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Operating Time (operating + time)
Kinds of Operating Time Selected AbstractsBipolar Microdebrider Reduces Intraoperative Blood Loss and Operating Time during Nasal Polyp SurgeryTHE LARYNGOSCOPE, Issue S1 2009Nishant S. Kumar BA No abstract is available for this article. [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] Laparoscopic cytoreductive nephrectomy with cytokine therapy for metastatic renal cell carcinomas compared with open nephrectomyASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2010T Fujita Abstract Introduction: We retrospectively reviewed and compared the operation records and long-term results of patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy and those who underwent open procedure. Methods: A total of 75 patients with mRCC who underwent cytoreductive nephrectomy between 1997 and 2007 were studied: 23 patients in the laparoscopy group (LCN group) and 52 in the open group (OCN group). Most patients received interferon-based cytokine therapy after surgery. Patients with tumor thrombus in the inferior vena cava were excluded from this study. Results: Operating time in the LCN group was significantly longer than in the OCN group (320.3 min vs 269.6 min, P=0.049). Blood loss was less in the LCN group (527.8 ml) than in the OCN group (1372.3 ml, P=0.072). Convalescence was shorter in the LCN group (18.1 d) than in the OCN group (32.9 d, P<0.0001). Median follow-up periods were 15 months (range 2,110 months) and 17 months (range 1,103 months) in the LCN group and OCN group, respectively. There was no statistically significant difference between the two groups with regard to disease-specific patient survival and progression-free survival. Conclusions: Laparoscopic cytoreductive nephrectomy is a feasible alternative for patients with mRCC because its benefits include less blood loss and shorter convalescence. In addition, the long-term oncological results of laparoscopic cytoreductive nephrectomy are comparable to those of the open procedure. [source] Safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles in vaginal hysterectomy: randomised controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2005M.A. Hefni Objective To assess the safety and efficacy of using the LigaSure vessel sealing system for securing the pedicles during vaginal hysterectomy in comparison with the conventional method of securing the pedicles by suture ligation. Design Randomised controlled trial. Setting Gynaecology Department, Benenden Hospital, Kent. Population One hundred and sixteen women undergoing vaginal hysterectomy were prospectively randomised to either LigaSure (Group I) or suture ligation (Group II) for securing the pedicles. Methods Data of patients were collected prospectively. Statistical analysis was performed using the Mann,Whitney U test, ,2 and Fisher's exact test as appropriate. Main outcome measures Operating time, operative blood loss and peri-operative complications. Results The operating time was significantly shorter in the LigaSure group compared with the control group (P < 0.04). There was no statistical significant difference between the two groups in operative blood loss (P= 0.433), but peri-operative haemorrhagic complications were less frequent in the LigaSure group (0%vs 6.8%, P= 0.057). Four patients in the control group required either conversion to laparotomy because of bleeding, return to theatre for immediate post-operative haemorrhage or readmission for vault haematoma, whereas none in the LigaSure group had bleeding from unsecured pedicles. Conclusion The LigaSure vessel sealing system is a safe alternative for securing pedicles in vaginal hysterectomy when compared with conventional suture ligation. Larger studies are required to determine its place in gynaecological surgery. [source] Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux disease,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2004R. Ackroyd Background: The aim of this study was to compare laparoscopic and open Nissen fundoplication for gastro-oesophageal reflux disease in a randomized clinical trial. Methods: Ninety-nine patients were randomized to either laparoscopic (52) or open (47) Nissen fundoplication. Patients with oesophageal dysmotility, those requiring a concurrent abdominal procedure and those who had undergone previous antireflux surgery were excluded. Independent assessment of dysphagia, heartburn and patients' satisfaction 1, 3, 6 and 12 months after surgery was performed using multiple standardized clinical grading systems. Objective measurement of oesophageal acid exposure and lower oesophageal sphincter pressure before and after surgery, and endoscopic assessment of postoperative anatomy, were performed. Results: Operating time was longer in the laparoscopic group (median 82 versus 46 min). Postoperative pain, analgesic requirement, time to solid food intake, hospital stay and recovery time were reduced in the laparoscopic group. Perioperative outcomes, postoperative dysphagia, relief of heartburn and overall satisfaction were equally good at all follow-up intervals. Reduction in oesophageal acid exposure, increase in lower oesophageal sphincter tone and improvement in endoscopic appearances were the same for the two groups. Conclusion: The laparoscopic approach to Nissen fundoplication improved early postoperative recovery, with an equally good outcome up to 12 months. