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1.
BMC Emerg Med ; 22(1): 170, 2022 10 24.
Article in English | MEDLINE | ID: covidwho-2089162

ABSTRACT

BACKGROUND: Acute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes. METHODS: Patients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences. RESULTS: Compared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED. CONCLUSION: The current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.


Subject(s)
Appendicitis , COVID-19 , Fecal Impaction , Humans , Infant , Adolescent , Appendicitis/epidemiology , Appendicitis/surgery , Appendicitis/diagnosis , COVID-19/epidemiology , Pandemics , Fecal Impaction/epidemiology , Appendectomy/methods , Acute Disease , Retrospective Studies , Length of Stay
2.
J Minim Invasive Gynecol ; 2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2061571

ABSTRACT

STUDY OBJECTIVE: To demonstrate a laparoscopic technique to remove a scar pregnancy. DESIGN: Stepwise demonstration of the surgical technique. SETTING: Santa Croce and Carle Hospital, Cuneo. INTERVENTION: Patient B.B. is a woman referred to our center for a suspected cesarean scar pregnancy (CSP) at 9 weeks gestation. CSP occurs approximately in 6% of all ectopic pregnancies. The estimated incidence is reported to be 1:1800 to 1:2500 in cesarean deliveries. Depending on its location, CSP can be categorized as either type 1, if the growth is in the uterine cavity, or type 2, if it expands toward the bladder and the abdominal cavity. If inadequately managed, it can lead to severe complications; most of them are hemorrhagic and can threaten the woman's life. There are several therapeutic approaches: local excision seems to be the most effective choice in type 2 CSP. In expert hands, the laparoscopic approach is perhaps the best surgical choice as tissue dissection, electrosurgical hemostasis, and vascular control can be effectively managed with minimal invasive access. Because severe intraoperative bleeding can occur, retroperitoneal vascular control is mandatory in this surgery. In type 1 CSP curettage, aspiration or hysteroscopic approach can be considered if the CSP is of small dimensions. A hysteroscopic approach can also be helpful in type 2 CSP during the laparoscopic removal, as intrauterine guidance. A potassium chloride local injection can be considered in a preoperative stage in the presence of a fetal heart rate. The systemic administration of methotrexate is usually ineffective as single agent, but it can be useful if administered as adjuvant therapy. Uterine artery embolization can be useful in an emergency setting to manage severe bleeding, but it can lead to complications in subsequent pregnancies and, more rarely, to premature ovarian failure. Considering poor bleeding at presentation, feasible dimensions, and the woman's desire for future pregnancy, ultrasound-guided aspiration and curettage was attempted. Because endouterine removal was incomplete, methotrexate injection was proposed as adjuvant therapy, but the administration was postponed as the patient tested positive for coronavirus disease 2019. A month later, beta-human chorionic gonadotropin level dropped from over 16 000 to 271 mU/mL, so an ultrasound and biochemical follow-up was performed. A month later, despite a low beta-human chorionic gonadotropin value, an increase in dimensions was observed at ultrasound, so surgical laparoscopic removal was offered. In this video article, laparoscopic removal of scar pregnancy is discussed in the following surgical steps: (1) Temporary closure of uterine arteries at the origin, using removable clips. (2) Retroperitoneal dissection to safely manage the scar pregnancy. (3) Dissection of the myometrial-pregnancy interface. (4) Double layer suture on the anterior uterine wall. CONCLUSION: Laparoscopic surgical management is a very effective surgical approach to remove CSP. Knowledge of retroperitoneal dissection and vascular control is necessary to carry out this surgical intervention safely and effectively.

