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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources

PubMedDate not supplied

Non small cell lung carcinoma (NSCLC) at stage 3. A fourteen years retrospective study of 449 patients. Indications of surgery in a multidisciplinary management.

Through a fourteen years retrospective study of all the patients treated at the State University of Liège, we have focused on the survival of 449 patients with, at least, a clinical stage 3 NSCLC disease (NORMS UICC). The whole study was divided in two periods (1972-1978, period 1, and 1979-1985, period 2) because, everything remaining nearly equal as far as the clinical material was concerned, period 2 was characterized by a different therapeutic attitude. Since 1979, the NSCLC stage 3's surgical indications have been widely extended. We have performed surgical resections in patients with NSCLC N2 disease because of positive homolateral mediastinal lymph nodes or with T3 disease. This led the NSCLC stage 3 resection rate to move from 26% in period 1 to 47% in period 2. We report here the effects of such a management on the short and long term survival and the stage 3 NSCLC global prognosis. We noted a modest significant increase in the NSCLC stage 3 global prognosis with a five year survival of 4% and 6% (period 1 and 2 respectively; P = 0.03). The 172 resected patients' outcome did not change (five year survival 11% (P1) and 12% (P2]. Although patients were not randomized, our results suggest that adjuvant therapy should not be added whenever the patient underwent a complete resection. On the other hand, it seems very useful indeed whenever the resection was partial. NSCLC patient at stage 3 who underwent a complete resection achieved a 37% five years survival.

Carcinoma, Non-Small-Cell Lung↗

PubMed2002

Quantitative methodology of evaluating surgeon performance in laparoscopic surgery.

Quantitative performance and skill assessments are critical for evaluating the progress of surgical residents and the efficacy of different training programs. Current evaluation methods are subjective and potentially unreliable, so there is a need for objective methods to evaluate surgical performance. We identify a feasible method to measure kinematic data in the live operating room setting and to assess the repeatability of an analysis method based on a hierarchical decomposition of surgical tasks. We used an optoelectronic motion analysis system to acquire postural data and tool tip trajectories of one expert surgeon over a period of four months. To assess repeatability of performance measures, we created a hierarchical decomposition diagram describing the procedure in terms of surgical tasks, tool sequences and fundamental tool actions. From the kinematic data, we extracted characteristic measures of individual tool actions and compared these measured distributions using the Kolmogorov-Smirnov statistic. The comparisons of distributions show consistent performance over time by a trained surgeon and little effect from patient variability, and so are likely reliable measures of performance. An expanded set of reliable kinematic measures will form the basis for quantifying surgical skill and should be useful in validating surgical simulations for use in training, certifying surgeons and designing and evaluating new surgical tools.

Biomechanical Phenomena↗

PubMed2003

Tracheotomy application and timing.

Tracheotomy is one of the most commonly performed surgical procedures among critically ill patients. In the past, tracheotomy was delayed as long as possible in ventilator-dependent patients because of concerns regarding injury to the airway from the surgical procedure. Greater recognition of the benefits of tracheotomy in terms of greater patient comfort and mobility has promoted its earlier performance. No data identify an ideal time for tracheotomy. The decision to convert a patient from translaryngeal intubation to a tracheostomy requires anticipation of the duration of expected mechanical ventilation and the weighing of the expected benefits and risks of the procedure. The convenience of percutaneous tracheotomy performed in the ICU by critical care specialists without formal surgical training has further promoted the adoption of tracheotomy for ventilator-dependent patients. Regardless of the method for performing tracheotomy, meticulous surgical technique and careful postoperative management are necessary to maintain the excellent safety record of tracheotomy for critically ill patients.

Cricoid Cartilage↗

PubMed2005

Evaluation of cerebral hypoperfusion by nuclear medicine imaging in a patient with Takayasu's arteritis.

