Learning curve in laparoscopic liver surgery: a fellow’s perspective

The learning curve for laparoscopic liver surgery is infrequently addressed in current literature. In this paper, we explored the challenges faced in embarking on laparoscopic liver surgery in a unit that did predominantly open liver surgery. In setting up our laparoscopic liver surgery program, we adopted skills and practices learnt during fellowships at various high volume centers in North America and Australia, with modifications to suit our local patients’ disease patterns. We started with simple minor resections in anterolateral segments to build confidence, which allowed us to train the surgical and nursing team before progressing to more difficult resections. Inter institutional collaboration and exchange of skills also enabled the synergistic development of techniques for safe progression to more complex surgeries. Multimedia resources and international guidelines for laparoscopic liver surgery are increasingly accessible, which further guide the practice of this emerging field, as evidence continues to validate the laparoscopic approach in well selected cases.     

The patient’s perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study

Background

The purpose of this study was to provide prospective independently analyzed evidence on how patients feel about a carpal tunnel release (CTR) performed under local anesthesia only (no sedation or tourniquet) versus with local anesthesia, intravenous (IV) sedation, and a tourniquet.

Methods

This prospective cohort study compared 100 consecutive CTRs done with only lidocaine and epinephrine in Saint John, New Brunswick to 100 consecutive CTRs done with IV sedation in Davenport, Iowa. Patient perspectives on the anesthesia were captured in a blinded questionnaire 1 week postoperatively.

Results

For subsequent surgery, 93 % of wide awake patients would choose local anesthesia only and 93 % of sedated patients would choose sedation. Wide awake patients spent less time at the hospital (M?=?2.6 h) than sedated patients (M?=?4.0 h; p?<?.001). Preoperative blood work, electrocardiograms, and/or chest radiographs were done for 3 % of wide awake patients and 48 % of sedated patients (p?<?0.001). Preoperative anxiety levels for wide awake patients were lower than for sedated patients (p?=?0.007); postoperative anxiety was similar. There were no anesthesia complications in either group. Narcotics were used by 5 % of unsedated patients and 67 % of sedated patients (p?<?0.001). Adequate pain control was reported by 89 % and 90 % of patients, respectively.

Conclusions

The majority of patients from both cohorts liked whichever method of anesthesia they received and would choose it again. However, sedated patients spent more time at the hospital, required more preoperative testing, and reported greater preoperative anxiety.     

Bladder augmentation from an insider’s perspective: a review of the literature on microcirculatory studies

International Urology and Nephrology - Augmentation cystoplasty is an exemplary multiorgan intervention in urology which is particularly associated with microvascular damage. Our aim was to review...     

Plastic surgery in a day surgery unit: 1 year’s experience

The study is of the different pathologies treated at the UCSI by a Plastic Surgery Unit during the course of a year. Variables such as age, sex, pathology and degree of patient satisfaction have been studied. The total number of patients treated was 678. The most common surgery was for skin tumours and hand pathology. Of those treated 96% demonstrated a high degree of satisfaction.     

Needlescopic surgery: what’s in the toolbox?

With a recent focus on minimizing the visibility of scars, minilaparoscopy has reemerged as an attractive option for surgeons. Minilaparoscopy, or needlescopic surgery, ultimately limits tissue trauma and improves cosmesis. We describe the tools that are available for surgeons who are considering utilizing this approach. Included in this review are the instruments, trocars, trocar-less instruments, and optics available for needlescopic surgery. Because this is a rapidly growing area of surgery, needlescopic surgery will benefit from additional product development with a focus on improving instrument strength and optics.     

Pitfalls in the management of patients with primary hyperoxaluria: a urologist’s perspective

The primary hyperoxalurias are rare, inherited diseases which commonly manifest early in life as urolithiasis. As these patients often present to the urologic surgeon, it is imperative that urologists understand the typical presentation, diagnosis, and management of urolithiasis associated with primary hyperoxaluria. In this review, the pertinent epidemiology and pathogenesis as they relate to the diagnosis and natural history of the disease are discussed. The literature on therapeutic options for primary hyperoxaluric patients with calculi is examined, and treatment strategies are suggested.