3.
World Journal of Laparoscopic Surgery ; 15(2):145-148, 2022.
Article in English | EMBASE | ID: covidwho-2006311

ABSTRACT

Background: SARS-CoV-2 virus infection was detected and discovered in Wuhan, China, in December 2019, and it was declared a pandemic by WHO in March 2020. Since then a lot of changes were noticed in surgical practice. Various recommendations were released by eminent surgical associations all over the world. This study was designed to study and analyze the findings and experience after resuming elective minimal invasive surgery during the pandemic. Materials and methods: This observational study was conducted at St Joseph’s Hospital, Ghaziabad, from May 2020 to May 2021. Various preoperative and postoperative findings were noticed and analyzed. The presence of SARS-CoV-2 virus was also analyzed in endotracheal aspirate and surgical smoke. Observation and results: A total of 287 cases underwent surgery. Most commonly performed surgery was laparoscopic cholecystectomy. The positivity rate for SARS-CoV-2 during preoperative work-up was 2.87%. Slightly more than 5% of cases in postoperative period had COVID-19-like symptoms. None of those patients were found positive on RT-PCR, and X-ray/CT findings were also suggestive of early postoperative changes only. Presence of SARS-CoV-2 virus was not detected in either endotracheal aspirate or surgical smoke. Neither surgery team nor OT staff had infection during this period. There was no mortality, and only 1 patient was found to be infected 2 weeks after discharge. Conclusion: Minimal invasive surgery for elective cases can be safely performed by taking precautions like PPE and smoke evacuation system during the COVID-19 pandemic. There is no evidence of transmission of infection through endotracheal aspirate or surgical smoke.

4.
European Journal of Molecular and Clinical Medicine ; 9(4):2497-2505, 2022.
Article in English | EMBASE | ID: covidwho-1995341

ABSTRACT

Background: The erector spinae plane (ESP) blockade acts as a potent unilateral analgesic technique. The block is performed by injecting local anaesthetic drug in the plane between the erector spinae muscle and the vertebral transverse process, with its effect due to diffusion of the local anaesthetic into the paravertebral space through spaces between the adjacent vertebrae. It is a relatively safe and easy technique as compared to the thoracic epidural because our target in ESP blockade is the transverse process, which is identified easily and is distant from neural or major vascular structures and the pleura. Aim of the study: To assess the analgesic effect of ultrasound guided unilateral erector spinae blockade in open cholecystectomy Material and methods:We present a case series of ESP blockade under ultrasound guidance in nine patients scheduled for open cholecystectomy because surgeons chose to avoid laparoscopic surgery due to the increased risk of COVID-19 infection due to intraperitoneal aerosol generation. Results: All patients with postoperative ESP blockade maintained an NRS pain score of 03/10 for 24 h, except for those requiring emergency analgesia. The pain relief was excellent in all our patients and there were no complaints of nausea, vomiting. Conclusion: ESP blockade is proving to be a successful technique for intraoperative and postoperative analgesia.

5.
Heliyon ; 8(8): e10303, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1996191

ABSTRACT

Objective: A system to provide feedback for laparoscopic training using an online conferencing system during the COVID-19 pandemic was developed. The purpose of this study is to evaluate this system from the trainer perspective. Design: A procedural feedback system using an online conferencing system was devised. Setting: Surgical training was observed using an online conferencing system (Zoom). Feedback was provided while viewing suture videos which are, as a feature of this system, pre-recorded. Feedback was then recorded. Trainer comments were then converted into text, summarized as feedback items, and sorted by suture phase which facilitates reflection. Trainers completed a questionnaire concerning the usability of the online feedback session. Results: Eleven trainers were selected. Physicians had an average experience of 21.9 ± 5.9 years (mean ± standard deviation). The total number of feedback items obtained by classifying each phase was 32. Based on questionnaire results, 91% of trainers were accustomed to the use of Zoom, and 100% felt that online procedural education was useful. In questions regarding system effectiveness, more than 70% of trainers answered positively to all questions, and in questions about efficiency, more than 70% of trainers answered positively. Only 55% of the trainers felt that this system was easy to use, but 91% were satisfied as trainers. Conclusions: The results of the questionnaire suggest that this system has high usability for training. This online system could be a useful tool for providing feedback in situations where face-to-face education is difficult.

