Articles: surgery.
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Innovations (Phila) · May 2008
Preoperative hemoglobin a1c predicts sternal wound infection after coronary artery bypass surgery with bilateral versus single internal thoracic artery grafts.
: Bilateral internal thoracic artery (BITA) grafting during coronary artery bypass (CABG) improves long-term and event-free survival but may carry a higher risk of wound complications. It is unknown whether preoperative hemoglobin A1c (HbA1c), a measure of long-term glucose control, predicts deep sternal wound infection (DSWI) after BITA grafting. ⋯ : Elevated preoperative HbA1c and BITA grafting were significant predictors of DSWI after CABG. Elevated HbA1c level should be considered in the risk/benefit analysis when selecting patients for BITA grafting.
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The primary goal of drilling procedures for the treatment of osteonecrotic lesions is revascularisation of the defect area. In the literature good results are reported for this technique in 70% of cases. Precise drilling of the necrosed area as part of a minimally invasive technique does, however, require unequivocal intraoperative identification of the region visually, either by arthroscopy or by fluoroscopy. ⋯ In future, we hope it will prove possible to transfer the image data back into the navigation system after they have been merged. At present this is only possible with CT and MRI images. A comparative clinical trial is needed to find to what extent the success rate is improved over that achieved with conventional techniques.
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Randomized Controlled Trial
Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage.
Spontaneous ICH is a devastating disease with high morbidity and mortality. Intracerebral hemorrhage lacks an effective medical or surgical treatment despite the acknowledged pathophysiologic benefits of achieved hemostasis and clot removal. Image-guided stereotactic endoscopic hematoma evacuation is a promising minimally invasive approach designed to limit operative injury and maximize hematoma removal. ⋯ Image-guided stereotactic endoscopic hematoma removal is a promising minimally invasive technique that is effective in immediate hematoma evacuation. This technique deserves further investigation to determine its role in ICH management.
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J Minim Invasive Gynecol · May 2008
Comparative StudyA comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice.
To compare gynecologic practice and perioperative outcomes of patients undergoing total laparoscopic hysterectomy and robotic hysterectomy before and after implementation of a robotics program. ⋯ A higher likelihood of exploratory laparotomy for hysterectomy in the prerobotic cohort versus the robotic cohort and a higher likelihood of intraoperative conversion to laparotomy with the prerobotic cohort than with the robotic cohort existed. Reduced operative time, reduced blood loss, and shortened length of stay may be achieved in patients who are treated robotically versus a nonrobotic approach. Robotics may facilitate the minimally invasive treatment of patients while potentially reducing the rate of abdominal hysterectomies.