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OBJECTIVE Posttonsillectomy hemorrhage can be life-threatening, so we investigated whether patients are at increased risk with an inexperienced surgeon. There is scant information on how surgical experience affects outcomes in pediatric tonsillectomy. We hypothesized that supervised residents would have longer operative times but no difference in complication rates compared to attending surgeons. STUDY DESIGN Retrospective case series of children who underwent tonsillectomy from July 2014 to April 2017 at a tertiary pediatric medical center. METHODS We assessed outcomes and operative times, based on the primary surgeon's level of training, for children (14 months to 22 years) who underwent tonsillectomy. RESULTS A total of 7,606 children were included (mean age 7.0 ± 4.1 years, 51% female) with a mean body mass index (BMI) of 18.6 ± 5.48 kg/m2 ; 76% were white; and 13% were black. Residents assisted with tonsillectomy in 43% of cases. The readmission rate (5%-6%) was not different (P = 0.48) by level of experience. Similarly, return to the operating room for control of hemorrhage (3.3%-3.5%) did not differ by level of experience (P = 0.95). The median procedure time for adenotonsillectomy was shortest for attendings (9 minutes), followed by fellows (13 minutes), and residents (14 minutes, P

BACKGROUND: This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS: Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS: A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P

OBJECTIVES: To describe a technique using bipolar electrosurgical forceps for haemostasis during open ovariectomy of bitches and queens and for castration of dogs and to determine whether these forceps reduced surgical time compared to ligation with suture. MATERIALS AND METHODS: Bipolar electrosurgical forceps were used for haemostasis in 3744 open surgeries including ovariectomies in bitches (n=1406) and queens (n=859) and castrations in dogs (n=1335). The forceps were also used to assist with ovariohysterectomy in bitches (n=89) and queens (n=55). The effect of bipolar electrocoagulation and other likely factors influencing surgical time was examined using linear regression analysis of 367 surgeries. RESULTS: The use of the forceps reduced surgical time by 9·7 ±2·8 minutes in bitches and by 3·0 ±1·5 minutes in queens. The complications encountered initially were small superficial skin burns requiring topical treatment and one case of haemorrhage associated with surgical technique. CLINICAL SIGNIFICANCE: Bipolar electrosurgical forceps reduce surgical time in ovariectomies, and complications are rare. This technique has promise for widespread application in veterinary practice to assist with haemostasis in ovariectomy of bitches and queens.

BACKGROUND The plethora of surgical procedures for prominent ear correction reflects lack of satisfaction with outcomes achieved. This paper describes a cartilage-cutting otoplasty procedure and reports an audit of its outcomes. METHODS Discharge coding was used to retrospectively identify patients who had undergone the otoplasty of interest at Middlemore Hospital, Auckland, during the 5 years from March 2010 to the end of February 2015. Hospital records were accessed. Demographic, procedure and patient satisfaction data were recorded and analysed (PASW/SPSS Statistics 18.0). Chi-square test and t-test were used to assess associations, with significance accepted at two-sided P

OBJECTIVE To determine the temperature of a vessel sealer and divider device during unilateral paralumbar laparoscopic ovariectomy in standing, sedated mares. STUDY DESIGN Prospective study. ANIMALS Fifteen healthy research mares. METHODS Healthy mares with normal ovarian palpation and ultrasonographic appearance were enrolled. Horses were restrained in standing stocks and sedated. A right or left paralumbar ovariectomy was performed with a laparoscopic portal and 2 instrument portals. Ovaries were excised with traumatic forceps and a blunt tip vessel sealer and divider. Temperatures of the vessel sealer and divider were recorded with a thermocouple device adhered to the tip of the instrument. Variables were reported as median and interquartile range (IQR). RESULTS Surgical time was 30 minutes (IQR, 25-32) including use of the vessel sealer and the divider for 4.1 minutes (IQR, 3.2-5.8). The tip of the instrument reached temperatures of 77°C (IQR, 72-85) during activation and 64°C (IQR, 61-67) at end cycle. The median increase in end-cycle instrument tip temperature per activation cycle was 2°C (IQR, -1-6). All mares returned to their intended use. CONCLUSION Despite the instrument temperatures observed during unilateral laparoscopic ovariectomy, surgical complications were minimal. The clinical relevance of the increase in instrument tip temperature of the vessel sealer and divider is presently unclear, but surgeons should use the instrument with caution, especially in close proximity to viscera. The increase in temperature observed at the tip of the vessel sealer and divider during unilateral ovariectomy could be associated with morbidity. The clinical relevance of instrument tip heating during other procedures, such as adhesiolysis and intestinal resection, is unknown and should be evaluated.

