Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity ( P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group ( P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.
We present a case of three multifocal synchronous ipsilateral clear cell, papillary type 1 and papillary type 2 renal cell carcinoma (RCC), with papillary type 2 RCC appearing bilaterally. With review of the literature, it was determined that multifocal synchronous RCC subtypes and bilateral renal tumors are both rare in occurrence.
Study Objective Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Design Randomized controlled trial Setting University based outpatient clinic. Patients or Participants Between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis. Interventions Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. Measurements and Main Results 41 patients were analyzed out of which 25 were allocated to the office group and 16 to the telemedicine group. Groups were homogenous to age (41.4 v 43.3 p.48), BMI (31.9 v 30.6 p=.52), distance in miles from home (12.7 v 12.4 p=.92) and parity (p=.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (IQR), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 (4.0, 4.5) v 4.5 (4.5, 5.0) p=.05), (4.0(4.0, 4.5) v 4.5(4.0, 5.0) p=.05). The remainder of the categories analyzed were not different between groups (Technical Quality (4.0 (3.8, 4.5) v 4.5 (3.9, 5.0) p=.13), Interpersonal Manner (4.0 (4.0, 4.5) v 4.5 (4.0, 5.0) p=.34), Communication (4.5 (4.0, 4.5) v 4.5 (4.3, 5.0) p=.21) and Accessibility and Convenience (4.0 (3.5, 4.5) v 4.0 (3.6, 4.5) p=.84)). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group visited the ER following the postoperative visit, and 0 in the telemedicine group (p=.42). Regarding phone calls to the clinic after postoperative visit, 5(20%) patients in the office group incurred in at least one call and 4(25%) did so in the telemedicine group (p=.92). Conclusion Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction, and does not appear to increase the risk of complications.
A 49-year-old female presented to the hospital with complaints of generalized weakness, subjective fevers, and chills. In the emergency department (ED), she was found to be hypotensive and tachycardic and met the sepsis criteria. A CT scan of the abdomen and pelvis (CT A/P) with contrast revealed a liver abscess and a foreign body (FB) that was suspected to be the cause of the liver abscess. Of note, the patient had undergone a recent dental procedure due to an infected root canal, which had involved a dental screw. The patient was uncertain whether the dental screw had been removed, but she felt as though it was no longer there. At this time, the clinical suspicion was high for FB secondary to this dental procedure. The patient underwent interventional radiology (IR)-guided liver abscess drainage and magnetic resonance cholangiopancreatography (MRCP) for the evaluation of the FB. An esophagogastroduodenoscopy (EGD) was performed, but no evidence of the FB was found. This warranted an exploratory laparotomy (EL) to ensure the successful removal of the FB. Upon gross visualization by surgery, the FB was revealed to be a bone that the patient did not recall ingesting. However, surgical pathology evaluation revealed that the FB was actually a plastic stick. This rare case highlights the clinical approach to FB ingestion when complicated by liver abscess, as well as successful treatment with EL as opposed to laparoscopy which is the procedure of choice.
Acute pancreatitis among the pediatric population can result from genetic disorders, anatomic anomalies, gallstones, trauma, and medications; trauma and idiopathic causes being the most common. Although chronic pancreatitis presents with increased severe long-term complications, acute pancreatitis presents with its share of complications such as fistulas, pseudocysts, and venous abnormalities. With an increase in hospitalization rates of acute pancreatitis among the pediatric population, the importance of understanding rare complications and how to further recognize these complications can aid in the diagnosis, medical management, and intervention necessary to optimize a patient's outcome. Our patient presented with a rare complication of splenic vein thrombosis (SVT), which is a complication that can also be observed in adults with acute pancreatitis. SVTs are uncommon in both the adult and pediatric populations, and they have received little attention or research in the pediatric population. We report a case that will highlight a rare case of SVT presenting in a pediatric patient with acute necrotizing gallstone pancreatitis.
In the United States, approximately one million gall bladders are removed annually through minimally invasive procedures, of which approximately four percent are converted to open surgery due to complications with the organ retrieval bag. Utilizing a seamless design, the Laparatus bag design will be able to withstand higher mechanical forces, thus preventing these complications. The improved design will be able to reduce costs by up to ten million dollars through reduced surgery time as well as reduced hospital stay.
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