Day 1 :
Keynote Forum
Juan A. Mira
ClÃnica Doctor Mira, Plastic Surgeon, Spain
Keynote: Augmentation mammaplasty: a 40 years experience
Time : 09:00 am - 09:35 am
Biography:
Juan A Mira is a Plastic Surgeon since 1975 from Valencia, Spain. He has published his first work on "Mamaplastia aumentativa via transareoar inferior: 100 casos" (Revista de Cirugía Plástica Iberolatinoamericana), in 2003 his revolutionary innovation in breast prostheses "Anatomic Asymmetric Prosthesis: shaping the breast" (Aesthetic Plastic Surgery) and in 2010 his "Anatomic Bilateral Contour Mammary Prosthesis: ABC”.
Abstract:
Maintaining the shape and position of female breast has been a permanent human desire. Since 5000 years to nowadays we have noticed this evidence. Sir Astley Cooper seemed to offer us a way to follow when he described his remarkable fascia in the middle of the XIX century. Anatomist and surgeons followed what they thought it was responsible for the shape and suspension of the gland. But it was the unjustifiably forgotten, Col. Christine Haycock who demonstrates during her 40 years' experience that neither Copper’s fascia nor breast weight have anything to do with shape and ptosis. This is an important detail that made us think about two important points in breast augmentation: form and permanence. We review the topic, from the first attempts of breast implants until today. We talk briefly about incisions, access, placement and implants. In order to reach conclusions that provoke a technique of simple breast augmentation for every plastic surgeon, always clinically safe and aesthetically pleasing. We consider here our proposed solutions describing a new shape of mammary prosthesis for preventing that aesthetic issue: naturally anatomical and therefore with shape and in pairs, not in units for both breasts, as they have all been developed in the last 60 years.
Keynote Forum
Ernesto Delgado Cidranes
Complutense University Madrid, Spain
Keynote: Real-time neuroaxial inflammation in lumbar pain through PET-MRI: Looking at the future
Time : 09:35 am - 10: 05 am
Biography:
Dr. Ernesto Delgado Cidranes MD. PhD. APMCM. FSNA. FSCTA is an Anesthesiology, Resuscitation and Intensive Care Professor at Complutense University Madrid, Spain. He is the Scientific Director of ISGAR Society (International Society of Urogynecology, Aesthetic and Research), Scientific Chairman of UroGyneTV. Founder and CEO Advanced Pain & Aesthetic Management Center, Madrid. Cheif Editor, Journal of Pain Management and Therapy. Editor for Journal of Anesthesiology and Critical Care. Expert on Advanced Ultrasound and Pelvic Floor Disorders. He’s also an expert in Stem Cells and Regenerative Medicine. AIUM Member, Head Pain Unit, Hospital La Milagrosa. Anesthesiologist & Pain Management at CIMEG, MADRID. Director of International Course “The Art of Lung Ultrasound”. Director for International Certification ISGAR STEM CELLS (Cadaver & Live). Members of Organizing Committee for Pain Medicine at World Series Conferences USA. Anesthesiologist Research Teknon Hospital Barcelona.
Abstract:
A case study was performed by evaluating 23 patients using PET-MRI by implication of neuro inflation in patients with poor response to usual treatments. PET-MRI was performed on all patients. According to the diagnosis of uptake, the therapeutic behaviour to be followed was defined, as well as the comparison with the final result and degree of satisfaction and decrease of the inflammatory focus for the control of persistent chronic pain. The results were satisfactory and definitive in all of the patients and we concluded that PET-MRI in real time is a powerful tool for the resolution of complex patients with chronic pain
Keynote Forum
Vakhtang Shoshiashvili
Research Institute of Clinical Medicine, European University, Georgia
Keynote: Transnasal sphenopalatine ganglion block for postdural puncture headache treatment after spinal anesthesia – case report
Time : 10:05 am - 10:45 am
Biography:
Vakhtang Shoshiashvili is specialized in Anesthesiology and has a quite a few experience of regional anesthesia and pain management. He also contributed in treatment of cancer pain conditions. Since, 2013 he is an expert in anesthesia and intensive care at TSMU and Ministry of Health Care and Social Affairs Republic of Georgia. Currently, he is also an Associate Professor at European University and since 2016 is working as an Anesthesiologist at Research Institute of Clinical Medicine Tbilisi, Georgia.
Abstract:
Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design and the technique used also affect the risk. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing and improves with lying down. Conservative therapies such as bed rest, hydration and caffeine are commonly used as prophylaxis and treatment for this condition. We are presenting a case report of PDPH after pilonidal cystectomy. The patient was a 23 years old male, non-smoker has spinal puncture with B. Braun Spinocan 25 G Quincke type needle on the L3-4 level. Five minutes later after injecting of 3.5 ml Marcaine (“Astra Zeneca”) there was an acceptable depth of spinal anesthesia where surgery and anesthesia was done without complication. On second day patient was ambulated at home, no headaches. On third day after surgery patient felt severe postural headache. Hydration and caffeine was not helpful. We decided to relieve this pain condition by the sphenopalatine ganglion block with 2% lidocaine application through the transnasal cotton ended catheter. Pain was relieved immediately. Duration of the application was five minutes. Procedure was repeated for 1 h with interval of three times. PDPH was relieved completely. We are concluding that sphenopalatine ganglion block with transnasal 2% lidocaine application is a simple, effective and safe tool for PDPH treatment which is usable for ambulated patients.