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissorsINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006AHMET TEFEKLI Objectives:, To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors. Methods:, Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed. Results:, One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 ± 16.7 min (range, 50,135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 ± 0.9 days (range, 1,4). After a mean follow up of 14.3 ± 5.9 months (range, 3,24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney. Conclusions:, Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved. [source] Review of the Liposuction, Abdominoplasty, and Face-Lift Mortality and Morbidity Risk LiteratureDERMATOLOGIC SURGERY, Issue 7 2005Robert A. Yoho MD Background The statistical discrepancies that exist in the mortality and morbidity risk literature are such that surgeons and patients cannot accurately assess the true risk rates associated with plastic surgery procedures. Objectives and Methods To review any relevant literature published to date in which the risk rates from liposuction, abdominoplasty, and rhytidectomy are cited and to reassess these figures alongside those published for both elective and emergency general surgeries. Results and Conclusion Despite the lack of reliable, comprehensive reporting of deaths and complications resulting from cosmetic surgeries, published data demonstrate that the risks associated with liposuction and rhytidectomy compare favorably with those from most general surgical procedures. In contrast, the morbidity and mortality rates from abdominoplasty remain unacceptably high. A significant lack of literature documenting cosmetic breast implant surgery and blepharoplasty risks is observed, which should be of concern to both patients and physicians. Liposuction and face-lift surgery data generally show that surgical centers are statistically safer than hospital operating rooms, although the data have not been standardized for the patients' American Society of Anesthesiologists (ASA) risk class, the health of the patient prior to surgery. General anesthesia may carry a risk roughly equivalent to or perhaps greater than cosmetic surgery, although, again, ASA class variables confound clear comparison between studies. Recent anesthesia literature refutes the many claims that general anesthesia risks are now remote: a landmark study that surveyed the entire scholarly literature showed a mortality rate of 1 in 13,000, roughly similar to overall cosmetic surgery mortality risks. Moreover, a prolonged operating time has been repeatedly implicated in other surgical literature to be related to morbidity and mortality. The latter certainly has relevance to cosmetic surgery. [source] A critical path method for the estimation of service restoration time in power distribution systemsEUROPEAN TRANSACTIONS ON ELECTRICAL POWER, Issue 4 2008C. Lakshminarayana Abstract Distribution systems (DSs) are invariably subjected to various types of faults, causing power blackouts to occur. Distribution Engineers have the main responsibility to minimizing the duration of these power blackouts. This minimization can be achieved by the detailed study of pre-fault load condition of the DS, isolating the faulted section, and restoring the supply to healthy sections of the DS. Hence the estimation of service restoration time (SRT) is very important in electrical distribution systems (EDS). The estimation of SRT requires detailed knowledge of the commencement time of the emergency diesel generator (EDG) in EDS and also the operating time of the various relays in EDS. This paper introduces a new concept of optimistic time (OT), pessimistic time (PT), and most likely time (MT) of starting of the EDGs in addition to the OT, PT, and MT of the operation of the relays. The proposed concept is tested on 14-bus, 17-bus, and 29-bus distribution networks. The results reveal that it is highly suitable technique for the estimation of SRT under abnormal conditions. Hence this technique can easily be improved in distribution automation/service restoration algorithms. Copyright © 2007 John Wiley & Sons, Ltd. [source] Novel modelling of residual operating time of transformer oilEUROPEAN TRANSACTIONS ON ELECTRICAL POWER, Issue 4 2003M. A. A. Wahab This paper presents techniques developed to accurately model the characteristics of transformer oil for the purpose of predicting the effect of aging on these characteristics. Aging causes some of the transformer oil characteristics to violate the internationally specified limits. The purpose of this simulation is to develop alternative techniques to predict the operating time after which these characteristics would violate the limits. The results obtained from monitoring of twenty in-service power transformers for long period of operating time up to ten years have been implemented in developing the proposed models. The physical, chemical and electrical characteristics have been determined periodically by internationally specified testing methods. The patterns of violation