Risk management for surgical energy-driven devices used in the operating room.

Complications related to energy sources in the operating room are not well-recognized or published, despite occasionally dramatic consequences for the patient and the responsible surgeon. The goal of this study was to evaluate the risks and consequences related to use of energy sources in the operating room. PATIENTS AND METHODS: Between 2009 and 2015, 876 adverse events related to health care (AERHC) linked to energy sources in the operating room were declared in the French experience feedback data base "REX". We performed a descriptive analysis of these AERHC and analyzed the root causes of these events and of the indications for non-elective repeat operations, for each energy source. RESULTS: Five different energy sources were used, producing 876 declared AERHC: monopolar electrocoagulation: 614 (70%) AERHC, advanced bipolar coagulation (thermofusion): 137 (16%) AERHC, ultrasonic devices: 69 (8%) AERHC, traditional bipolar electrocoagulation: 32 AERHC, and cold light: 24 AERHC. The adverse events reported were skin burns (27.5% of AERHC), insulation defects (16% of AERHC), visceral burns or perforation (30% of AERHC), fires (11% of AERHC), bleeding (7.5% of AERHC) and misuse or miscellaneous causes (8% of AERHC). For the five energy sources, the root causes were essentially misuse, imperfect training and/or cost-related reasons regarding equipment purchase or maintenance. One hundred and forty-six non-elective procedures (17% of AERHC) were performed for complications related to the use of energy sources in the operating room. CONCLUSION: This study illustrates the risks related to the use of energy sources on the OR and their consequences. Most cases were related to persistent misunderstanding of appropriate usage within the medical and paramedical teams, but complications are also related to administrative decisions concerning the purchase and maintenance of these devices.

"Wrap technique": a new operative procedure using a self-adhesive prosthesis for laparoscopic ventral rectopexy.

The aim of the present study was to describe and assess a new method of fixation using a self-adhesive prosthesis (Adhesix(™)) in laparoscopic ventral rectopexy (LVR). The technical principles are based on a very low dissection and the adhesive properties of the prosthesis which can be applied to the rectum without stitches or staples. The prosthesis is made from polypropylene coated with a synthetic hydrogel. The binding of the prosthesis to rectum and vagina takes place in a wet environment after a few minutes and enables the shaping of the mesh on the surface of the rectum (wrap effect). Between March 2010 and March 2013, 41 patients were operated on using LVR with a self-adhesive prosthesis. The effectiveness of prosthesis fixation was evaluated in a subset of 27 patients suffering from complete rectal prolapse. With a median follow-up of 30 months, there were no major complications and no recurrence. In this initial experience, LVR with a self-adhesive prosthesis does not increase the risk of recurrence. No undesirable effects were associated with the prosthesis.

Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique.

An international working party with experience in the performance of an alternative haemorrhoid operation through the use of the circular stapler was convened for the purpose of developing a consensus as to the criteria for undertaking this procedure. The agenda consisted of first, naming the operation; second, the indications and contra-indications for its performance; and third, the preferred surgical technique. Among the recommendations for individuals who plan to embark on this surgery are that experience with anorectal surgery and an understanding of anorectal anatomy are requisites; experience with circular stapling devices is essential; and the surgeon must attend a formal course which should include lectures, videos, the application of the instrument in models, and observation of the operation as performed by a surgeon recognized by his or her peers-leading ultimately to undertaking the procedure while being observed by an experienced surgeon. Following satisfactory completion of the above, independent responsibility should be determined by an individual's department of surgery.

Circular stapled anopexy for haemorrhoidal disease: results.

OBJECTIVE: Stapled anopexy is a new approach for haemorrhoids requiring surgical treatment. This study reviews the available information concerning the present results of this procedure. METHODS: Medline and hand search of the literature was conducted to identify available information on the procedure, with a special interest for the on-going or published randomized clinical trials. RESULTS: The advantages of the stapled approach of haemorrhoids were analyzed in the different areas of concern, including postoperative pain reduction, length of hospital stay and sick-leave, postoperative wound care and type and rate of complications. Continence status, symptom cure and patient satisfaction following stapled anopexy are also reported. CONCLUSION: Stapled anopexy is probably less painful than conventional haemorrhoidectomy. Other advantages in the short term result from this new approach. Long term efficacy of the procedure is still unknown.

