Displaying publications 61 - 80 of 188 in total

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  1. Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, et al.
    Int J Surg, 2019 Nov 06;72:156-165.
    PMID: 31704426 DOI: 10.1016/j.ijsu.2019.11.002
    INTRODUCTION: The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication.

    METHODS: A steering group was formed to review the existing guideline and propose amendments to the 17-item checklist. A Delphi consensus exercise was utilised to determine agreement across a list of proposed modifications to the STROCSS 2017 guideline. An expert panel of 46 surgeons were invited to assess the proposed updates via Google Forms.

    RESULTS: The response rate was 91% (n = 42/46). High agreement was reached across all the items and the guideline was finalised in the first round. The checklist maintained 17-items, with modifications primarily considered to improve content and readability.

    CONCLUSIONS: The STROCSS 2019 guideline is hereby presented as a considered update to improve reporting of cohort, cross-sectional and case-control studies in surgery.

    Matched MeSH terms: Surgeons
  2. Wong EHC, Lim CC, Ong CA, Narayanan P
    Int J Surg Case Rep, 2020;72:587-589.
    PMID: 32698294 DOI: 10.1016/j.ijscr.2020.06.086
    BACKGROUND: Cholesterol granuloma (CG) is a rare entity but is the commonest lesion in the petrous apex. They are associated with chronic ear disease and previous temporal bone surgery. While bone wax has been known to cause foreign body reaction due to its non-resorbable property in the mastoid, it has not been documented to cause CG formation.

    CASE PRESENTATION: We described a 43 years old male who presented with a right mastoid swelling, nine years after a right retro-sigmoid craniotomy and excision for a cerebellopontine angle meningioma. He also had multiple cranial neuropathies involving trigeminal, facial and vestibulocochlear nerves. Temporal bone CT and MRI showed features suggestive of cholesterol granuloma with extensive bony erosions. He was treated with surgical excision and drainage where bone wax residues were found intraoperatively. Histopathological analysis of the lesion confirmed the diagnosis of cholesterol granuloma. Post-operatively, the mastoid swelling resolved and his recovery was uneventful.

    CONCLUSION: Our case showed that CG could manifest as a complication of bone wax usage in a neurosurgical procedure. Even though further study is needed to draw a definitive conclusion on this theory, we believe this paper will contribute to the current literature as it is the only reported case of cholesterol granuloma with bone wax as the possible causative agent. This is important so that surgeons are aware of this potential complication and use this haemostatic agent more judiciously.

    Matched MeSH terms: Surgeons
  3. Sharouny H, Narayanan P
    Iran Red Crescent Med J, 2015 Jan;17(1):e17104.
    PMID: 25763256 DOI: 10.5812/ircmj.17104
    INTRODUCTION: Frontal sinus mucoceles are the commonest among all paranasal mucoceles. With introduction of functional endoscopic sinus surgery, surgeons prefer endoscopic management of sinus mucoceles, but lesions that appear in the lateral part of the frontal sinus can be difficult to access and often need external approaches.

    CASE PRESENTATION: We described a lateral frontal sinus mucocele with intra-orbital extension, which was successfully managed by endoscopic sinus surgery.

    CONCLUSIONS: Endoscopic sinus surgery is the treatment of choice in most frontal sinus mucoceles including lateral frontal mucoceles.

    Matched MeSH terms: Surgeons
  4. Sharouny H, Omar RB
    Iran Red Crescent Med J, 2014 Dec;16(12):e17066.
    PMID: 25763237 DOI: 10.5812/ircmj.17066
    INTRODUCTION: Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.

    CASE PRESENTATION: We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.

    CONCLUSIONS: Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger's needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

    Matched MeSH terms: Surgeons
  5. Othman MY, Blair S, Nah SA, Ariffin H, Assanasen C, Soh SY, et al.
    JCO Glob Oncol, 2020 08;6:1328-1345.
    PMID: 32886560 DOI: 10.1200/GO.20.00284
    PURPOSE: Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor boards (MDTBs) are lacking in low- and middle-income countries (LMICs). We aimed to profile the landscape of pediatric solid tumor care and practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMICs.