Objective Evaluate the impact of endoscopic partial inferior turbinectomy (EPIT) associated with primary rhinoseptoplasty on quality-of-life outcomes (QOL), complications, and surgical duration. Study design Randomized clinical trial. Methods Individuals with nasal obstruction aged ≥ 16 years who were candidates for functional and aesthetics primary rhinoseptoplasty were evaluated from March 2014 through May 2015. Eligible participants were randomly allocated to rhinoseptoplasty with or without EPIT (excision of one-third of the inferior turbinates). Results Fifty patients were studied. Most were Caucasian and had moderate/severe allergic rhinitis symptoms. Mean age was 36 ( ± 14.5) years. Rhinoseptoplasty was associated with improvement in all QOL scores irrespective of turbinate intervention (P 0.05). There were no differences between the groups regarding presence of the complications. Surgical duration was higher in the EPIT group (212 minutes ± 7.8 vs. 159.1 ± 5.6; P ? 0.001). Conclusions Turbinate reduction through EPIT during primary rhinoseptoplasty did not improve short-term general and specific QOL outcomes. The use of EPIT increases surgical time considerably without improving QOL scores. There was no difference in postoperative incidence of complications, suggesting that EPIT is a safe technique. Level of evidence 1b. Laryngoscope, 128:57-63, 2018.

Objectives To describe outcomes for endoscopic ear surgery (EES) for pediatric cholesteatoma at a tertiary pediatric hospital. Methods Retrospective case series of 65 pediatric cholesteatoma cases in 38 ears. Subgrouping based on cholesteatoma type and EES type. Surgical findings, outcomes, and demographic data were evaluated. Results Endoscopes were used in 65 pediatric cholesteatoma cases in 38 primary ears (34 patients), followed for an average of 2.6 years (9 months to 4.6 years). The endoscope was used as the primary visualization tool in 31 (81.6%) ears (EES 2 or 3), and as an adjunct to the microscope in seven ears (EES 1). Twenty-two (57.9%) ears and 35 (53.4%) cases were transcanal endoscopic ear surgery (EES 3 or TEES). Overall, there was recurrence in five (13.2%) ears and residual in four (10.5%) ears. Cholesteatoma was acquired in 27 ears, with average age 10.9 years; and congenital in 11 ears, with average age 3.8 years. Surgical time was longer for acquired cases (226 vs. 154 minutes). Hearing outcomes were comparable for both cholesteatoma types. Residual disease was seen in three (11.1%) acquired ears and one (9.1%) congenital ear. Overall, the lowest rates of recurrent and residual disease were seen in EES 3 cases, and relatively low rates in EES 2 and 3 ears, including four (12.9%) recurrences and two (6.5%) ears with residual disease. Conclusion The endoscopes are a viable tool for resection of pediatric cholesteatoma and provide excellent visualization of the middle ear and associated recesses. Level of Evidence 4. Laryngoscope, 127:2653–2658, 2017

Objectives/Hypothesis Cochlear implantation for patients with common cavity deformity (CCD) can be difficult, with a higher incidence of intra- and postoperative complications; outcomes with CCD patients are also highly variable. In this study, surgical time was compared between the traditional facial recess approach (TFRA) and the transmastoid slotted labyrinthotomy approach (TSLA). Audiological outcomes and the benefit of using customized electrode arrays for CCD patients are also discussed. Study Design Retrospective review of 13 cochlear implant (CI) patients with CCD. Methods Six patients were implanted with the TFRA using traditional electrodes, and seven patients were implanted with the TSLA using customized electrodes. Intra- and postoperative complications were reviewed. Audiological outcomes were measured 3 months to 2 years after CI activation. Results The mean surgical time for TSLA group was nearly half as long as for the TRFA group (P .05). Conclusions For CCD patients, TSLA for cochlear implantation is recommended due to shortened surgical time; customized electrode arrays may be additionally advantageous in terms of audiological outcomes. Level of Evidence 4. Laryngoscope, 2017

Objective To describe a suture-free ureterovesical anastomosis using a microvascular anastomotic system (MAS) and compare the surgical time and bursting pressure to a sutured ureterovesical anastomosis (SA) with and without an extravesical seromuscular tunnel (EVSMT). Study Design Randomized, unblocked design, ex vivo study. Animals Three canine cadavers. Methods For each cadaver, the ureters were sectioned into 3 equal lengths. The 6 sections were randomly assigned to receive either the MAS or end-side SA. The first cadaver (3 MAS, 3 SA) was used to refine the technique, and the remaining 2 cadavers were used for evaluation. Surgical time and bursting pressure of the anastomosis were compared between MAS and SA (n = 6 per technique). After bursting pressure testing of each anastomosis, an SMT was created over the anastomoses. Bursting pressures were again recorded and compared across techniques. Results The surgery time was significantly shorter for MAS (median 5.4 minutes) than SA (median 15.8 minutes; P = .002). The bursting pressure was significantly higher for MAS (median 189.5 cmH2O) than SA (median 64 cmH2O; P = .002). The bursting pressure for MAS-EVSMT (median 398.5 cmH2O) was not significantly different from the SA-EVSMT (median 321 cmH2O, P = .567); however, the creation of an SMT significantly increased the bursting pressure for both techniques (P = .028, respectively). Conclusion This study demonstrated the feasibility of a suture-free ureterovesical anastomosis in the canine cadaver using a commercially available MAS. The MAS anastomosis was faster and resulted in higher bursting pressures than SA. The creation of an SMT improved the bursting resistance of both techniques but there was no difference between the techniques covered by an EVSMT.