In patients with Takayasu's arteritis presenting with cerebrovascular insufficiency, deciding whether and how to perform surgical intervention is difficult. We report successful extra-anatomical cerebrovascular reconstruction in a patient with Takayasu's arteritis involving the aortic arch. A 27-year-old woman was diagnosed with Takayasu's arteritis with occlusion of all three branches of the aortic arch. Single-photon emission computed tomography and positron emission tomography of the brain were useful in assessing the indication and effect of surgical treatment. Right common ilioaxillary artery bypass grafting was performed, and at 18-month follow-up the patient remained symptom-free. Extra-anatomical bypass can be a therapeutic option for surgical management of Takayasu's arteritis with aortic arch involvement.

Adult↗

PubMed2005

A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology.

BACKGROUND: With the recent trend for nondermatologists to treat dermatologic disorders, this retrospective biopsy study reviews the accuracy of the clinical diagnosis of physicians of different specialties performing surgical dermatologic procedures. OBJECTIVE: We assessed the diagnostic abilities of nondermatologist physicians who performed various types of skin biopsies and compared them with those of dermatologists. METHODS: The clinical diagnoses of family physicians, plastic, general, and orthopedic surgeons, and internists and pediatricians versus dermatologists were correlated with the histopathologic diagnoses. In total, 4451 cases were analyzed. RESULTS: Dermatologists diagnosed twice the number of neoplastic and cystic skin lesions correctly (75%) than nondermatologists (40%). The clinical diagnosis rendered by family practitioners matched the histopathologic diagnosis in only 26% of neoplastic and cystic skin lesions. Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in the recognition of skin tumors than family physicians, but still had a diagnostic accuracy rate of only 45%. Inflammatory skin diseases were correctly diagnosed in 71% of the cases by dermatologists but in only 34% of the cases by nondermatologists. LIMITATIONS: A limitation of this retrospective, unblinded study is the use of the clinical data from the pathology requisition form as a surrogate for clinical diagnostic accuracy. CONCLUSIONS: The overall accuracy of the clinical diagnosis depends heavily on the clinicopathologic correlation. Without sufficient clinical data, the histopathologic diagnosis will be limited or restricted. This review concludes that without basic dermatology knowledge, clinicopathologic correlation is compromised.

Biopsy↗

PubMed2001

The performance of master surgeons on standard aptitude testing.

BACKGROUND: Identification of the desired psychomotor abilities of optimal surgical performance, if possible, would be useful in the selection of surgical trainees. The aim of this study was to determine the level of these abilities among endoscopic consultant surgeons held in high regard by their peers. METHODS: Twenty endoscopic consultant "master" surgeons were tested on three aptitude tests: the Gibson Spiral Maze Test (error score measures eye-hand coordination), the Crawford Small Parts Dexterity Test (execution time indicates manual dexterity), and the Space Relations Test (correct scores reflect visuo-spatial ability). Their performance was compared with that of 20 medical students and the reference norm as provided by the tests' manuals. RESULTS: The median scores of master surgeons fell in the 20th, 24th, and 30th percentiles, whereas the scores of medical students fell in the 50th, 20th, and 65th percentile of norm reference for the Gibson Spiral Maze, Crawford Small Parts Dexterity, and Space Relations tests, respectively. The master surgeons enacted significantly fewer errors (Gibson Spiral Maze), had similar execution times (Crawford Small Parts Dexterity), and lower visuo-spatial scores (Space Relations) than medical students. CONCLUSION: The level of eye-hand coordination and manual dexterity of master surgeons was found to be higher than that of the average norm including medical students, while their visuo-spatial ability was lower.

Aptitude Tests↗

PubMed1995

Palliation of irresectable hilar cholangiocarcinoma with biliary drainage and radiotherapy.

Twelve patients with irresectable or recurrent hilar cholangiocarcinoma were treated with internal biliary drainage followed by intraluminal (iridium-192) and external-beam radiotherapy. Biliary drainage was accomplished by means of a combined surgical and interventional radiological approach. Initial biliary decompression was performed surgically by tumour resection, intrahepatic biliary enteric bypass or distal biliary-enteric anastomosis with a temporary stent. Maintenance of internal biliary drainage and application of intraluminal radiotherapy were accomplished radiologically with the use of percutaneous dilatation and metallic expandable biliary endoprostheses. Median survival was 14.5 months; all 12 patients survived for at least 6 months. Early complications during radiotherapy were minor and included two patients with cholangitis and one with transient haemobilia. Jaundice was relieved in ten of 12 patients, while episodes of cholangitis were seen during long-term follow-up in 11 (median 1.5 episodes per patient). Internal biliary drainage, in conjunction with radiotherapy, appears to be safe and effective palliation of irresectable or recurrent hilar cholangiocarcinoma. Patients can maintain a reasonable quality of life with an acceptable incidence of cholangitis, without the hindrance of external drainage devices.

