Objective:This study aimed to explore the safety and feasibility of gasless transoral vestibular robotic resection of thyroglossal duct cysts. Methods:The clinical data of patients who underwent gasless transoral vestibular robotic resection of thyroglossal duct cysts at the Department of otolaryngology, Sun Yat-sen Memorial Hospital, Sun yat-sen university from September 2020 to May 2022 were analyzed. The operative time, blood loss, postoperative complications, postoperative pain score, postoperative aesthetic score, and recurrence were prospectively evaluated. Results:All patients completed the operation successfully and no case conversed to an open operation. The operation time was 104.00（95.00, 131.25） minutes, and the surgical blood loss was 15.00（10.00, 16.25） mL. The drainage volume was（59.71±9.20） mL. Postoperative pathology was consistent with thyroglossal duct cysts. There was no local reswelling, subcutaneous hematoma, emphysema, skin flap necrosis, infection and other complications. The postoperative hospital stay was 3.00（2.00, 3.00） days. Six patients had mild sensory abnormalities of the lower lip 3 months after surgery, and all patients were satisfied with the cosmetic outcomes. No recurrence was found during the 5-26 months follow-up. Conclusion:gasless transoral vestibular robotic resection of thyroglossal duct cysts is safe and feasible, with hidden postoperative scars and good cosmetic outcomes. It can provide a new choice for patients with thyroglossal duct cysts.
Humans ; Robotic Surgical Procedures ; Thyroglossal Cyst/pathology* ; Postoperative Complications ; Cicatrix/pathology* ; Pain, Postoperative

In the past, the report of shoulder instability undergoing open shoulder stabilization had satisfactory outcomes of greater than 90%. However, the functional loss of open procedure is severe in abduction and external rotation especially. Current arthroscopic techniques for shoulder instability result in success rate equal to open surgical procedure when the labrum is properly fixed to the glenoid rim using suture anchors, the capsule is tightened, and associated bony and soft tissue pathology is addressed. The arthroscopic surgery facilitates the view within shoulder joint for more accurate diagnosis, reduces operating time, minimises postoperative pain, reduces operative morbidity, improves shoulder function, and provides the possibility to perform other procedure simultaneously. However, to accomplish a successful arthroscopic stabilization procedure and to prevent complications, numerous advanced arthroscopic skill must be mastered. Although the arthroscope provides means to visualize new lesions, the pathomechanism and biomechanical explanation is not clear yet. Further studies are necessary to develop for shoulder reconstruction.
Arthroscopes ; Arthroscopy ; Diagnosis ; Pain, Postoperative ; Pathology ; Shoulder Joint ; Shoulder* ; Suture Anchors

OBJECTIVETo investigate the complications of tongue base reduction with radiofrequency tissue ablation on patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and find out the effective prevention strategies.

METHODSOne hundred and ninety three OSAHS patients diagnosed by polysomnography were received tongue base reduction with radiofrequency tissue ablation between March 2008 and December 2009. The intraoperative and postoperative complications including bleeding, hematoma of tongue base, abscess of tongue base, altered taste, tongue numbness, deviation of tongue extension movement, dysfunctions of pronunciation and swallowing as well as the managements were analyzed retrospectively.

RESULTSNo perioperative complications occurred. There were 186 cases with postoperative pain (96.4%), 155 cases with submandibular edema (80.3%). Nocturnal sudden cardiac death was encountered in 1 case and secondary bleeding in 1 case. There was no ulceration of tongue base mucose, hematoma or abscess of tongue base, altered taste, tongue numbness, tongue deviations, speech, swallowing and taste disorder after operation. The scale of postoperative pain claimed by patients was ranged between mild to moderate. Diclofenac suppository had analgesic effect for these patients. The quantity of bleeding in patient with secondary hemorrhage was so little that after proper treatment the bleeding was stopped and never happened again. Patient with nocturnal sudden cardiac death occurred at thirty-seven hours after operation, because of swelling and pain of tongue base aggravated sleep apnea and night hypoxemia inducing fatal arrhythmia.

