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Surgical Experience (surgical + experience)
Selected AbstractsSurgical experience and outcome of scleral buckling procedures in retinal detachmentACTA OPHTHALMOLOGICA, Issue 2009C ARNDT Purpose The purpose of this study was to evaluate the impact of the surgeons' experience on the anatomical and functional outcome of primary scleral buckling surgery in rhegmatogenous retinal detachment. Methods The charts of patients presenting with a retinal detachment between 2000 end 2006 were analyzed retrospectively. All patients with macular involvement treated with scleral buckling surgery were included. The surgeons were designated according to the "on call" list. Junior surgeons were fellows with less than 2 years of experience, physicians with more than 2 years of experience were defined as senior surgeons. Results Among the 115 included patients, 76 (65,8%) were operated by senior surgeons. The age, duration of symptoms, initial visual acuity, extension of the retinal detachment were similar in both groups. The primary reattachment rate was 87,7% in the senior surgeon group versus 92,1% in the junior surgeon group (p=0,36). In the eyes operated by senior surgeons, the final visual acuity was better than 20/40 in 78,5% versus 63,2% in eyes operated by junior surgeons (p=0,09).However, in phakic eyes with limited retinal detachments, the senior surgeons achieved better functional results (p<0.01). Conclusion The surgical experience, except in some subgroups of patients, did not significantly influence the anatomical or the functional overall outcome of patients undergoing primary scleral buckling surgery in retinal detachment with macular involvement. [source] Assessing competency in Dentoalveolar surgery: a 3-year study of cumulative experience in the undergraduate curriculumEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2007J. A. Durham Aim:, To assess and observe the development of competence in oral surgical skills during a 3-year undergraduate programme. Method:, Over a 3-year period 75 students were followed through from the beginning of their clinical course to their Bachelor of Dental Surgery graduation and their surgical experience monitored by the use of logbooks. Their development of competence was assessed objectively through structured assessments and subjectively by a single tutor responsible for each year. Assessments were made of their ability in exodontia, pre-surgical assessment and the surgical extraction of teeth/roots. Results:, Seventy-three students completed the course (97%). Successful completion rates for the objective testing were 100% for both exodontia and pre-surgical assessment. The surgical assessment, (surgical extraction of a tooth or root) had a successful completion rate of only 23% and the caseload for students was low with a mean of four teeth removed surgically upon graduation. Relationships were examined between total numbers of teeth extracted, total number of minor oral surgical procedures completed and the successful completion of the surgical competence assessment, but no significant relationships were found. Conclusions:, This study demonstrates that it is possible to achieve objectively measurable levels of competence in undergraduates undertaking oral surgery procedures. It is however, a labour and time intensive process and appropriate clinical and teaching resources are required. National co-operation towards agreed standardised competencies should be encouraged to allow data to be pooled and more powerful analyses to occur. [source] Radical prostatectomy in obese patients: Improved surgical outcomes in recent yearsINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2010Uri Lindner Objectives: Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. Methods: Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25,30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. Results: Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18,1.09), were not shown. Conclusion: As surgical experience with high BMI patients has developed, RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar. [source] Utilization of the Edge-to-Edge Valve Plasty Technique to Correct Severe Tricuspid Regurgitation in Patients with Congenital Heart DiseaseJOURNAL OF CARDIAC SURGERY, Issue 6 2009Yong-chao Cui Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using the edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods: From December 2002 to August 2007, severe tricuspid regurgitation was corrected with a flexible band annuloplasty and edge-to-edge valve plasty technique in nine patients with congenital heart disease. The age ranged from 7 to 62 years (average 24.4 years). Congenital cardiac anomalies included atrioventricular canal in five cases, secundum atrial septal defect in three cases, and cor triatriatum in one case. Results: No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in six cases and mild tricuspid regurgitation in three cases at discharge. The follow-up ranged from 12 months to 70 months (average 39.3 months). No tricuspid stenosis was found. No to mild tricuspid regurgitation was present in eight cases, and moderate tricuspid regurgitation in one case at the latest follow-up. Conclusions: Edge-to-edge valve plasty is an easy, effective, and acceptable additional procedure to correct severe tricuspid regurgitation in patients with congenital heart disease. [source] Eleven-Year Experience in Diagnosis and Surgical Therapy of Right Atrial MassesJOURNAL OF CARDIAC SURGERY, Issue 1 