[Results of surgical interventions performed for pulmonary tuberculosis during the last four years in Algerian hospitals and sanatoria: possibilities of excision].
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Hospitals↗
SEARCH · PubMed Health
Results for “Surgical Performance”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Teaching and assessing competence in cataract surgery.
PURPOSE OF REVIEW: To review recent literature regarding innovative techniques, methods of teaching and assessing competence and skill in cataract surgery. RECENT FINDINGS: The need for assessment of surgical competency and the requirement of wet lab facilities in ophthalmic training programs are being increasingly emphasized. Authors have proposed the use of standardized forms to collect objective and subjective data regarding the residents' surgical performance. Investigators have reported methods to improve visualization of cadaver and animal eyes for the wet lab, including the use of capsular dyes. The discussion of virtual reality as a teaching tool for surgical programs continues. Studies have proven that residents trained on a laparoscopic simulator outperformed nontrained residents during actual surgery for both surgical times and numbers of errors. Besides virtual reality systems, a program is being developed to separate the cognitive portion from the physical aspects of surgery. Another program couples surgical videos with three-dimensional animation to enhance the trainees' topographical understanding. SUMMARY: Proper assessment of surgical competency is becoming an important focus of training programs. The use of surgical data forms may assist in standardizing objective assessments. Virtual reality, cognitive curriculum and animation video programs can be helpful in improving residents' surgical performance.
Cataract Extraction↗
Core competency in laparoendoscopic surgery.
BACKGROUND: Concern about patient safety and physician competence was highlighted by the Institute of Medicine report, revealing the prevalence of fatal medical errors. There is also awareness that technical difficulties specific to laparoendoscopic surgery can cause medical errors. Reported herein is a review of the evidence pertaining to objective assessment of core competency components in laparoendoscopic surgery: cognitive skills, technical skills, surgical performance, and judgment. METHODS: PubMed and MedLine searches were performed to identify articles with combinations of the following key words: core competency, competency, laparoscopy, training, assessment, and curriculum. Further articles were obtained by searching reference lists of identified papers and through personal communication. CONCLUSIONS: The available evidence suggests that it is currently possible to objectively assess core competency components in laparoendoscopic surgery: knowledge and clinical judgment with well-established tests and innate technical abilities with computer-based simulators with embedded metrics. Simulation training is conducted to a proficiency criterion regardless of the number of repetitions or practice hours. Reports indicate that skills learned on a simulator transfer to the operating room. However, to date, objective assessment of surgical performance can be obtained only through review of unedited video tapes of surgical procedures by disinterested experts as recently demonstrated by our Japanese colleagues in urology.
Clinical Competence↗
Contemporary performance of surgical ventricular restoration procedures: data from the Society of Thoracic Surgeons' National Cardiac Database.
BACKGROUND: Surgical ventricular restoration (SVR) is an operation that demonstrates promise to improve outcomes for patients with left ventricular dysfunction. Current use and operative outcomes of SVR have come from centers of expertise, and operative risks of SVR in community practice are unknown. We sought to characterize the performance of SVR nationally and describe the acute risks of mortality and major morbidity plus predictors of adverse outcomes. METHODS: We identified patients undergoing an SVR procedure at US hospitals participating in the Society of Thoracic Surgeons (STS) National Cardiac Database from January 2002 to June 2004. Baseline characteristics, operative characteristics, clinical outcomes, and predictors of adverse procedural outcomes were analyzed. RESULTS: There were 731 patients who underwent SVR at 141 of STS's 576 hospitals, and 20 centers performed 10 SVR procedures or more. The operative mortality was 9.3%; reoperation in 14.1%, stroke in 3.3%, renal failure in 8.1%, and prolonged ventilation in 21.5%. Combined death or major complications occurred in 33.5%. Major predictors of this combined end point were age, female sex, creatinine > or = 2 mg/dL, insulin-dependent diabetes, myocardial infarction within 1 week, history of congestive heart failure, 3-vessel coronary disease, severe mitral insufficiency, and status of surgery. CONCLUSION: This study provides a first look at use and outcomes of SVR in a national sample. Although a quarter of STS sites are performing SVR, most have limited experience and perioperative events are somewhat higher than prior selected series. Further studies of SVR are needed to improve patient selection and procedural performance.