Keynote Forum
Ashraf EL-Molla
Prince Sultan Military Medical City, Saudi Arabia
Keynote: Victims and culprits of evidence biased and chaotic medicine presented by hemodynamic monitors
Time : 1100 AM - 11.35 AM
Biography:
Ashraf EL-Molla, M.B., B.Ch., M.Sc., M.D, Consultant Anesthesiologist, Ministry Of Health, Egypt, Cairo. He is interested in airway management, his recent publication “Bridging Bronchus, type six as a new rare case of a bronchial anomaly
Abstract:
Hemodynamic monitoring in critical care setting and perioperative period has been studied for decades and generated a large number of publications. We observed a conceptual shift in philosophy by monitoring static parameters of dynamic, functional and flow directed hemodynamic monitors (HM). We also witnessed the change of hemodynamic monitoring from invasive to minimally invasive and finally non-invasive technologies. In the era of evidence based medicine, it is imperative to realize that the evidence of HM to improve patients’ outcome is either small or, more often non-existent. Apart from the well known limitation related to modern dynamic monitors, none of the cardiac output (COP) monitors available today consistently present with <30% mean percentage error and >92% concordance. Most widely used modern dynamic COP monitors demonstrate a mean percentage error around 40-45% and most devices present with concordance <92%. Despite these disappointing results, it is surprising that a professional discipline such as medicine is able to conduct clinical studies using devices that have been consistently demonstrated inaccuracy and generate positive clinical outcome results. We consider this deviation as evidence bias or chaotic medicine as best or may be evidence corrupted medicine as worst. The reason for lack of evidence is probably related to the fact that human physiology is an incredibly a complex model. The novel hemodynamic devices provide a false sensation of security as those monitors are claimed to be effective to characterize fluid responsiveness which is taken as a sign of hypovolemia. This approach ignores the fact that HM cannot differentiate between absolute hypovolemia induced by blood and fluid loss and surgical stress which releases catecholamine that leads to vasoconstriction and various anaesthetic drugs that produce vasodilatation and relative hypovolemia as well as myocardial depression. We call for transparency in clinical research and a complete review as well as urgent refinement and modification of most of the present monitors not only for better patients’ outcome, but also for us as physicians who accepted what other industries dealing with life and death would clearly consider unacceptable
- Robotic Surgery | General Surgery | Hand Surgery | Plastic surgery | Anesthetics | Pain Management Spinal & Epidural Anesthesia | Anesthesia Equipment
Location: Spain
Session Introduction
Melissa G Medina
University of Illinois College of Medicine at Peoria, USA
Title: Telemedicine and telerobotics: From science fiction to reality
Biography:
Dr. Medina is obtained her medical degree at Loyola University Stritch School of Medicine and is in her fourth year of surgical residency at the University Of Illinois College Of Medicine at Peoria
Abstract:
Advances in communication technologies have paved the way for telemedicine to transform the delivery of medical care throughout the world. Coinciding developments in minimally invasive surgery and in particular teleoperated robotic surgical systems will allow the surgeon to deliver expert care in remote locations. This study presents a systematic review of telemedicine, focusing on telerobotic surgical systems. A brief historical review of telemedicine and telerobotics is provided, including a description of the various subtypes of telemedicine. Currently available systems and recent experimental utilization, including long-distance remote telesurgery, are discussed. Experimental telerobotic surgical systems and future developments in the field are reviewed and the potential applications are considered. Future challenges to the implementation and opinions on the future direction of telerobotics are provided in this review
Shagun Bhatia Shah
Rajiv Gandhi Cancer Institute and Research Centre, India
Title: Anaesthesia for robotic surgery: Patient positioning, ergonomics and clinical pearls
Biography:
Shagun Bhatia Shah is a motivated and dedicated anaesthesiologist with seventeen years of experience in anaesthesia and over 50 publications in various international peer reviewed journals. Her interest in oncoanaesthesia drove her to practice as a consultant at RGCI&RC. Her specific interests include recent advances in anaesthesia like USG-guided nerve blocks, difficult airway and anaesthesia for robotic surgery. She is certified in TOE (Trans oesophageal echocardiography) use and utilizes it for managing cardiac patients undergoing non-cardiac oncosurgery. She has successfully conducted clinical trials like “Optic Nerve Sheath Diameter Guided Non-Invasive ICP Measurement In Patients Undergoing Robotic Surgery In Steep Trendelenberg Position” and is presently conducting the trial “TOE for intraoperative goal directed fluid therapy in cardiac patients undergoing non cardiac oncosurgery and robotic surgery in ST-position” among others. She is ready to walk that extra mile with post- operative and terminally ill cancer patients to alleviate their pain and suffering
Abstract:
Robotic surgery has revolutionised patient management and opened newer doors for the anaesthesiologists regarding patient safety. Patient positioning and operation theatre (OT) configuration assumes unique importance for robotic surgery due to multiple factors. First and fore-most, the position cannot be changed once the robot is docked. Further, adequate surgical exposure requires extreme positioning and revamping of the existing positioning devices. In addition, there is restricted access to the patient and its antecedent problems. Last, but not the least, space restriction and protection of patient from the clashing robotic arms requires special devices and several unfavourable position modifications. Position related nerve palsies, pressure ulcers, port site necrosis, venous thrombosis and other injuries are on the rise in the recent years and appropriate measures may make it largely preventable. Extreme positioning causes physiological changes necessitating changes in ventilatory strategies and anaesthetic techniques. Our experience of providing perioperative and anaesthetic care for more than 3000 robotic surgeries (various surgical disciplines) has helped us to highlight the major positioning associated deficiencies and anaesthetic and other problems during robotic surgeries. We have also attempted to find practical solutions for the same and to define the best practices for robotic positioning using a thorough review of literature.
