Operative time
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PURPOSE OF THE STUDY The aim of the study was to compare the duration of corrective surgery for scoliosis in relation to the intra-operative use of either fluoroscopic or CT navigation. MATERIAL AND METHODS The indication for surgery was adolescent idiopathic scoliosis in younger patients and degenerative scoliosis in middleage or elderly patients. In a retrospective study, treatment outcomes in 43 consecutive patients operated on between April 2011 and April 2014 were compared. Only patients undergoing surgical correction of five or more spinal segments (fixation of six and more vertebrae) were included. RESULTS Transpedicular screw fixation of six to 13 vertebrae was performed under C-arm fluoroscopy guidance in 22 patients, and transpedicular screws were inserted in six to 14 vertebrae using the O-arm imaging system in 21 patients. A total of 246 screws were placed using the C-arm system and 340 screws were inserted using the O-arm system (p < 0.001). The procedures with use of the O-arm system were more complicated and required an average operative time longer by 48% (measured from the first skin incision to the completion of skin suture). However, the mean time needed for one screw placement (the sum of all surgical procedures with the use of a navigation technique divided by the number of screws placed using this technique) was the same in both techniques (19 min). DISCUSSION With good teamwork (surgeons, anaesthesiologists and a radiologist attending to the O-arm system), the time required to obtain one intra-operative CT scan is 3 to 5 minutes. The study showed that the mean time for placement of one screw was identical in both techniques although the average operative time was longer in surgery with O-arm navigation. The 19- minute interval was not the real placement time per screw. It was the sum of all operative times of surgical procedures (from first incision to suture completion including the whole approach within the range of planned stabilization) which used the same navigation technique divided by the number of all screws inserted during the procedures. The longer average operative time in procedures using O-arm navigation was not related to taking intra-operative O-arm scans. The authors consider surgery with an O-arm imaging system to be a safer procedure and use it currently in surgical correction of scoliosis. CONCLUSIONS The study focused on the length of surgery to correct scoliosis performed using either conventional fluoroscopy (C-arm) or intra-operative CT scanning (O-arm) showed that the mean placement time for one screw was identical in both imaging techniques when six or more vertebrae were stabilised. The use of intra-operative CT navigation did not make the surgery longer, and the higher number of inserted screws provides evidence that this technique is safer and allows us to achieve good stability of the correction procedure. Key words: virtual CT guidance, O-arm, scoliosis, transpedicular screw.
- MeSH
- chirurgie s pomocí počítače přístrojové vybavení metody MeSH
- délka operace MeSH
- fluoroskopie přístrojové vybavení metody MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- ortopedické fixační pomůcky * MeSH
- peroperační péče MeSH
- počítačová rentgenová tomografie přístrojové vybavení metody MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- skolióza diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
BACKGROUND: To this date, the impact of body weight on total hip arthroplasty is still debated. The literature lacks evidence on the impact of body weight on surgical times and complications. METHODS: We retrospectively evaluated all the patients who underwent primary total hip arthroplasty (THA), collecting patients' pre-operative BMI before surgery. We recorded the surgical approach performed (anterior or posterolateral), and their duration. All the major complications were recorded. RESULTS: Seven-hundred-thirty-two cases were included (627 posterolateral and 105 anterior approach). The mean BMI was 27.3. The mean surgical time was 90.8 minutes (104.9 for anterior and 88.5 for posterolateral approach). We found a significant positive relationship between BMI and surgical times for both cases treated with a posterolateral approach, and (even more remarked) in case anterior approach. Thirty-nine cases (5.3%) had major complications; 27 of them (69.2%) were overweight or obese. The surgical times of those who had complications were significantly higher compared to others. CONCLUSIONS: Patients' body weight, and in particular their Body Mass index, has a direct impact on the duration of THA surgical procedures, particularly if performed using an anterior approach, and an indirect effect on complication rates.
