(Objectives) Laparoscopic sacrocolpopexy (LSC) is becoming a more popular alternative for pelvic organ prolapse (POP) repair in Japan in the recent years. This study aimed to evaluate the safety and efficacy of LSC. (Patients and methods) This is a retrospective study on all the LSC cases that were performed in Urogynecology center, Kameda Medical Center, Japan from January 2013 to March 2016. Medical records of all the patients were retrieved and details on operating time, estimated blood loss, perioperative complications, anatomical recurrence (postoperative POP-Q stage≥II) rate and reoperation rate were assessed.Our procedure of LSC used two pieces of polypropylene mesh placed on the vesico-vaginal and recto-vaginal space in which the dissection was extended to the level of the bladder neck and levator ani muscle. Subtotal hysterectomy was performed in almost all patients with uterus except in 39 women who chose to preserve their uterus. Additionally, multivariate analysis of risk factors for recurrence-free survival was performed using the Cox regression method. (Results) Five hundred and five patients who were diagnosed as POP (cystocele, rectocele, enterocele, uterine prolapse, vaginal vault prolapse) were included. The mean operating time and estimated blood loss were 236 min and 27.2 ml. There were 2.6% perioperative complication rate and 1.0% severe complication rate (Clavien grade≥IIIa). With a median follow-up of 12 months, anatomical recurrence rate was 8.0%, significant anatomical recurrence (stage≥III) rate was 1.2% and reoperation rate was 1.0%. Preoperative POP-Q stage IV was found as independent risk factors for anatomical recurrence. (Conclusions) The present study demonstrated a relatively low complication rate, low significant anatomical recurrence rate and low reoperation rate. Therefore, LSC is a safe and effective surgical treatment for various types of POP.
Background: No consensus has been reached on the best surgical approach for secondary hyperparathyroidism. We evaluated the short-term and long-term efficacy and safety of total parathyroidectomy with autotransplantation (TPTX+AT) and subtotal parathyroidectomy (SPTX).Methods: We retrospectively analyzed the data of 259 patients undergoing TPTX+AT or SPTX between 2010 and 2021 in the Second Affiliated Hospital of Soochow University, and carried out follow-up. We compared the differences in symptoms, serological examinations, complications and mortalities between the two groups, and explored the risk factors of poor prognosis, death and recurrence.Results: Of the 259 patients, 208 underwent TPTX+AT and 51 underwent SPTX. The postoperative day 1 serum intact PTH level was higher in TPTX+AT group than that in SPTX group (P=.023). The risk of all-cause mortality in TPTX+AT group was lower (P =. 018), and recurrent PTX was more common in TPTX+AT group (P =. 011). The risk of recurrence was similar. There was no significant difference in the incidence of most complications including hematoma, recurrent laryngeal nerve injury, wound infection, adverse cardiovascular outcomes, fracture and permanent hypoparathyroidism between two groups. Results from Cox regression showed the SPTX operation approach (HR 3.53, P = 0.021) and older age (HR 1.06, P = 0.035) were risk factors of all-cause mortality.Conclusion: Due to the lower risk of death after TPTX+AT and the low renal transplantation rate, we prefer TPTX+AT to treat most Chinese population with secondary hyperparathyroidism.
Purpose
This study was performed to compare the application of robot-assisted thoracoscopic surgery with video-assisted thoracoscopic surgery in the treatment of pulmonary sequestration (PS) in children.
Methods
Clinical data of 128 consecutive pediatric patients undergoing robot-assisted thoracoscopic surgery or video-assisted thoracoscopic surgery for PS from May 2019 to July 2022 at our institution were reviewed. 62 patients underwent robotic-assisted thoracoscopic surgery (RATS group),while 66 patients underwent video-assisted thoracoscopic surgery (VATS group). There were no significant differences in age, weight, gender, type of PS, preoperative infection and surgical method between the two groups. Aberrant artery was ligated with silk suture or vascular clips and lobectomy, partial lobectomy or sequestrectomy was performed depending on the type of lesion in the two groups. Perioperative outcomes were compared between the two groups to evaluate the efficacy of the RATS.
Results
Neither group had surgical mortality.One case in each group required conversion to thoracotomy (1/62 vs 1/66, P>0.999).The median operation time of the RATS group was 77.5(60.0,111.3) minutes, while the VATS group was 60.0(40.0,75.0)minutes which had a significant difference (P<0.001) between the two groups.However, RATS was associated with less intraoperative bleeding [2.0(1.0, 2.0) ml vs 5.0(2.0, 5.0)ml, P <0.001], shorter postoperative duration [5.0(4.0, 6.0)days vs 6.0(5.0, 7.0)days, P<0.001] and shorter drainage days [1.0(0.8, 1.3)days vs 2.0(1.0, 3.0)days, P<0.001] compared with VATS. No significant difference was found for postoperative complications (hydrothorax and pneumothorax) incidence between two groups.
Conclusion
Although there was limitation of application of RATS in low-age, low-weight infants, RATS was a feasible and safe approach for pediatric patients with PS over 6 months and more than 7kg in weight. Furthermore, due to the enhanced vision and hand-wrist control, RATS had some advantages over VATS with less intraoperative blood loss and shorter postoperative drainage time and hospital duration.
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