ABSTRACT
Introduction/BackgroundRobotic surgery (RS) in gynaecological oncology has been shown to overcome the limitations of conventional laparoscopy, improve perioperative outcomes and reduce length of stay (LOS). RS has lower conversion rates and shorter learning curve than laparoscopic surgery (LS). The blood loss is significantly less. RS is preferred in morbidly obese women. We share our experience of introducing RS at our centre and study its impact on our clinical outcomes and service.MethodologyRS was introduced in December 2020 during COVID-19 pandemic. A second surgeon trained from September 2021. Data was collected prospectively recording indications, operating-time, blood loss, LOS and complications. Outcomes were compared with the Hospital Episode Statistics (HES) data and cost analysed.ResultsUntil May 2022, 143 cases underwent RS using da Vinci- Si, X or Xi robots. Most women (84) had endometrial cancer. Complexity of surgery increased in latter half with women with BMI>40kg/m2(23), large fibroid uterus(22), ovarian cancer staging(12) and radical hysterectomy(3). Median docking time was eight minutes, median operating-time was 150 minutes and median blood loss was 50 mls. Average LOS was 1.8 days and median LOS 1 day(range 0–6 days). Average LOS for LS was 3 days and open abdominal surgery 8.6 days. Minor complications(11) were treated conservatively. Two patients with adhesions had bladder injury. One surgery was converted to open abdominal surgery during the early learning phase. Introduction of robotic surgery increased the minimal-access surgery (MAS) rate by 15%. The operating-time showed decreasing trend with experience while surgical productivity {average number of cases per theatre list} remained the same.ConclusionThere is a significant reduction in hospital stay and a clear cost benefit of robotic surgery. There is a significant increase in the MAS rates even during the early phase of learning with no increase in overall morbidity.
ABSTRACT
Background: Peripheral nerve injuries make up many upper extremity musculoskeletal disorders (UE-MSDs), as peripheral nerves in the upper extremities are susceptible to damage due to their superficial course and length. The health and economic burdens of peripheral nerve injuries are rising. Upper-limb peripheral nerve injuries caused by prone positioning in COVID-19 patients in intensive care have occurred during the current global pandemic. Understanding the incidence and causation of these injuries is essential, as these affect primarily young workers and athletes with skeletal immaturity and contribute to significant morbidity. Methods and Patients: A total of 789 patients, 481 of whom were male and 308 female, with limited upper-extremity movements, scapular winging, and pain due to upper brachial plexus, long thoracic and accessory nerve injuries (459 right, 282 left, and 48 bilateral) were included in the study. Patient age at the onset of injury ranged between 11 months and 68 years. Results: A total of 18 causes of peripheral nerve injury were identified among the 789 patients with UE-MSD. The most affected patients (12.7%) were involved in sports and related activities, with 20 different sports and related activities reported in this patient population. Weightlifting caused the most (10.9%) number of injuries in this group. Incidences in the least affected patients were due to massage and viral infection, at 0.6% and 0.6% respectively. Conclusions: Sports and recreational-related physical activities are essential components of a healthy lifestyle, and may help decrease the incidence of obesity, diabetes, and cardiovascular diseases. Injury and fear of impairment, however, can be barriers in the participation of these activities. Surgery and other interventions can help maximize return to work and regular activities after UE-MSDs.
ABSTRACT
The SARS-CoV-2 (COVID-19) pandemic is having a large effect on the management of cancer patients. This study reports on the approach and outcomes of cancer patients receiving radical surgery with curative intent between March and September 2020 (in comparison to 2019) in the European Institute of Oncology, IRCCS (IEO) in Milan and the South East London Cancer Alliance (SELCA). Both institutions implemented a COVID-19 minimal pathway where patients were required to self-isolate prior to admission and were swabbed for COVID-19 within 72 h of surgery. Positive patients had surgery deferred until a negative swab. At IEO, radical surgeries declined by 6% as compared to the same period in 2019 (n = 1477 vs. 1560, respectively). Readmissions were required for 3% (n = 41), and <1% (n = 9) developed COVID-19, of which only one had severe disease and died. At SELCA, radical surgeries declined by 34% (n = 1553 vs. 2336). Readmissions were required for 11% (n = 36), <1% (n = 7) developed COVID-19, and none died from it. Whilst a decline in number of surgeries was observed in both centres, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.