Unilateral cleft lip

Background: One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19 th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago. Purpose: The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy. Results: This systematic review and meta-analysis represent the largest comparison in literature between the thyroidectomy procedure with the second-generation Advanced Harmonic Scalpel Ultrasonic Focus (UAS FOCUS) versus the conventional Clamp-and-Tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10.361 patients. The incidence of transient recurrent laryngeal nerve was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63 to 0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT. Conclusion: Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication. 

Sutureless FOCUS harmonic scalpel versus clamp-and-tie techniques for thyroidectomy: A meta-analysis of 43 randomized controlled trials

OBJECTIVE
One minute of operating room (OR) time costs $36 to 37. However, ORs are notoriously inefficient. There is growing literature on improving OR efficiency, but no formal review of this topic within otolaryngology has been performed. This study reviews and synthesizes the current literature on improving OR efficiency within otolaryngology.


DATA SOURCES
MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, preprints.org, and medRxiv were searched on November 4, 2022.


REVIEW METHODS
Published English studies were included if they reported on metrics for improving OR efficiency within otolaryngology. There were no publication date restrictions. Articles were screened by 2 reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analysis reporting for scoping reviews was followed.


RESULTS
The search yielded 9316 no-duplicate articles; 129 articles were included. Most of the studies reported on head and neck procedures (n = 52/129). The main tactics included surgical considerations: hemostatic devices, techniques, and team/simultaneous approaches; anesthetic considerations: local anesthetic and laryngeal mask airways; procedure location considerations: procedures outside of the OR and remote technologies; standardization: equipment, checklists, and personnel; scheduling considerations: use of machine learning for booking, considering patient/surgeon factors, and utilizing dedicated OR time/multidisciplinary teams for on-call cases.


CONCLUSION
The current literature brings to attention numerous strategies for improving OR efficiency within otolaryngology. Applying these strategies and implementing novel techniques to manage surgical cases may assist in offloading overloaded health care systems and improving access to care while facilitating patient safety and outcomes. Anticipated barriers to implementation include resistance to change, funding, and the current strain on health care systems and providers.

Improving Operating Room Efficiency in Otolaryngology-Head and Neck Surgery: A Scoping Review.

Objective: The basic aim of this study is to find out comparison between conventional and harmonic techniques in bleeding control during Thyroidectomy. Methodology: This randomized control trial was conducted in Surgery Department, Bahawal Victoria Hospital Bahawalpur. This study was completed in 5 months (August 2018 to January 2019) and all the patients under trial were asked for informed consent. A total number of 100% (n=62) were taken in this trial and online source Openepi.com was used for calculating sample size. Patients were selected by lottery method. Computer software SPSS version 23.2 was used for complete data entry and analysis. All the descriptive variables like onset of action and age were presented as SD and mean. Statistical test ANOVA was applied to find the significance among all groups. Chi square test was applied for analysis of continuous stats among groups. P value 0.05 was to be considered as significant. Result: A total number of 100% (n=62) patients were included, divided into two equal groups, 31 in each i.e. harmonic scalpel and conventional knot groups. The mean age of the patients, in harmonic scalpel group, was 45.29±4.56 years. There were 64.5% (n=20) males and 35.5% (n=11) females. The mean age of the patients, in conventional knot, was 44.96±2.97 years. There were 74.2% (n=23) males and 25.8% (n=8) females. No significant difference was found for age (t=0.329, p=0.743) and gender (χ 2 =0.683, p=0.409) in groups. The main outcome variables of this study were the time of procedure (minutes) and blood loss volume (ml). The mean time of procedure was 98.80±16.52minutes and 119.81±9.95 minutes for the harmonic scalpel and conventional knot groups respectively. Significant difference was found for the time of procedure in groups (t=-6.060, p-value = 0.000). Conclusion: The whole study can be ended with this conclusion that the harmonic scalpel is more effective than the conventional method of ligation or knotting in thyroidectomy. Its use offer many clinical benefits including reduction in time of surgery and blood volume as well. Keywords: Thyroidectomy, Harmonic, Conventional and Bleeding control. DOI : 10.7176/JMPB/54-09 Publication date : April 30 th 2019

/pdf/comparison-between-conventional-and-harmonic-techniques-in-29at0yn1m1.pdf

Comparison between conventional and harmonic techniques in bleeding control during Thyroidectomy

Objective: To contrast results of two surgical methods for correction of Unilateral Cleft lip. Methodology: Prospective study was conducted from October 2018 to October 2019 after ethical approval from institute ethical board. Data was collected than arranged over Microsoft Excel 2007.Variables then formed or for further statistical results data was entered in SPSS version 15.0. Variables were assessed by using. . Standard Deviation and Mean was calculated and presented for quantitative data like age and weight. Frequency (percentages) were calculated and presented for qualitative data such as gender and outome variables. Post stratification statistical chi square test was used to see effect modification. P value ≤ 0.05 was considerable. Results: Out of 100% (n=66) unilateral cleft lip patients, 50% (n=33) patients each were operated with Modified Millard’s incision and Delaire’s functional method respectively. Various parameters were analyzed—white roll match, cupid bow, lip length and alar dome demonstrated favorable measurements in Millard’s group and the vermilion match, scar appearance, nostril symmetry and alar base was better in Delaire’s methods. All the differences in these parameters were not statistically significant, except lip length (p=0.023). Conclusion: Overall clinical outcomes like vermilion match, white roll, and cupid bow appearance was similarly effective in both techniques. Outcome related to lip length was considerable in incision by Millard’s technique. Similarly nasal symmetry was better in Delaire’s functional method. This leads to significance of one method over other. Keywords: Primary Repair, Modified Millard’s, Delaire’s Functional Method Unilateral Cleft Lip. DOI : 10.7176/JMPB/54-04 Publication date : April 30 th 2019

/pdf/comparison-of-outcome-of-modified-millard-s-incision-and-1v1kl9vehp.pdf

Comparison of outcome of Modified Millard’s Incision and Delaire’s Functional Method in Primary Repair of Unilateral Cleft Lip.

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Comparison between conventional and harmonic techniques in bleeding control during Thyroidectomy

Comparison of outcome of Modified Millard’s Incision and Delaire’s Functional Method in Primary Repair of Unilateral Cleft Lip.