© 2014 Wiley Periodicals, Inc. Background. Preliminary case series have reported clinical feasibility and safety of a transoral minimally invasive technique to approach parapharyngeal space masses. With the assistance of the surgical robotic system, tumors within the parapharyngeal space can now be excised safely without neck incisions. A detailed technical description is included. Methods. After developing compressive symptoms from a parapharyng-eal space lipomatous tumor, the patient was referred by his primary oto-laryngologist because of poor open surgical access to the nasopharyngeal component of the tumor. Results. Transoral robotic assisted resection of a 54-3 46-mm paraphar-yngeal space mass was performed, utilizing 97 minutes of robotic surgical time. Pictorial demonstration of the robotic resection is provided. Conclusion. Parapharyngeal space tumors have traditionally been approached via transcervical skin incisions, typically including blunt dissection from tactile feedback. The transoral robotic approach offers magnified 3D visualization of the parapharyngeal space that allows for complete and safe resection.

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed orthopedic procedures in the United States. Repair of the ACL often requires the use of autografts or allografts, and the RN first assistant (RNFA) often is the team member responsible for preparing the graft. Common grafts used in ACL repair include bone-patellar tendon-bone, hamstring, Achilles tendon, quadriceps tendon, and tibialis anterior tendon. The RNFA must be competent in preparing all of these grafts and in understanding the advantages and disadvantages of using each graft, such as the reasons for graft choice, and must ensure that all graft-related supplies and equipment are available and ready for use. The ability to prepare all graft types expands treatment options, reduces surgical time, and enhances the role of the RNFA.

Background Some authors recommend primary closure of the defect before placement of the mesh. The purpose of this study is to compare laparoscopic ventral hernia repair (LVHR) without primary closure of the defect (NPCD) versus LVHR with primary closure of the defect (PCD). Methods A retrospective review of 134 LVHR was performed. Each group included 67 cases. For the PCD group the robotic platform was used. Results Groups were similar in terms of demographics and comorbidities. For NPCD and PCD groups mean surgical time was 87.9±53.1 and 107.6±33.9 minutes (p = 0.012); conversion to open surgery was seen in 3(4.5%) and 1(1.5%) (p = 0.310); complications were 7(10.4%) and 2(3%) (p = 0.084); and finally, recurrences were seen in 5(7.5%) and 1(1.5%) (p = 0.095). Conclusions PCD has longer surgical time, however, a tendency in terms of complications and recurrences was found favoring the PCD group. The robotic assistance is a good alternative when primary closure of the defect is attempted. Copyright © 2014 John Wiley & Sons, Ltd.

Background Prototyping technologies for reconstructions consist of obtaining a 3-dimensional model of the object of interest. Solid models are constructed by the deposition of materials in successive layers. The purpose of this study was to perform a double-blind, randomized, prospective study to evaluate the efficacy of prototype use in head and neck surgeries. Methods Thirty-seven cases were randomized into prototype and nonprototype groups. The following factors were recorded: the time of plate and locking screw apposition, flap size, time for reconstruction, and an aesthetic evaluation. Results The prototype group exhibited a reduced surgical time (43.7 minutes vs 127.7 minutes, respectively; p = .001), a tendency to reduce the size of the bone flap taken for reconstruction, and better aesthetic results than the group that was not prototyped. Conclusion The use of prototyping demonstrated a trend toward a reduced surgical time, smaller bone flaps, and better aesthetic results. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1773–1782, 2014

Background The hand surgery service in our major trauma centre comprised predominantly emergency surgery with poor theatre access, resulting in many cases being postponed and performed after hours and with low rates of supervision. Method We report the results of a before-and-after study describing the change in processes and outcomes associated with a change in the model of care to a sequestered, area-wide hand surgery service. The study uses data from 12 months prior to and 12 months after the change in practice. Results The hand service experienced a 24.7% increase in demand for surgery in the first 12 months after the relocation. However, demand for overnight beds fell by 303%, the rate of specialist supervision increased from 23.5% to 81.3% (P < 0.0001), the time between admission and surgery fell from 5.1 to 2.7 h (P < 0.0001), the rate of cancellations fell from 21.8% to 7.7% (P < 0.0001), the proportion of emergency surgery conducted in normal hours increased from 65.8% to 93.6% (P < 0.0001), the 28-day unplanned reoperation rate fell from 1.2% to 0.5% (P = 0.02) and surgical time decreased to an equivalent of 41 half day operating sessions per year. Conclusion These outcomes are in line with international experiences of service centralization. The project may be used as a template for practice change in other surgical fields.