Steven S Tsoraides
University of Illinois-College of Medicine at Peoria, USA
Title: Review and update: robotic transanal surgery (RTAS)
Biography:
Steven S Tsoraides has completed his medical degree and MPH degree from the University of Illinois, College Of Medicine at Peoria (UICOMP). After completing his Residency at UICOMP where he was also an Administrative Chief, he went on to complete a fellowship in Colorectal Surgery at Southern Illinois University, School of Medicine. He is currently an Associate Professor in Clinical Surgery and a Residency Program Director
Abstract:
As the field of surgery advances, new approaches have allowed surgeons additional flexibility to perform further interventions with minimal or no external incisions. For many years, single site access (SSA) has been used for transanal procedure and platforms allowing modified endoscopic approaches have been available. These platforms have limitations related to access, visualization, dexterity, camera control and instrumentation. Recently, surgical robotics companies have developed and introduced new technologies and platforms, which may help address some of these limitations. Comprehensive internet, open access and medical and industry conference reviews of robotic surgery platforms and technology available for use in SSA surgery were conducted and 30 articles were found using keywords robotic surgery, transanal, single site and robotic transanal surgery. A PubMed, Medline, Journals @OVID and open access search for data related to these platforms and technologies was also performed yielding 11 articles. Abstracts were reviewed for those written in the English language, leaving 40 articles which were then filtered for those pertaining to robotic surgery, transanal. 58 abstracts were found, duplicates were eliminated and the remaining 35 articles were read in their entirety by two reviewers. Several new and existing platforms are identified for use in SSA surgery for transanal surgery as well as abdominal and transoral surgery. These are reviewed, including brand, features, approved and suggested uses and potential limitations. New robotic technologies serve to enhance the ability of surgeons to perform SSA surgery. This next generation of robotic surgery technology overcomes some of the limitations of preceding endoscopic SSA surgery technology and will enhance the advancement of robotic transanal surgery, but outcomes and performance data are still limited.
Karol Szyluk
District Hospital of Orthopedics and Trauma Surgery, Poland
Title: Treatment of proximal humeral fractures-osteosynthesis and alloplasty of the shoulder joint
Biography:
Karol Szyluk is an Orthopaedic Surgeon. He has completed his Graduation at Silesian Medical University, Katowice, Poland in the year 2001. He is a Consultant and Deputy Head in District hospital of Orthopedics and Trauma Surgery in Piekary Slaskie, Poland. He is a Professional Member of the Polish Society of Orthopaedics and Traumatology, Polish Society of Sports Medicine, Polish Society of Shoulder and Elbow, Société Européenne Pour La Chirurgie De L'epaule Et Du Coude, European Society for Surgery of the Shoulder and the Elbow, European Wrist Arthroscopy Society. He is an author and co-author of more than 30 scientific papers, published in scientific literature. He is the Reviewer of the Medical Science Monitor, Scientific Consultant at Hofer-medical, Scientific Consultant at Lima Corporate, Member of the Scientific Council of the Center Medical Training Pact. He is the Head of the research project from 2017 to 2020 with the title: “The effect of selected genetic factors on the efficiency of the treatment process of tennis elbow (lateral Epicondylitis) with autologous platelet rich plasma”.
Abstract:
Fractures of the proximal humerus account for about 5-7% of all fractures. The incidence is approximately 70 per 100,000 per year, but rises to 400/100.000/ year in women over 70 years old. In women ≥80 years old, the incidence is third only to fractures of the proximal femur and of the distal radius. Despite the rapid development of surgical techniques and an increasingly perfect implant, the treatment of proximal humeral fractures is a serious challenge. Firstly, this is related to the extremely complex biomechanics of this anatomical region and the action of muscles attaching to tuberosity of the proximal humerus, which, by pulling, lead to the displacement of bone fragments. Secondly, it is due to anatomical factors such as blood supply and the morphology of the articular surface. Therefore, the following questions are still relevant: who needs surgery, when to operate, what technique to use, how to reduce the risk of complications. Imaging tests and the necessary use of available fracture classifications are certainly useful in making decisions, but is reliance on these criteria a guarantee of success? And finally, which patients need fixation with plates and who require alloplasty. The question is complex. Especially when the surgeon has at his disposal: anatomical shape and fully modular prostheses-the fourth generation
Nikola Bradic
University Hospital Dubrava, Croatia University North, Croatia
Title: Management of primary graft dysfunction after heart transplantation
Biography:
Nikola Bradic is working in Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia for the last twenty years. He is specialist of Anesthesiology and subspecialist of Intensive Medicine. He is also Senior Lecturer in University North, Varazdin, Croatia, Department of Biomedical Sciences and has lectures in topics of anesthesiology, resuscitation and intensive medicine. Currently, he is working on several scientific projects and multicenter trials from the field of cardiac anesthesiology and care of cardiac patients in intensive medicine. Primary interests are in patients' hemodynamics, pharmacotherapy, mechanical heart support and echocardiography
Abstract:
Introduction: Approximately, 4-15% heart transplants, recipients do not survive in initial months after transplantation. The leading cause of early mortality after HTx is primary graft dysfunction (PGD) in which pathophysiology remains unknown. Between years 2013 and 2015, we had 41 heart transplantations in our institution and three of them developed signs of PGD. All of them we treated with VA ECMO combined with levosimendan in continuous infusion in early phases.