6.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-341959

ABSTRACT

Objective: A system to provide feedback for laparoscopic training using an online conferencing system during the COVID-19 pandemic was developed. The purpose of this study is to evaluate this system from the trainer perspective. Design: A procedural feedback system using an online conferencing system was devised. Setting : Surgical training was observed using an online conferencing system (Zoom). Feedback was provided while viewing suture videos which are, as a feature of this system, pre-recorded. Feedback was then recorded. Trainer comments were then converted into text, summarized as feedback items, and sorted by suture phase which facilitates reflection. Trainers completed a questionnaire concerning the usability of the online feedback session. Results: Eleven trainers were selected. Physicians had an average experience of 21.9 ± 5.9 years (mean ± standard deviation). The total number of feedback items obtained by classifying each phase was 32. Based on questionnaire results, 91% of trainers were accustomed to the use of Zoom, and 100% felt that online procedural education was useful. In questions regarding system efficacy, more than 70% of trainers answered positively to all questions, and in questions about efficiency, more than 80% of trainers answered positively. Only 55% of the trainers answered that this system was easier to use than face-to-face feedback, but 91% were satisfied as trainers. Conclusions: The results of the questionnaire suggest that this system has high usability for training. This online system could be a useful tool for providing feedback in situations where face-to-face education is difficult.

7.
EJVES Vascular Forum ; 54:e29-e30, 2022.
Article in English | EMBASE | ID: covidwho-1982965

ABSTRACT

Introduction: The COVID-19 pandemic has affected the health services globally. The impact on the provision of vascular access services for patients with chronic kidney disease is not known. One can speculate that reduced hospital bed capacity, limited elective theatre lists, and the shielding requirement for vulnerable patients in this particular group will have an adverse effect. This study was conducted to evaluate the effect of the COVID-19 pandemic on dialysis access procedures performed at a tertiary care centre. Methods: This was a single centre, retrospective, observational study of all dialysis access procedures performed between January 2019 and December 2020. Patient data were collected from electronic patient records, operation theatre databases, and clinical case records. Vascular access procedures were categorised according to the site and type of dialysis access (autogenous/non-autogenous fistulas) and secondary access procedures. Secondary access procedures were those that dealt with complications of vascular access. Peritoneal access procedures were also included in the data. Placement of acute and long term dialysis catheter lines were excluded. Pre-COVID data from 2019 were compared with the 2020 data. Statistical methods for data analysis were performed using SPSS version 23.0 by applying Pearson’s chi square test for variables to measure the significance of outcome. Results: A total of 271 dialysis access related procedures were performed in 2019 versus 212 in 2020. There was a significant drop of 21.7% in the total number of dialysis access procedures during the COVID-19 pandemic in the year 2020 (p <.05). In the pre-COVID era, 162 (59.8%) procedures were the formation of autogenous arteriovenous fistulas. The case mix consisted of 69 (25.5%) radiocephalic fistulas, 70 (25.8%) brachiocephalic fistulas, 13 (4.8%) first stage basilic vein transpositions, and 10 (3.7%) second stage basilic vein transpositions. In comparison, during the year 2020, 118 (55.7%) procedures were autogenous arteriovenous fistulas. The case mix included 54 (25.5%) radiocephalic fistulas and a similar proportion of brachiocephalic fistulas (n = 54 [25.5%]), six (2.8%) first stage basilic vein transpositions, and four (1.9%) second stage basilic vein transpositions. There were 14 (5.2%) non-autogenous arteriovenous graft formations in 2019 versus 21 (9.9%) in 2020 (p <.05). There were 53 (19.5%) secondary vascular access procedures in 2019 versus 30 (14.1%) in 2020 (p <.05). The proportion of peritoneal dialysis catheter placements, repositioning, and catheter exchanges increased slightly. Forty-two (15.5%) procedures were done in 2019 versus 43 (20.3%) in 2020. The proportion of new peritoneal catheters was significantly higher in the year 2020 (p <.05). There were 35 (12.9%) new peritoneal dialysis catheter placements (nine laparoscopic/26 open insertions) in 2019, whereas in 2020 there were 38 (17.9%) n (one laparoscopic, 31 open and five percutaneous). There were no laparoscopic peritoneal dialysis catheter placements after the start of the pandemic. Conclusion: During the COVID-19 pandemic, there was a significant reduction in the total number of vascular access procedures performed and also secondary surgical interventions, but an increase in the use of arteriovenous grafts. The number of new peritoneal dialysis access increased despite overall reduction in the total number of procedures. Percutaneous peritoneal tube insertion technique was introduced during the pandemic to reduce hospital admissions while laparoscopic techniques were abandoned.