Aged↗

PubMed2003

Complete staged palliation of hypoplastic left heart syndrome in a child with cystic fibrosis.

In recent years, the palliative treatment of Hypoplastic Left Heart Syndrome (HLHS) with a three-staged surgical repair has gained widespread acceptance in North America and elsewhere and has significantly improved the life-expectancy of these children. We report on a child in whom the diagnosis of cystic fibrosis (CF) was made shortly after the first-stage palliation (modified Norwood procedure), and in which surgical palliation was successfully completed with second- (bidirectional Glenn) and third-stage (fenestrated Fontan) procedures. During this period, the child suffered several CF-related complications, i.e. repeated respiratory failure, meconium ileus and coagulation abnormalities, which required adjustment of the anaesthesia, surgical and intensive care management. Considering the trend to perform surgical corrections of major cardiac defects in the early neonatal period, before concomitant genetic diseases are discovered, paediatric cardiac anaesthesiologists, surgeons and intensivists may be confronted with more cases of open heart surgery in infants with CF in the future.

Cystic Fibrosis↗

PubMed2003

A system for the diagnosis, placement, and prosthetic restoration of root form implants (U.S. Patent #5,769,636).

It is difficult to achieve a high degree of reproducibility when using a diagnostic wax-up as the template for fabrication of a definitive implant restoration. Here a method for implant prosthesis treatment planning is described that allows fabrication of the provisional restoration before surgical placement of the implant. The method involves 6 steps: (1) determining the mesiodistal inclination of the implant, (2) determining the buccolingual dimension of the alveolar ridge, (3) determining the proper position of the implant, (4) fabricating the surgical guide, (5) fabricating the provisional restoration, and (6) performing surgical placement of the implant followed by immediate placement of the provisional restoration.

Alveolar Process↗

PubMed2001

Morbidity of first trimester aspiration termination and the seniority of the surgeon.

Vacuum aspiration is a safe, acceptable, and efficacious method of first trimester pregnancy termination. The success and complication rates are thought to be partially dependent on operator experience and gestation. We examined this further by studying the outcome of 828 consecutive surgical abortions up to 13 weeks gestation in our hospital. The following outcomes were measured: surgical curettage for presumed retained products of conception; continuing pregnancy; uterine perforation; pelvic sepsis requiring intravenous antibiotics; and blood transfusion required. The complete abortion rate was 94.6% and the rate of continuing pregnancy 0.24%. There was a significant relationship between efficacy and seniority of the surgeon; consultants, senior registrars, registrars, and senior house officers had complete abortion rates of 97.8, 92.8, 94.7, and 88.4% respectively (P = 0.039). Parity did not affect efficacy. Terminations at 12-13 weeks gestation were associated with a significantly lower complete abortion rate. The rates of uterine perforation, blood transfusion, pelvic sepsis requiring intravenous antibiotics, and overnight hospital admission were 0.24, 0, 0.97, and 1.69% respectively. Thus, the only significant factors affecting outcome of surgical abortion are grade of operating surgeon or terminations performed at later gestations of 12-13 weeks. It is vital that physicians performing surgical terminations are adequately trained.

Abortion, Induced↗

PubMed2002

Congenital conductive hearing loss.