sequence of the standard limits, against operating time, by different transformer oil characteristics have been revealed and the most common pattern has been determined. The definition of residual operating time (trot) of the different transformer oil characteristics has been introduced. The choice of transformer oil breakdown voltage trot to represent that of the transformer oil characteristics has been justified. Modelling of trot as a function of transformer oil breakdown voltage, total acidity and water content by multiple-linear regression has been proposed and verified. Also, polynomial regression model of trot as a function only of transformer oil breakdown voltage has been given. The accuracy and applicability of these models and the different modelling techniques have been discussed and proved. [source] Efficacy of ProTaper Universal rotary retreatment system for gutta-percha removal from root canalsINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2008L.-S. Gu Abstract Aim, To evaluate the efficacy of the ProTaper Universal rotary retreatment system for gutta-percha (GP) removal from root canals. Methodology, Root canals of 60 extracted human maxillary anterior teeth were prepared and filled with laterally condensed GP and AH Plus sealer. Teeth were divided into three groups: group A , GP removal completed with the ProTaper Universal rotary retreatment system and with further canal repreparation accomplished with ProTaper Universal rotary instruments; group B , GP removal was completed using Gates Glidden drills and Hedström files with chloroform as a solvent, followed with further canal repreparation with ProTaper Universal rotary instruments; group C , the same as group B for GP removal with further canal preparation with stainless steel K-flex files (Kerr). The operating time was recorded. Teeth were rendered transparent for the evaluation of the area of remaining GP/sealer in bucco-lingual and mesial,distal directions. Statistical analysis was performed by using repeated measures analysis of variance and anova. Results, The ProTaper Universal technique (group A) resulted in a smaller percentage of canal area covered by residual GP/sealer than in groups B and C, with a significant difference between groups A and C (P < 0.05). Mean operating time for group A was 6.73 min, which was significantly shorter (P < 0.05) than group B (10.86 min) and group C (13.52 min). Conclusions, In this laboratory study all test techniques left GP/sealer remnants within the root canal. The ProTaper Universal rotary retreatment system proved to be an efficient method of removing GP and sealer from maxillary anterior teeth. [source] Robotic assisted radical cystectomy: short to medium-term oncologic and functional outcomesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2008P. Dasgupta Summary Purpose:, To report short- and medium-term oncological and functional outcomes of the first robotic-assisted laparoscopic radical cystectomy (RARC) series from the UK. Materials and methods:, Thirty patients underwent RARC between 2004 and 2007 at our unit. We report oncological and functional outcomes of this procedure in 20 patients (17 ileal conduit and three Studer Pouches), who have completed at least 6 months of follow up. Results:, There were 17 men and three women, median age 66 years (range 38,77 years). Median operating time was 330 min (range 295,510 min), and median blood loss 150 ml (range 100,1150 ml). There were two major complications (10%); a port site bleed and a rectal injury. The median follow up of this cohort is 23 months (range 7,44 months). One patient died of distant metastases at 8 months, and another developed a right ureteric tumour at 7 months. None of the patients had local pelvic or port site recurrence. The overall and disease-free survival are 95% and 90% respectively. Functional complications included a neovesico-urethral stricture at 3 months, a left upper ureteric stricture at 6 months and an incisional hernia at 12 months. Conclusion:, Robotic-assisted laparoscopic radical cystectomy is an emerging minimally invasive procedure which at short- to medium-term follow up, in our experience, is oncologically and functionally equivalent to open radical cystectomy. [source] Morbidity following dental treatment of children under intubation general anaesthesia in a day-stay unitINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2004S. Atan Summary. Objectives., To determine which variables were best related to the overall morbidity of a child undergoing dental general anaesthetic (GA) and then to use these variables to determine those factors that might influence the extent and severity of morbidity experienced by healthy children following dental GA. Sample and methods., Data were collected on anxiety, pain and morbidity, GA procedure and dental procedure from 121 children attending a day stay GA unit for dental treatment. Patients were interviewed preoperatively, postoperatively before discharge then four further times over the next 148 h. Data were analysed using multivariate regression. Results., Thirty-one per cent of subjects had restorative work, 60% had at least one tooth extracted, 54% had a surgical procedure. Use of local analgesia reduced postoperative pain whilst