- MeSH
- délka operace MeSH
- dospělí MeSH
- index tělesné hmotnosti MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody škodlivé účinky MeSH
- obezita komplikace MeSH
- pooperační komplikace * epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tělesná hmotnost * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The aim of this study is to evaluate the operative time intervals for major orthopaedic surgeries and analyze the correlation of different operative factors on total operative time. MATERIAL AND METHODS Specific time intervals; anesthesia release time (ART), surgical preparation time (SPT), operative procedure time (OPT), and anesthesia end time (AET); were recorded by independent observers. Total operative procedure time (TOPT), was also calculated and statisctical correlation analysis was performed between TOPT and study parameters. RESULTS The difference for ART and SPT time intervals between age groups below 65 and 65 to 85 years were found statistically significant. As the patient's age increased, ART and SPT time intervals were also significantly increased. As the patients ASA status increased, the ART intervals were also increased. ART and AET time intervals were significantly longer for residents compared to specialists. DISCUSSION This is one of the first studies in the literature analyzing different time intervals and their correlation on total operative time for major orthopaedic surgeries. Current study also analyzed the effects of other factors including age and ASA score of the patients, type of anesthesia and experience of anesthegiogist on operative time intervals. This study was designed for the analysis of specific time intervals previously described in the literature for only some major orthopaedic surgeries. By this way, we aimed to achieve a homogenous study group and to obtain comparable results with the literature. CONCLUSIONS The strongest correlation was found between ART and TOPT. As the patient's age increased, ART and SPT time intervals were also significantly increased. Increased age and higher ASA scores with an unexperienced anesthegiologist significantly increased the ART intervals. Therefore, reducing ART is the most important factor in reducing TOPT. Key words:arthroplasty, anaesthesia, operation time.
- MeSH
- délka operace * MeSH
- lidé MeSH
- předoperační péče MeSH
- totální endoprotéza kolene * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Operačná liečba primárneho obštrukčného megaureteru (POM) bola vykonaná u 69 deti (82 ureterov) v priemernom veku 10,5 mesiacov. 52 (63 %) megaureterov bolo spojených s funkčnou léziou obličky, 35 (51 %) detí malo symptomatickú uroinfekciu. Dočasná perkutánna nefrostómia vykonaná u 32 deti (2 x bilat.) viedla okrem zlepšenia funkcie obličky resp. ústupu pyelonefritídy k zníženiu stupiía dilatácie a možnosti reimplantácie močovodu bez nutnosti modeláže v 56 %. Paquinova metóda reimplantácie bola použitá 65 krát, 17 krát sa močovod modeloval podľa Hendrena. K úprave pasáže moču došlo v 94 %, k úprave resp. zlepšeniu a stabilizácii obličkovej funkcie v 88 %. Pooperačné komplikácie sa vyskytii u 4 (6 %) detí - 2 x pyelonefritida, 2 x došlo k vzniku striktúry ureterocystoneoststómie - boli úspešne riešené reoperáciou. Pokročilé poškodenie obličky pred operáciou progredovalo a neskôr viedlo k nefrektómii u 4 (6 %) deti, vždy pri megaureteri ťažkého stupňa. Rozbor klinického materiálu potvrdil, že POM je závažné ochorenie. Jeho včasná operačná liečba prináša dobré a trvalé výsledky.
Primary obstructive megaureter (POM) was surgically tretated in a group 69 children at the age of 2,5 months - 4 years (mean 10,5 m.). At the time of diagnosis, from 82 ureterorenal units 52 (63%) showed damage to renal function, 35 (5l%) children suffered from coexistent symptomatic urinary infection. In 32 children temporary percutanneous nephrostomy (2 bilat.) was performed because of pyelonephritis, extreme dilatation and/or renal damage, m 19 (56%) it has led to significant decrease of the grade of dilatation enabling to reimplant the ureter without the need ol of tapering. With 65 ureters Paquin method of reimplantation was used, 17 ones were tapered according to Hendren. Surgery normalised urine passage in 94% and has led to recovery, improvement and/or stabilization of renal function in 88%. Postoperative complications occured in 4 (6%) children - pyelonephritis exacerbation in 2, in another 2 ureterocystoneostomy stricture requiring surgical repair (successful). In 4 (6%) children with high grade POM serious preoperative kidney damage progressed despite the lack of obstruction after surgery and later on led to nephrectomy. The analysis of this group has confirmed that POM is a serious disease. Its early surgical treatment brings good and persistent results.