Aged↗
[Tasks and performance of surgical dispensary consultation hours for patients with benign upper abdominal diseases].
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Abdomen↗
[Positional changes of the lower and upper anterior teeth after surgical correction of mandibular prognathism].
BACKGROUND/AIM: To establish the influence of surgical corrections of mandibular prognathism upon the position of the lower and upper anterior teeth (incisors). METHODS: The changes in position of the lower and upper anterior teeth (incisors) after the surgical correction of mandibular prognathism were analyzed by means of x-ray craniometry in 183 patients (female: n = 110, male: n = 73) in which the correction had been made in accordance with the principles of sagital osteotomy of the mandibular ramus. There were 4 angular and 2 linear parameters determined in the pre- and postoperative tele-x-ray-pictures. The changes of these parameters were tested by means of the parametric statistic tests. RESULTS: The performed surgical procedures did not cause statistically significant changes in the angular parameters. The changes of both linear parameters were thought highly statistically significant. CONCLUSION: Under the influence of the performed surgical procedures no changes were found in the position of anterior teeth (incisors) in relation to SN and the mandibular plane. They were actually moved along with the medium fragment of the lower jaw and that fragment was moved linearly backwards along the occlusal plane with a practically insignificant rotation in the cranial direction.
Adult↗
The value of virtual reality-simulator training in the development of laparoscopic surgical skills.
OBJECTIVE: To determine the effectiveness of virtual reality (VR) training in improving the surgical skills of medical students and gynecologic trainees. DESIGN: A prospective observational study to assess the changes observed in objectively measured surgical performance after VR training. SETTING AND POPULATION: University teaching hospital and the laboratories of the University of Western Australia. PARTICIPANTS: Fifteen 5th-year medical students, six junior-doctor trainees (years 1-3), and eight senior trainees (years 4-6). INTERVENTIONS: Standard gynecologic procedures before and after VR training were undertaken on sheep. The procedures were video-recorded and edited to blind the scorer as to identity and seniority of the operator. The procedures were scored using a combination of operative time and penalties for surgical errors. The surgical scores were correlated with the VR scores. MEASUREMENTS AND MAIN RESULTS: Operative skills were assessed using a combination score compiled from scores obtained while undertaking salpingectomy, salpingotomy, and tubal clipping. Virtual reality scores were also a combination score derived from summation of various computer-calculated measures of time and accuracy in undertaking two standardized exercises. RESULTS: The baseline VR scores were significantly related to the overall pre-training scores (salpingectomy p = .032). A better initial VR score was also predictive of better surgical performance. The initial VR score was also predictive of improvement observed between baseline and post-training (p = .004). CONCLUSION: Virtual reality training is of value in improving surgical skills in the clinical environment. It appears to be of most value in the earliest stages of training. These data suggest that serious consideration should be given to incorporating VR training into the training program of obstetricians and gynecologists at an early stage.
Adult↗
Surgery or chemoneurolysis for complete vagal denervation of rat stomach?
This study compared the completeness of vagal denervation of the rat stomach by transection vagotomy to that by chemoneurolysis (30% ethyl alcohol) alone or supplemented by truncal vagotomy. The H+ output over 6 hr with vagotomy by chemoneurolysis (10.5 +/- 0.7 mumol, mean +/- SEM, N = 10) or truncal vagotomy and chemoneurolysis (10.9 +/- 1.1 mumol, mean +/- SEM, N = 10) was similar to that with transection vagotomy, but significantly (P less than 0.01) lower than that with truncal vagotomy by chemoneurolysis (17.9 +/- 1.1 mumol, N = 10). The latter output was similar to that of truncal vagotomy performed surgically (18.2 +/- 1.3 mumol, N = 10). Reserpine (0.1 mg/kg intraperitoneal) stimulated gastric acid secretion relative to control values (207 +/- 3.1 mumol vs 67 +/- 3.2 mumol, N = 10, P less than 0.001) and transection vagotomy, vagotomy by chemoneurolysis, or truncal vagotomy and chemoneurolysis were more effective (P less than 0.01) than truncal vagotomy performed surgically or by chemoneurolysis in preventing this stimulation. Insulin stimulated the H+ output (184 +/- 2.9 mumol vs 62 +/- 3.1 mumol, N = 10, P less than 0.001) and transection vagotomy, vagotomy by chemoneurolysis, or truncal vagotomy and chemoneurolysis were more effective (P less than 0.01) than truncal vagotomy done surgically or by chemoneurolysis in preventing this action. These results were reproducible in experiments done after three months. This investigation shows that transection vagotomy, vagotomy by chemoneurolysis, and truncal vagotomy plus chemoneurolysis are equally effective in achieving vagal denervation of the rat stomach and are superior in this respect to truncal vagotomy done surgically or by chemoneurolysis.