2007Nezihi Kucukarslan M.D. A review of surgical experience with right atrial tumors in 11 patients from our institution has been presented in this article. Methods: Eleven cases, operated for a tumor mass in the right atrium in our institution between January 1993 and December 2004, were retrospectively reviewed for their clinical presentation, diagnostic workup, method of surgical procedure, and histopathologic findings. Electrocardiogram, transthoracic, and transesophageal echocardiography, computerized tomography, and nuclear magnetic resonance imaging were available for all patients during the diagnostic evaluation. Surgical procedure notes, photos, and file recordings were reviewed when available. The surgeons were also interviewed when necessary. Results: Right atrial tumors were diagnosed in 11 patients (6 males and 5 females). The average age of the patients was 34 ± 11 years (ranging between 21 and 65 years). The histopathological examination of the surgically removed specimen revealed a benign tumor in eight patients (73%), and a malignant process in three (23%). In eight patients with a benign tumor, atrial myxoma was the leading cause in half of the cases. Hydatid cyst (n = 2), lipoma (n = 1), and right atrial thrombus (n = 1) were detected in the remaining four patients. One patient died of heart failure after surgery. The diameters of the excised masses were 2 ± 0.5 cm versus 7 ± 1 cm. Conclusions: Tumors of the right atrium are rarely seen, and necessitate a unique attention during the process of diagnosis and surgical treatment. We present our surgical experience of 11 patients with right atrial mass. The differentiation of the right atrial tumors with the diagnostic tools before surgery, the determination of the spreading, and the structural properties of the mass may designate surgical approach and prognosis. [source] A Xiphoid Approach for Minimally Invasive Coronary Artery Bypass SurgeryJOURNAL OF CARDIAC SURGERY, Issue 4 2000Federico Benetti M.D. However, opening the pleura has been a limitation of using these approaches. Aim: We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery. Methods: We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 ± 10 years and 65% were men. The mean Parsonnet score was 23 ± 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 ± 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 ± 5 months. Conclusions: Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay. [source] Stridor and Dysphagia in Diffuse Idiopathic Skeletal Hyperostosis (DISH),THE LARYNGOSCOPE, Issue 2 2006Dominic M. Castellano MD Abstract As otolaryngologists, we are the first consulted for stridor and dysphagia. One must consider both extrinsic and intrinsic etiologies in the differential diagnosis of these symptoms. We report a series of patients with diffuse idiopathic skeletal hyperostosis (DISH) who presented with stridor or dysphagia. We describe the initial presenting symptoms, physical examination/radiographic findings, and discuss the management options. Traditional teaching is that surgery is rarely indicated for DISH of the cervical spine. Recommendations regarding the role of surgery as well as a review of our surgical experience are discussed. [source] The Learning Curve in Stapes Surgery and Its Implication to TrainingTHE LARYNGOSCOPE, Issue 1 2006FRCS, M. W. Yung PhD Objective: To identify the stapedotomy learning curve of two U.K. otolaryngologists. Study Design: A retrospective review of the outcome of first 100 stapedotomy operations by each surgeon. Included in the study was a postal survey of the incidence of stapes surgery by U.K. otolaryngologists. Setting: Two tertiary referral centers. Patients: All ears in which primary stapedotomy was performed for otosclerosis. Nonotosclerotic cases and malleus stapedotomy cases were excluded. Intervention: One surgeon used the technique of small fenestra stapedotomy with either a Teflon-wire or titanium piston but without vein graft interposition, whereas the second used the technique of stapedotomy with vein graft interposition and a Teflon piston. Main Outcome Measures: A moving average with a window of 15 dB was used to plot learning curves for the postoperative air-bone gaps. Using a postoperative air-bone gap of 20 dB or better as a definition of ,success,' the success rates with the increase in surgical experience of both surgeons were plotted on graphs, the learning curves. The end point of the learning curve was defined as the point where the curve reached its peak, and the results were sustainable. Results: There was no clear-cut end point in both learning curves, although it appears that there is a landmark point at 60 to 80 cases for both surgeons. Both surgeons also had one "dead ear" in their first 15 cases. The postal survey showed that some trainers only performed small numbers of stapes surgery, whereas some otolaryngologists who performed stapedotomies regularly were not trainers. Conclusions: The study supports a learning curve in stapes surgery. To maximize the training opportunity of trainee surgeons, it may be advisable for learning centers to form network to provide target training for the trainee who has demonstrated the necessary dexterity and temperament of an otologist. [source] Safety of Modified Radical Neck Dissection for Differentiated Thyroid Carcinoma,THE LARYNGOSCOPE, Issue 3 2004Michael E. Kupferman MD Abstract Objectives/Hypothesis The management of cervical metastases from differentiated thyroid carcinoma (DTC) remains controversial. Most surgeons perform a