bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH8.2 Trans-umbilical versus peri-umbilical incision for general laparoscopic surgery
Authors: Jones Stacey , Sheredi Mohamed 
Published: November 2022

Abstract

Aims
The aim of this study was to determine whether a trans-umbilical or peri-umbilical incision is a better route for the initial umbilical trocar in general laparoscopic surgery in terms of post-operative pain, risk of surgical site infection (SSI), post-operative complications and scar cosmesis.

Methods
This was a prospective study of 128 patients who underwent a trans-umbilical incision and 97 patients who had a peri-umbilical incision during general laparoscopic surgery between January 2020 and July 2021. Demographic data and type of surgery were obtained from the operation note. Following the procedure each patient was contacted via telephone and asked questions regarding, post-operative pain, SSI, post-operative complications and cosmetic satisfaction.

Results
Of the 128 patients within the trans-umbilical group, 57.8% were female with a mean age of 44.4 years and a BMI of 26.6 kg/m2. Whereas, in the peri-umbilical group 62.9% were female with a mean age of 50 years and a BMI of 29.8 Kg/m2. The most common operation performed was laparoscopic cholecystectomy in both groups. The trans-umbilical group experienced less post-operative pain than expected p=0.03, less post-operative complications p=0.009 and better scar cosmesis satisfaction p=0.001. There was no statistically significant difference in the rate of SSI p=0.73.

Conclusion
The trans-umbilical incision for initial peritoneal access in general laparoscopic surgery is recommended due to the lower than expected post-operative pain, reduced post-operative complication rates and increased patient satisfaction with regards to scar cosmesis.
TH8.5 VTE Pharmacological Prophylaxis in Oesophagogastric Cancer Resection Patients: A Triple Cycle Closed Loop Audit Against NICE Guidance NG89
Authors: Baxter Jessica , Room Hywel , Parsley Conor , Smith Benjamin , Sechante Chalint 
Published: November 2022

Abstract

Aims
NICE NG89 Guidance introduced in 2018 recommends 28 days extended VTE pharmacological prophylaxis in patients who have major abdominal surgery for cancer. In 2018, our oesophagogastric unit protocols prescribed only inpatient VTE prophylaxis. Through the interventions of clinician education and modified unit protocols we improved our unit's compliance with NICE NG89.

Methods
We conducted a three cycle hybrid audit. 50 patients who underwent either oesophagectomy or gastrectomy were randomly chosen from 2017–19 (Cycle 1), 2019–21 (Cycle 2) and 2021–22 (Cycle 3). The first cycle intervention was the requirement for 14 days postoperative VTE pharmacological prophylaxis. The second cycle intervention increased this requirement to 28 days. All cycles additionally had interventions of clinician education.

Results
Against the NICE NG89 recommendation for 28 days postoperative pharmacological prophylaxis, our audit showed 14% compliance in Cycle 1, 26% in Cycle 2 and 91% in Cycle 3. The median duration of VTE prophylaxis prescription (combined inpatient and outpatient) was 7 days in Cycle 1, 23 days in Cycle 2 and 28 days in Cycle 3. The correct dose by weight for VTE prophylaxis was prescribed in 89% of cases in Cycle 1 and 100% of cases in Cycle 2 and 3. Whilst small numbers preclude statistical analysis, there were 2 bleeding events and 1 VTE event in both Cycles 1 and 2 but none in Cycle 3.

Conclusions
Our unit made a stepwise improvement against the NICE NG89 recommendation for extended VTE prophylaxis in cancer resections. Furthermore, clinician education improved correct weight based dosage.
TH8.8 Retrospective study on the safety of thyroid surgery with confirmed benign histology in a UK district general hospital
Authors: Adedeji Ayodeji , Omakobia Eugene , Agada Frank , Gordon Conor 
Published: November 2022

Abstract

Aim
With increasingly aging population, more thyroidectomies are being performed in the elderly. These surgeries may be suspected to be unsafe as majority of the geriatric population suffer from comorbidities. Our local study explored the safety of thyroid surgery with confirmed benign histology in the elderly, with the post-operative complication rates being the primary outcome measures.

Methods
The study group included patients over 75 years who had thyroid surgeries with confirmed benign histology in a UK district general hospital from January 2010 to January 2022. We then analysed the rates of complications including temporary hypocalcemia, permanent hypocalcemia, vocal cord palsy and haematoma.