Animals↗
A randomised control trial of surgical task performance in rigid bronchoscopy: foreign body extraction with optical versus non-optical forceps.
There are currently two types of forceps used for foreign body removal at rigid bronchoscopy, these can be classified as standard bronchoscopy forceps and optically guided grasping forceps. In order to evaluate them in the removal of foreign bodies from the tracheo-bronchial tree a randomised subject controlled trial was conducted. All 80 bronchoscopies were recorded and analysed by a single observer according to predetermined criteria for surgical error. The data was analysed using a t-test for paired groups. The results showed no significant differences between the two groups. We conclude that no clear advantages were found comparing the optically guided forceps with the standard bronchoscopy forceps and that further clinical evaluation will be difficult to initiate.
Animals↗
[A case of primary tracheal adenoid cystic carcinoma performed curative surgical resection].
A 67-year-old woman who was diagnosed as a relative early primary tracheal adenoid cystic carcinoma by preoperative examination underwent surgical resection. The histopathological extension of this carcinoma into the tracheal wall was much greater than was suggested before operation and 6 tracheal rings was curatively resected circumferentially. Median sternotomy and transection of the left brachiocephalic vein facilitated access to the trachea. To resect the extensive segment of the trachea, the right pulmonary ligament and hilum were mobilized. Additionally Dedo's laryngeal release was performed to lessen the tension at the anastomosis. Then the flap of the pleura and adipose tissue with the right internal mammary artery and vein was wrapped around the anastomosis for revascularization and protection of brachiocephalic artery. The postoperative course was not eventful. The postoperative dysphagia by Dedo's laryngeal release was mild and resolved within 7 days after operation. And the postoperative mammary arteriography showed the vessels around the anastomosis. This wrapping procedure is easy and does not need a laparotomy. So we think it is beneficial for prevention against postoperative complications of tracheoplasty.
Aged↗
Robot-assisted stapedotomy: micropick fenestration of the stapes footplate.
OBJECTIVE: Micropick fenestration of the stapes footplate, a difficult step in stapedotomy, was selected for trials evaluating the potential for robotic assistance (RA) to improve clinical measures of surgical performance. STUDY DESIGN: In a surgical model of stapedotomy, we measured accuracy of fenestration to a desired point location and force applied to the stapes footplate. Performance variables were measured for 3 experienced and 3 less-experienced surgeons. RESULTS: RA significantly reduced the maximum force applied to the stapes footplate. For fenestration targeting, RA significantly improved accuracy for less-experienced surgeons and significantly worsened targeting for more-experienced surgeons. CONCLUSIONS: RA significantly improves performance for micropick fenestration in a surgical model of stapedotomy. For certain tasks, RA differentially affects performance for users of different experience levels. CLINICAL SIGNIFICANCE: These are the first results showing quantitative improvements in performance during simulated ear surgery using RA and differential effects of RA on performance for users of different experience levels.
Clinical Competence↗
Left ventricular function and cardiopulmonary performance following surgical treatment of morbid obesity.