an increase in the number of surgical procedures increased it. Increase in anaesthetic time was related to increased odds of feeling sleepy and nauseous, females were more likely to complain of sleepiness or weakness. Feelings of dizziness were increased if the patient was given local analgesia during the procedure. Conclusions., Pain following dental GA was the most prevalent and long lasting symptom of postoperative morbidity in this study. Reductions in operating time and improvement in pain control have the potential to reduce reported morbidity following dental GA. [source] Evaluation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycineINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2006KOBAYASHI YASUYUKI Aim: We evaluated the functions of an affected kidney after laparoscopic partial nephrectomy (LPN) using renal scintigraphy with 99mtechnetium-mercaptoacetyltriglycine (99mTc-MAG3). Methods: Split renal function of 10 patients who underwent LPN for renal tumors was assessed using renal scintigraphy with 99mTc-MAG3 before surgery, and 1 week and 3 months post-surgery. Results: Median operating time was 196.5 min, median tumor diameter was 2.3 cm, mean blood loss was 64 mL and mean ischemic time was 38.5 min. Median change in serum creatinine level pre- to post-surgery was 0.15 mg/dL. Median contribution of the affected kidney to total renal function (calculated using 99mTc-MAG3) was 50.0%, 41.7% and 36.1% before surgery, 1 week and 3 months after LPN, respectively. In one patient, the tumor was resected after cooling of the affected kidney with ice slush for 15 min, and the split renal function ratio remained as high as 50% at 3 months post-operatively despite a total ischemic time of 61 min. Conclusions: This paper evaluated renal function on the affected side before and after surgery by measuring split renal function with renal scintigraphy using 99mTc-MAG3. Risk factors for renal dysfunction in the affected kidney after LPN include age over 70 years with more than 30 min warm ischemic time, re-clamping of the renal artery procedure, and a warm ischemic time greater than 60 min. We believe that renal cooling with slush ice prevents renal dysfunction of the affected kidney after LPN with longer warm ischemic times. However, an easier renal cooling technique should be sought for regular use of cooling procedures in LPN. [source] Complications and the learning curve for a laparoscopic nephrectomy at a single institutionINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2006TORU KANNO Background:, We assessed our experiences in performing a laparoscopic nephrectomy, with regard to complications and the learning curve, during a 4-year period. Methods:, Between November 2000 and October 2004, a total of 78 laparoscopic nephrectomies were performed at our institution (37 radical nephrectomies, 30 nephroureterectomies and 11 simple nephrectomies). The patient charts were retrospectively reviewed to identify any operative and postoperative complications, and also to evaluate the operating time. Results:, A total of eleven complications (14.1%) occurred in our series (nine operative and two postoperative complications). All operative complications were due to vascular injuries (n = 9), five (2.6%) of which required an open conversion. The operating time and the rates of complications decreased significantly as the surgeons' experiences increased. Conclusion:, A laparoscopic nephrectomy could be performed as safely as previously reported. In addition, the learning curve for a laparoscopic nephrectomy appeared to be good over the initial 50 procedures at our institution. [source] Hand-assisted retroperitoneoscopic radical nephrectomy: Initial experienceINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2002AKIHIRO KAWAUCHI Abstract Objectives: To report our initial experience of hand-assisted retroperitoneoscopic radical nephrectomy for stage T1 renal tumors. Methods: The clinical data on 22 consecutive patients who had undergone hand-assisted retroperitoneoscopic radical nephrectomy and 22 who had undergone open radical nephrectomy were reviewed. The operation was performed with a hand placed retroperitoneally through a pararectal longitudal 7,7.5 cm incision using a LAP DISC. Results: The total operating time was between 2.3 and 5.8 h (mean: 3.4 h). The estimated blood loss was between 15 and 650 mL (mean: 170 mL). The complication rate was 9% (2/22). No conversions to open procedure occurred. In comparison to open radical nephrectomy, the operating time was similar (3.4 vs 3.9 h) whereas the estimated blood loss was significantly less in this procedure (170 vs 495 mL). During the convalescence period the patients revealed significantly less postoperative pain, shorter intervals to resuming oral intake and more rapid return to normal activities compared to the open radical nephrectomy patients. Conclusion: Hand-assisted retroperitoneoscopic radical nephrectomy is an effective and safe procedure for T1 renal tumors. [source] Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: A phase II study following the learning curveJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2005Michitaka Fujiwara MD Abstract Background and Objectives A preliminary study on the use of laparoscopy-assisted