    METHODS: Using online surveys, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, one pediatric surgeon and one pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires.

    RESULTS: In 37 (80.4%) of 46 identified PSTUs, availability of pediatric-trained specialists was as follows: oncologists, 94.6%; surgeons, 91.9%; radiologists, 54.1%; pathologists, 40.5%; radiation oncologists, 29.7%; nuclear medicine physicians, 13.5%; and nurses, 81.1%. Availability of pediatric-trained surgeons, radiologists, and pathologists was significantly associated with the existence of MDTBs (P = .037, .005, and .022, respectively). Among 43 (89.6%) of 48 respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported > 50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between oncologists and surgeons. The majority agreed that MDTBs helped to improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations were the top barriers.

    CONCLUSION: This first known profile of pediatric solid tumor care in Southeast Asia found that availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs in this region. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathologic diagnoses were the most common limitations for MDTBs. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.

    Matched MeSH terms: Surgeons
  6. Padur AA, Kumar N
    J Vasc Bras, 2019 Jul 12;18:e20190021.
    PMID: 31360158 DOI: 10.1590/1677-5449.190021
    The facial artery is the main artery of the face and variations in its origin and its branching pattern have been documented. We report herein multiple facial artery branch variations in the face. A large posterior (premasseteric) branch originated from the left facial artery and coursed upwards behind the main trunk of the facial artery. This artery presented with a straight course and was closely related to the anterior border of the masseter. The branch then terminated by supplying the adjacent connective tissue below the parotid duct. It was also observed that the facial artery was very thick and tortuous and terminated as the superior labial artery. Knowledge of this variation is of great clinical significance in facial operations, especially for maxillofacial surgeons and plastic surgeons, because it forms the anatomical basis for the facial artery musculo-mucosal flap.
    Matched MeSH terms: Oral and Maxillofacial Surgeons; Surgeons
  7. Zawiah Kassim, Fauziah Ahmad, Rusnaini Mustapha Kamar, Karis Misiran
    MyJurnal
    Safety and feasibility of transoral robotic surgery (TORS) in adults for otolaryngology surgery,
    mainly in the treatment of oropharyngeal carcinoma and obstructive sleep apnoea has already
    been established several years ago. However, less is known with respect to the role and safety
    of TORS for otolaryngology surgery in the paediatric age group and its description in the
    literature is currently insufficient. As paediatric patients are unique in their anatomy, physiology
    and pharmacological kinetic, special attention and consideration has to be applied when using
    TORS, hence this increases the perioperative challenges. Herewith we present our experience
    in anaesthetising a paediatric patient for TORS adenotonsillectomy which is the first not only
    in our centre but in Malaysia. Our major obstacle was the limited airway access as the area of
    concern was shared by the anaesthesiologist, surgeon and also the robotic system.
    Haemodynamic stabilisation was a challenge compared to the conventional method as the
    operative time increased due to robot docking time and the new surgical learning process. In
    our opinion, the key point for the success of TORS adenotonsillectomy in paediatric patients is
    good communication and teamwork between all personnel involved in the surgery.
    Matched MeSH terms: Surgeons
  8. Khoriati AA, Shahid Z, Fok M, Frank RM, Voss A, D'Hooghe P, et al.
    J ISAKOS, 2024 Apr;9(2):227-233.
    PMID: 37949113 DOI: 10.1016/j.jisako.2023.10.015
    Matched MeSH terms: Orthopedic Surgeons*
  9. Shahrun Niza AS, Nani Harlina ML, Razrim R, Ussof Eskaandar MH, Rohaizak M
    MyJurnal