8.
Surg Endosc ; 2022 Jul 19.
Article in English | MEDLINE | ID: covidwho-1966143

ABSTRACT

BACKGROUND: Laparoscopic surgery is rapidly expanding in low-and middle-income countries (LMICs), yet many surgeons in LMICs have limited formal training in laparoscopy. In 2017, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. In light of COVID-19, SAGES adapted GLAP to a virtual format with telesimulation. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in resource-limited settings. METHODS: Participants from San Jose, Costa Rica, Leon, México, and Guadalajara, México enrolled in the virtual GLAP curriculum, meeting biweekly for 2-h didactic classes and 2-h hands-on live simulation practice. Surgical residents' laparoscopic skills were evaluated using the five Fundamentals of Laparoscopic Surgery (FLS) tasks during the initial and final weeks of the program. Participants also completed pre-and post-program surveys assessing their perception of simulation-based training. RESULTS: The study cohort consisted of 16 surgical attendings and 20 general surgery residents. A minimum 70% response rate was recorded across all surveys in the study. By the end of GLAP, residents completed all five tasks of the FLS exam within less time relative to their performance at the beginning of the training program (p < 0.05). Respondents (100%) reported that the program was a good use of their time and that education via telesimulation was easily reproduced. Participants indicated that the practice sessions, guidance, and feedback offered by mentors were their favorite elements of the training. CONCLUSION: A virtual simulation-based curriculum can be an effective strategy for laparoscopic skills training. Participants demonstrated an improvement in laparoscopic skills, and they appreciated the mentorship and opportunity to practice laparoscopic skills. Future programs can expand on using a virtual platform as a low-cost, effective strategy for providing laparoscopic skills training to surgeons in LMICs.

9.
World Journal of Laparoscopic Surgery ; 15(1):v, 2022.
Article in English | EMBASE | ID: covidwho-1917992
10.
J Minim Invasive Gynecol ; 29(9): 1110-1118, 2022 09.
Article in English | MEDLINE | ID: covidwho-1907328

ABSTRACT

STUDY OBJECTIVE: To evaluate patient characteristics that affect access to minimally invasive gynecologic surgery (MIGS) subspecialty care and identify changes during the coronavirus disease 2019 pandemic. DESIGN: Retrospective cohort study of patients referred to MIGS from 2014 to 2016 (historic cohort) compared with those referred to MIGS in 2020 (pandemic cohort). Primary outcome was the interval between referral and first appointment. SETTING: Single-institution academic MIGS division. PATIENTS: Historic cohort (n = 1082) and pandemic cohort (n = 770). INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Demographics and socioeconomic variables (race, ethnicity, language, insurance, employment, and socioeconomic factors by census tract) and distance from hospital were compared between historic and pandemic cohorts with respect to referral interval using the chi-square, Fisher exact tests, and logistic regression. After adjusting for referral indication, being unemployed and living in an area with less population density, less education, and higher percentage of poverty were associated with a referral interval >30 days in the historic cohort. In the pandemic cohort, only unemployment persisted as a covariate associated with prolonged referral interval and new associated variables were primary language other than English (odds ratio, 3.20; 95% confidence interval [CI], 1.60-6.40) and "other" race (odds ratio, 2.22; 95% CI, 1.34-3.68). The odds of waiting >30 days increased by 6% with the addition of 1 demographic risk factor (95% CI, 1.01-1.10) and by 17% for 3 risk factors (95% CI, 1.03-1.34) in the historic cohort whereas no significant intersectionality was identified in the pandemic cohort. Average referral intervals were significantly shorter during the pandemic (31 vs 50 days, p <.01). Telemedicine appointments had a significantly shorter referral interval than in-person appointments (27 vs 47 days, p <.01). Of patients using telemedicine, a greater proportion were non-Hispanic, English speaking, employed, privately insured, and lived further from the hospital (p <.05). CONCLUSION: Time from referral to first appointment at a tertiary-care MIGS practice during the coronavirus disease 2019 pandemic was shorter than that before the pandemic, likely owing to the adoption of telemedicine. Differences in socioeconomic and demographic factors suggest that telemedicine improved access to care and decreased access disparities for many populations, but not for non-English-speaking patients.