CONCLUSIONSPostoperative pain and submandibular edema were 2 most common postoperative complications which can be easily controlled by antibiotics, Glucocorticoids and Diclofenac suppository. For those severe OSAHS patients accompanied by cardiopulmonary diseases, the tongue base reduction with radiofrequency tissue ablation can induce nocturnal sudden cardiac death. It is important to pay more attention on arrhythmias at night in severe OSAHS patients.

Adult ; Catheter Ablation ; adverse effects ; Edema ; pathology ; Female ; Humans ; Male ; Middle Aged ; Pain, Postoperative ; pathology ; Postoperative Complications ; Sleep Apnea, Obstructive ; surgery ; Tongue ; surgery

PURPOSE: Recently, conjunctivochalasis repair surgery using electrocauterization has been gaining popularity. However, patients with electrocauterized conjunctivoplasty tend to complain of more postoperative pain than patients undergoing simple excision with suturing. Therefore, we investigated the effects of electrocauterization on inflammation of the conjunctiva using an experimental animal model and compared these with the effects of simple excision with suturing. METHODS: Ten New Zealand white rabbits underwent cauterization in the right eyes and excision and suturing in the left eyes. For each eye, we excised or electrocauterized the inferior bulbar conjunctiva, 1 mm in width and 6 mm in length, 2 mm from the limbus. A fine-needle electrode was inserted subconjunctivally, and electrocauterization was performed. In the contralateral eye, the corresponding area was excised and re-approximated with 10-0 nylon sutures. Sutures were removed after 14 days. Tissue samples were obtained at 21 days post-procedure, and inflammatory cells were counted in five randomly selected fields (x200) on hematoxylin-eosin stained slides. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta concentrations in tears were measured using enzyme linked immunosorbent assays. RESULTS: All cauterized eyes demonstrated smooth surface healing without scarring after 5 days, whereas sutured eyes presented with mild edema with some scarring until the suture was removed. The number of inflammatory cells was significantly greater in sutured eyes compared with cauterized eyes (p = 0.035, Mann-Whitney U-test) at 21 days post-procedure. Tear TNF-alpha and IL-1beta concentrations at 21 days were similar in both groups. CONCLUSIONS: Electrocauterization for conjunctivoplasty seems to be advantageous in terms of inflammation compared with simple suturing and excision.
Animals ; Conjunctiva/pathology ; Conjunctivitis/*pathology/*surgery ; Disease Models, Animal ; Edema/pathology/prevention & control ; Electrocoagulation/*methods ; Humans ; Male ; Pain, Postoperative/pathology/*prevention & control ; Rabbits ; *Suture Techniques ; Treatment Outcome