Congenital conductive hearing loss due to ossicular deformities can be treated by either rehabilitation with a hearing aid or surgical reconstruction. We present the results of exploratory tympanotomy performed in a large paediatric otolaryngology centre in 67 patients with non-serous congenital conductive hearing loss. Forty-two children had malformation of one or more ossicles without fixation of the stapes, and 19 had fixed stapes. In 26 cases, the surgeon decided not to perform surgical correction. Seven operated patients were lost to follow-up. As a group, 47 per cent of the patients who underwent reconstruction showed no significant benefit from surgery, with post-operative air-bone gaps (ABG) greater than 30 dB. Assessment of the results by pathology showed that 64 per cent of the patients with mobile stapes had an air-bone gap within 30 dB compared to only 33 per cent of the patients with fixed stapes. One patient sustained severe sensorineural loss after the procedure. Considering that exploratory tympanotomy is a relatively minimal, benign procedure but that findings during exploration may exclude the option of reconstruction (in 39 per cent of our patients), we suggest exploring the ear, but in a more realistic, informed way.

Adolescent↗

PubMed1989

[Surgical treatment of refractory tennis elbow. Apropos of 126 cases].

The authors have performed surgical treatment in 126 cases of resistant lateral tennis elbow. It is an easy and quick surgical technique, consisting of a desinsertion of the epicondylar muscles, with or without arthrotomy depending on the clinical symptoms associated with an articular lesions. One hundred and twelve cases have been successful and only fourty cases have obtained bad results. Best results are obtained in young people and in sportsmen presenting with an early lesion.

Aged↗

PubMed1992

New technology in U.S. Army health care: the role of laparoscopic cholecystectomy.

In the near future, laparoscopic cholecystectomy could become one of the most frequently performed surgical procedures in U.S. military hospitals. To determine the best way to implement this new technology in the U.S. Army Health Services Command (HSC), we have assessed the safety, efficacy, and health consequences of laparoscopic cholecystectomy. Approximately 2,800 open cholecystectomies are performed annually in HSC hospitals, 11% of them on active duty personnel. If cholecystectomies were performed using laparoscopic surgical techniques on active duty patients who meet currently accepted indications, 3,360 personnel duty days lost to convalescence and 7,048 days of limited duty (time on physical profiles) would be recouped. Applying the procedure to other beneficiaries (dependents and retired service members) would result in a potential annual savings of 11,000 hospital bed days. If implemented using stringent criteria for training and certification, these savings could be achieved with no increase in patient morbidity or mortality and with significant improvement in patient outcome.

California↗

PubMed1999

[Revision of iris incarceration after trabeculectomy in congenital glaucoma. A case report].

BACKGROUND: Incarceration of the iris is a potential complication following trabeculectomy in primary congenital glaucoma. Although this complication is mentioned in the literature, nothing is reported about the technique of surgical revision. PATIENT: In a patient with primary congenital glaucoma we had to perform surgical revision of the anterior chamber, because progressive pupil peaking had developed after trabeculectomy and the optical axis had been obstructed. Simple resolving of uveal tissue from the incarceration site was not possible; the iris incarceration had to be cut under gonioscopic control. CONCLUSION: Surgical revision of an incarceration of the iris can be safely performed by means of gonioscopy. The outcome of intraocular pressure is not necessarily influenced.

Female↗

PubMed1987

[Role of echography in the study of retroperitoneal tumors].

Fourteen patients affected by primitive retroperitoneal tumors were examined by means of sonography in order to assess the value of this technique in this type of pathology. Ten patients underwent fine needle biopsy, 5 barium meal examination, 2 intravenous pyelography. In 8 patients CT was also performed. Surgical removal or explorative laparotomy followed by histological examination was performed in all patients. Sonography proved reliable in identifying and in assessing the type of the lesion (if associated with fine needle biopsy which was performed in 10 out of 14 patients). Sonography proved little less satisfactory in determining the site and the local extension of the lesion since the huge dimensions of the tumor did not always allow to use those semeiologic signs described in the literature. All tumors examined presented, in fact, as large masses, this fact indicating the scanty progress sonography has taken in the field of the early diagnosis. Since the huge dimensions of these tumors do not always allow a complete surgical removal, and because of their proven tendency of relapsing, the prognosis of these tumors seems to persist unfavourable notwithstanding the widespread use of sonography.

Humans↗

PubMed2006

[Retroperitoneal approach and pelvic peritoneoectomy in the surgical management of advanced ovarian cancer].