Cases: First patient, 53 years old male, with previous valve replacement and CABG surgery, became hemodynamically unstable soon after HTx in ICU despite of inotropic and vasoactive medical support. Emergency Transesophageal echocardiography (TEE) has shown dilated right atrium and akinetic right ventricle. Extracorporeal membrane oxygenation (ECMO) established immediately supported with continuous levosimendan infusion of 0.1 mcg/kg/ min. After 24 hours, levosimendan discontinued and ECMO continued for the next 5 days. In that period, TEE has shown improvement of right and left heart function and decrease of heart dimensions. Fifth day, ECMO discontinued, and several days later patient transferred on ward. Second patient, 39 years old male could not be weaned from CPB and ECMO with levosimendan started in operating room (OR). He stabilized hemodynamically, but his postoperative course was complicated with surgical bleeding and subsequent multiple revisions. Patient received levosimendan (0.1 mcg/kg/min) for 32 hours and was on ECMO for 72 hours. TEE on the postoperative day 5 showed left ventricle with normal diastolic diameter with systolic collapse and akinetic right ventricle (EFRV 15%). Despite all measures, the patient did not survive. Third patient, 47 year old male could not be weaned from CPB. TEE has shown significant dilatation of both ventricles with global hypocontractility. ECMO and levosimendan (0.1 mcg/ kg/min) were established; levosimendan was discontinued after 24 hours and ECMO discontinued on day 3 after HTx. In this period, TEE has shown improvement of contractility with EFLV 60%. At day 6 after ECMO removal, patient was discharged to the ward.
Conclusion: In case of PGD after HTx, combination of emergency ECMO and levosimendan has shown positive effect on hemodynamic parameters and recovery of heart function. Encouraging number of survival patients could be explained with small number of patients, and possibly would reach the data from other world centers, as we will inevitably have more patients with PGD complications. According to the suggestions of ISHLT consensus, usage of ECMO reduces the amount and dose of other inotropic and vasoactive drugs and improves the overall outcome. Results of other centers, suggest usage of ECMO over the other mechanical devices for heart support in PGD. Combination of ECMO with levosimendan within first 24 hours after HTx with PGD may shorten the time of ECMO and improve survival, and therefore could become standard treatment for PGD after transplantation in the future.
Lago G
University of Parma, Italy University of Rome Tor Vergata, Italy
Title: Thoracoscopic video-assisted sympathicotomy for the treatment of hyperhidrosis: 20 years’ experience with minimally invasive technique
Biography:
Lago G has completed his Graduation from University of Padova, Italy. During his medical school he has developed interest in Plastic Surgery and before graduation he has participated in several research projects, especially in the field of tissue bioengineering. After his graduation he moved to USA, where he worked as Research Fellow at Brigham and Women’s Hospital in Boston. Later he returned to his home country and started his Residency program in Plastic and Reconstructive Surgery at the University of Parma, Italy
Abstract:
Statement of the Problem: Hyperhidrosis is a frequent disorder with an estimated prevalence of 3% in the general population. This condition carries relevant impairments in social relationships for the patients. Hyperhidrosis can affect different anatomical areas with palmar region being the most disturbing for everyday activities and social relevance. Several conservative and topical treatments are available for the patients but their efficacy is often limited and temporary. Video-assisted thoracoscopic sympathicotomy of T2 and T3 ganglia with a minimally invasive technique might represent a definitive treatment for palmar and axillary hyperhidrosis.
Methodology & Theoretical Orientation: This minimally invasive approach for thoracoscopic sympathicotomy was first described by Raposio et al., two decades ago. This single-entry thoracoscopic procedure is carried out with a specifically modified endoscope equipped with optic fiber and a wire loop for electrocautery at its distal end. Since 1995, 760 patients have been treated in our department with this surgical technique.
Findings: Out of 1520 thoracoscopic video-assisted sympathicotomy performed in the last 20 years, 1428 resulted in complete resolution of palmar hyperhidrosis. In 46 subjects, the procedure could not be completed due to the presence of vascular structures overlying sympathetic ganglia. In 6 patients symptoms relapsed after the procedure, most likely due to accessory sympathetic pathways. Only 2 patients complained of generalized compensatory hyperhidrosis.