approach to treat gastric carcinoma resulted in higher morbidity. Study Design A prospective phase II study of laparoscopy-assisted distal gastrectomy (LADG) was performed for patients with preoperative diagnosis of T1 N0 stage cancer located in the lower or middle-third stomach. Bleeding amount, operating time, mortality, morbidity, and the number of lymph node retrieval were recorded and compared with the preliminary series reported previously by the same authors. Results Between 2000 and 2002, 47 patients were accrued. The mean blood loss and postoperative hospital stay were significantly decreased compared with the previous series, whereas the operating time was not. There were no in-hospital deaths, with the incidence of anastomotic leakage significantly decreased. All patients remain disease-free to date. Conclusions LADG can be performed safely and morbidity, no longer, is a drawback by experienced hands that have reached plateau of the learning curve, although it remains a time-consuming procedure. Its application to gastric cancer surgery is feasible for early stage cancer, and its applicability to the treatment of T2 stage cancer will be the next issue to be explored. J. Surg. Oncol. 2005;91:26,32. © 2005 Wiley-Liss, Inc. [source] Surface anisotropy for monitoring the wear of IC engine cylindersLUBRICATION SCIENCE, Issue 1 2004C. Pandazaras Abstract The present work proposes a methodology for monitoring the wear of internal combustion engine cylinders. This could be useful in calculating the time at which maintenance should be done on such a tribosystem or in determining its lifetime. On the basis of experimental data obtained using a friction,wear simulator, and through the determination of certain standardised and non-standardised micro-geometric parameters of the cylinder surface that change with respect to operating time, it is shown that the characteristic that exhibits the most variation is the cylinder surface anisotropy. This factor participates to a large degree in the partial hydrodynamic lubrication mechanism of the reciprocating piston ring system and, as it is associated with the stage of wear, better expresses the characteristics of the cylinder's worn surface. As a consequence, by prescribing a limit for the maximum acceptable anisotropy as a basic criterion, the ultimate tolerable stage of wear is controlled simultaneously and vice versa. [source] Acute airway obstruction in an infant with Pierre Robin syndrome after palatoplastyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2004C. Dell'Oste This report describes a complication of post-operative oedema of the palate, tongue and pharynx after a Perko-revised cleft palate repair, which resulted in a life-threatening airway obstruction in an infant with Pierre Robin syndrome. Although infants experiencing airway problems after Wardill,Kilner, von Langenbeck and Furlow palatoplasty have been described, airway complications in a group of Perko-revised repair children have not been previously reported. We speculate that this complication, which occurred in the absence of a history of previous airway problems, is due to prolonged operating time and excessive pressure exerted on the base of the tongue by the Kilner,Doughty retractor. Acknowledgments of this risk permits to identify those patients prior to surgery so that they can be managed appropriately. [source] Theatre times and delays in elective oral and maxillofacial listsORAL SURGERY, Issue 4 2009W. Aleid Abstract Aim:, Cancelled operations are a major drain on hospital resources. The maxillofacial department at the Leicester Royal Infirmary (LRI) performs at least 14 elective operating sessions each week. A study reported that our cancellation rate or performance indicator (PI) was 0.3% at LR1. The most common reasons for cancellation of procedures at that time were lack of post-operative beds and insufficient operating time. This study aimed to continue to develop a methodology for looking at this complex issue and to further investigate the reasons for delay to assess whether the system could be managed more efficiently. Material and Methods:, In this study, the computerised theatre records system has been utilised to investigate the reasons for theatre delays. A retrospective analysis of data for 1212 patients treated in the 1 year period between December 2006 and December 2007 was performed. Results and Conclusions:, Eight hundred and forty-nine patients were treated on a day-surgery basis, of which 710 were dentoalveolar procedures and 139 were other operations. The remaining 363 patients were treated as in-patients of which 97 were oncological patients, 84 orthognathic, 35 salivary gland surgery, 65 traumas, and 82 other operations. Sixty-four (5.28%) of these treatment episodes were logged as delayed. The main reasons for delays were related to the ward (17%) or anaesthetist (22%). The operating time consumed 74% of the overall time in theatre complex. The utilisation of operating time was much better for in-patient operations (81%) than day-surgery procedures (64%). Suggestions have been made to reduce theatre delays. [source] Mandibular reconstruction after resection of benign tumours using non-vascularised methods in a series of patients that