The lumbar discectomy has steadily improved since its introduction by Mixter and Barr in 1934. The results of standard discectomy are good, but surgeons must still contend with the "failed disc" syndrome. This is most likely caused by excessive damage to the contents of the epidural space during surgery. The application of microsurgical techniques to lumbar discectomy greatly minimizes disruption of the integrity of normal anatomy. Meticulous hemostasis may help to speed the process of convalescene, and the retention of epidural fat around the nerve root may help to prevent adhesions, which is a common cause of late, "failed disc" syndrome. High resolution computerized tomography of the lumbar spine provides an accurate means of preoperatively assessing both bony and soft tissue pathology of the spine, including nerve roots and the thecal sac. The author reviewed 84 cases of microsurgery of herniated lumbar discs at Yonsei University, Severance hospital and Young Dong hospital from April, 1982 to August, 1982 to August, 1983. Conclusions: 1) Among 84 patients, the ratio of male to female was 1.63:1(52pts:32pts) and cases in the 3rd and 4th decades were 60.7% of the total. 2) The most frequent level of herniation was L4-5 intervertebral space(73%), left side. 3) In preoperative studies, a spinal CT scan was taken in 78pts(93%), and in 31pts(37%), a spinal CT scan alone was taken. The accuracy of spinal CT scan was 100%. 4) Of operative findings, 50 lesions(60%) were identified as protruding discs and 34 lesions(18.1%) as ruptured ones. 5) Among 84 cases, 31pts(37%) received flavotomy and 53pts(63%) received flavectomy or small partial hemilaminectomy. 6) The advantages of microsurgery of herniated lumbar discs were magnified vision and brilliant illumination, precise identification of structures in deep fields(including nerve root and its related structures), a marked advantage to dissect the adhered nerve root to its surrounding structures, its capacity to preserve the integrity of normal tissue, and meticulous hemostasis. This resulted in marked reduction in immediate postoperative pain, early ambulation and early discharge. 7) 100% of microsurgery for herniated lumbar disc disclosed from good to excellent results. 8) After microsurgery, no cases needed re-operation and there were no recurrent disc herniations.
Diskectomy ; Early Ambulation ; Epidural Space ; Female ; Hemostasis ; Humans ; Lighting ; Male ; Microsurgery* ; Pain, Postoperative ; Pathology ; Spine ; Tomography, X-Ray Computed

OBJECTIVE: To discuss the clinical features, diagnosis and endoscopic surgical intervention for small steoma of nasal sinuses causing nasal and facial pain. METHOD: A retrospective review was performed on 21 patients with nasal and facial pain caused by small osteoma of nasal sinuses, and nasal endoscopic surgery was included in the treatment of all cases. RESULT: The nasal and facial pain of all the patients was relieved. Except for one ase exhibiting periorbital bruise after operation, the other patients showed no postoperative complications. CONCLUSION Nasal and facial pain caused by small osteoma of nasal sinuses was clinically rare, mostly due to the neuropathic pain of nose and face caused by local compression resulting from the expansion of osteoma. Early diagnosis and operative treatment can significantly relieve nasal and facial pain.
Endoscopy ; Face ; Facial Pain ; Humans ; Nasal Surgical Procedures ; Osteoma ; surgery ; Paranasal Sinuses ; pathology ; Postoperative Complications ; Retrospective Studies

OBJECTIVE: To investigate the therapeutic effects of coblation treatment via endoscopy in epiglottic benign tumors. METHOD: Retrospective analysis was carried out in 128 patients with epiglottic benign tumors who underwent coblation treatment via endoscopy. The complications and therapeutic effect were analyzed. RESULT: The effective rate of treatment was 100% in cyst of epiglottis and in papillary epithelioma, and was 96.36% in hypertrophy of lingual tonsils. The pseudomembrane 1 w after operation. Postoperative pain is slight. There were no complications such as dyspnea, bleeding and infection. CONCLUSION Radio frequency coblation via endoscopy will be applicable in the therapy of epiglottic benign tumors.
Carcinoma, Papillary ; surgery ; Catheter Ablation ; Cysts ; Endoscopy ; Epiglottis ; pathology ; surgery ; Humans ; Hypertrophy ; Laryngeal Neoplasms ; surgery ; Pain, Postoperative ; Retrospective Studies

BACKGROUND: The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. METHODS: A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N  = 70) and R-Y group ( N  = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. RESULTS: The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P  = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P  = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P  = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P  = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P  = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P  = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P  = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P  = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P  = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P  = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. CONCLUSIONS: Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-10001434.
Humans ; Stomach Neoplasms/pathology* ; Anastomosis, Roux-en-Y/methods* ; Quality of Life ; Treatment Outcome ; Gastrectomy/methods* ; Postoperative Complications ; Gastroenterostomy/methods* ; Pain