Conclusion & Significance: Video-assisted thoracoscopic sympathicotomy represents a definitive treatment for palmar and axillary hyperhidrosis and it should be considered when conservative options failed to relieve the symptoms. This minimally invasive approach provides effective resolution for this disorder with minimal postoperative complication rate
Edoardo Raposio
University of Parma, Italy Tor Vergata University of Rome, Italy
Title: 7 years’ experience in migraine surgery with minimally invasive and endoscopic technique
Biography:
Raposio E has completed his Graduation at the University of Genoa with specialization in Plastic and Reconstructive Surgery and Hand Surgery; PhD at the University of Tromso, Norway, and is currently the Director of the Chair and Residency Program in Plastic Surgery at the University of Parma, Italy. During his academic career, he has gained international experience as Visiting Professor in several Plastic Surgery Departments, both in Europe and USA. His clinical activities are mainly focused on the surgical treatment of migraine headache and primary hyperhidrosis with minimally invasive techniques.
Abstract:
Statement of the Problem: Migraine Headache (MH) is a very common disorder affecting 1.7-4% of the world’s adult population. The first line therapy for these patients is usually a combination of conservative treatments. Despite this large variety of options available, some patients remain refractory. For such group, migraine surgery might offer a definitive solution for their medical condition. In these patients, migraine is usually caused by extracranial nerve compression due vascular, fascial or muscular structures nearby. The aim of migraine surgery is to relieve such compression at specific trigger points located in the occipital, temporal and frontal regions.
Methodology & Theoretical Orientation: From 2011, in our plastic surgery unit at the University of Parma, Italy, we performed 235 surgical procedures for migraine in patients suffering from either frontal, occipital or temporal headache. In patients with occipital and temporal migraine, nerve decompression was achieved by occipital and superficial temporal artery ligation, respectively. Vessels were previously localized by mean of portable doppler device. In patients suffering from frontal headache, we performed nerve decompression with single-entry endoscopic myotomies of procerus, corrugator and depressor supercilii muscles.
Findings: Among patient suffering from occipital migraine, 95% of them observed significant improvement of their condition, with 86% reporting complete relief. In temporal migraine, positive outcome was achieved in 83% of the patient’s m50% complete elimination and 33% partial improvement. In patient treated with endoscopic frontal myotomies, positive results were observed in 94% of the patients 32% complete elimination and 62% partial improvement.
Conclusion & Significance: Migraine is a common and debilitating condition that can be treated successfully with minimally invasive surgical procedures. Our results suggest that vascular compression is the main causative agent in occipital and temporal migraine.
Mohsen Jahandideh
Isfahan University of Medical Sciences, Iran
Title: Novel approaches to anesthesia in electroconvulsive therapy
Biography:
Mohsen Jahandideh has graduated from Medical School from Azad University and always been passionate about Anaesthesiology. Currently, he is pursuing his career as a resident of anaesthesiology from Univesity of Medical Science
Abstract:
Electroconvulsive therapy (ECT) is a treatment used in various kinds of psychiatric disorders including depression, catatonia and manic disorders. There are a number of methods used to apply in ECT and there may be some complications including bradycardia, tachycardia and ECG changes. The contraindications for ECT include; intracranial hypertension, presence of a mass lesion in the brain, brain aneurysms, recent MI, angina, CHF and retinal detachment. The chronic use of psychiatric medications and co-existing medical situations warrant special care prior to ECT. Anesthesia is used to prevent unpleasant memories, while providing a prompt recovery. It is also used to preclude injury to bones due to abrupt muscle contractions during ECT. There have traditionally been various methods for providing pre-oxygenation and anesthesia during ECT. Different kinds of anesthetic drugs and neuro muscular blocking agents have also been used in this regard. But recently there many researches has been done regarding newer methods of providing preoxygenation and also different kinds of anesthetics used alone or in combination with each other that challenge the traditional methods of pre-oxygenation and anesthesia and can create better clinical results with less complications. In addition, different combinations of neuromuscular blocking agents have been studied in ECT which have yielded promising results in ECT and can reduce unwanted complications of traditional neuromuscular blocking agents. It is important for anesthesiologists to be familiar with these new methods in order to provide the best possible options for patients who require ECT in order to increase clinical results and decrease adverse complications of this procedure. We have reviewed a number of most recent studies in this regard. Although, many studies have been undertaken to improve anesthetic care furring ECT and lower the incidence of complications, there are still many questions that need to be addressed and more studies should be done to answer such questions and provide a higher standard of care for anesthesia during ECT
Karzan Seerwan Abdulla
University of Sulaymaniyah, Iraq
Title: Surgical management and outcome of complex bile duct injury after laparoscopic cholecystectomy
Biography:
Karzan Seerwan Abdullah finished his medical school in 2001 in University of Sulaimani medical college. He completed his Doctoral degree and training in General Surgery in different surgical centers in Iraq as a candidate of Iraqi council for medical specialization in 2008. He completed his fellowship training in Hepatobiliary surgery and liver transplantation at Apollo transplant institute and CLBS in Delhi in 2012. Currently, he is a teacher in Sualimani medical school and Kurdistan Board of GI surgery. His area of interest is management of bile duct injury and pancreatic cystic lesions and he has many publications in local and international journals
Abstract:
Background: There are many causes of bile duct injury. Iatrogenic bile duct injury, being the most common cause; Bile duct injury is one of the complex situations produced by a surgeon in apparently healthy patients and is associated with a significant rate of morbidity and a low rate of mortality. It needs multidisciplinary team approach between surgeons, radiologist and endoscopist. It offers better chances for an initial diagnosis, treatment options, management and follow-up of complications for the patient. We considered complex injuries: 1) injuries that involve the confluence; 2) injuries in which repair attempts have failed; 3) any bile duct injury associated with a vascular injury; 4) or any biliary injury in association with portal hypertension or secondary biliary cirrhosis. The present review is an evaluation of our experience in the treatment of these complex biliary injuries.