did not undergo radiotherapyORAL SURGERY, Issue 1 2009D. Mehrotra Abstract Aim:, A case series analysis of 52 consequent subjects of immediate mandibular reconstruction after tumour resection using non-vascularised methods, undertaken at U.P. King George's University of Dental Sciences and King George's Medical University, is being reported. To assess the success of reconstruction on subjective and objective evaluation based upon Mandibular Reconstruction Assessment Scale (MRAS) questionnaire. Methods:, Patients with benign mandibular tumours irrespective of age, sex, site and socio-economic status were included. Primary reconstruction was carried out after resection in two surgical units on surgeon's choice using stainless steel wire (6/52; 12%), stainless steel reconstruction plate (10/52; 19%) or titanium reconstruction plate (36/52; 69%) without bone graft (23/52; 44%) or with bone graft (29/52; 56%). Bone grafts were harvested from iliac crest (21/52; 40%), rib (2/52; 4%) and an additional pectoralis major myocutaneous flap with iliac crest bone graft (6/52; 12%) to provide cover to the reconstruction plate was also used. Results:, The primary outcome measurements were wound healing, mouth opening, chewing efficiency, jaw movements, cosmetic achievement and speech on a five-point scale, all of which improved significantly after surgery. The overall complication rate was 17%. Three patients (6%) had loosening of the screw, two (4%) showed dehiscence of the plate, two (4%) showed tumour recurrence and one (2%) had infection of the graft that was subsequently removed. Conclusion:, Titanium reconstruction plates with iliac crest graft provided good result in the absence of microvascular reconstruction because of unavailable long operating time and lack of expertise. Long-term satisfactory rehabilitation can be achieved using removable dentures or prosthesis on dental implants on the contraption provided by the non-vascularised tissue despite non-calcified bone visible on the skiagram. [source] Properties of the Duane plot for repairable systemsQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 1 2002Steven E. Rigdon Abstract The Duane plot is a plot of cumulative operating time against the cumulative failure rate on double logarithmic axes. It is often claimed that the power law process, a non-homogeneous Poisson process with intensity function , implies a linear Duane plot. We show that this implication and its converse are false. Copyright © 2002 John Wiley & Sons, Ltd. [source] Groundwater circulation well operation using wind turbine,generated energyREMEDIATION, Issue 3 2008Ron Gallagher An investigation was conducted regarding the potential economic benefits associated with using a wind turbine to power a groundwater circulation well (GCW) at the former Nebraska Ordnance Plant Superfund site. The first phase of the investigation used a 10-kilowatt-rated grid inter-tie wind turbine to partially offset the purchase of electricity from the utility company. The second phase consisted of the conversion of the grid inter-tie system to an off-grid system that stored energy using batteries. During the second phase, the GCW system was operated using either wind turbine power or utility power, and the other system components were operated using utility power. The study showed that a significant amount of power purchased from the utility company was used for nonessential purposes (other than operating the GCW pump and essential treatment components). One nonessential power consumer was the continuous heating of the equipment shelter for operator comfort during their 10-minute visit every few days. Wind-turbine reduction in utility power consumption was evaluated, and the operating time of a hypothetical system powered solely by the wind turbine was compared to the actual GCW operating time. This study indicates that retrofitting this GCW system did not economically offset power costs from a cheap, readily available grid system. Perhaps at a remote location with a more energy-efficient design and operation and the inclusion of green power benefits (in some monetary amount), the wind turbine results will be more favorable. The study of a renewable energy application at the site highlighted opportunities for significant electrical energy savings regardless of the source of the electricity. © 2008 Wiley Periodicals, Inc. [source] ENT challenges at the small scaleTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 2 2007C. J. Coulson Abstract Background In this paper we consider two relatively frequently performed operations in the field of ear, nose and throat (ENT) surgery and consider how they could be improved by using robotic applications. We consider currently available robots and propose theoretical robotic solutions. Methods The application of robotic systems for both cochlear implantation and endoscopic sinus surgery was considered. Currently available robotic systems were reviewed and those with potential use in ENT surgery were identified. For aspects of operations where there is no available technology, hypotheses are presented on how robots could help. Results Three robotic systems were identified with potential usage in ENT: the PathfinderÔ neurosurgical robot, the Acrobot® knee