    A surgeon’s experience plays an important role in breast conserving surgery (BCS). The common conception is that, the more junior is the operating surgeon, the surgical margin will be wider or closer to the tumour edge. Thus the aim of this study is to look into the adequacy of surgical margin performed by different level of surgeons’ experience in patients whom underwent wide local excision (WLE) and hook-wire localization (HWL) in our surgical unit. The surgical experience of the operating surgeon and their surgical margins will be analyzed. This is a retrospective study from January 2000 to December 2012. Eighty-eight patients with early breast cancer underwent WLE and HWL by 3 different groups of surgeons (breast surgeons, junior surgeons and surgical registrars) were included. The surgical margins were analyzed for involved-margin, closed-margin or excessed-margin.The incidence of involved-margin, closed-margin and excessed-margin is the lowest among breast surgeons compared to other groups. However, the results were not statistically significant. The incidence of involved surgical margin is significantly higher within junior surgeons for HWL compared to the breast surgeons. The incidence of involved, closed or excessed surgical margin were lowest when performed by breast surgeon but not significantly different between the three groups. However, for HWL the breast surgeons significantly better compared to the other groups.
    Matched MeSH terms: Surgeons
  10. Leonar, J.H., Siti Salmiah, M.D., Das, S., Ayiesah, H.R.
    MyJurnal
    Arthroscopic sub acromial debridement surgery with acromioplasty is one of the shoulder surgeries performed to treat chronic shoulder pain. This surgical procedure is usually indicated in sub acromial impingement syndrome of shoulder, degenerative rotator cuff tears, severe functional limitation of shoulder joint and often surgery was performed in cases where all the conservative management had failed in the treatment of chronic shoulder pain. Even though the patient would be referred for early rehabilitation, post operative management of this surgical condition is highly challenging. Movement of the shoulder joint is often related with scapulo-thoracic joint, acromio-clavicular joint and sternoclavicular joint and the shoulder movements are governed by various different muscular forces from these joints. Failure to understand this biomechanical complexity of shoulder joint during post operative rehabilitation results in failure of the surgical outcome and might cause severe functional limitation with recurrent shoulder pain. Often in clinical practice, greater emphasis is given to achieve and regain movements in shoulder joint at the expense of the joint stability. However, inadequate scapular stability might further predispose the shoulder joint to excessive loading and results in repetitive injuries leading to chronic shoulder pain. This might affect the surgical and clinical outcome of the acromioplasty and result in surgical failure. Hence, surgeons and clinicians need to understand the biomechanical contributions in the post operative rehabilitation of the shoulder joint. The present case report emphasises the biomechanical model of post operative rehabilitation of a patient who had arthroscopic sub acromial debridement with acromioplasty.
    Matched MeSH terms: Surgeons
  11. Razman, J.
    MyJurnal
    Surgical training worldwide has been reformed from
    the since 19th century until the present era. It started as
    a trade which eventually was transformed into a
    profession that acquires skills and knowledge. The
    apprenticeship model was introduced amongst the
    Western surgeons as the standard approached for
    surgical training. The surgery was learned through
    direct observation without any formal and structured
    education. William S Halstead had introduced the new
    approach of training the surgeons in America
    following his landmark lecture at Yale University in
    1904 (1). His principle was based on direct the
    German Surgical training which emphasized on basic
    sciences in the curriculum and Sir William Ossler
    concepts of bedside rounds. This has lead to the
    development of Halsted principals of surgical training
    which included intense and repetitive exposure in