Objectives: To review surgical management of complex bile duct injury, review morbidity and mortality following surgical repair.
Method: We retrospectively analyzed surgical management and outcome of complex biliary injuries following cholecystectomy in 29 patients diagnosed intraoperatively following cholecystectomy or referred post operatively to our center in Sulaymaniyah governorate from January 2013 to March 2018.
Result: During the study period we have managed 59 cases of bile duct injury which they have referred to our center or consulted during cholecystectomy. Twenty nine patients were selected according to our selection criteria. Nineteen patients were female (65.5%). 21 patients with confluence injury, 5 patients with previous attempt by general surgeon, 2 patients with vascular injury and one patient with portal hypertension. In 27 patients, we performed mucosa to mucosa anastomosis between hepatic ducts and Roux-en-Y loop of jejunum. In 2 patients we performed portojejunostomy as a salvage procedure. Six patients developed stricture within 6 months for which we performed re-do anastomosis. We referred 3 patients for liver transplantation. Two patients died within 10 days of surgery because of sepsis. Both patients of porto-eneterostomy developed stricture and subsequent biliary cirrhosis.
Conclusion: Complex bile duct injury has bad prognosis and affect quality and quantity of life of the patients. The proximal the injury worse the prognosis; Porto-enterostomy has very bad outcome.
Yamin Zheng
Xuanwu hospital-Capital Medical University, China
Title: Nonmetal clip migration after laparoscopic cholecystectomy and bile duct exploration
Biography:
Yamin Zheng has completed his MD at Capital Mecial University, Beijing, China. Currently, he works as a Surgeon and a Professor. He has published more than eight papers in SCI journals as first author.
Abstract:
Nonmetal clip were applied to ligate cystic duct and gall bladder vessels as an alternation for metal clip in cholecystectomy (LC) and laparoscopic bile duct exploration (LCBDE). This study aims to explore nonmetal clip migration cases after LC or LCBDE and make literature review. This study reported seven cases of nonmetal clip migration into the gastrointestinal tract or bile duct. Combined with previous literature, it was discussed about the possible risk factors, clinical presentations, outcomes and treatment. Six cases of nonmetal clip migration after LC and LCBDE were found, including 3 cases of Hem-o-lock clips and 3 cases of absorbable clips. The incidence rate of nonmetal clip migration was 1.8% (6/326). Among all complications of 51 cases, the complication rate of clip migration was 11.8%. Four clips migration cases were found after LCBDE T-tube Drainage (66.7%) and two after Primary Closure (33.3%). Five patients with clip migration into CBD (83.3%) and two patients with clip migration into duodenum (16.7%). Five patients got clips removed one case was just observed. Literature review showed more cases about nonmetal clip migration. In conclusions, postoperative nonmetal clip migration was not rare after LC and LCBDE. Migrated clip in CBD may perform stone and lead to severe complication. We should pay more attention to correctly apply clips during LCBDE, make strict follow-up and timely treatment after clip migration.
Itee Chowdhury
Rajiv Gandhi Cancer Institute, New Delhi, India
Title: Pleth varibility index based intraoperative fluid management in head and neck free flap reconstructive surgeries
Biography:
Itee Chowdhury is Senior Consultant in the Department of Anaesthesiology at Rajiv Gandhi Cancer Institute and Research Centre New Delhi India, working as oncoanaesthetist for the last twenty years. She is also a Post Graduate guide for Diplomate of National Board (DNB) Government of India which takes keen interest in research activity. She has more than twenty publications in various anaesthesia journals. This project was conceived with the aim to find a cause of free flap failures involving Re-explorations. The results were very encouraging and benefited reconstructive surgeons at her institute.
Abstract:
Background: Head and neck reconstructive surgeries involving microvascular free tissue transfer (free flap) poses a major challenge in achieving a good cosmetic and functional outcome. Intraoperative fluid administration may be an important determining factor for a successful outcome. Static parameters like central venous pressure, mean arterial pressures, heart rate measurements for intraoperative fluid administration may not be reliable. Pleth varibility index (PVI) is a dynamic non invasive parameter for intraoperative fluid administration and can easily be obtained by pulse co-oximeter derived value. PVI enables goal directed tailor maid fluid administration preventing fluid overload thus preventing possible tissue oedema, thrombus formation and flap failure.