replacement system and the autonomous smart drill for drilling a cochleostomy. Conclusions The challenge for the future of ENT is being able to perform tasks beyond the level of human perception and abilities. The examples presented here demonstrate that microtechnologies could be used to reduce complications, decrease operating time and improve clinical results. Copyright © 2007 John Wiley & Sons, Ltd. [source] Technical Aspects of Unilateral Dual Kidney Transplantation from Expanded Criteria Donors: Experience of 100 PatientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010B. Ekser One option for using organs from donors with a suboptimal nephron mass, e.g. expanded criteria donors (ECD) kidneys, is dual kidney transplantation (DKT). In adult recipients, DKT can be carried out by several techniques, but the unilateral placement of both kidneys (UDKT) offers the advantages of single surgical access and shorter operating time. One hundred UDKT were performed using kidneys from ECD donors with a mean age of 72 years (Group 1). The technique consists of transplanting both kidneys extraperitoneally in the same iliac fossa. The results were compared with a cohort of single kidney transplants (SKT) performed with the same selection criteria in the same study period (Group 2, n = 73). Ninety-five percent of UDKTs were positioned in the right iliac fossa, lengthening the right renal vein with an inferior vena cava patch. In 69% of cases, all anastomoses were to the external iliac vessels end-to-side. Surgical complications were comparable in both groups. At 3-year follow-up, patient and graft survival rates were 95.6 and 90.9% in Group 1, respectively. UDKT can be carried out with comparable surgical complication rates as SKT, leaving the contralateral iliac fossa untouched and giving elderly recipients a better chance of receiving a transplant, with optimal results up to 3-years follow-up. [source] Gyrus PlasmaKinetic bipolar coagulation device for liver resectionANZ JOURNAL OF SURGERY, Issue 3 2010Jeremy Tan Abstract Background:, Liver parenchymal transection can be associated with significant blood loss and morbidity. We present our initial experience with the Gyrus PlasmaKinetic coagulation device in liver parenchymal resection in both cirrhotic and non-cirrhotic patients. Methods:, Liver resections were performed in 51 consecutive patients, from 20 July 2005 to 31 August 2007, using the Gyrus PlasmaKinetic coagulator. Requirement for blood transfusions, operating time, duration of hospital stay and major complications were evaluated initially for the group as a whole. Subsequently, the 11 patients with histologically confirmed cirrhosis (nine men, two women, median age 54 years, range 24,74 years) were compared with 40 patients without cirrhosis (25 men, 15 women, median age 57 years, range 24,87 years). Results:, There were 34 men and 17 women. The median age was 56 (range 24,87 years). There were 48 open procedures and 3 laparoscopic procedures. There were 30 major resections (>2 segments) and 21 minor resections (one to two segments). The overall median operating time was 260 min (range 90,690). Length of stay had a median of 9 days, range 4,50 days. Twenty-one patients (41%) required a blood transfusion. Two biliary leaks were observed in non-cirrhotic patients initially before the settings of the Gyrus device were optimized. Conclusions:, The Gyrus PlasmaKinetic coagulation device is a novel instrument for hepatic parenchymal transection in liver resection, which can be safely used in cirrhotic and non-cirrhotic patients. [source] Modifying techniques in deep inferior epigastric artery perforator flap harvest with the use of preoperative imagingANZ JOURNAL OF SURGERY, Issue 9 2009Warren M. Rozen Abstract New techniques in the harvest of deep inferior epigastric artery perforator (DIEP) flaps have become introduced as a result of modern imaging technologies that can allow virtual surgery to be achieved preoperatively. With computed tomographic angiography, individual anatomy can be appreciated in detail to a level not previously appreciated. These imaging techniques can be successfully used to guide DIEP flap surgery. ,Optimal' perforators can be selected based on size, location, intramuscular and subcutaneous course, and their association with motor nerves. Flap design can be safely achieved based on the cutaneous distribution of perforators. Abdominal wall closure can be improved based on the abdominal contour seen with imaging. Preoperative planning can aid patient selection, plan all aspects of the operative technique, reduce operating time and improve operative outcomes. [source] Use of the harmonic scalpel in thyroidectomyANZ JOURNAL OF SURGERY, Issue 6 2009David J. Parker Abstract Thyroidectomy is a surgical procedure that requires meticulous dissection, safe anatomical exposure and effective haemostasis. Use of the harmonic scalpel in thyroidectomy may assist in achieving these goals, particularly in respect to enabling efficient haemostatic coagulation and division of small vessels. This report demonstrates the results of utilizing the harmonic scalpel in a series of 88 prospective thyroidectomies in patients under the care of two surgeons over a 2-year period recording a number