BACKGROUNDS/AIMS: Laparoscopic cholecystectomy can reduce postoperative pain and recovery time. However, some patients experience prolonged postoperative hospital stay. We aimed to identify factors influencing the postoperative hospital stay after laparoscopic cholecystectomy. METHODS: Patients (n=336) undergoing laparoscopic cholecystectomy for gallbladder pathology at 8 hospitals were enrolled and divided into 2 groups: 2 or less and more than 2 days postoperative stay. Perioperative factors and patient factors were retrospectively analyzed. RESULTS: The patient population median age was 52 years, and consisted of 32 emergency and 304 elective operations. A univariate analysis of perioperative factors revealed significant differences in operation time (p<0.001), perioperative transfusion (p=0.006), emergency operation (p<0.001), acute inflammation (p<0.001), and surgical site infection (p=0.041). A univariate analysis of patient factors revealed significant differences in age (p<0.001), gender (p=0.036), diabetes mellitus (p=0.011), preoperative albumin level (p=0.024), smoking (p=0.010), and American Society of Anesthesiologists score (p=0.003). In a multivariate analysis, operation time (p<0.001), emergency operation (p<0.001), age (p=0.014), and smoking (p=0.022) were identified as independent factors influencing length of postoperative hospital stay. CONCLUSIONS: Operation time, emergency operation, patient age, and smoking influenced the postoperative hospital stay and should be the focus of efforts to reduce hospital stay after laparoscopic cholecystectomy.
Cholecystectomy, Laparoscopic* ; Diabetes Mellitus ; Emergencies ; Gallbladder ; Humans ; Inflammation ; Length of Stay* ; Multivariate Analysis ; Pain, Postoperative ; Pathology ; Postoperative Complications ; Retrospective Studies ; Smoke ; Smoking

BACKGROUND: For complicated appendicitis, in contrast to simple appendicitis, laparoscopic appendectomy (LA) is considered a relative or absolute contraindication because of the higher postoperative complication rate than that of open appendectomy (OA), especially, high incidence of intra-abdominal abscess. The purpose of this article is to assess the feasibility of LA for complicated appendicitis. METHODS: A retrospective review of 35 LA and 128 OA for the cases of gangrenous, perforated appendicitis, and periappendiceal abscess between May 1995 and June 1997 was performed. Patients were identified through the hospital pathology registry. We compared data from both groups with respect to operative times, postoperative pain, duration of ileus, length of hospital stay, and complication rate, with special attention to the incidence of intra-abdominal abscess. RESULTS: 1) The male:female ratio of LA (1:1.2) was significantly lower than that of OA (1:0.45) (p<0.05). There was no significant difference in the age distribution between both groups. 2) The mean operative time of LA (58.3 minutes) was significantly longer than that of OA (51.8 minutes) (p<0.05). 3) The mean number of injections of analgesics and the mean duration of ileus represented an advantage for LA (1.2 times and 1.8 days) than those of OA (1.6 times and 2.0 days). But these differences did not reach statistical significance. 4) The length of hospital stay of LA (6.5 days) was shorter than that of OA (7.8 dyas) (p<0.05). 5) Overall postoperative complication rate was lower in LA (11.4%) compared with OA (11.7) (p>0.05). But LA was associated with higher incidence of postoperative intra-abdominal abscess (3/35, 8.6%) than OA (3/128, 2.3%) (p=0.114). There was one serious intra-abdominal abscess in the LA, which required reoperation. The rest 2 cases in the LA and all 3 cases in the OA were treated conservatively. CONCLUSIONS: LA for complicated appendicitis could afford the merits of shorter hospital stay, reduced incidenceof wound infection, and comparable incidence of overall complication rate. To reduce the incidence of postoperative intra-abdominal abscess, copious irrigation and adequate drainage should be recommended.
Abdominal Abscess ; Abscess ; Age Distribution ; Analgesics ; Appendectomy ; Appendicitis* ; Drainage ; Humans ; Ileus ; Incidence ; Length of Stay ; Operative Time ; Pain, Postoperative ; Pathology ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Wound Infection