    managing surgical patients under the supervision of
    skilled surgeons, acquiring the knowledge of scientific
    basis of surgical diseases and as the surgical trainee
    received enhanced responsibility and independence
    with each advancing year (2). Since then, Halsted
    principle of surgical training has become the
    foundation of most established surgical training
    worldwide. The principles have been expanded and
    upgraded and since then six cores competencies have
    been identified for the surgical residents to achieve
    and master during the training course (3). There were
    medical knowledge, patient care, interpersonal and
    communication skills, professionalism, practice-based
    learning and improvement and system based practice.
    From the Malaysia perspective, surgical training was
    done through the overseas Royal colleges after the
    independence in 1957. The local programme started in
    1982 through the initiative of local universities that
    initially offered surgical training programme in
    General surgery, Orthopedics and otorhinolaryngology
    (4). Since then through the collaborations of Ministry
    of Health and other professional bodies various
    surgical training programme has been established to
    provide training opportunities which will eventually
    serving the nation. The subcommittee of the National
    Conjoint Board for General Surgery was the
    consultative body to oversee and manage the
    implementation of the surgical training. Since the
    establishment, the subcommittee was responsible in
    streamlined the training curriculum for all the
    universities that offered the course, centralized and
    standardized the intake of the trainees, coordinating
    the national exit examination and advising new
    application for graduate training in general surgery.
    The important milestone of the subcommittee was the
    task given to develop the national surgical
    postgraduate curriculum for the doctors who are
    interested in becoming a surgeon in the country. The
    curriculum is being developed to create a pathway for
    surgical training from the internship until subspecialty
    training. The development encompasses the
    governance, the curriculum development, the training
    process and learning outcome according to the latest
    evidence based on post graduate training. The
    programme should be the foundation in producing well
    trained surgeons towards 2050 through TN50.
    Matched MeSH terms: Surgeons
  12. Adlin Dasima, A.K., Nadia Hanom, I., Siti Aznida, A.K., Rusnaini, M.K., Mohd Fahmi, Z., Mohd Nazir, M.S., et al.
    MyJurnal
    This is our first experience in providing general anaesthesia for robotic-assisted thyroidectomy (RAT). It is rather a
    new experience for our anaesthetic team and few issues should be addressed. The conduct of RAT must be fully
    understood and familiarized as it may present with few challenges for the anaesthesiologists. The key point of
    success during this learning curve period is the importance of teamwork between the anaesthesiologists and the
    operating surgeons. The specific anaesthetic challenges include limited access to the patient post-docking of the
    robot, the need of extra precautions of the anaesthetic circuit and IV line connections, a vigilant anaesthesiologists
    and options for postoperative pain relief.
    Matched MeSH terms: Surgeons
  13. Lam, C.S., Mushawiahti, M., Bastion, M.L.C.
    MyJurnal
    Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2 with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL) implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation, which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade after the cataract operation.
    Matched MeSH terms: Surgeons
  14. Abu-Hammad S, Elsayed SA, Nourwali I, Abu-Hammad O, Sghaireen M, Abouzaid BH, et al.
    J Craniomaxillofac Surg, 2020 Apr;48(4):458-462.
    PMID: 32184074 DOI: 10.1016/j.jcms.2020.02.023
    OBJECTIVES: This study aimed to explore gender differences on career satisfaction among oral and maxillofacial surgeons (OMFS) and to compare their views on female gender representation in leadership and mentorship positions.