Results
41 elderly patients underwent thyroid surgery with confirmed benign histology in our facility within the period. 78% of them had thyroid lobectomy and the commonest indication for surgery was benign multinodular goitre. There were no haematomas, no permanent vocal cord palsies and no cases of permanent hypocalcemia. Only 3(7.3%) patients had transient hypocalcemia, and 2(4.9%) had vocal cord palsy which all resolved before 6 months.

Conclusions
Our study has demonstrated that it is generally safe to perform thyroidectomy in the elderly population with low hypocalcemia and vocal cord palsy rates as compared to the British Association of Endocrine and Thyroid Surgeons’ report of 10.2% and 7.8% for hypocalcemia and early cord palsy rates respectively in all age-groups. Nevertheless, we would advocate appropriate patient selection in terms of ASA classification. For example, 50% of those who had post-operative vocal cord palsy in our study had an ASA of 3.
TH8.9 Impact of laparoscopic sleeve gastrectomy on fibrosis stage in patientswith child–A NASH–related cirrhosis
Authors: Salman Mohamed , Noureldin Khaled , Issa Mohamed , Tourky Mohamed , Badawi Marwa , Abdelaziz Ayyat 
Published: November 2022

Abstract

Introduction
Bariatric surgery can improve non-alcoholic fatty liver disease (NAFLD). This work endeavored to evaluate laparoscopic sleeve gastrectomy (LSG) in cases with compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and its impact on fibrosis stage.

Methods
A prospective work involved 132 cases with Child-A NASH-related cirrhosis suffering from morbid obesity scheduled for LSG. They had preoperative assessment, wedge biopsy, and ultrasound-guided true-cut liver biopsy after 30 months. Patients with F4 fibrosis were included. Liver condition was assessed based on NALFD Activity Score (NAS).primary outcome measure was the impact of LSG on fibrosis stage and its relation to weight loss.

Results
Analysis included only 71 patients who completed the 30-month follow-up period. By the end of follow-up interval, there was a substantial weight loss with a reasonable resolution of comorbidities. median NAS decreased from 6 (1–8) to 3 (0–6) after surgery. Fibrosis score regressed to F2 in 19 patients (26.8%) and F3 in 29 (40.8%). Patients with improved scores had a significantly higher amount of weight loss (p &lt; 0.001). Improvement was more frequent in males (p = 0.007). By 30 months after treatment, 53.8% of cases with borderline NASH and 36.8% of those with probable NASH showed complete resolution, and 44.7% of patients with NASH showed improvement. Steatosis improved in 74.6% of patients.

Conclusion
Patients with NASH-related liver cirrhosis of Child class A, LSG may be a secure approach for the management of morbid obesity. It has a long-term benefit for both obesity and liver condition with significant improvement of steatosis, steatohepatitis, and fibrosis.
324 Total Knee Arthroplasty in Haemophilia Patients: A Systematic Review and Meta-Analysis of Long-Term Survivorship, Functional Outcomes and Complications
Authors: Fu H , Peacock C , Wang C , Kader D , Asopa V , Sochart D 
Published: November 2022

Abstract

Aim
End-stage arthropathy is a well-known complication of haemophilia, with recurrent haemarthroses leading to joint destruction, deformity, pain, and stiffness. In the knee, this is often treated with total knee arthroplasty (TKA), which can be more challenging in patients with haemophilia (PwH) and associated with poorer outcomes. We conducted a systematic literature review and meta-analysis to determine implant survivorship, functional outcomes, and complication rates.

Method
A systematic review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting TKA outcomes with Kaplan-Meier survivorship in PwH (PROSPERO registered). Meta-analysis was performed for survivorship and outcomes, and the results were compared to outcomes from the National Joint Registry (NJR).

Results
19 studies, totalling 1187 TKAs (average age 39 years) were reviewed. In PwH, implant survivorship at 5, 10, and 15 years was 94%, 86%, and 76% respectively, whereas NJR reported survivorship for males &lt;55 years was 94%, 90%, and 86%. Survivorship generally improved over the time period studied (1973–2017) but was inversely correlated with HIV infection (common in PwH). Range of motion improved by 10–20° post-operatively, and there were large improvements in Patient Reported Outcome Measures (PROMS). The prosthetic joint infection rate (PJI) was 6% compared to 0.5–1% in non-PwH, but the reporting of other complications, especially haematological, was inconsistent.