BACKGROUND: It is well established that morbid obesity affects the respiratory system and the diastolic function of the heart. During exercise, cardiopulmonary reserve is exhausted because of augmented requirements, leading to a significant intolerance. A study was undertaken to investigate the influence of body weight loss on the characteristics of the left ventricle (LV) and on exercise capacity in obese patients before and 6 months, following vertical banded gastroplasty (VBG). METHODS: 16 morbidly obese individuals (BMI > 40 kg/m2) scheduled for VBG were studied. A symptom-limited cardiopulmonary exercise test and a complete transthoracic echocardiogram were performed 1 day before operation and 6 months postoperatively (after the patients achieved a body weight loss of > 20% of their pre-operative values). RESULTS: Exercise duration increased significantly 6 months following surgery. The mean O2 consumption at peak exercise (peak VO2) and at the anaerobic threshold (VO2AT) was significantly higher after weight loss. 6 months after VBG the LV thickness decreased significantly. Regarding the diastolic indices, isovolumic relaxation time (IVRT) and early/late (E/A) velocity ratio, there was a significant improvement after weight loss. Simple linear regression analysis revealed that peak VO2 and VO2AT were significantly correlated with IVRT and E/A velocity ratio. CONCLUSIONS: Weight loss after VBG improves the cardiac diastolic function and this is associated with an improvement in cardiopulmonary exercise performance. Left ventricular filling variables could be considered among the most important determinants of exercise intolerance in obese individuals.
Adult↗
Pupil dilation with intracameral lidocaine during phacoemulsification.
PURPOSE: To evaluate pupil dilation by an intracameral injection of nonpreserved lidocaine 1% during phacoemulsification cataract extraction and compare the results with those using conventional topical mydriatics. SETTING: Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. METHODS: A prospective comparative case series study was conducted. The study included 57 patients who were given topical mydriatics (30 eyes) or intracameral lidocaine (27 eyes) to dilate the pupil for phacoemulsification and intraocular lens implantation. The topical group received 3 drops of cyclopentolate 1% and phenylephrine 5% given 5 minutes apart starting 60 minutes before surgery. The intracameral group received preservative-free lidocaine 1% (0.2 to 0.3 mL) injected just before the procedure began. No epinephrine was added to the irrigating solution. In both groups, the horizontal pupil diameter was measured before and after pupil dilation using the same caliper. Total surgical time, need for a mydriatic agent during the procedure, and subjective surgical performance were recorded. RESULTS: The mean age, sex, cataract density, baseline horizontal pupil diameter, and mean duration of the surgery were the same between the topical group and intracameral group. The mean pupil dilation was 4.52 mm +/- 0.08 (SD) in the intracameral group and 4.06 +/- 0.09 mm in the topical group; the difference between groups was statistically significant (P = .001). There was no significant difference between groups in the overall subjective surgical performance (P = .74). No patient in the intracameral group and 2 patients in the topical group required an intracameral mydriatic injection. CONCLUSION: During phacoemulsification, intracameral preservative-free lidocaine 1% provided rapid, effective mydriasis comparable that of topical mydriatics.
Aged↗
Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees?
BACKGROUND: It is essential that surgical trainees obtain adequate operative experience without compromising patient outcome. The aim of this study was to compare the reexcision and local recurrence rates between consultants (attending surgeons) and surgical trainees (residents) after breast conservation surgery. METHODS: Prospective data were obtained from the local breast cancer registry for all patients who had breast-conservation surgery between 1994 and 2000. Reexcision was carried out if the margins were deemed inadequate after taking the clinical and pathologic features into consideration. RESULTS: The primary operation (n = 505) was wide local excision = 377; wire-guided excisions = 107; and quadrantectomy = 21 patients. Sixty-five percent (n = 330) were operated on by consultants and 35% (n = 175) by residents. Second procedures (n = 137) were performed for involved margins in 95 and close margins in 31 patients. The patients in both groups were equally matched. The reexcision rate was similar for both groups of surgeons (P = 0.58). On multivariate analysis, the factors determining reexcision were nodal status, type of first procedure, and tumor type. The local recurrence rate was comparable in both groups (P = 0.33). CONCLUSIONS: In patients with breast cancer treated by conservation surgery during a 7-year period, the reexcision and local recurrence rates were similar for both groups of surgeons.
Analysis of Variance↗
The impact of preoperative gonadotropin-releasing hormone agonist treatment on laparoscopic excision of ovarian endometriotic cysts.
