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Brian N. Arnold Daniel C. Thomas Vikrant Bhatnagar Justin D. Blasberg Zuoheng Wang Daniel J. Boffa Frank C. Detterbeck Anthony W. Kim 《Surgery》2019,165(2):450-454
Background
Robot-assisted thoracoscopic lobectomy has been shown to be a safe approach to pulmonary lobectomy. This study sought to define, mathematically, the learning curve for RATS lobectomy.Methods
Patients undergoing robot-assisted thoracoscopic lobectomy at a single institution from 2010 through 2016 were considered. Covariates included patient demographics, comorbidities, operating time, length of stay, estimated blood loss, and postoperative complications. A cumulative sum analysis of operating time was performed to define the learning curve.Results
A total of 101 patients were included. Three distinct phases of the learning curve were identified: cases 1–22, cases 23–63, and cases 64–101. There was a statistically significant difference in operating time and estimated blood loss between phases 1 and 2 (P < .05, P?=?.016, respectively) and between phases 1 and 3 (P < .05, P?=?.006, respectively). There was no statistically significant difference in comorbidities, chest tube duration, length of stay, postoperative complications, or conversion rate across the learning curve.Conclusion
Based on operating time, the learning curve for robot-assisted thoracoscopic lobectomy is 22 cases, with mastery achieved after 63 cases. No differences in length of stay, chest tube duration, conversion rate, or complication rate were observed in the learning curve. Other factors not measured in this study may play a role in the learning process and warrant further study. 相似文献6.
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Shasanka Shekhar Panda Sandeep Agarwala Sushil Kumar Kabra Veereshwar Bhatnagar 《Indian journal of pediatrics》2014,81(7):660-664
Objective
To study the incidence and type of pulmonary function abnormalities after thoracotomy in children.Methods
Children below 12 y of age who had undergone thoracotomy for any condition and have at least 2 y follow up were included in the study. Detailed assessment of the patients included history and general examination, clinical assessment of pulmonary function, bedside tests to assess pulmonary function and laboratory pulmonary function test using portable spirometer.Results
Fifty two patients were included in the study. Twenty-seven were cases of esophageal atresia with trachea-esophageal fistula (EATEF), nine pulmonary metastasis from abdominal solid tumors, six mediastinal masses, three hydatid cyst, three eventration of diaphragm, two bronchiectasis, and one each of H-type TEF and congenital esophageal stenosis. The mean age at the time of evaluation was 6.3 y (range 2–18 y). While all the patients were clinically assessed, only 25 (48 %) were eligible for bedside tests and 23 (44 %) for spirometery. The incidences of abnormalities picked were: dyspnea during exercise 8/52 (15.4 %), dyspnea on exercise and on climbing stairs 1/52 (2 %), decreased breath holding time 2/25 (8 %), abnormal incentive spirometry 1/25 (4 %), mild restrictive pattern on pulmonary function test (PFT) 11/23 (47.8 %), moderate restrictive pattern on PFT 2/23 (8.7 %). None had an obstructive pattern on PFT.Conclusions
Though the incidences of pulmonary function abnormalities were high, these were of mild grade. Close follow up of patients after thoracotomy would be needed for early pick up and appropriate management of these abnormalities to prevent long-term consequences. 相似文献8.
Alisha Gupta Sandeep Agarwala Nikhil Tandon M. Srinivas Minu Bajpai Devendra Kumar Gupta Arun Kumar Gupta Chandersekhar Bal Rakesh Kumar Veereshwar Bhatnagar 《Indian journal of pediatrics》2014,81(8):780-784
Objectives
To evaluate the management and outcome of children with pheochromocytoma and determine the role of cortex preservation in cases of bilateral disease.Methods
Retrospective review of children, below 12 y of age, with pheochromocytoma managed between November 2003 and December 2012 was done.Results
Twelve patients, nine boys and three girls with median age 9 y were enroled. Eleven (92 %) had adrenal tumors and in one it was extra-adrenal. Five (42 %) had bilateral disease. Ten presented with hypertension, one with headache and one with abdominal pain and fever. All were stabilized pre-operatively with alpha and beta blockers and volume expansion. Six children with unilateral disease underwent total adrenalectomy. Out of five with bilateral disease, one child underwent bilateral total adrenalectomy and was later started on hormone replacement. Remaining four underwent total adrenalectomy on one side and partial on the other side. Post-operatively all became symptom free and normotensive and were off medications within 1 mo. Two children developed recurrence 1 mo post-operatively, one with an initial unilateral pheochromocytoma and one with paraganglionoma. At the last follow up, 10 out of 12(83 %) were disease free while two with recurrence are still awaiting surgery.Conclusions
Surgical resection of pheochromocytoma is effective treatment to achieve cure and prolong survival. Cortex preservation should be done in bilateral disease as risk of recurrence in such cases seems to be of lesser significance as compared to the morbidity and mortality of adrenal insufficiency and consequent lifelong hormone replacement. 相似文献9.
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Sanjeev Jindal Sunita Kulkarni Soheyl Sheikh Vinod V. Chandar Dipti Bhatnagar Amit Aggarwal 《Oral Radiology》2008,24(1):42-48
Mucormycosis is a rare, often fatal disease that is caused by zygomycetes, which are common fungi frequently found in the
soil and decaying vegetation. Diabetes mellitus, malnutrition, and an immunocompromised state favor the growth of various
microorganisms, including zygomycetes and the normal flora of the oral cavity, which are otherwise nonpathogenic, leading
to opportunistic infections. Here we report a case of mucormycosis presenting with extensive necrosis of the maxilla along
with rhinocerebral involvement in a 60-year-old patient suffering from uncontrolled diabetes with ketoacidosis. 相似文献