Conclusions
TKA in PwH has similar 5-year survivorship to non-PwH, but a six-fold higher infection rate. There were marked improvements in range of motion and PROMS, but complications were poorly reported. There remains a need for larger, long-term studies with standardised reporting.
178 The Effect of Ophthalmic Surgery for Graves’ Orbitopathy on Quality of Life – A Systematic Review and Meta-Analysis
Authors: Woo T , Li C , Ganesananthan S , Rajendram R , Uddin J , Lee R , Dayan C , Taylor P 
Published: November 2022

Abstract

Background
Graves’ orbitopathy has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia and improve aesthetics. We aimed to quantify the effect of different surgical approaches on quality of life.

Method
Electronic databases were used from inception until 22nd March 2021 to identify studies assessing quality of life pre- and post-surgical intervention for Graves’ orbitopathy. Two reviewers independently extracted data and performed quality assessments. Random-effects and Bayesian models for meta-analyses were utilised.

Results
10 articles comprising 632 patients were included. All used the Graves’ Ophthalmopathy Quality of Life questionnaire (GO-QOL). For GO-QOL appearance, the pooled standardised mean improvement for patients after surgery was +0.72 (95% CI 0.50–0.94) I2=69% (95% CI 52–80%). For GO-QOL visual functioning, the pooled SMD for patients after surgery was +0.41 (95% CI 0.25–0.58) I2=60% (95% CI 36–74%). For visual appearance, orbital decompression yielded the greatest improvement (SMD+0.84, 95%CI 0.54–1.13) followed by eyelid surgery (SMD+0.38, 95% CI 0.05–0.70), while strabismus correction had no significant effect (SMD +0.94, 95% CI -0.10–1.99). Conversely strabismus correction was associated with the greatest improvement (SMD+1.25, 95%CI 0.29–2.21) in visual functioning, outperforming orbital decompression (SMD+0.29, 95%CI 0.15–0.43) and eyelid surgery (SMD+0.12, 95%CI -0.18–0.41).

Conclusions
Ophthalmic surgery results in substantial improvements in quality of life in patients with Graves’ orbitopathy, with greater perceived effects on appearance than visual function. Orbital decompression has particular impact on visual appearance, strabismus surgery may benefit both visual appearance and function equally whereas eyelid surgery benefits appearance alone.
187 The Impact of Electronic Pathways and Digital Systems on Neck of Femur Fracture Outcomes: A Systematic Review
Authors: Tandon D , Curlewis K , Vusirikala A , Subramanian P , Patel A 
Published: November 2022

Abstract

Aim
Electronic pathways and digital systems are novel interventions in medicine that include clinical decision support systems and checklists for care delivery. The primary aim of this systematic review was to outline the impact of electronic pathways and digital systems on neck of femur (NOF) fracture outcomes as according to Best Practice Tariff (BPT) outcomes.

Method
A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Studies were included for review if they addressed the impact of an electronic pathway or digital system on at least one of the BPT outcome measures. Studies were excluded from the review if they were not written in English. After 698 citations were independently reviewed by two authors, 6 papers were included for full text review. The data was significantly heterogenous, hence a narrative synthesis was performed. Risk of bias for each paper was assessed using the Downs and Black scale.

Results
Time to theatre, length of hospital stay and management of osteoporosis for secondary fracture prevention displayed statistically significant improvements. Mortality and post-operative complications demonstrated non-significant improvements. No outcome measures were adversely affected. The identified studies had a similar risk of medium bias.

Conclusions
Electronic pathways and digital systems have a statistically significant positive impact on several NOF fracture outcomes. Due to the novel nature of electronic pathways and digital systems in orthopaedics, a limited number of studies were identified for review. More high-quality homogenous prospective cohort studies are required to allow for a meta-analysis.
853 The Use of 3d-Printed Wrist Models to Aid Patient Understanding of Diagnosis and Treatment
Authors: Carvill M , Brown M , Rust P 
Published: November 2022

Abstract

Aim
Models of the wrist allow for complex anatomy to be visualised and explained, aiding clinician to patient discussion. This pilot study aimed to investigate in impact on patient understanding of their diagnosis and treatment using a 3D-printed model hand in consultation.