Subject(s)
COVID-19 , COVID-19/epidemiology , Female , Gynecologic Surgical Procedures , Humans , Minimally Invasive Surgical Procedures , Pandemics , Retrospective Studies
11.
Diseases of the Colon and Rectum ; 65(5):96, 2022.
Article in English | EMBASE | ID: covidwho-1893878

ABSTRACT

Purpose/Background: Combined endoscopic robotic surgery (CERS) is a novel surgical technique that modifies traditional endoscopic laparoscopic surgery with robotic assistance to aid in removal of complex colonic polyps. Hypothesis/Aim: This study aimed to evaluate the safety and outcomes of combined endoscopic robotic surgery. Methods/Interventions: A retrospective review of a prospective database was conducted. Patients underwent CERS by a single colorectal surgeon from March 2018 to October 2021. Polyps were initially found by a referring gastroenterologist and deemed unresectable by traditional endoscopy. Complex polyps were identified in the colon endoscopically while the da Vinci Xi robot was utilized to aid in polyp resection. Once complete, the resection site was over-sewn with absorbable Lembert sutures under endoscopic supervision. Based on pathology, patients were instructed to undergo repeat colonoscopy 3 to 12 months from their operative date. Results/Outcome(s): Combined endoscopic and robotic surgery was successfully completed in 85 of 93 (91%) cases. Patients were converted to other procedures due to discovery of a smaller polyp than anticipated, concern for malignancy, involvement of the ileocecal valve, inability to lift the polyp, or involvement of the appendiceal stump. Among the 85 participants seeing CERS to completion, average age was 66 years (SD=10), body mass index was 29 (SD=6), and history of abdominal surgeries was 1 (SD=1). Median operative time and polyp size were 73 mins (range 31-184 mins) and 40 mm (range 5-180 mm), respectively. Most common polyp locations were cecum, ascending, and transverse colon (29%, 29%, 24%). Pathology mainly demonstrated tubular adenoma (76%). To date, 40 patients underwent follow-up colonoscopy, with an average follow-up time of 7 months (range 3-22 months). Of those, one patient (2.5%) had resection site polyp recurrence. Limitations: Limitations for our study include lack of randomization and follow-up rate to assess for recurrence. The low compliance rate may be due to patient reluctance to get a colonoscopy or procedure cancelations/ difficulty scheduling due to changing COVID-19 regulations. Conclusions/Discussion: Most recent literature reports median operative times for combined endoscopic laparoscopic surgery (CELS) as 85 mins (range 50-225 mins) and 135 mins (range 120-170 mins). Resection site polyp recurrence for traditional endoscopic mucosal resection and CELS ranges from 13.1% and 3.3-10%, respectively. Our findings suggest that CERS is associated with decreased operating time and resection site polyp recurrence. Overall, CERS is a practical technique that enhances current methods for the resection of complex colonic polyps.