neck dissection (ND) for clinically apparent disease. The extent of nodal dissection varies from regional to comprehensive. Morbidity from ND in the setting of DTC remains high, particularly when performed in the setting of a thyroidectomy (TT). To determine complications from ND for DTC, we retrospectively reviewed our surgical experience of modified radical neck dissection for nodal metastases. Study Design Retrospective chart review. Methods Between 1997 and 2002, 39 consecutive patients (31 females and 8 males) underwent 44 comprehensive NDs of levels II,V for DTC. Central compartment dissection (CCD) (levels VI and VII) was also performed during 23 of these procedures. Twenty (45.5%) patients had prior treatment elsewhere. Preoperative pathology revealed papillary carcinoma in 22 patients (56.4%), tall cell variant in 11 (28.2%), and follicular variant in 6 (15.4%). Results Ten patients (20%) underwent ND alone, whereas 6 (14%) underwent simultaneous ND and TT. Fifteen patients underwent simultaneous ND, TT, and CCD (30%). Temporary hypocalcemia occurred after 21% of NDs that were performed in the setting of either TT or CCD or both. There were no cases of permanent hypoparathyroidism. Transient regional lymph node (RLN) paresis occurred in two patients and was associated with a concomitant central compartment nodal dissection; there were no permanent RLN palsies. Transient spinal accessory nerve paresis developed after 27% of NDs performed. Two patients developed chyle leaks. Conclusions When ND is necessary for the treatment of thyroid malignancies, the procedure can be performed safely with acceptable morbidity. [source] Surgical management of extracranial carotid artery aneurysmsANZ JOURNAL OF SURGERY, Issue 4 2009Anwar S. Choudhary Abstract Extracranial carotid artery aneurysms are uncommon and not much is known about them. The purpose of this study is to report the authors' surgical experience and present a review of this entity. This single institution experience shows that resection of these aneurysms and restoration of flow can be accomplished using a number of surgical techniques with relatively low morbidity and mortality. Endovascular techniques are also increasingly being considered in the repair of these aneurysms, although long-term data from such techniques are not currently available. [source] Surgical training in gastrointestinal procedures within a UK gynaecological oncology subspecialty programmeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2010R Naik Objective, An analysis of surgical experience in gastrointestinal procedures within a UK-based gynaecological oncology centre to which subspecialty fellows within the subject are exposed. Design, Retrospective study. Setting, Northern Gynaecological Oncology Centre, Gateshead, UK. Population, All women undergoing bowel surgery over a six-year period, 1 January 2000 to 31 December 2005. Methods, Cases were analysed by specialty and grade of surgeon performing the procedure. Main outcome measure, Proportion of cases to which subspecialty fellows were exposed. Results, Two hundred and sixty-two women (11.5%) underwent bowel surgery out of 2280 women undergoing major surgery for gynaecological cancer. This included ovarian/primary peritoneal cancer in 186 women (71%). Of these 262 cases, 238 operations (91%) were performed by a gynaecological oncologist, 20 (7.5%) were performed jointly with the gastrointestinal surgeons and four (1.5%) were performed solely by the gastrointestinal surgeons. A gynaecological oncology subspecialty fellow performed 21 (8%) and assisted in an additional 204 operations (78%). Perioperative morbidity and mortality statistics in addition to overall survival outcomes were comparable to the published literature. Conclusions, A significant proportion of major surgical operations performed within a gynaecological oncology centre require gastrointestinal procedures. The majority of these procedures can be performed by gynaecological oncologists with an acceptable perioperative morbidity and mortality rate. Subspecialty training has the potential to allow trainees significant exposure to these procedures. An accredited post-Fellowship Training Programme can provide the opportunity for hands-on experience to allow gynaecological oncologists the confidence and credibility to perform these procedures independently. [source] Training for laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgeryBJU INTERNATIONAL, Issue 6b 2010Sean P. Stroup A combination of refinements in laparoscopic instrumentation and increasing surgical experience has driven innovation in the area of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES). By combining working ports and the extraction incision into one site, LESS allows access to the peritoneum with fewer incisions and less scarring than the traditional multiport laparoscopic technique. Reduced incisional morbidity and improved cosmesis have sparked a growing interest in the utilization of these techniques to perform urological surgery. Mastering of the technique requires training and repetition to develop the muscle memory required to perform these challenging procedures. Although there has been an explosion of literature published about initial experiences with LESS and NOTES, little has been written about training and implementation of this approach. Here, we describe our institutional experience and the essential elements of a LESS and NOTES training curriculum and offer some insight into establishing a successful programme. [source] | ||||||||||