHOLECYSTECTOMY

To furtherly reduce the subxiphoid port site pain,improve the cosmetic result and patient satisfaction,and increase the safety for patients underwent laparoscopic cholecystectomy by advanced laparoscopic knotting skill.Methods:Among our 1500 patients underwent laparoscopic cholecystectomy since 1991,120 cases of modified laparoscopic cholecystectomy (MLC) were performed with three 5-mm ports and one 10-mm port(for laparoscope and sepcien withdrawn).There were 25 male and 95 female patients with an average age of 55 years (24～77years).The indications for MLC included polypoid lesions of gallbladder (21),simple cholecystitis(3),cholecystolithiasisi with chronic cholecystitis(84),with acute suppurative cholecystitis(7),with atrophic cholecystitis(5).Results:There were 5 patients underwent combined laparoscopic appendectomy(3),fenestration of hepatic cyst(1),and drainge for liver abscess(1).The average operative time for MLC was 55 minutes(30～150min),blood loss was 10ml(3～50ml),and postoperative stay was 3 days(1～5days).There were no conversion from MLC to either LC or open surgery,without mortality.Complications were limited to two patients(1.7%).One was retained common bile duct stone and another was port site bleeding after operation.They were treated by transduodenal endoscopic stone retrieval and simple suture ligation,respecrtively.Conclusions:The advantages of MLC conducted mainly by advanced laparoscopic knotting techniques were no more laparoscope (either 2-mm or 5-mm)needed,no sacrifice of good illumination and laproscopic image.Most of all,its costeffective and operative safety were all improved furtherly.

A Randomized Control Trial Comparing Direct Stripping and Bipolar Electrocoagulation for Laparoscopic Endometriotic Cystectomy-Surgical and Histopathological Aspects

The present study compared two different techniques of endometriotic cystectomy at the hilus : continuation of strip-ping and bipolar elctrocoagulation and cuttin . This was a randomized controlled study was done on 64 patients, who had laparoscopically confirmed endometriomas > 3 cm in diameter. Endometriotic cystectomy was initiated by excision of a circular rim of tissue at the original adhesion site followed by stripping and randomization was done at the ovarian hilum into 2 groups. In Group I surgery was completed by continuation of stripping and in group II surgery was completed by bipolar coagulation and cutting with scissors. Operative time and operative difficulty were evaluated at both steps by the same surgeon. Histopathology confirmation of the loss of normal ovarian tissue was recorded in the excised cyst and at the hilus separately. Data was analysed using Stata software, fisher’s exact test was employed to assess operative difficulty and Kruskal-Wallis test was used to evaluate ovarian tissue quality. The mean operating time was reported to be significantly lesser in the coagulation and cutting group. The operative difficulty was comparable in two groups. The number of primordial follicles sacrificed showed no significant difference in both groups. Complication rate in terms of hemorrhage was higher in the direct stripping group.

Exploring ideal operative time for best outcomes in gastric cancer surgery:A multi-institutional study based on KLASS-07 database

Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.

Pattern of Presentation of Iatrogenic Biliary Injury Following Laparoscopic Cholecystectomy

Background: Cholecystectomy is one of the most now common abdominal surgeries performed every day. The incidence of bile duct injury (BDI) following open cholecystectomy is only 0.1% - 0.2%. After the introduction of laparoscopic cholecystectomy, the incidence has gone up to 0.4% - 0.7%. The present study is a prospective analysis of all patients with bile duct injury who were admitted to Dhaka Medical College Hospital during or at a variable period following cholecystectomy. Methods: To determine the pattern of presentation of iatrogenic biliary injury following cholecystectomy in the department of surgery of Dhaka Medical College Hospital, a total of 30 patients were purposively selected from May 2018 to November 2018. Patient particulars, records of physical and clinical evaluation, and operative details were collected by individual researchers. Data analysis was done by SPSS for windows version 21. Results: BDI was found very common among the age group 21 - 30 yrs (36%) and female dominant (60%). Majority of the patients presented with abdominal pain (96%), intra-abdominal collection (88%), biliary peritonitis (68%), cholangitis (60%), and obstructive jaundice (40%), and biliary fistula (40%). Laparoscopic cholecystectomy (84%) was the principal cause of biliary injury in our study. 48% of patients experienced clinical features within 7 days post-cholecystectomy. Per-operative diagnosis was done in only 12% of cases. 44% of patients in this study were recognized as Bismuth grade-3, followed by 36%, grade-2 patients. Management outcomes included wound infection (41.66%), minor bile leak (25%), peritonitis (8.33%), and renal impairment (8.33%). Conclusion: The effect of BDI is an extremely distressful clinical condition for the patients and their family members, hence proper care and management protocol should be followed.