[Treatment of hemorrhoids with the Longo technique. Preliminary results of a prospective study on 94 cases]. / Le traitement de la maladie hémorroïdaire par la technique de Longo. Résultats préliminaires d'une étude prospective portant sur 94 cas.

AIM OF STUDY: The aim of this multicenter prospective study was to report the early results of Longo procedure for the surgical treatment of hemorrhoids disease. PATIENTS AND METHOD: From April 1998 to July 1998, 94 patients (60 men and 34 women with a mean age of 47 years) were treated according to Longo procedure for a mucosal prolapse (12 grade II, 63 grade III, and 19 grade IV). All patients were evaluated at 2 and 6 postoperative months. The technique consisted in the reduction of mucosal and hemorrhoidal prolapses with a circular suturing device. RESULTS: Postoperative morbidity rate was 6.3% (n = 6). A rectal bleeding occurred within 12 hours after surgery in five patients. The mean postoperative length of hospital stay was 36 hours (range: 24-72 hours). The only antalgic prescribed was paracetamol. Local care was not necessary in any patient. After 6 months, 89 patients (94.7%) were very satisfied, three patients (3.2%) were satisfied (rectal sub-mucosal abscess in one case, functional troubles in two cases) and two patients (2.1%) were not satisfied (persistence of mucosal prolapse). CONCLUSION: These preliminary results are satisfactory but need to be confirmed by a prospective randomized trial, comparing Milligan Morgan procedure and Longo procedure.

[Elective cholecystectomy by celioscopy versus subcostal approach cholecystectomy. Comparative study of postoperative pain and discomfort]. / Cholécystectomie élective par coelioscopie versus abord sous-costal. Etude comparative de la douleur et du confort post-opératoire.

The aim of this prospective study was to evaluate postoperative pain and discomfort in 70 patients undergoing cholecystectomy. The choice of surgical approach was left to the surgeon. Accordingly, these patients were then divided in two groups: laparoscopic cholecystectomy (group I; n = 37); classic cholecystectomy (subcostal incision) (group II; n = 33). There was no significant difference between these groups concerning weight/height ratio, size and number of stones. Patients in group II were older (55 +/- 16 years) than those in group I (46 +/- 11 years) (P < 0.01). The mean duration of surgery was shorter in group II (96 +/- 31 min) than in group I (119 +/- 49 min) (P < 0.01). Postoperative discomfort was evaluated by (group I versus group II respectively): a) the mean length of hospital stay after surgery (3.7 +/- 1.5 versus 6.7 +/- 1.1 days, P < 0.02); b) the mean delay to return of intestinal motility (1.5 +/- 0.6 versus 2.0 +/- 0.6 days, P < 0.001); c) the mean perfusion time (1.4 +/- 0.6 versus 2.6 +/- 0.8 days, P < 0.001); d) intensity of postoperative pain which was evaluated daily. There was no significant difference between these two groups concerning the use of analgesics; however, a statistically significant difference was found in the visual and verbal scales, starting on the second postoperative day and in autonomy as early as the first postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)

[Elective surgical treatment of colonic diverticulosis]. / Traitement chirurgical électif de la diverticulose colique.

In a retrospective study from 1978 to 1990, 143 patients had elective surgery for colonic diverticular disease. Surgical indications were: uncomplicated diverticulitis (128), functional discomfort (6), suspicion of associated neoplasia (6), bleeding (3). The overall mortality is 1/143 (0.6 p. cent). 3 patients (2.2 p. cent) had to be reoperated for anastomotic fistula with peritonitis. Definitive re-establishment of digestive continuity was done in 139 patients (98.6 p. cent). Our results suggest that surgery is to be widely indicated for diverticular disease. Resection must be performed in every patients presenting with an history of two or more acute recurrences, with a fistula, and when clinical and/or radiological abnormalities continue after a first acute crisis.

[Role of echotomography in the diagnosis of renal masses. Comparative study with computerized tomography, arteriography and anatomopathological studies (100 cases)]. / Place de l'échotomographie dans le diagnostic des masses rénales. Etude comparative avec la tomodensitométrie, l'artériographie et l'examen anatomo-pathologique (cent cas).

The authors have selected a series of 100 recent cases of solid and fluid-filled tumors, all of which were explored by nephro-urotomography and ultrasound. These two procedures constituted the basis of the examination. In case of doubt, they had recourse to CT scans. They consider that arteriography is likely to become exceptional.