Objective To prospectively evaluate ovariectomy and ovariohysterectomy via midline coeliotomy when being employed by supervised final year veterinary students for the purpose of routine canine neutering. Methods One hundred and eight female dogs of various breeds, presented to a veterinary teaching hospital for neutering, were randomly allocated to one of two surgery groups, ovariectomy or ovariohysterectomy. The specified procedure was performed by a supervised final year veterinary student. If the duration of surgery exceeded 2 hours or if major surgical or anaesthetic complications occurred, the supervising surgeon intervened to complete the procedure. Results Data analysed included age, weight, time from first incision to start of closure, duration of closure, total surgical time and length of incision. Fifty-four dogs underwent each procedure. There was no significant difference between the two surgery groups for any of the measured variables. Clinical Significance Ovariectomy is not associated with shorter surgical times or smaller abdominal incisions than ovariohysterectomy when employed by inexperienced surgeons. As no major complications novel to ovariectomy occurred in this cohort of dogs, this study adds support to the existing literature indicating that ovariectomy is an acceptable alternative to ovariohysterectomy for canine neutering.

Objective To describe a technique for treating pyometra in dogs using a 3-portal laparoscopic-assisted ovariohysterectomy (LAOVH) and evaluate outcome. Study Design Retrospective case series. Animals Dogs (n = 12). Methods Dogs with open or closed-cervix pyometra with moderately sized (1–4 cm) uterine horn diameters based on preoperative ultrasonography and no evidence of perforation were included in the study. A 3-portal technique for LAOVH was used. A wound retraction device was inserted into the caudal portal after enlargement of the incision to 3–4 cm to simplify removal of the uterus with minimal tension. Results Twelve dogs (median weight, 23.3 kg; range, 2.1–46.0 kg) met the inclusion criteria. Median uterine diameter was 3.0 cm (range, 1.2–4.0 cm). Median surgical time for LAOVH was 107 minutes (range, 82–120 minutes). Complications included mild hemorrhage from the uterine vessels in 1 dog during uterine removal through the wound retraction device and intra-abdominal uterine rupture in 1 dog which necessitated conversion to an open approach. All dogs recovered from surgery and were discharged. Conclusions LAOVH can be used for treatment of select cases of canine pyometra. Careful case selection is mandatory to improve success and minimize conversion to an open approach. Gentle handling of the reproductive organs is imperative to avoid iatrogenic uterine rupture.

Objective To describe a technique for ovariectomy through a colpotomy using a chain ecraseur with laparoscopic guidance and report outcome in 4 mares. Study Design Case series. Method After insertion of a laparoscope into the abdomen through the left flank, colpotomy was performed to allow introduction of an ecraseur into the caudal aspect of the abdomen. Grasping and removal of the ovary and evaluation of the pedicle was observed via the laparoscope. The laparoscope was then inserted in the right flank for right ovariectomy. The colpotomy was closed in a continuous suture pattern using laparoscopic or long needle holders. Results Insertion of a laparoscope allowed ready identification of the ovaries and capture within an ecraseur, including assurance that no other tissues were contained within ecraseur chain. The mesovarial pedicles were easily be examined for hemorrhage. Surgical time for ovariectomy was 10–15 minutes with no postsurgical complications. Closure of the colpotomy healed without complications. Conclusion Laparoscopic-assisted ecraseur ovariectomy is inexpensive, rapid, and a safe alternative to other methods of open and laparoscopic ovariectomy.

Objective To report a laryngotomy approach for the removal of the nasal septum in adult horses. Study Design Descriptive study. Animals Horses (n = 10). Methods Near-total resection of the nasal septum was made using a modification of a previously reported 3-wire technique using a trephination approach and a 2-wire technique using a laryngotomy approach. Surgical time, ease of technique, complications, and outcome were recorded. At 45 days, horses were euthanatized and septal measurements made. Results Near-total resection of the nasal septum was accomplished with both techniques without complications. Incisional complications occurred in the trephination group and transient granulation tissue formation near the rostral stump occurred in the laryngotomy group. The laryngotomy technique was technically easier and resulted in a more cosmetic outcome. Conclusions A laryngotomy approach is safe and expedient for near-total resection of the nasal septum with minimal complications.