Purpose of this study: The purpose is to study PVI based goal directed fluid administration in these long duration specialized surgeries and compare the outcome with that of body mass index (BMI) based fluid therapy.
Methodology: A randomized prospective study on eighty patients of head and neck surgery involving free flap of four to five hour duration was conducted, one group of forty patients received fluid therapy based on body weight @ 6-8mL/ kg. Another study group of forty patients received intraoperative fluid therapy based on pulse oximetry derived PVI value ranging from 4-11. Data collected from mean arterial pressures, total crystalloid, colloids transfused urine output, thromboelastography parameters like R time, K time, alpha angle, maximum amplitude (MA) and LY3O and blood lactate levels in both groups. Results were analyzed and tested by appropriate statistical methods.
Findings: The PVI group data results showed significantly less total fluid administration, normal blood lactate levels and thromboelastography parameters within normal range compared to patients in group receiving intraoperative fluid based on body weight, which was statistically significant.
Conclusion & Significance: Pleth Variability Index may be a good alternative for goal directed intraoperative fluid management avoiding fluid overload which is non-invasive requiring minimum space in operating room. We also recommend routine thromboelastography in this group of patients at the end of surgical procedure as a guide to assess coagulation status. Adequate tissue perfusion and prevention of hypocoagulability and hypercoagulability in the study [PVI] group that may help in better microvascular free flap outcome.
- Vein Surgery | General Surgery | Hand Surgery | Plastic surgery | Robotic Surgery | Anxiolytics Benefits of Anesthesia | Pediatric Anesthesia | Steroidal Anesthesia
Location: Spain
Session Introduction
Juan A. Mira
Clinica Doctor Mira, Spain
Title: Simple and effective profiloplasty
Biography:
Juan A Mira is a Plastic Surgeon since 1975 from Valencia, Spain. He has published his first work on "Mamaplastia aumentativa via transareoar inferior: 100 casos" (Revista de Cirugía Plástica Iberolatinoamericana), in 2003 his revolutionary innovation in breast prostheses "Anatomic Asymmetric Prosthesis: shaping the breast" (Aesthetic Plastic Surgery) and in 2010 his "Anatomic Bilateral Contour Mammary Prosthesis: ABC”
Abstract:
Rhinoplasty is undoubtedly the most compromised of all cosmetic surgery interventions. Each patient has personal features and therefore requires a totally personalized nose, adapted to his face, and that shall be unique in all parameters. We review here a basic rhinoplasty, after we performed 4000 without pretending to exhaust possibilities: first visit, exploration, photographs, image digitalization, preoperative analytical study, hospital, operating room, anesthesia, assistants, immediate discharge, final discharge and following reviews. In brief, all things that can help all those who start in this difficult art will complement this by explaining the bases of the profiloplasty: how can we combine rhinoplasty with an elevation with a lip lift and chin reshaping with an autoimplant to obtain an excellent result.
Seshadri Mudumbai
Stanford University School of Medicine, USA
Title: Maintenance and governance of perioperative informatics management systems
Biography:
Seshadri Mudumbai after completing both Patient Safety Fellowship and a Masters in Health Services Research at Stanford, he joined the faculty as an Assistant Professor in the Department of Anesthesiology, Perioperative, and Pain Medicine in 2014. He is the Medical Director for VISN 21 Clinical Informatics Systems and Perioperative Analytics, Veterans Health Administration. He helps lead a five person team with the maintenance and governance for VISN 21 perioperative informatics systems, PICIS, which is installed in the OR, PACU and ICU for five major facilities. He has helped to lead multiple major implementation of Picis and conduct research and publish on informatics issues
Abstract:
As perioperative informatics management systems (PIMS) have been increasingly adopted and implemented by many healthcare facilities, attention is now being directed towards the ongoing maintenance and governance of PIMS. This attention is also necessary to align PIMS to the Triple aim recommendations developed by the institute for healthcare improvement. The triple aim recommendations include improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care. This presentation will provide information and best practices regarding maintenance and governance of PIMS with special emphasis on developing a checklist of key goals. Discussion topics will include upgrades, change requests, unintended consequences of bad change management or poor communication, and ongoing provider education issues. Author will also provide an review of best practices of Anesthesia Information Management System (AIMS) implementation, address the structure of PIMS, typical timelines and resource allocation systems as well as including PIMS in quality of care development
Karol Szyluk
District Hospital of Orthopedics and Trauma Surgery, Poland
Title: Arthroscopic Bankart lesion repair with a suture anchor – long term results
Biography:
Karol Szyluk is an Orthopaedic Surgeon. He has completed his Graduation at Silesian Medical University, Katowice, Poland in the year 2001. He is a Consultant and Deputy Head in District hospital of Orthopedics and Trauma Surgery in Piekary Slaskie, Poland. He is a Professional Member of the Polish Society of Orthopaedics and Traumatology, Polish Society of Sports Medicine, Polish Society of Shoulder and Elbow, Société Européenne Pour La Chirurgie De L'epaule Et Du Coude, European Society for Surgery of the Shoulder and the Elbow, European Wrist Arthroscopy Society. He is an author and co-author of more than 30 scientific papers, published in scientific literature. He is the Reviewer of the Medical Science Monitor, Scientific Consultant at Hofer-medical, Scientific Consultant at Lima Corporate, Member of the Scientific Council of the Center Medical Training Pact. He is the Head of the research project from 2017 to 2020 with the title: “The effect of selected genetic factors on the efficiency of the treatment process of tennis elbow (lateral Epicondylitis) with autologous platelet rich plasma”
Abstract:
Introduction & Aim: The shoulder joint is the most common dislocated joint in the human body. The aim of the study was to analyze late results of arthroscopic repair of Bankart lesions in patients with post-traumatic anterior shoulder instability.