- MeSH
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- obstrukce močovodu diagnóza chirurgie vrozené MeSH
- perkutánní nefrostomie MeSH
- předškolní dítě MeSH
- ureter abnormality chirurgie MeSH
- urografie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Syndroma caudae equinae (SCE) je ochorenie prevažne produktívneho veku, často s vážnymi následkami. Autori prehodnotili súbor 101 pacientov liečených pre SCE za obdobie 12 rokov (1996-2007) a sledovali u nich dynamiku rozvoja príznakov podľa etiológie. Pacientov s diskogénnym SCE minimálne rok po skončení liečenia, kedy ich zdravotný stav už bol ustálený, pozvali na kontrolné vyšetrenie a skúmali u nich vplyv predoperačného časového intervalu, t.j. doby od vzniku ťažkostí po chirurgické uvoľnenie nervových štruktúr na nasledujúce ukazovatele: pretrvávanie bolesti, úpravu citlivosti, sfinkterových porúch a motorických funkcií. Na základe získaných poznatkov zo súboru 68 pacientov s diskogénnym SCE, ktorí sa podrobili kontrolnému vyšetreniu alebo odpovedali dotazníkom z celkového počtu 101 pacientov, po štatistickom spracovaní ?2 (chí kvadrát) testom a v prípade, kde boli hodnoty menšie alebo rovné 5, bol použitý Fisherov exaktný test, autori konštatujú, že predoperačný časový interval v skúmanom súbore u diskogénnych SCE nemal vplyv na konečný výsledok liečby. Naopak predoperačný časový interval závisel od príčiny vzniku SCE, najkratší je u pacientov s voľným sekvestrom a veľkými herniami intervertebrálnych diskov v spinálnom kanáli. Pomalšie sa SCE rozvíja pri stenózach spinálneho kanála a najpomalšie pri nádoroch.
Cauda equina syndrome (CES) is disease that occurs predominantly in people of productive age, frequently involving serious consequences. The authors evaluated a group of 101 patients treated for CES over a period of 12 years (1996-2007) and followed the dynamics of the development of symptoms in terms of etiology. At a minimum of one year after the completion of treatment (when the condition of the patients was stable), all subjects were invited for checkup examination. Correlations were established between the influence of the pre-operative time interval, i.e. the period between the onset of disease and surgical decompression of neural structures, and the persistence of pain, the restoration of sensitivity and re-establishment of sphincter function. Based on data derived from a group of 68 patients (from a total of 101) with discogenic CES, those who presented for checkup or returned a questionnaire, and statistical analyses (?2 test, and in situations with values of 5 or less, Fisher exact test) the authors concluded that preoperative time interval had no influence on the outcomes for patients in the group studied. It is interesting to note that preoperative time interval was dependent on the etiology of CES - it was at its shortest in the patients with free sequester or large pieces of intervertebral disc sequesters herniated into the spinal canal. Symptoms of CES arising out of spinal stenosis developed more slowly.
Cíl studie: Cílem naší studie bylo porovnat neinvazivní monitoraci pomocí esCCO (monitor Vismo od firmy NihonKohden) s monitorací LiDCOrapid, na našem pracovišti rutinně používanou u rizikových pacientů podstupujících břišní operaci. Typ studie: Observační. Typ pracoviště: Operační sály (všeobecná chirurgie) fakultní nemocnice. Materiál a metoda: Do studie byli zařazeni pacienti ASA III, u nichž byla plánována břišní operace delší než 90 minut. Srdeční výdej byl měřen metodami esCCO a LiDCOrapid zároveň. První měření bylo provedeno před úvodem do anestezie a poté každých 15 minut během operace. Poslední měření bylo zaznamenáno po extubaci pacienta. Výsledky obou technik byly porovnány metodami Bland-Altman a polárním grafem ke zjištění shody v srdečním výdeji a jeho změnách. Výsledky: Celkem bylo shromážděno 141 párových měření od deseti pacientů. Bland-Altmanova analýza korigovaná pro opakovaná měření ukázala chybu (bias) + 1,2 l/min, hranice shody (limits of agreement) ? 2,6 l/min a procentuální chybu 57 %. Míra shody ve směru změny mezi dvěma po sobě jdoucími měřeními mezi monitorem esCCO a tomu odpovídajícím měřením pomocí LiDCOrapid byla 80 %. Metodikou polárního grafu byla určena úhlová chyba (angular bias) +11° s radiálními limity shody (limits of agreement) -40° a +62°. Závěr: Monitorace hemodynamiky pomocí esCCO přináší výsledky odlišné od těch naměřených metodou LiDCOrapid. V současné době neinvazivní monitorace pomocí esCCO nepředstavuje plnohodnotnou náhradu pro monitoraci pomocí LiDCOrapid.