Clinical results, complications and the outcome of using either a carbon dioxide (CO₂) laser, diode laser or electrocautery (ELEC) for resection of the soft palate with an extended palatoplasty technique in brachycephalic dogs with upper airway obstructive syndrome were compared. Dogs were randomly allocated into three groups (n=20 in each group): ELEC, diode and CO₂ groups. The palatoplasty was made at the rostral aspect of the tonsils. A respiratory clinical score, ranging from 0 (normal) to 4 (cyanosis), was attributed to each dog before surgery and at 0 hours, 24 hours, two weeks and six months after surgery. A favourable outcome was defined as a one point or greater decrease in score 24 hours after surgery. The proportion of dogs with a favourable outcome was significantly higher in the CO₂ (n=15) and ELEC groups (n=15) in comparison with the diode group (n=7) (OR=5.6, 95 per cent confidence interval 1.4 to 21.9). Surgical time was significantly shorter (P

Introduction: The purpose of this study is to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of recurrent lumbar disc herniation. Methods: Thirty-six patients with recurrent lumbar disc herniation were treated using MED (30 men and six women; mean age: 45.7 years, range: 26–80 years; mean follow-up: 24.4 months, range: 12–52 months; mean duration between the primary and revision surgery: 65.9 months, range: 1–320 months) (recurrent group). Sex- and age-matched patients with primary lumbar disc herniation treated by MED served as the control group (primary group). The clinical outcomes were evaluated using the Japanese Orthopaedic Association score for low back pain and questionnaires regarding MED. Results: The average Japanese Orthopaedic Association scores before surgery and at the final follow-up were significantly lower in the recurrent group than in the primary group (10.8 ± 3.4 versus 15.0 ± 4.0 before surgery, P=0.001 and 25.4 ± 2.6 versus 26.8 ± 1.9 at follow-up, P=0.013), while the average recovery rates were not significantly different between the two groups (80.3 ± 14.1% versus 84.5 ± 14.6, P=0.22). The surgical time was significantly longer for the recurrent group than for the primary group (83.0 ± 41.8 min versus 67.1 ± 18.1 min,P=0.042). Of the 18 questionnaire respondents, 17 answered that postoperative pain was milder after MED than after a standard discectomy. Conclusion: MED is a feasible surgical option for recurrent lumbar disc herniation, yielding surgical outcomes comparable to those obtained in primary lumbar disc herniation.

Objective— To describe a technique for laparoscopic ovariectomy (LapOVE) in small dogs, and compare the surgical time, complications, and postoperative activity of dogs undergoing LapOVE to those undergoing conventional traditional open ovariectomy (OOVE). Study Design— A randomized, controlled clinical trial. Animals— Intact small breed (

One thousand intracapsular cataract extractions were performed by two ophthalmologists over a 57-day period at Lahan Eye Hospital in Nepal. Ninety-nine per cent of eyes had a visual acuity of less than 3/60 at surgery. Ninety-eight per cent of eyes achieved a visual acuity of 3/60 or better with aphakic spherical correction at discharge, of which 69% had a visual acuity of 6/36 or better. In 314 eyes seen at 1-month follow-up, 88% achieved 6/18 or better with full aphakic correction. The surgical time averaged less than 10 min and the cost of disposables less than pounds 1 per operation.

Aim: Although most partial liver resections are performed for malignant lesions, an increasing contingent of benign lesions is also considered for surgery. The aim was to assess post-operative morbidity and mortality after liver resection for benign hepatobiliary lesions in comparison with outcome after resection of malignant lesions. Methods: A total of 286 liver resections were undertaken between January 1992 and December 2004. After exclusion of resection for bile duct tumours or hepatocellular carcinoma, 205 partial liver resections were retrospectively analysed. Results: Patients with benign lesions comprised 34% of the group (n=70). Benign lesions mainly consisted of focal nodular hyperplasia (n=12; 17%) and liver haemangiomas (11; 15.7%). The malignant lesions consisted of colorectal tumour metastases (n=121; 89%). Patients with benign lesions predominantly underwent minor liver resections (66 vs. 47%; P=0.013). The overall post-operative morbidity occurred in 31% (64/205). Major morbidity occurred in 16% (22/135) in the malignant group compared with 9% (6/70) in the benign group (P=0.099). No differences were seen in major post-operative morbidity in the earlier period compared with the later period (14 vs. 14.3%, P=0.950). In multivariate analysis, only presence of comorbidity (P=0.017), prolonged surgical procedure (P=0.021) and surgical irradicality (P=0.039) maintained significance as independent risk factors for major morbidity. Conclusion: Limited liver resections for the treatment of a wide range of benign hepatobiliary lesions are associated with low morbidity and no mortality. However, the indications must be assessed with care. The presence of comorbidity, prolonged surgical time and incomplete resections were associated with major morbidity.