Method
3D-printed model wrists based on dissection specimens done in Anatomy, University of Edinburgh, were created to demonstrate a variety of pathologies, including triangular fibrocartilage tears and scapholunate ligament injuries. Patients participated by questionnaire at hand clinic appointment with responses recorded on a visual analogue scale (VAS) for criteria including confidence explaining their condition to others, and satisfaction before and after use of the models.

Results
48 patients participated in the study with 38 questionnaires fully completed. Median age was 44 years old; the right hand was affected more than the left (17 vs. 15) and bilateral in 6 patients.
Use of the models saw a significant improvement in patient confidence to explain their condition to a family member (mean change 2.46, range -3 to 8.5; p&lt;0.001), although a wide range of responses were recorded demonstrating individual differences and preferences. Patient satisfaction was excellent (mean 9.25) when the models were used, and a positive net promoter score (mean 9.29) showing patients would recommend the consultation style.

Conclusions
This pilot study suggests that 3D-printed wrist models aid in patient education at consultation, building patient confidence and maintaining satisfaction. Given the range of responses and individual nature of learning it is likely these models will complement radiological images in this setting.
415 Virtual Reality Simulator use in Orthopaedic Training: What do the Trainees Think?
Authors: Hunt Laurence , Lubwama Baker , Al-Uzri Muntadhir , Lam Angela , Kang Niel 
Published: November 2022

Abstract

Aim
To gather the opinions of orthopaedic trainees on the use of virtual reality (VR) simulators in their training.

Method
Twelve entry level orthopaedic trainees trialled a tibial nailing surgery on a VR simulator. Each participant completed a pre- and post-intervention questionnaire containing twelve 10-point Likert scale questions assessing their opinions on VR simulator use in their training. Paired data sets were analysed using the Wilcoxon signed-rank test.

Results
Only 25% of participants had previously experienced a VR simulator, yet participants felt strongly that VR simulators had a place in orthopaedic training (M = 8.750 ± 1.288) and that if they had access, they would use a VR simulator to practice surgical skills (M = 9.000 ± 1.044). After trying the VR simulator, participants felt more strongly that VR simulators should be a mandatory part of orthopaedic training (M = 6.750 ± 1.658 to M = 7.500 ± 1.567, P = 0.048); VR simulators are an engaging learning tool (M = 8.583 ± 1.379 to M = 9.417 ± 0.793, P = 0.029); access to a VR simulator would improve their training (M = 8.250 ± 1.545 to M = 9.250 ± 0.866, P = 0.036) and VR simulators will form the basis of orthopaedic training in the future (M = 5.250 ± 2.734 to M = 6.667 ± 2.498, P = 0.032).

Conclusions
Orthopaedic trainees want VR simulators in their training and will use them if given access. A positive reception from trainees is vital in order to effectively implement VR simulators into orthopaedic training.
851 3D Printing Technology in Microsurgical Reconstruction of the Maxilla and Mandible at Great Ormond Street Hospital (GOSH)
Authors: Howard Theodore , Eriksson Sofia 
Published: November 2022

Abstract

Aim
Since its development, three-dimensional (3D) printing has been used successfully in many industries, however its use in surgery is still in its infancy. We present two cases where 3D printing technology was used to aid surgical planning and guide free-flap microsurgical reconstruction.

Method
A free fibula flap was performed following a hemi-maxillectomy for a mucoepidermoid carcinoma of the palate. 3D-technology was used to design the position of the osteotomies, osteosynthesis and osseo-integrated dental implants by our in-house 3D technician. A 3D-printed cutting guide was created for the fibula and a custom-made titanium plate was designed for the maxillary reconstruction. Similar 3D-technology was used in a free DCIA flap mandibular reconstruction following resection of a mandibular ameoblastoma. Lower limb CTA showed bilateral peronea arteria magna. Thus, a DCIA flap was performed. A 3D computer-aided design-model for the surgical procedure was created allowing for precise measurement of iliac crest bone and cutting guides were created to aid mandibular resection and ensure accurate bone harvest.

Results
Both patients underwent successful reconstruction, the flaps maintained good perfusion with strong and consistent doppler signals with healthy skin paddles post-operatively. The patients recovered well; one remains in the immediate post-operative period and one-month follow-up of the DCIA flap showed good position of the bone flap with reasonable movement of the mandible.

