SURGICAL STRATEGIES

Minimally invasive hip fracture surgery: are outcomes better? J Orthop Trauma. 2009 Jul;23(6):447-53.Although a significant heterogeneity exists between pooled studies, minimally invasive hip fracture plating, nailing, or external fixation was associated with a decrease in transfusion rate [relative risk of 0.63 as compared to standard SHS (95% confidence interval 0.41 to 0.96; I(2) = 83.6%)]. There was no significant difference for the other comparisons, including mortality between minimally invasive plating, nailing, or external fixation and standard insertion of an SHS.

[First robotic-assisted laparoscopic liver resection in Latin America.]Arq Gastroenterol. 2009 Jan-Mar;46(1):78-80. Portuguese Case report

The impact of robotics on practice management of endometrial cancer: transitioning from traditional surgery. Int J Med Robot. 2009 May 19. [Epub ahead of print] Robotics was associated with significantly less blood loss (p < 0.0001). Complication rates were significantly lower in the robotic group compared to the laparotomy group (p = 0.05).

Comparison of Robotic-assisted versus Retropubic Radical Prostatectomy Performed by a Single Surgeon . Anticancer Res. 2009 May;29(5):1637-42. Significant differences were found in blood loss (robotic-assisted laparoscopic radical prostatectomy 314 mL vs. retropubic radical prostatectomy 912 mL) and transfusion rates (RALP 13.3% vs. RRP 60%) between groups.

Research and development of a new RF-assisted device for bloodless rapid transection of the liver: Computational modeling and in vivo experiments. Biomed Eng Online. 2009 Mar 18;8(1):6. [Epub ahead of print] A new RF-assisted device for bloodless, rapid liver resection was designed, built and tested. The results demonstrate the potential advantages of this device over others currently employed.

Endovascular treatment of aortic aneurysms: state of the art.Curr Treat Options Cardiovasc Med. 2009 Apr;11(2):136-45. Distinct advantages of EVAR over open repair have been demonstrated, including a less invasive operative exposure, decreased transfusion requirements, shortened intensive care unit and hospital stay, and decreased perioperative mortality. It is our opinion that in 2009, anatomically suitable patients should be offered EVAR as first-line therapy, except for the less common scenario of the young and fit patient, for which open repair should be strongly considered.

Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial. Liver Transpl. 2009 Jan;15(1):102-5. The aim of this study was to compare the Cavitron ultrasonic surgical aspirator (CUSA) with bipolar cautery (BP) to CUSA with a radiofrequency coagulator [TissueLink (TL)] in terms of efficacy and safety for hepatic transection in living donor liver transplantation.CUSA with TL is superior to CUSA with BP for donor hepatectomy in terms of blood loss and speed of transection with no increase in morbidity

The use of bipolar hemosealing technology in orthopedic oncology: safety and clinical impact. Orthopedics. 2008 Oct;31(10).Controlling blood loss during orthopedic oncology surgery is both challenging and vital to a successful outcome. Coagulation using traditional cautery is often cumbersome, requiring identifying occult vessels, securing them with clamps, and discharging current, resulting in charred, desiccated tissue. These limitations of traditional cautery are addressed with the application of a bipolar hemosealing instrument (BPS 5.0; TissueLink, Dover, New Hampshire), a device that denatures the collagen in blood vessels, providing rapid hemostasis.The overall transfusion rate was significantly lower in the overall study group (P 5 .012). This was most dramatically seen in resections around the hip (P 5 .003).

Radiofrequency-assisted liver resection in patients with hepatocellular carcinoma and cirrhosis: preliminary results. Transplant Proc. 2008 Dec;40(10):3523-5. Radiofrequency (RF)-assisted liver resection has been shown to allow virtually bloodless procedures without the need for vascular exclusion maneuvers. RF-assisted liver resection was a safe, feasible procedure associated with low morbidity and hospital mortality rates even in cases of liver cirrhosis. It is highly recommended for patients with HCC not suitable for liver transplantation.

Laparoscopic liver resection assisted by the laparoscopic Habib Sealer. Surgery. 2008 Nov;144(5):770-4. Epub 2008 Sep 19. Radiofrequency has been used as a tool for liver resection since 2002. A new laparoscopic device is reported in this article that assists liver resection laparoscopically. Twenty-four patients completed the procedure comprising tumorectomy (n = 7), multiple tumoretcomies (n = 5), segmentectomy (n = 3), and bisegmentectomies (n = 9). Vascular clamping of portal triads was not used. The mean resection time was 60 +/- 23 min (mean +/- SD), and blood loss was 48 +/- 54 mL. None of the patients received any transfusion of blood or blood products perioperatively or postoperatively.