Objective— To describe the safety, surgical time, and complications associated with 3 techniques for achieving hemostasis during laparoscopic-assisted ovariohysterectomy (LAOVH). Study Design— Prospective, randomized clinical trial. Animals— Female dogs (n=30). Methods— Dogs were randomly assigned to 1 of 3 methods for achieving ovarian pedicle hemostasis during LAOVH: extracorporeal modified Roeder knot application (suture group), metal clip application using a multifire 10 mm laparoscopic clip applier (clip group), or use of a novel 5 mm bipolar vessel-sealing device (vessel-sealing group). In all dogs a 3 median portal technique was used. Results— Controlling for the dogs' bodyweights, there was a significant association between surgical time and which method for hemostasis was used. This association was different when comparing the first 5 procedures using each method to the second 5. For a 20 kg dog, the surgical time (95% CI) for the first 5 procedures was 80 (69–91), 68 (57–79), and 33 (21–45) minutes for the suture, clip, and vessel-sealing groups, respectively. For the second 5 procedures surgical time was 71 (60–81), 50 (39–60), and 40 (29–51) minutes. Pedicle hemorrhage occurred in all dogs in the clip group, 3 dogs in the suture group, and none of the dogs in the vessel-sealing group although in all cases was considered hemodynamically inconsequential. All dogs recovered uneventfully. Conclusions— All methods of hemostasis were safe for pedicle sectioning. A learning curve exists for clip and suture methods. Clinical Relevance— Use of a vessel-sealing device significantly shortens surgical time and provides excellent hemostasis during LAOVH.

Objectives— To review indications, benefits, and complications of surgical stapling in animals. Study Design— Literature review. Results— Benefits and complications of surgical stapling depend on the procedure performed. Use of surgical staplers does not improve wound strength but may decrease surgical time. Clinical Relevance— In patients at significant risk for intraoperative contamination or morbidity from prolonged anesthesia time, use of stapling devices should be considered.

Although arteriovenous fistulae are the preferred form of dialysis vascular access they continue to have significant problems with maturation failure. The Optiflow device is a sutureless anastomotic conduit which could potentially reduce surgical time and also standardize the surgical procedure. We report herein on the "First in Man" experience with the Optiflow device.

The objectives of this study were to compare (1) the extent of thermal damage and (2) the time between the 5-mm LigaSure V (LS5) and 10-mm LigaSure Atlas (LS10) vessel sealing devices (VSD) when performing open ovariectomy in dogs. A prospective, randomised, clinical trial was performed in 40 client-owned sexually entire female dogs. In each dog, one ovary was randomly assigned to be surgically removed using LS5 and the contralateral using LS10. The depth of thermal spread, measured on histopathological preparations, was significantly larger for LS10 (LS10 1.35±0.23 mm v LS5 0.82±0.10 mm; P

Objectives:Evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage and associated health care cost for pediatric adenotonsillectomy.Methods:Retrospective chart analysis from a tertiary care pediatric hospital of patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and chi-square analysis was used to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.Results:A total of 1280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the 3 instrumentation groups. When examining the various instruments’ effects on procedure time in minutes, univariat...

Objectives:(1) Determine whether Accreditation Council for Graduate Medical Education fellowship-trained pediatric anesthesiologists improve the efficiency of pediatric operations at hospitals that do not have dedicated pediatric operating rooms (ORs). (2) Determine what anesthesia practices may account for a difference in efficiency between general and pediatric anesthesiologists.Methods:This retrospective chart review study compared the anesthesia-controlled time (ACT) between pediatric and general anesthesiologists for pediatric adenotonsillectomies performed at an academic county hospital without dedicated pediatric operating rooms (ORs). All patients age 12 years and under who underwent tonsillectomy or adenotonsillectomy from January 2008 to July 2013 at San Francisco General Hospital were included. Patient demographics, surgical time, ACT, and anesthesia techniques were compared between pediatric and general anesthesiologists.Results:Pediatric anesthesiologists had significantly shorter ACT than ge...

AORN supports the Joint Commission's requirements and guidelines to promote correct site surgery, including preoperative verification, site marking, and conducting and documenting a surgical time out. This article highlights the success of a well-implemented surgical time out policy and procedure at a two-bed combat support hospital in northern Iraq. Policy implementation, training, documentation, and quality management chart checks prevented any incidence of wrong site surgery through the completion of more than 900 procedures on more than 400 patients during a 15-month period. AORN J 89 (March 2009) 535–537. © AORN, Inc, 2009.