of parameters, including operative times and post-operative complications. These data were compared with a retrospective cohort of 57 patients who underwent thyroidectomies by the same two surgeons prior to the introduction of the harmonic scalpel. The results of this study show that the use of the harmonic scalpel decreased surgical operating time by 20 min (22.5%) for a hemithyroidectomy and 13.5 min (12%) for a total thyroidectomy. Harmonic scalpel use was not associated with an increased complication rate and has been demonstrated to be a very efficient and safe tool in assisting with the conduct of a thyroidectomy. [source] LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS WITH SYMPTOMATIC GALLSTONE DISEASEANZ JOURNAL OF SURGERY, Issue 5 2008Emmanuel Leandros Background: The aim of this study was to evaluate the outcome in patients with liver cirrhosis who underwent laparoscopic cholecystectomy for symptomatic gallstone disease. Methods: Retrospective analysis of prospectively collected data of 34 patients operated between March 1998 and April 2006. Results: There were 19 male and 15 female patients with a median age of 62 years. Cirrhosis aetiology was viral hepatitis in 25 patients, alcohol in 6, primary biliary cirrhosis in 2 and in 1 patient the cause was not identified. Twenty-three were classified as Child,Pugh,Turcotte stage A and 11 as Child,Pugh,Turcotte stage B. The median Model For End-Stage Liver Disease score was 12. Median operating time was 96 min. In three patients there was conversion to open cholecystectomy. Postoperatively, one patient died and six more patients had complications. Median postoperative stay was 3 days. Patients with acute cholecystitis did not have increased morbidity, but had significantly longer hospital stay. Conclusion: Laparoscopic cholecystectomy can be carried out with acceptable morbidity in selected patients with well-compensated Child A and B stages liver cirrhosis. Patients with evidence of significant portal hypertension and severe coagulopathy should avoid surgery. [source] Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinomaANZ JOURNAL OF SURGERY, Issue 7 2005Man-Chiu Cheung Background: Laparoscopic renal surgery is now accepted within the urological community and its indication is extended to oncological operation. The oncological outcome and survival of patients undergoing laparoscopic radical nephrectomy for clinically localized renal cell carcinoma were evaluated. Methods: From October 1998 to July 2003, 100 patients underwent laparoscopic radical nephrectomy for clinically localized renal cell carcinoma. All operations were performed by transperitoneal approach with early vascular control. Perioperative events and pathological data were recorded prospectively. Patients were followed up by clinical examination, chest radiograph, ultrasonography and/or computed tomography where appropriate. Results: The median age of patients was 61 years. Median operating time was 120 min and blood loss was 100 mL. There were five open conversions. There was no perioperative mortality but 11 patients had complications. Resection margins were clear in all but one patient. The median tumour size was 4.6 cm. The median follow-up time was 30 months. All patients survived up to the date of review. No patient developed port-site recurrence but two patients had recurrence at the renal bed 1 year after the operation. Five patients developed distant metastases involving liver, lung and bone. Conclusion: Laparoscopic radical nephrectomy is a safe and efficacious treatment option for clinically localized renal cell carcinoma. The intermediate-term oncological outcome appears favourable. [source] Laparoscopic radical prostatectomy: early safety and efficacyANZ JOURNAL OF SURGERY, Issue 12 2004Liam C. Wilson Background: To evaluate the initial results of laparoscopic radical prostatectomy at this institution. Methods: Between January 2000 and September 2003, 30 patients underwent laparoscopic radical prostatectomy. Peri- and postoperative data were accumulated prospectively and maintained in a database. All patients have a minimum of 6 month follow up. Results: There were no conversions to open surgery, and there were no re-operations. Mean operating time was 328 (195,490) min. There was one intraoperative rectal injury which was repaired laparoscopically. Three patients (10%) required blood transfusion. Postoperatively, there were two cases of respiratory depression, one case of haemoptysis and one upper gastrointestinal bleed. Two anastomotic leaks were successfully treated conservatively, one of which was the only readmission to hospital. There was one case of clot retention requiring manual irrigation of the bladder. Mean hospital stay was 2.75 (1,10) days, with six of the last 10 patients being discharged on the first postoperative day. Continence rates at 6 months are 83%. Positive surgical margins occurred in seven patients (23%). At 12 months of follow up, one patient (4.5%) has had biochemical recurrence. Conclusions: Our initial results are comparable to, or better than, the initial series in high volume centres. The procedure is feasible in appropriately selected cases in the Australasian environment. [source] | ||||||||||||||||||||||||||||||||||