Objective: The aim of the study was to compare the esCCO Vismo (Nihon Kohden, Japan) monitor to the routinely used LiDCOrapid (LiDCO Group, Great Britain) monitor in patients undergoing abdominal surgery. Design: Observational study. Setting: General surgery operating theatres in a University Hospital. Materials and methods: ASA III patients scheduled for elective major abdominal surgery with expected operation duration over 90 minutes were included in the study. Cardiac output measurements by esCCO and LiDCOrapid were recorded before induction of anaesthesia, every 15 min throughout the surgery and after extubation. The agreement and trending ability of the two methods were tested with the Bland-Altman analysis and polar plot, respectively. Results: A total of 141 paired readings from 10 patients were collected. The Bland-Altman analysis corrected for repeated measures showed a bias of +1.2 l/min, limits of agreement ?2.6 l/min and percentage error of 57 %. The direction of change between consecutive esCCO measurements and the corresponding LiDCOrapid measurements showed a concordance rate of 80 %. In the polar plot, the angular bias was +11° with radial limits of agreement from -40° to +62°. Conclusion: Hemodynamic monitoring with esCCO yields cardiac output values different from those measured by LiDCOrapid. esCCO cannot be currently recommended as a reliable surrogate for LiDCOrapid.
- Klíčová slova
- esCCO, LiDCO,
- MeSH
- analýza pulzové vlny přístrojové vybavení MeSH
- diagnostické techniky kardiovaskulární MeSH
- hemodynamika MeSH
- lidé středního věku MeSH
- lidé MeSH
- minutový srdeční výdej MeSH
- monitorování fyziologických funkcí * metody MeSH
- perioperační péče * metody MeSH
- pozorovací studie jako téma MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
Kontinuální monitorace glykemie se stala standardem léčby pacientů s diabetes mellitus 1. typu. Obě podoby - monitorace v reálném čase se svými alarmy nebo intermitentně skenovaná monitorace podobná spíše klasickému glukometru - si našly své pacienty. Článek popisuje principy fungování a rozdíly mezi oběma metodami a nabízí návod pro výběr pacienta.
Continuous blood glucose monitoring has become the standard treatment for type 1 diabetes mellitus. Both forms, real-time monitoring with alarms and intermittently scanned monitoring similar to a classic glucometer, have found their patients. The article describes the principles of operation and the differences between the two methods and offers guidance for patient selection.
- Klíčová slova
- kontinuální monitorování glykemie,
- MeSH
- inzulinové infuzní systémy MeSH
- krevní glukóza MeSH
- lidé MeSH
- selfmonitoring glykemie MeSH
- Check Tag
- lidé MeSH
Cíl studie: Analýza perioperačních výsledků laparoskopicky asistované myomektomie.Typ studie: Pilotní studie.Pracoviště: Gynekologicko-porodnické oddělení, Endoskopické výukové centrum, Nemocnice Kladno.Materiál a metodika: 8 konsekutivně vybraných žen bylo léčeno metodou laparoskopicky asistované myomektomie. Laparoskopický výkon byl proveden v případech, kde byl myom větší než 6 cm.Výsledky: Aplikace operační techniky laparoskopicky asistované myomektomie byla úspěšná ve všech případech. Ve studované skupině byla průměrná délka operace 76 min (50 - 90) a průměrná hmotnost odstraněného nádoru 151,7 g (45 - 220). U jedné pacientky bylo nezbytné provést relaparoskopii pro pokračující krvácení.Závěr: Laparoskopicky asistovaná operace je proveditelná u žen s děložním myomem, je-li navrhována myomektomie.
Objective: To analyze perioperative outcomes of laparoscopically assisted myomectomy.Design: Pilot study.Setting: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Hospital Kladno, Czech Republic.Material and methods: Eight consecutive women with fibromyoma were treated by laparoscopic assisted myomectomy. Laparoscopic surgery was performed based on size of fibromyoma over 6 cm.Results: The application of the operative technique of laparoscopically assisted myomectomy was effective in all out exception. In the studied group the mean operative time and the mean of weight of the specimen were 76 min (range 50 - 90) and 151,7 g (ragne 45 - 220), respectively. In one patient the relaparoscopy for bleeding was necessary.Conclusion: Laparoscopic assisted surgery is feasibile in women with fibromyoma and may also be considered for myomectomy.