Objective— The purpose of this study was to determine the feasibility of using laparoscopy to remove cryptorchid testes from standing horses. Study Design— Prospective clinical study. Animals or Sample Population— Eleven client-owned horses ranging in age from 4 months to 2 years. Methods— Abdominal insufflation was initiated and maintained using a 20 F insufflation tube, attached via a stopcock, to the low pressure regulator on a standard carbon dioxide pressure tank. After trocar and laparoscope placement in the ipsilateral flank the testes were identified. Local anesthesia of the structures to be manipulated was administered through the instrument channel on the operative laparoscope, using a catheter with a needle attached. Testes were grasped with large laparoscopic forceps and exteriorized through the abdominal wall. Ligation and transection of the mesorchium was extracorporeal. The descended testes were removed using a standard standing technique. Results— Complications were minor, including mild colic in one horse. The mean surgical time for standing laparoscopic cryptorchidectomy and castration of these colts was 58.9 ±24.3 minutes. Conclusions and Clinical Relevance— Standing laparoscopic cryptorchidectomy, using the instrumentation described, is a safe and practical technique in young horses.

Objectives To implement a minimal invasive approach in cochlear implant surgery for children and adults. In order to decrease surgical complications and morbidity with the surgery. Subjects and methods During a 1-year period, 12 consecutive patients (5 female and 7 male; age range, 1.5 to 78 years; mean age, 14.5 years), who had cochlear implantation (1 Nucleus and 11 Clarion) through a new surgical approach, were prospectively evaluated. Results The surgical approach was accomplished in all the patients with no major complications. The mean surgical time was 3.2 hours and the mean time between surgery and process of programming was 2.7 weeks. Conclusion The surgical trauma and postoperatory edema was decreased and allowed programming of the implant in a shorter period of time.

Objective: SurgiSIS is a bioactive material derived from porcine small intestinal mucosa (SIS). This material promotes early vessel growth, provides scaffolding for the remodeling tissues, and is inexpensive and ready-to-use. We evaluated efficacy, safety, and surgery time of SIS myringoplasty, and compared with patients’ temporalis fascia (PTF) repair in children.Method: Prospective, 2-group (SIS and PTF) randomized, blinded study in a tertiary-care pediatric institution; 404 children with tympanic membrane (TM) repair were randomly assigned to receive SIS or PTF myringoplasty. Primary outcomes were the healing of the TM and surgical time. Ten years’ follow-up was obtained in all enrolled children.Results: Four hundred thirty-two TM (217 in the SIS and 215 in the ATF groups) perforations were treated. There were 212 stable TM closures in the SIS (97.2%) and 204 (94.8%) in the PTF arm. TM closure was higher in the SIS arm. Results were not statistically significant (OR = 0.4, 95% CI 0.12-1.41). SIS myring...

Objective: Determine the incidence of postoperative complications associated with bone anchored hearing aid—BAHA—implantation in one surgical time frame for children and adolescents.Method: Retrospective study at 2 tertiary referral centers. A total of 84 patients less than 18 years old (104 BAHA procedures) with conductive, mixed, and single sided deafness between 2003 and 2010.Results: Postoperative complications occurred in 21 (20.2%) implants placed. Complications related to skin in 11 (10.5%) cases, implant extrusion occurred in 7 (6.7%) cases, and loss of abutment occurred in 3 (2.8%) cases. 40 dB average functional hearing gain was observed in the whole group of patients.Conclusion: We found overall incidence (20.2%) of postoperative complications for this group involving 2 different centers and implantations in one surgical time frame, which is not higher than that reported in the 2 stage procedure. These results support the feasibility and safety of single-stage surgery for BAHA implantation in t...

Our purpose was to determine whether non-closure of the visceral peritoneum alters post-operative outcome at abdominal hysterectomy. A prospective, randomized trial was performed. Of the 100 evaluable subjects, 50 had the visceral peritoneum left open whereas 50 were closed. Patients were observed for evidence of morbidity after the operation. Analysis of data was performed with use of the unpaired t-test for continuous variables. The visceral peritonization process at abdominal hysterectomy does not provide immediate post-operative benefits while unnecessarily lengthening surgical time and anesthesia exposure. We suggest that visceral peritonization process can be abolished at abdominal hysterectomy.

Purpose Despite its clinical advantages, MIVS poses significant challenges in performing airtight incisions especially dealing with 23-gauge system. Aim of this paper was to assess the feasibility of performing 23-g MIVS using an injector system for trocar insertion. Methods 60 consecutive eyes of 56 patients underwent 23-g pp vitrectomy and gas endotamponade for the treatment of Regmatogenous Retinal detachment and Diabetic Prolipherative Retinopathy by the same surgeon (SD). 30 eyes were operated on with standard one-step 23-g and 30 using a prototype of injector holding the same 23-g trocar cannula system. The trocar squeezed into the plunger of the injector. The device had a metallic terminal oriented with a fix angle, allowing the insertion in the settled direction, able to fix the globe and displace the conjunctiva at the same time.Main outcome measure were sclerotomies airtightness, surgical time and complications. Results In the 30 eyes operated with the 23-g ones step system 9 sclerotomies were sutured, in 5 refilling was required. Mean surgical time were 54 minutes. In the 30 eyes operated with the new device, the inserter was easy to apply in all cases and was useful especially in the nasal quadrant. Also dealing with sunken eyes the inclination of the system 5-10° tangential to the sclera was easily achieved. No suture was placed, refilling was needed in 3 cases. Mean surgical time was 45 minutes. No complications due to these device were highlighted. Conclusion The new injector was safe and effective. The device facilitates the insertion manoeuvre allowing easier and quicker trocar positioning helping the airtight wound construction. MIVS success lie in the surgeon’s skill but also in the development of the technology and instrumentations.

