Effect of different impression techniques on the dimensional accuracy of impressions using various elastomeric impression materials: an in vitro study.

UNLABELLED: Production of exemplary crowns and fixed partial dentures depends upon the usage of impression material and its technique of usage that accurately reproduces prepared teeth and their relationship to the adjacent oral structure. AIM: To evaluate the linear dimensional accuracy of the elastomeric impressions using various impression techniques using different combinations of viscosities of impression materials. MATERIALS AND METHODS: Crown preparation was done in a dentulous acrylic resin denture base model with six natural teeth embedded into it was made to represent the dentulous maxillary arch. A total of 55 impressions were obtained and poured in die stone using various impression techniques with different combinations of viscosities of impression materials. RESULTS: Among the six techniques used, the heavy body light body two-step technique using custom tray showed the least distortion which was closely followed by the putty wash two-step technique with 2 mm spacer using stock tray. CONCLUSION: The study revealed that the heavy body light body two-step technique with custom tray provided the best results. CLINICAL SIGNIFICANCE: Dimensional accuracy of impressions is very much required for precisely fitting of prosthesis. This study may be helpful to select the technique and materials as per clinical requirement of accuracy of impressions.

Surgical staging of endometrial cancer: robotic versus open technique outcomes in a contemporary single surgeon series.

Patients prefer robotic surgery due to perceived cosmetic advantages and quicker resumption of regular activity. We compared the results of hysterectomy and surgical staging for endometrial cancer using robotic versus open techniques in patients operated on by a single surgeon. A retrospective clinical data analysis was performed of all patients who underwent surgical staging for endometrial cancer. Patients selected for open techniques underwent surgery between January 2003 and December 2005, whereas patients selected for da Vinci robotic surgery were operated on between June 2006 and June 2008. The study was approved by the Institutional Review Board (IRB). The preoperative diagnosis of endometrial cancer was confirmed using endometrial biopsy. Data were collected and comparative analyses were made using mean or chi-squared test or other appropriate statistical techniques. The study population consisted of 97 patients (open, N = 38; robotic, N = 59). Mean age was 66.5 ± 1.97 versus 59.5 ± 1.43 years, mean parity was 2.11 versus 1.93, and mean body mass index (BMI) was 32.2 ± 2.03 versus 39.3 ± 2.03 (P = 0.02) for open versus robotic surgery, respectively. Operating time and lymph node (LN) yield was 175.24 ± 4.6 versus 185.27 ± 4.4 min, number of pelvic LNs were 8.6 versus 11.34, and aortic LNs were 3.5 versus 1.9 in the open versus robotic groups, respectively. Although mean BMI was higher, blood loss, complications, and hospital stay were significantly lower for patients undergoing robotic surgery. Overall, complications occurred in 5/38 (13%) patients in the open group and 2/59 (3%) patients in the robotic group. Of the two complications in the robotic group, there was one injury to the external iliac vein requiring open surgical management with blood transfusion resulting in a hospital stay of 7 days; however, no other patient required blood transfusion in either surgical group. Robotic surgery results in less blood loss and shorter hospital stay and yields comparable number of lymph nodes, which are adequate for staging. It also results in reduced surgical risks in patients with higher BMI who are prone to higher co-morbidities. Robotic surgery is a useful minimally invasive tool for the comprehensive surgical staging of patients with endometrial cancer.

Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant.

Laboratory studies are commonly performed after surgery, but with little evidence of clinical utility. We evaluated our experience with measuring a complete blood count (CBC) to determine peripheral blood leukocyte count (WBC) postoperatively following consecutive robotic hysterectomies. From January 2008 through November 2009, two surgeons (KM, HM) performed 204 robotic hysterectomies. Patient age, weight, height, indication for surgery, surgical procedure, operative time, estimated blood loss, hospital length of stay, postoperative fever, and complications were prospectively recorded and correlated with WBC measured on the day after surgery. The postoperative WBC was elevated (>11,000/µl) in 59/204 (29%) patients. Eight (4%) patients had marked leukocytosis (WBC >15,000/µl; maximum 16,600/µl). There was no correlation between postoperative leukocytosis and operative time, BMI, performance of lymphadenectomy, or length of hospitalization. The only factor significantly associated with elevated postoperative WBC was elevated preoperative WBC (P < .001). Also, there was no correlation between postoperative leukocytosis with fever or infectious complications. The mean T max was 37.1ºC and T max over 38ºC was seen in nine patients. Of the five women who developed infectious complications, only one (diagnosed with pneumonia) had a minimally elevated postoperative WBC (11,600/µl); the other four (pneumonia and pelvic abscess, two each) had normal postoperative WBC. Routine measurement of WBC after robotic hysterectomy is not useful. In about 25% of cases there will be a slight leukocytosis, and rarely (about 4%) will the WBC exceed 15,000/µl. In no case was measurement of postoperative WBC clinically relevant.