The Modified Procedure of Totally Tubeless PNL

Mini percutaneous nephrolithotomy (mPNL) is a standard treatment for kidney stones larger than 1.5 cm, with the placement of a nephrostomy drainage at the end of it, which is considered the standard procedure, but tubeless/ totally tubeless mPNL techniques reduce postoperative discomfort in patients and shorten hospital stays. The aim of article was to compare the efficacy and safety of our proposed modified method of totally tubeless mPNL with control of the parenchymal canal, with existing methods of tubeless/totally tubeless mPNL. Novelty of the study presented by modified method of totally tubeless mPNL. During the period from 2018 to 2020 we performed 486 mPNL were performed in our clinic in total, among which 63 (12.9%) patients underwent tubeless PNL. Patients whose surgeries ended with using tubeless techniques were divided into three groups: Group I – 22 patients who had tubeless mPNL (with ureteral stent), Group II (20 patients) – totally tubeless mPNL with a safety thread (the proposed procedure), Group III (21 patients) – totally tubeless mPNL. In all three groups, the access point was most often made through the lower group of renal calyces: Group I – 12 (54.5%), Group II – 14 (70.0%), Group III – 13 (61.9%); then through the middle calyx: Group I – 8 (36.4%), Group II – 6 (30.0%), Group III – 7 (33.3%); and the upper calyx: Group І – 2 (9.1%), Group ІІ – 0%, Group ІІІ – 1 (4.8%), no differences in the distribution of access points between groups were found (p=0.67). There were no differences in the distribution of tract sizes between the groups (p=0.95) with tract dilatation to 16.5/17.5 Fr was performed most often: Group I – 12 (54.5%), in Group II – 11 (55.0%) and Group III – 11 (52.4%). The mean duration of surgery in Group I was 83.0±22.9 min, in Group II – 74.9±13.6 min, in Group III – 72.6±12.0 min (p=0.47). This study confirms the high effectiveness of totally tubeless mPNL. The proposed modification to perform totally tubeless mPNL allows you to have permanent postoperative control over the parenchymal channel and in case of postoperative bleeding it enables you to immediately insert nephrostomy drainage through the safety thread. Study contributes to practical methods as an intermediate step for surgeons who are considering transition to a totally tubeless PCNL technique.

Using self -suture branching artificial vesssels in aortic arch surgery at Hanoi Heart Hospital

Background: For aortic arch surgery, the improvement of anastomosis technique, and the improvement of using self-suture branching artificial vessels have shortened the time and reduced the cost of surgery. The study aimed to evaluate the improved results of using self-suture branched artificial vessels in aortic arch surgery. Methods: A retrospective descriptive study of the use of self-suture branching artificial vessels in aortic arch surgery at Hanoi Heart Hospital from October 2018 to May 2021. Results: There were 33 cases of aortic arch replacement using self-suture branching artificial vessels. The rate of postoperative bleeding was 6.06%. The rate of artificial vessel infection is 0%. Conclusion: Using self-suture branching artificial vessels in aortic arch surgery is a safe and effective technique.

Video-Assisted Thoracoscopy for Vertebral Body Tethering of Juvenile and Adolescent Idiopathic Scoliosis: Tips and Tricks of Surgical Multidisciplinary Management

VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.

Is hydronephrosis a risk factor for complications in conventional percutaneous nephrolithotomy?

Objective: To assess Hydronephrosis as a Risk Factor for complications in Conventional Percutaneous Nephrolithotomy. Study Design: Cross Sectional Descriptive study. Setting: Kidney Centre Post Graduate Training Centre, Karachi. Period: January to December 2020. Material & Methods: This study was done to know post-operative complications including bleeding, infection, and incomplete stone clearance in patients with or without hydronephrosis undergoing percutaneous nephrolithotomy. After applying the inclusion/ exclusion criteria it was found that the patients with hydronephrosis had less bleeding as compared to the no hydronephrosis group. In the same way, they also had fewer nephrostomy tubes placed, and chest drain insertion. All other complications were approximately the same in each group. Patients were selected using non-probability consecutive sampling technique. Percentage and frequencies were determined for quantitative variables. Mean and standard deviation were determined for quantitative variables. Results: Total 300 cases were studied fulfilling inclusion criteria. There were 70.07% male and 29.3% female cases. Age range of the patients was 18-60 years. There were 52.7% cases with hydronephrosis, placed in one group and 47.3% cases were without hydronephrosis placed in other group. Most common complication was postoperative bleeding reported in 48.9% cases with hydronephrosis as compared to 56.2% cases without hydronephrosis. Mean operative time was 115.7 ± 41.9 minutes in patients with hydronephrosis and 135 ± 35.4 minutes in patients without hydronephrosis. Conclusion: Patients with hydronephrosis experienced less postoperative complications, after PCNL as compared to those without hydronephrosis.

Intraoperative Bleeding Management: An Updating Literature Review: Review Article

Background: Intraoperative bleeding remains a major complication during and after surgery, leading to increased morbidity and mortality. Several influences determine the complex causes of bleeding in surgical patients. About 75 to 90% of early intraoperative and postoperative bleeding is due to technical factors. In some cases, however, acquired or congenital coagulopathies can stimulate, if not directly cause, surgical bleeding. Objectives: This paper aims to overview etiology, causes, diagnosis, and updated management of intraoperative bleeding. Methods: The review article ran from July 1, 2021 to October 31, 2021. We searched articles on etiology, causes, and treatments published in English worldwide in the Medline, EBSCO and PubMed databases. No software was used to analyze the data. Team members reviewed the data to determine initial results. Results: All patients scheduled for elective surgery should be screened for possible hemostatic defects using tests, and, if necessary, laboratory tests. Treatment of intraoperative bleeding consists of identifying patients at risk and understanding the effect of surgery on hemostasis. For patients at high risk of bleeding, a pre-operative meeting with a multidisciplinary team (anesthesiologist, surgeon, hematologist, radiologist) can discuss the correct surgical procedure. Conclusion: Technical variables account for 75-90% of initial intraoperative and postoperative bleeding. However, in other cases it is associated with acquired or congenital coagulation disorders. All patients scheduled for elective surgery should be checked for problems with hemostasis. Treatment of intraoperative bleeding involves identifying those at risk and understanding the effect of surgery on hemostasis.