ObjectiveSurgiSIS is a new bioactive material derived from porcine small intestinal mucosa (SIS). This acellular, easily absorbable collagen matrix promotes early and new vessel growth, and provides scaffolding for the remodeling tissues. This is an inexpensive and ready-to-use alternative to autologous grafts. We evaluated the efficacy, safety, and surgery time of SIS myringoplasty, and compared clinical outcomes with patient's temporalis fascia (PTF) repair in children.MethodsProspective, 2-group (SIS, and PTF) randomized, blinded study in a tertiary-care pediatric institution. 82 children for whom tympanic membrane (TM) repair was indicated were randomly assigned to receive either SIS or PTF myringoplasty. Patients and examining physician were blinded to surgical modality. Primary outcomes were the healing of the TM and surgical time; secondary outcome was presence of any reaction or inflammation of the TM. 2-year follow-up was obtained in all enrolled children.ResultsA total of 82 TM (43 in the SIS an...

Vessel sealing (VS) is well established in laparoscopic ovariectomy (OVE) in dogs. The objectives of this study were to evaluate the efficacy of ovarian pedicle haemostasis by VS using a commercially available VS tool in open OVE and compare it with suture ligation (SL). A prospective, randomised clinical trial including 20 female dogs was designed. Open OVE was performed via a standard mid-line celiotomy by a single surgeon using a standardised protocol. At random, the right ovarian pedicle was sealed (VS) or ligated (SL) whereas the left pedicle was treated by the alternative technique. Surgical times for procedural stages and intra-operative complications were recorded and statistically evaluated. Total surgical time was 29.28±11.13 minutes (range 12.50-62.13 minutes) and time from identification to removal of the ovary was significantly less when sealing (VS 2.22±0.58 minutes) than when ligating (SL 4.10±1.13 minutes P=0.0001). Intra-operative complications were rare for both techniques (failure of the electrode of the VS device (n=3); ovarian pedicle haemorrhage due to ligature slippage (n=1)). The results of the current study indicate that ovarian pedicle haemostasis achieved by VS is significantly faster than by placement of ligatures without appearing to compromise safety.

A considerable amount of research is being undertaken regarding the possibility of bridging loss of nerve substance with different guiding tubes, in order to improve functional outcome, reduce the surgical time, and reduce damage at donor nerve sites. A review of the literature and personal research allows us to state that: for short gaps, biological tubes (autologous veins) may give good results and also allow chemotactic attraction with selective arrangements of motor and sensory axons. Gaps longer than 1 cm do not allow tropism and are associated with failure to support axonal regrowth. Artificial biodegradable conduits still show results that are controversial; they may give good results provided that the material of which they are made is perfectly tolerated. Empty tubes, longer than 8-10 mm, besides being deprived of the chemotactic attraction, may collapse or be partially reabsorbed and replaced by scar. Probably in the near future biological or biodegradable tubes, containing laminin-like substances or muscle scaffold, will allow us to bridge increasingly large defects in nerves.

Introduction: Cerebrospinal fluid (CSF) leaks involving the lateral extension of the sphenoid sinus create unique challenges for the endoscopic approach. Such defects are typically inaccessible through a typical transethmoid or transsphenoid corridor. Recently, an endoscopic transpterygoid approach to the lateral sphenoid recess has been adopted and reported by several groups. However, this technique requires extended surgical time and can put the sphenopalatine ganglion and maxillary division of the trigeminal nerve at risk. In the current study we detail our experience with an extended transnasal transsphenoidal approach to lateral sphenoid sinus CSF leaks and meningoencephaloceles.

SURGICAL site infections are a common, frustrating and potentially costly complication encountered at all levels of veterinary surgery. Many contributing factors have been associated with an increased risk of postoperative infections in both human and veterinary surgery. Surgical time, presence of

We describe our experience with the technique of fistulization for the treatment of Bartholin's abscesses and cysts. The principal objective of this treatment is the restoration of the normal gland's function. The study group included 46 patients who underwent the procedure during a 12-year period. Eight patients had to undergo a refistulization, a recurrency rate of 17.4%. The fistulization procedure provides satisfactory results in a high percentage of cases. It is a simple procedure requiring very little surgical time and has fewer recurrences than marsupialization and other forms of drainage.