    METHODS: A questionnaire was distributed among a sample of female and male OMFS surgeons in Egypt, Jordan and Saudi Arabia. Data were statistically analyzed to calculate significant differences between gender groups.

    RESULTS: A total of 110 (70 males and 40 females) or (18.7%) of a total of 587 (OMFS) surgeons in the three countries participated. Respondents had a mean age of: 39.2 ± 9.0 years (range = 25-60 years). Significantly more males (60) than females (24) indicated satisfaction with their careers (P = 0.008), and significantly more males (66) than females (23) thought that OMFS is the right specialty for them (P 

    Matched MeSH terms: Oral and Maxillofacial Surgeons*
  15. Thong HK, Wong DKC, Gendeh HS, Saim L, Athar PPBSH, Saim A
    J Med Life, 2021;14(4):468-480.
    PMID: 34621369 DOI: 10.25122/jml-2020-0119
    The novel Coronavirus Disease 2019 (COVID-19) has brought unprecedented changes in the way conventional health care is delivered. This study examined if clinicians' perceptions regarding telemedicine and its barriers to implementation in Malaysia have changed during this pandemic. A cross-sectional survey was conducted among Malaysian medical doctors of various specialties in four urban healthcare facilities between June 2020 and July 2020. A total of 146 (41.7%) out of 350 responses were obtained. 62% of doctors reported a reduction greater than 50% in outpatient visits during the COVID-19 pandemic. The majority of doctors either found telemedicine useful in situations similar to COVID-19 (34.2%) or that it is essential to their daily practice (42.5%). However, only 22% reported using telemedicine for consultation during the COVID-19 pandemic. 74% of doctors felt that telemedicine would only benefit up to 30% of their patient population. Significantly more female doctors (80%) felt that telemedicine would benefit their patients compared to male doctors (45.8%) (P=0.03). Physicians (51.3%) were more inclined to adopt telemedicine in comparison to surgeons (32.4%) (P=0.03). The majority cited medico-legal issues and consent (80.6%), billing and charges (66.7%) and insurance reimbursement (62.5%), technical difficulties (62.5%) as their barrier to the adoption of telemedicine. Female doctors and physicians were more willing to adopt telemedicine when compared to male doctors and surgeons. Although the COVID-19 pandemic appeared to improve the perception, significant barriers should be resolved before many can incorporate it into their practice.
    Matched MeSH terms: Surgeons*
  16. Koh PS, Chan SC
    J Nat Sci Biol Med, 2017 Jan-Jun;8(1):4-10.
    PMID: 28250667 DOI: 10.4103/0976-9668.198356
    Adult-to-adult living donor liver transplantation (LDLT) is widely accepted today with good outcomes and safety reported worldwide for both donor and recipient. Nonetheless, it remained a highly demanding technical and complex surgery if undertaken. The last two decades have seen an increased in adult-to-adult LDLT following our first report of right lobe LDLT in overcoming graft size limitation in adults. In this article, we discussed the operative techniques and challenges of adult right lobe LDLT incorporating the middle hepatic vein, which is practiced in our center for the recipient operation. The various issues and challenges faced by the transplant surgeon in ensuring good recipient outcome are explored and discussed here as well. Hence, it is important to understand that a successful recipient operation is dependent of multifactorial events starting at the preoperative stage of planning, understanding the intraoperative technical challenges and the physiology of flow modulation that goes hand-in-hand with the operation. Therefore, one needs to arm oneself with all the possible knowledge in overcoming these technical challenges and the ability to be flexible and adaptable during LDLT by tailoring the needs of each patient individually.
    Matched MeSH terms: Surgeons
  17. Thanigasalam T, Reddy SC, Zaki RA
    J Ophthalmic Vis Res, 2016 4 7;10(4):375-84.
    PMID: 27051481 DOI: 10.4103/2008-322X.158892
    PURPOSE: Cataract surgery is the most common intraocular surgery performed all over the world and has advanced technically in recent years. As in all surgeries, complications are unavoidable. Herein we report factors associated with complications and visual outcomes of cataract surgery.

    METHODS: This retrospective cohort study included data of 1,632 cataract surgeries performed from 2007 to 2010 which was obtained from the cataract registry of the Malaysian National Eye Database. Demographic features, ocular and systemic comorbidites, grade of surgeon expertise and duration of surgery, type of anesthesia, intraoperative and postoperative complications, and the type of intraocular lens were recorded. Best corrected visual acuities were compared before and after the operation.

    RESULTS: Mean patient age was 66.9 years with equal gender distribution. The majority of subjects had age related cataracts. Phacoemulsification was done faster than other surgeries, especially by specialist surgeons. History of prior ocular surgery and operations performed under general anesthesia were associated with greater complications. Phacoemulsification was associated with less complications and better visual outcomes. The age and etiology of cataract did not affect complications. Malays, absence of ocular comorbidities, left eyes and eyes operated under local anesthesia were more likely to experience more visual improvement. Gender, age, cause of cataract, systemic comorbidities and surgeon expertise as well as intra-and postoperative complications did not affect the visual outcomes.

    CONCLUSION: Phacoemulsification had good visual outcomes in cataract surgery. Duration of surgery, expertise of the surgeon and complications did not affect the visual outcomes.

    Matched MeSH terms: Surgeons
  18. Tengku Shaeran TA, Shaari R, Abdul Rahman S, Alam MK, Muhamad Husin A
    J Oral Biol Craniofac Res, 2017 Jan-Apr;7(1):7-12.
    PMID: 28316914 DOI: 10.1016/j.jobcr.2016.10.007
    BACKGROUND: Bilateral sagittal split osteotomy (BSSO) is the most versatile procedure and adopted by many surgeons to relocate the mandible in patients having mandibular prognathism (MP). Injury to the inferior alveolar nerve (IAN) and unfavorable splits are two surgical complications of BSSO which are associated with mandibular morphology. Uses of cone beam computed tomography (CBCT) in providing 3-D images has gained a wider acceptance in surgical field nowadays. Its advantages are including reduced cost, lesser radiation dose and smaller physical footprint comparing to the conventional computed tomography.