12.
Fertility and Sterility ; 116(3 SUPPL):e207, 2021.
Article in English | EMBASE | ID: covidwho-1880369

ABSTRACT

OBJECTIVE: The purpose of this study is to determine the positive predictive value (PPV) of diagnosis for endometriosis by the Nezhat Endometriosis Advisor (NEA) mobile application to serve as a screening tool MATERIALS AND METHODS: A retrospective cohort study was conducted at a university-affiliated private practice. Inclusion criteria were women with no previous surgical diagnosis of endometriosis who also completed an endometriosis assessment using the application. Patients with symptoms desiring definitive diagnosis and treatment of endometriosis then underwent laparoscopic surgery once surgeries were once again allowed. The diagnosis of endometriosis was confirmed visually by a surgeon specialized in treating endometriosis and also through biopsy sent to pathology. The primary outcome measured was the PPVof NEA mobile application questionnaire to the surgical diagnoses of endometriosis. RESULTS: A total of 100 patients met the inclusion criteria for this study. 95% of the patients whose score on the app was 90% or above, had a surgical pathology confirmed diagnosis of endometriosis (PPV 95%). CONCLUSIONS: NEA mobile application questionnaire has a high PPVof 95% for diagnosing endometriosis and can help identify a patient population that may require surgical treatment for pelvic pain or unexplained infertility. This will be helpful as it may lead to earlier diagnosis and management of endometriosis. Patients can reduce risk exposure of COVID-19 by avoiding multiple medical office visits. The COVID-19 pandemic has also decreased the availability of healthcare for many, and they may suffer for a long time with pain or infertility before a diagnosis is made. The mobile application is a possible alternative method to assess risk of endometriosis while avoiding risk of COVID-19 exposure. Patients can be medically treated based on symptoms and application results until surgery can be performed. With further research, the application has the potential to be the diagnostic measure of endometriosis. More research is needed to determine the continued accuracy of the application in different patient population and demographics IMPACT STATEMENT: Endometriosis is ectopic uterine lining growing outside the uterus which causes pain and infertility. Currently, definitive diagnosis is with pelvic laparoscopic surgery, as no screening test is widely available or accepted. The Coronavirus Disease 2019 (COVID-19) pandemic due to the infectious pathogen Severe Acute Respiratory Syndrome Coronavirus 2 has altered ambulatory and inpatient health care. For several months commencing March 2020, non-emergent surgeries came to an abrupt hault due to the COVID- 19 pandemic. Many patients who were scheduled to have diagnostic laparoscopies for suspected endometriosis were not able to have their surgeries performed. As an alternative NEA was utilized to determine the likelihood of endometriosis based on self-answered questionnaires about experienced symptoms. The mobile app is free and available for patients worldwide. Patients with a high probability of endometriosis can be treated medically until surgery resume.

13.
BMC Surg ; 22(1): 168, 2022 May 10.
Article in English | MEDLINE | ID: covidwho-1833304

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused a global health crisis in 2020. This pandemic also had a negative impact on standard procedures in general surgery. Surgeons were challenged to find the best treatment plans for patients with acute cholecystitis. The aim of this study is to investigate the impact of the COVID-19 pandemic on the outcomes of laparoscopic cholecystectomies performed in a tertiary care hospital in Germany. PATIENTS AND METHODS: We examined perioperative outcomes of patients who underwent laparoscopic cholecystectomy during the pandemic from March 22, 2020 (first national lockdown in Germany) to December 31, 2020. We then compared these to perioperative outcomes from the same time frame of the previous year. RESULTS: A total of 182 patients who underwent laparoscopic cholecystectomy during the above-mentioned periods were enrolled. The pandemic group consisted of 100 and the control group of 82 patients. Subgroup analysis of elderly patients (> 65 years old) revealed significantly higher rates of acute [5 (17.9%) vs. 20 (58.8%); p = 0.001] and gangrenous cholecystitis [0 (0.0%) vs. 7 (20.6%); p = 0.013] in the "pandemic subgroup". Furthermore, significantly more early cholecystectomies were performed in this subgroup [5 (17.9%) vs. 20 (58.8%); p = 0.001]. There were no significant differences between the groups both in the overall and subgroup analysis regarding the operation time, intraoperative blood loss, length of hospitalization, morbidity and mortality. CONCLUSION: Elderly patients showed particularly higher rates of acute and gangrenous cholecystitis during the pandemic. Laparoscopic cholecystectomy can be performed safely in the COVID-19 era without negative impact on perioperative results. Therefore, we would assume that laparoscopic cholecystectomy can be recommended for any patient with acute cholecystitis, including the elderly.


