Surgery
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Prophylactic synthetic mesh can be safely used to close emergency laparotomies, even in peritonitis.
This study was conducted to determine the efficacy and safety of the use of a partially absorbable large pore synthetic prophylactic mesh in emergent midline laparotomies for the prevention of evisceration and incisional hernia. ⋯ The use of a partially absorbable, lightweight large pore prophylactic mesh in the closure of emergency midline laparotomies is feasible for the prevention of incisional hernia without adding a substantial rate of morbidity to the procedure, even if high contamination or infections are present.
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Multicenter Study Observational Study
Assessment of surgery residents' operative skills in the operating theater using a modified Objective Structured Assessment of Technical Skills (OSATS): a prospective multicenter study.
With the implementation of competency-based curricula, Objective Structured Assessment of Technical Skills (OSATS) increasingly is being used for the assessment of operative skills. Although evidence for its usefulness has been demonstrated in experimental study designs, data supporting OSATS application in the operating room are limited. This study evaluates the validity and reliability of the OSATS instrument to assess the operative skills of surgery residents in the operating theater. ⋯ Assessment of operative skills in the operating theater using this modified OSATS instrument has the potential to establish learning curves, allowing adequate monitoring of residents' progress in achieving operative competence. The Alphabetic Summary Scale seems to be of additional value. Use of the Overall Performance Scale should be reconsidered.
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Comparative Study
Simultaneous lung resection via a transdiaphragmatic approach in patients undergoing liver resection for synchronous liver and lung metastases.
For patients with synchronous liver and lung metastases from colorectal cancer, the invasiveness of adding thoracic to abdominal surgery is an obstacle to concurrent liver and lung metastasectomy. We developed a simple technique to resect lung lesions via a transdiaphragmatic approach without thoracic incision in patients undergoing liver metastasectomy. ⋯ Simultaneous transdiaphragmatic resection of peripheral lung lesions is safe in patients undergoing liver resection. The low-invasive transdiaphragmatic approach facilitates aggressive operative treatment for synchronous liver and lung metastases.
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Comparative Study
Differential recurrent laryngeal nerve palsy rates after thyroidectomy.
Recurrent laryngeal nerve (RLN) palsy is a devastating complication of thyroidectomy. Although neurapraxia is thought to be the most common cause, the underlying mechanisms are poorly understood. The objectives of this study were to examine the differential palsy rates between the left and right RLNs, and the role of intraoperative nerve swelling as a risk factor of postoperative palsy. ⋯ The right-left differential rates of post-thyroidectomy RLN palsy seemed to be due in part to differential RLN diameters, with stretch having a more deleterious effect on RLNs with a smaller diameter; also, edema as a result of stretch might be an underlying mechanism for postoperative neurapraxia and palsy. Thyroid surgeons should be aware of the different vulnerabilities of each RLN and develop practices to avoid iatrogenic injury.
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Hypothermia occurs in as many as 7% of elective colorectal operations and is an underestimated risk factor for complications and death. Rewarming of hypothermic patients alone is not sufficient to prevent such adverse events. We investigated the outcomes of patients who became hypothermic (<35°C) after elective operations and compared them with closely matched, nonhypothermic operative patients to better define the impact of hypothermia on surgical outcomes, as well as to identify independent risk factors for hypothermia. ⋯ Hypothermia is associated with an increased rate of mortality and complications. Preventive treatment of these risk factors before operation and aggressive warming measures in the "at risk" population may decrease hypothermia-related morbidity and mortality in elective operations. Randomized-controlled trials should be conducted to evaluate the impact of aggressive warming measures in the at-risk population.