OBJECTIVE: To compare surgical performance and recurrence rates in patients submitted to laparoscopy for endometrioma excision following GnRH agonist (GnRH-a) treatment versus no preoperative medical treatment. DESIGN: Controlled clinical study. SETTING: A tertiary care university hospital. PATIENTS: Twenty patients with unilateral endometriomas underwent operative laparoscopy after 3-month GnRH-a treatment, whereas 21 patients underwent laparoscopic excision of endometriomas without preoperative medical treatment. INTERVENTIONS: Operative laparoscopy was performed with the stripping technique using a four-puncture approach. MAIN OUTCOME MEASURE: A blinded videotape review was undertaken to evaluate the duration and complexity of the different phases of surgery. Recurrence rates were evaluated at 1-year follow-up ultrasonography. RESULTS: No significant difference was found between the two groups in total operative time, cyst excision time, time needed for cyst capsule stripping and coagulation of ovarian parenchyma, and the complexity of the latter phases; recurrence rates also were comparable. CONCLUSION: Preoperative GnRH-a treatment for endometriomas does not seem to offer any advantage in terms of subsequent surgical performance.
Adult↗
Relative value guide basic units in operating room scheduling to ensure compliance with anesthesia group policies for surgical procedures performed at each anesthetizing location.
Many anesthesia groups provide services in a spectrum of anesthetizing locations, including offices, free-standing ambulatory surgery centers, diagnostic clinics, and traditional hospital operating rooms. The use of a uniformly understood measure of case complexity could assist an anesthesia group in ensuring appropriate anesthesia provider expertise and equipment availability at each anesthetizing location. In this article, we show how the American Society of Anesthesiologists' Relative Value Guide (ASA RVG) basic units can be used as a criterion to establish the maximum level of complexity of cases performed at each location by an anesthesia group. By reviewing ASA RVG basic units at several anesthetizing locations in lowa, we found that ASA RVG basic units differ among sites. The ASA RVG basic units can be used to identify cases that are seemingly unexpected for an anesthetizing location. There are several reasonable values that an anesthesia group can use for its maximum number of basic units at an anesthetizing location.
Ambulatory Surgical Procedures↗
Metastasis of malignant melanoma in the small intestine. A case report.
Malignant melanoma is the most common metastatic tumor of the gastrointestinal tract and can present with fairly non-specific symptoms. A 63-year old man with previous enucleation of the left eye for a malignant coroidian melanoma presented signs of intestinal subocclusion. Weight loss and a palpable mass deep on the paraumbilical left region were the significant physical signs. Because the state of the patient had worsened, the diagnosis was made by ultrasonography examination. Segmental intestinal resection with regional lymph node dissection was performed. Surgical resection can be performed safely as patients for whom all sites of disease are completely resected experience significant improvements in survival times, compared with patients who undergo an incomplete resection. For selected patients, surgical treatment of metastatic melanoma involving the gastrointestinal tract is appropriate therapy.
Choroid Neoplasms↗
Comparison of outcomes of three different surgical techniques performed for stress urinary incontinence.
BACKGROUND: The aim was to compare the efficacy of Burch colposuspension, transvaginal four-corner bladder neck suspension (FCBNS) and the vaginal wall sling (VWS) procedures in patients with stress urinary incontinence. METHODS: A retrospective analysis was performed on 88 patients who underwent Burch colposuspension (n = 20), FCBNS (n = 29) and VWS (n = 39) for stress urinary incontinence. Objective and subjective cure rates at 3 months and annually after the operation were the primary outcome measures. RESULTS: The patients were similar in age, parity, menopausal status, grade of cystocel and preoperative residual urine volumes. Fourteen out of 20 (70%) patients showed improvement in the group undergoing Burch colposuspension, 29 out of 39 (74.4%) patients showed improvement in the FCBNS group, and 28 out of 29 (96.6%) patients showed improvement in the VWS group. The mean length of follow up was 3.8 years (range 3-5). CONCLUSION: In this study, the VWS procedure had a higher long-term cure rate of stress urinary incontinence when compared with the Burch colposuspension and the FCBNS procedures.
Adult↗