OBJECTIVE: To share our experience in surgical management of advanced ovarian cancer applying a retroperitoneal approach and performing pelvic peritoneoectomy for the achievement of an optimal debulking in this disease. MATERIAL: Thirty eight patients age ranging from 36 to 77 years (average 55,7 years) staged: I - 2 (5,3%), II - 4 (10,5%), //III/ - 28 (73,7%) and IV - 4 (10,5%) had been operated on. Thirty patients presented without previous therapy, 3 - after total abdominal hysterectomy with adnexes, 1 - after supravaginal hysterectomy with adnexes, 1 - after unilateral adnexectomy and 3 - after neoadjuvant chemotherapy. METHODS: All 38 patients had been submitted to retroperitoneal approach during the laparotomy and it had been performed surgical procedures including various degrees of radicalness towards the pelvic structures (uterus, parameters vagina) with or without pelvic peritoneoectomy. The latter had been performed in 28 patients (73,7%). Selective lymph node dissection is carried out in 21 cases (55,3%), total omentectomy - in 36 cases (94,7%) and appendectomy - in 23 (60,5%). RESULTS: Maximal (no evidence of disease) and optimal (less than 2 cm lesion) cytoreduction is achieved in 23 (60,5%) and 8 (21,1%) patients, respectively - totally in 81,6% of all patients. The most common site of suboptimal (> 2 cm) residual masses is the anterior rectal wall and cavum Douglasi - 85,7%, Lymph node metastases is detected in 33%, metastases in omentum - in 75%, parametrial invasion - in 25%, vaginal metastases - in 8,3%, metastases in appendix and Fallopian tubes - in 47,8% and 8,8%, respectively and invasion of tumor's capsula - in 34, 2%. CONCLUSION: Retroperitoneal approach and pelvic peritoneoectomy are feasible and safe and lead to high percentage of optimal debulking, which is the main prognostic factor in advanced ovarian cancer patients.

Adult↗

PubMed2000

Tracheotomy complications: a retrospective study of 1130 cases.

BACKGROUND: Tracheotomy is one of the most frequently performed surgical procedures in the critically ill patient. It is frequently performed as an elective therapeutic procedure and only rarely as an emergency procedure. Complications occur in 5% to 40% of tracheotomies depending on study design, patient follow-up, and the definition of the different complications. The mortality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severely ill patients, and in small children. METHODS: A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studied the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths. RESULTS: In total, 1130 tracheotomies were performed. Major complications occurred in 49 of the cases, and 8 deaths were directly attributed to the tracheotomy. The most common complication was tracheal stenosis, which occurred in 21 cases. Hemorrhage was the second most common complication, which occurred in 9 cases. CONCLUSION: This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common complication in contrast to other series. Our opinion is that this may reflect tracheal damage originally caused by prolonged intubation before the tracheotomy. We believe that all other complications of tracheotomy may be prevented or minimized by careful surgical technique and postoperative tracheotomy care.

Female↗

PubMed2003

The effect of stress-inducing conditions on the performance of a laparoscopic task.

BACKGROUND: The availability of objective means for assessment of surgical skills has made it possible to evaluate the effect of adverse environmental conditions on surgical performance. METHODS: Participants performed a laparoscopic transfer task under five conditions: a simple verbal mathematical task (M), operating theatre background noise at 80 to 85 dB (N), performance as quickly as possible (T), all three stressors combined (A), and quiet conditions (Q). The effect of these conditions on performance was evaluated by using a motion analysis system and an error score. RESULTS: The study included 13 right-handed surgeons with varying levels of laparoscopic experience. There was a significant increase in the path length per movement of the right hand (p = 0.001) under T and a significant increase in the path length per movement of the left hand under M (p = 0.002), T (p = 0.01), and A (p = 0.02). A significantly higher number of errors occurred under all four stress-inducing conditions. The effect was more pronounced when all the stressors were applied in combination ( p = 0.001) followed by performance under M (p = 0.005), then T (p = 0.01) and N (p = 0.03). CONCLUSIONS: All three stressors led to impaired dexterity and an increase in the incidence of errors.

Adult↗