    PURPOSE: This study aims to identify the differences in morphology of prognathic and non-prognathic mandible at BSSO sites using cone beam computed tomography images.

    METHODS: This retrospective study involved 51 CBCT images of patients having mandibular prognathism and without mandibular prognathism. The latter group made up from patients with Class I skeletal pattern. Samples were taken using purposive sampling method from two clinical centers.

    RESULT: Prognathic mandible has higher lingula level, superiorly and buccally placed inferior alveolar nerve canal at distal second molar, thinner mediolateral width of ramus at anterior and posterior part and thinner anteroposterior width of the ramus.

    CONCLUSION: Morphology of mandible in patients with mandibular prognathism (MP) was significantly different from patients without mandibular prognathism (WMP) for most of the parameters. The high risk parameters may be highlighted to the patients using cone beam computed tomography images.
    Matched MeSH terms: Surgeons
  19. Chan CYW, Chung WH, Mihara Y, Lee SY, Ch'ng PY, Hasan MS, et al.
    J Orthop Surg (Hong Kong), 2020 8 9;28(3):2309499020936005.
    PMID: 32762498 DOI: 10.1177/2309499020936005
    PURPOSE: Various surgical strategies including combined approach and spinal osteotomies in severe rigid scoliosis had been reported with significant perioperative complication rates. The use of single-staged posterior spinal fusion (PSF) utilizing a dual attending surgeon strategy for severe rigid scoliosis has not been widely reported.

    METHODS: This was a retrospective study aimed to evaluate the perioperative outcome of single-staged PSF in severe rigid idiopathic scoliosis patients (Cobb angle ≥90° and ≤30% flexibility). Forty-one patients with severe rigid idiopathic scoliosis who underwent single-staged PSF were included. The perioperative outcome parameters were operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, transfusion rate, patient-controlled anesthesia morphine usage, length of postoperative hospital stay, and perioperative complications. Radiological parameters included preoperative and postoperative Cobb angle, correction rate, side-bending flexibility, and side-bending correction index.

    RESULTS: The mean age was 16.9 ± 5.6 years. The mean preoperative Cobb angle was 110.8 ± 12.1° with mean flexibility of 23.1 ± 6.3%. The mean operation duration was 215.5 ± 45.2 min with mean blood loss of 1752.6 ± 830.5 mL. The allogeneic blood transfusion rate was 24.4%. The mean postoperative hospital stay was 76.9 ± 26.7 h. The mean postoperative Cobb angle and correction rate were 54.4 ± 12.8° and 50.9 ± 10.1%, respectively. The readmission rate in this cohort was 2.4%. Four perioperative complications were documented (9.8%), one somatosensory evoke potential signal loss, one superficial infection, one lung collapse, and one superior mesenteric artery syndrome.

    CONCLUSIONS: Severe rigid idiopathic scoliosis treated with single-staged PSF utilizing a dual attending surgeon strategy demonstrated an average correction rate of 50.9%, operation duration of 215.5 min, and postoperative hospital stay of 76.9 h with a 9.8% perioperative complication rate.

    Matched MeSH terms: Surgeons/standards*
  20. Mohd Rashid MZ, Sapuan J, Abdullah S
    J Orthop Surg (Hong Kong), 2019 3 12;27(1):2309499019833002.
    PMID: 30852960 DOI: 10.1177/2309499019833002
    BACKGROUND:: Trigger finger release utilizing wide-awake local anesthesia no tourniquet (WALANT) usage in extremity surgery is not widely used in our setting due to the possibility of necrosis. Usage of a tourniquet is generally acceptable for providing surgical field hemostasis. We evaluate hemostasis score, surgical field visibility, onset and duration of anesthesia, pain score, and the duration of surgery and potential side effects of WALANT.

    METHODS:: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded.

    RESULTS:: Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference.

    CONCLUSION:: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.

    Matched MeSH terms: Surgeons
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