Subject(s)
COVID-19 , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Cholecystitis , Acute Disease , Aged , COVID-19/epidemiology , Cholecystectomy, Laparoscopic/methods , Cholecystitis/epidemiology , Cholecystitis/surgery , Cholecystitis, Acute/epidemiology , Cholecystitis, Acute/surgery , Communicable Disease Control , Germany/epidemiology , Humans , Pandemics , Retrospective Studies , Tertiary Care Centers , Treatment Outcome
14.
Urological Science ; 33(1):1-2, 2022.
Article in English | EMBASE | ID: covidwho-1818473
15.
World Journal of Laparoscopic Surgery ; 14(3):V, 2021.
Article in English | EMBASE | ID: covidwho-1771537
16.
British Journal of Surgery ; 109(SUPPL 1):i50, 2022.
Article in English | EMBASE | ID: covidwho-1769150

ABSTRACT

Aim: Determine the percentage of women with groin hernia undergoing laparoscopic repair at RD&E hospital and if it was offered during clinic visit. Background: The lifetime risk of groin hernia in women is 3-5.8%. The incidence of missed femoral hernia at re-operation after open repair in women is 41%. The HerniaSurge group has recommended laparoscopic repair of all groin hernias in women as it offers opportunity to identify all types of groin hernias and reduces post-operative pain and recurrence. Method: All female patients undergoing groin hernia surgery at RD&E hospital from 1 Feb 2018-31 Jan 2020 were identified. Patients undergoing surgery after this period were not included as the surgical practice was changing due to COVID-19 pandemic. Electronic patient records including clinic letters, operative notes, radiology reports and follow up letters were reviewed. Results: 117 female patients undergoing groin hernia repair were identified. During clinic visit, rationale for laparoscopic surgery was documented only in 29/117 while discussion regarding material risks of surgery was documented in 51/117. Only 41/117 (35%) patients underwent laparoscopic hernia repair. Conclusion and second cycle: The current practice at RD&E requires improvements in terms of documentation of material risks associated with groin hernia repair and offering laparoscopic repair for women with groin hernias. For the next cycle, we aim to present at the local audit meeting and then collect further data to evaluate improvements in practice. We also aim to create a standardised electronic clinic letter and operative note format to bring uniformity of care.

17.
Surg Endosc ; 36(9): 6368-6376, 2022 09.
Article in English | MEDLINE | ID: covidwho-1606260

ABSTRACT

BACKGROUND: The COVID-19 pandemic challenges our ability to provide surgical education, as our ability to gather and train together has been restricted due to safety concerns. However, the importance of quality surgical education has remained. High-fidelity simulation platforms have been developed that merge virtual reality video streams to allow for remote instruction and collaboration. This study sought to validate the use of a merged virtual reality (MVR) platform for the instruction and assessment of the fundamentals of laparoscopic surgery (FLS) skills. METHODS: This was a prospective randomized controlled non-inferiority study. Thirty participants were randomized between three groups: The standard group received in-person instruction and expert feedback, the experimental group received identical training via the MVR platform, and the control group practiced on their own, but received no feedback. All participants were pre-tested for baseline performance at the beginning of the study. Change in performance was evaluated immediately after training and one month later for retention. Ordinary one-way analysis of variance was used to evaluate the effects of time, group, and time-on-group. RESULTS: The pre-test confirmed baseline homogeneity between the groups. MVR was non-inferior to standard in-person training for total FLS times on either the post-test (p = 0.632) or the retention test (p = 0.829). Performance was also identical between MVR and standard training groups for each of the individual FLS tasks. Each group improved significantly in nearly all tasks after practice; however, the standard and MVR training groups both improved significantly more than controls for the ligating loop, extracorporeal suturing, intracorporeal suturing, and total FLS task training but did not reach statistical significance for peg transfer and pattern cut tasks. CONCLUSION: This randomized, controlled trial has demonstrated the use of an MVR platform as non-inferior to in-person instruction for the FLS program, forming the foundation for future work on remote instruction and collaboration.