Conclusions
3D technology has the potential to improve the quality of craniofacial reconstructions. This technology allows the reconstructive surgeon to improve accuracy, demonstrate complex anatomy, plan and execute complex surgical plans with improved functional and aesthetic outcomes.
61 Comparison of Clinical Outcomes of Robotic Versus Open Pancreaticoduodenectomy Using a New ‘Therapeutic Index’ Tool for Quality Assessment of Surgery: A Systematic Review and Meta-Regression Analysis
Authors: Mantzavinou Artemis , Uppara Mallikarjuna , Chan Jeremy , Patel Bijendra 
Published: November 2022

Abstract

Aim
Pancreaticoduodenectomy (PD) is a challenging procedure with peri-operative complications. Robotic surgery offers improved dexterity, visibility, and accessibility. Recently, many centres have reported improved clinical outcomes for robotic PD. We reviewed the safety and efficacy of robotic PD in comparison to open PD using ‘Therapeutic Index’ (TI).

Method
A systematic review of the literature was conducted in various databases. Articles published between January 2010 and March 2021 reporting totally-robotic and open PD were included, according to PRISMA guidelines. The Cochrane tool was used for risk of bias assessment. We compared 30-day mortality rates (MR30), lymphadenectomy rates (LR), R0 resection rates (R0RR) and therapeutic index (TI). STATA 16.1 was used for statistical analysis.

Results
The four studies that met inclusion criteria included 5090 PDs, out of which 617 were totally robotic (RPD) and 4473 were open (OPD).
Variance ratio tests demonstrated a) Higher TI for RPD versus OPD (1807.42 vs 1723.37, p=0.86), b) Significantly smaller MR30 (2.50 vs 19.00, p=0.0004), c) Significantly lower R0RR (130.50 vs 939.25, p=0.00) and d) No significant difference in LR between RPD and OPD (35.63 vs 38.25, p=0.81).
Meta-regression analysis showed a significantly higher TI coefficient of RPD than OPD (0.66 vs -0.40, p=0.08, α=0.1).

Conclusions
Our study suggests that robotic PD is safe and not inferior to open PD and our analysis RPD demonstrated a higher therapeutic index than OPD. Randomised controlled trials are required to establish the efficacy of robotic PD. Also, standardisation of reporting mortality, survival and oncological outcomes is needed for the effective calculation of TI.
158 Virtual Interactive Surgical Skills Classroom: A Parallel-Designed, Non-Inferiority, Adjudicator-Blinded, Randomised Controlled Trial (VIRTUAL)
Authors: Fricker Monty , Nathan Arjun , Georgi Maria , Patel Sonam , Kien Man Kien , Asif Aqua , Sinha Amil , Mullins William , Shea Jessie , Hanna Nancy , Monks Massimo , Peprah David , Sharma Akash , Ninkovic-Hall George , Lamb Benjamin , Kelly John , Sridhar Ashwin , Collins Justin 
Published: November 2022

Abstract

Introduction
Virtual classroom training (VCT) is a novel educational method that permits accessible, distanced interactive expert instruction. We aimed to evaluate the efficacy of VCT in comparison to face-to-face training (FFT) and non-interactive computer-based learning (CBL) for basic surgical skills training.

Method
72 participants recruited from five London medical schools underwent stratified block randomisation into three equal intervention groups based on subjective and objective suturing experience. VCT was delivered via the BARCO weConnect platform and FFT was provided by expert instructors. Optimal student-to-teacher ratio was used, 12:1 for VCT and 4:1 for FFT. The assessed task was interrupted suturing with hand-tied knots. The primary outcome was post-intervention Objective Structured Assessment of Technical Skills (OSATS) score, adjudicated by two blinded experts and adjusted for baseline proficiency.

Results
VCT was non-inferior to FFT (adjusted difference 0.44, 95% CI: -0.54 to 1.75, delta 0.675), VCT was superior to CBL (adjusted difference 1.69, 95% CI 0.41 to 2.96) and FFT was superior to CBL (adjusted difference 1.25, 95% CI 0.20 to 2.29). FFT alone was associated with student travel expenses (mean £4.88, SD 3.70). Instructor hours used per student for VCT and FFT were 0.25 and 0.75, respectively.

Conclusions
VCT has a similar educational benefit to FFT and is a suitable modality of high-quality surgical skills education. VCT provides greater accessibility and resource efficiency compared to FFT. VCT satisfies the requirement for social distancing during the COVID-19 pandemic and is better than non-interactive CBL. VCT has the potential to improve global availability and accessibility of surgical skills training.