Direct retroperitoneal pelvic packing versus pelvic angiography: A comparison of two management protocols for haemodynamically unstable pelvic fractures.Injury. 2008 Nov 28. [Epub ahead of print]. Pelvic packing is as effective as pelvic angiography for stabilising haemodynamically unstable casualties with pelvic fractures, decreases need for pelvic embolisation and post-procedure blood transfusions, and may reduce early mortality due to exsanguination from pelvic haemorrhage

Significant small-bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy. Gastrointest Endosc. 2008 Dec;68(6):1209-1214. Capsule endoscopy (CE) is considered a first-line investigation for obscure GI bleeding (OGIB) and small-bowel polyp or tumor detection. The reliability of a negative CE in excluding gross small-bowel pathology remains unclear. New imaging modalities, such as double-balloon enteroscopy (DBE), CT enterography (CTE) or magnetic resonance enterography (MRE) now provide complementary roles to CE for these indications.

Management of upper gastrointestinal bleeding.

Right Hepatic Lobectomy Using the Staple Technique in 101 Patients.
J Gastrointest Surg. 2007 Aug 15; [Epub ahead of print] Application of vascular stapling devices for parenchymal transection in major hepatic resection is a safe technique, with low transfusion requirements and minimal postoperative bile leak. The technique allows for rapid transection of the entire right hepatic lobe in under 10 min.

Is patient outcome affected by the administration of intravenous fluid during bowel preparation for colonic surgery?
Ann R Coll Surg Engl. 2007 Jul;89(5):487-9. This study indicates that a calculated volume of intravenous fluid administered during bowel preparation improves patient outcomes with respect to blood transfusion and postoperative oliguria. We advocate calculated intravenous fluid administration in all patients undergoing bowel preparation prior to colonic surgery.

Preoperative proximal splenic artery embolization: a safe and efficacious portal decompression technique that improves the outcome of live donor liver transplantation.
Transpl Int. 2007 Jul 6; [Epub ahead of print] Proximal splenic artery embolization enabled shortening of operating time, reduced blood loss, led to less need for transfusion, and significantly reduced the post-transplant portal venous velocity and ascites.

Results of major hepatectomy without vascular clamping using radiofrequency-assisted technique compared with total vascular exclusion.
Hepatogastroenterology. 2007 Apr-May;54(75):806-9. Major hepatectomy using radiofrequency-assisted technique decreases the rates of blood transfusion, postoperative liver failure, ICU admission, postoperative stay and the price, when compared to total vascular exclusion.

An electrode array that minimizes blood loss for radiofrequency-assisted hepatic resection.
Med Eng Phys. 2007 Jun 22; [Epub ahead of print] Description of a new device able to promote coagulation of large vessels (>3mm) in the resection plane. This device may reduce blood loss related morbidity during resection and reduce treatment time by coagulating all vessels in the resection plane.

Concomitant intraoperative splenic artery embolization and laparoscopic splenectomy versus laparoscopic splenectomy: comparison of treatment outcome.
Am J Surg. 2007 Jun;193(6):713-8. Concomitant splenic artery embolization and laparoscopic splenic reduced operative blood loss when compared with laparoscopic splenectomy procedure alone. Splenic artery embolization is a useful intraoperative adjunctive procedure that should be considered in patients undergoing laparoscopic splenectomy for hematologic disorders who are Jehovah's Witness or with significant hypersplenism because of benefit of reduced blood loss.

Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift.
J Trauma. 2007 Apr;62(4):834-9; discussion 839-42. Preperitoneal pelvic packing (PPP) is a rapid method for controlling pelvic fracture-related hemorrhage that can supplant the need for emergent angiography. There is a significant reduction in blood product transfusion after PPP, and this approach appears to reduce mortality in this select high-risk group of patients

Modification of retropubic adenomectomy: improved hemostasis and outcome.
Int Urol Nephrol. 2007 Jan 31; [Epub ahead of print] Our modification is based on the employment of the ligation of both the deep dorsal penile vein (DDPV) and the lateral vesicoprostatic pedicles before enucleation of adenoma in retropubic adenomectomy, for treatment of bladder outflow obstruction due to large benign prostate hyperplasia (BPH). This modification eliminates any possible source of bleeding and therefore converts an operation which is traditionally associated with blood loss to a totally bloodless procedure.