Subject(s)
COVID-19 , Laparoscopy , Virtual Reality , Clinical Competence , Humans , Laparoscopy/education , Pandemics , Prospective Studies
18.
Critical Care Medicine ; 50:103-103, 2022.
Article in English | Academic Search Complete | ID: covidwho-1592451

ABSTRACT

Laparoscopic cholecystectomy (LC), one of the most common surgical procedures performed in the U.S., offers a window into the effects of the pandemic on routine surgical care. To chart the performance rate of LC, we used 4 sequential temporal phases based on statewide incidence data on COVID-19: pre-pandemic, 1st peak, recovery, and 2nd peak. The purpose of our study was to analyze the effects of the COVID-19 pandemic at a Level-1 trauma center on the performance rate of LC over time. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

19.
British Journal of Surgery ; 108(SUPPL 7):vii170, 2021.
Article in English | EMBASE | ID: covidwho-1585092

ABSTRACT

Introduction: Ingestion of foreign bodies are not uncommon, however enterohepatic migration of fish bones causing liver abscesses remains a rare phenomenon. Case Report: We present the case of a 58-year-old female admitted with 11 days history of fever, rigors, shortness of breath and malaise associated with vomiting and diarrhoea. Her COVID-19 rapid antigen test was negative. She was tender in the left lower quadrant of her abdomen and inflammatory markers were markedly high so initial differential diagnosis included colitis and diverticulitis. Contrast Computed Tomography of the abdomen and pelvis showed an 8.1cm irregular hepatic lesion initially thought to be a multiloculated abscess, malignancy or complex cyst. She was started on broad-spectrum antibiotics, escalated to Intensive Care Unit (ICU) and discussed at the hepato-biliary multi-disciplinary team (MDT) where magnetic resonance images demonstrated a perforated duodenum from a 2.5cm fish bone penetrating from the duodenal wall into the liver parenchyma causing a necrotic abscess. She underwent percutaneous drainage of the hepatic abscess. Endoscopic retrieval was then attempted;however, the fish bone was not visualised. Definitive management followed with laparoscopic removal of the fish bone and primary duodenal repair. Discussion: Identification of the cause of the abscess during MDT discussion enabled prompt source control which was key in managing intra- abdominal sepsis - radiological drainage in the first instance prevented secondary peritonitis from a potentially ruptured abscess and enabled the patient to be de-escalated from ICU. Previous literature suggests endoscopic retrieval however, laparoscopic surgery remains safer for managing complications following removal of sharp foreign bodies.

20.
British Journal of Surgery ; 108(SUPPL 7):vii108, 2021.
Article in English | EMBASE | ID: covidwho-1585084

ABSTRACT

Aims: According to Good Surgical Practice set by the RCS England, surgeons need to keep themselves up to date and maintain the competence in all areas of their practice. Literature and guidelines recommended the use of AirSeal insufflation in laparoscopic surgery for the safety during the first surge of Covid-19. Our objectives were to measure the level of knowledge and confidence of surgical trainees in using the AirSeal insufflation system in laparoscopic surgery at our institution and to help trainees achieve competence. Method: Multiple small group training sessions were delivered to 14 surgical doctors adhering to safety protocols. The concept of the AirSeal insufflation system, its benefits, limitations, set up and troubleshooting were delivered using lectures, videos and hands-on training. The change in level of knowledge and confidence in practical skills were assessed by analyzing the responses to the questionnaire completed before and after the course. Results: • 60% reported increase in knowledge of the AirSeal system • 50% reported increase in confidence of the practical skills • The mean rating for usefulness and satisfaction of the advanced training sessions was 9 out of 10. Conclusion: The dramatic improvement in self-perceived confidence of practical skills and knowledge of the AirSeal system was achieved among surgical doctors. Adaptation to the situation and introduction of this advanced technology to the trainees in elective and emergency settings helped promote the skills and safety at workplace during this pandemic especially with the support of flexible training sessions.

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