Material & Methods: The study involved 92 patients (92 shoulders) after arthroscopic Bankart lesion repair, in patients with post-traumatic anterior shoulder instability and non-engaging Hill-Sachs lesion with a suture anchor. All patients were operated on in the lateral decubitus position using FASTak 2.8 mm, suture anchors (FASTak, Arthrex, Naples, Florida). The duration of follow-up ranged from 6 to 12.5 years (mean: 8.2 years). To assess the results of surgical treatment, the Rowe and University of California at Los Angeles rating system (UCLA) were used.
Results: Based on Rowe scores, there were 71(81.5%) excellent, 12 (12.6%) good, 5 (5.3%) satisfactory and 2 (2.1%) poor results. Rowe scores improved in a statistically significant manner (p=0.00) post-surgery, to a mean of 90 (range: 25-100). UCLA scores improved in a statistically significant manner (p=0.00), reaching post-operative levels of 12-35 (mean: 33.5). There were 9 recurrences, one case of axillary nerve praxia and one case of anchor loosening.
Conclusions: arthroscopic treatment of post-traumatic anterior shoulder instability gives good results and low recurrence rate irrespective of the number of previous dislocations, age or sex.
Nikola Bradic
Cardiovascular Anesthesiology and Cardiac Intensive Medicine University Hospital Dubrava, Croatia University North, Department of Biomedical Sciences, Croatia
Title: Right heart dysfunction in cardiac surgery - prevention and management
Biography:
Nikola Bradic, MD is working on Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia for the last twenty years. He is specialist of anesthesiology and subspecialist of intensive medicine. He is also senior lecturer in University North, Varazdin, Croatia, Department of Biomedical Sciences, and has lectures in topics of anesthesiology, resuscitation and intensive medicine. Currently is working on several scientific projects and multicenter trials from the field of cardiac anesthesiology and care of cardiac patients in intensive medicine. Primary interests are in patients' hemodynamics, pharmacotherapy, mechanical heart support and echocardiography
Abstract:
Background: Left ventricular failure (LVF) has been established as the cause for circulatory shock for the long period of time. On the other side, the role of right ventricular failure (RVF) as the cause of circulatory shock is still insufficiently recognized in perioperative settings. Most of cases were investigated in cardiac surgery, but in non-cardiac surgery, this entity type is neglected, although, the reasons for RVF could be result from the same pathophysiology reasons. According to the newest investigations and Evaluation and Management of Right-Sided Heart Failure published in last Scientific Statement from the American Heart Association (1), this review would like to show potential causes, diagnoses and treatment for RVF.
Pathophysiology: Incidence of RVF appears in very high percentage of patients, depending of the cause. During cardiothoracic surgeries, RVF approximately in 1% after cardiotomy, 5-12% in patients undergoing heart transplantation (because of pulmonary hypertension or primary graft failure) and over the 30% in patients who need LV assist devices implantation. Further, RVF can be consequence of acute or chronic increases in pulmonary pressures, acute ischemia during surgery, disruption of left and right ventricular interdependence and cardiomyopathies as the consequence of myocarditis. In the postoperative period, acute RVF occurred in almost half of the patients, which are hemodynamically unstable. This is the result of myocardial depression after extracorporeal circulation (ECC), which is usually mild, but can exacerbate in vulnerable patients.
Clinical presentation and diagnose: Clinical presentation of acute RVF mainly varies depending on the primary cause, the occurrence of other diseases, and depends about reserve of the right heart. Right heart failure may occur suddenly during or immediately after surgery in, previously, unrecognized but compensated RHF. Diagnose is typically relies on echocardiography (transesophageal and/or transthoracic), and it is recommended to use both techniques and different views to estimate right ventricular structures and function. Pulmonary artery catheter (PAC) can give valuable information about functional status of both ventricles, pulmonary resistance, changing in trends of measured values. Usage of PAC in today practice should be reserved for the patients with previously known RVF but in combination with echocardiography is extremely useful for patients in postoperative period. Changes in electrocardiogram (ECG) in acute RVF are limited with very low sensitivity and specificity.
Treatment of RVF: The treatment of RVF can be directed on several ways. First, it is necessary to decrease RV afterload and optimization of preload. This can be accomplished with ventilation strategies, preventing of rhythm disturbances and keeping of atrioventricular synchronicity. If this measures stay without results, pharmacological treatment must be established. Inotropic support with phosphodiesterase III inhibitors and levosimendan are recommended due to their inotropic and vasodilatative (especially on pulmonary circulation), while beta agonists are recommended as the second line of inotropic support, due to their negative effects (increasing oxygen consumption and arrhythmogenic effect). If patients need support with vasoconstrictors (due to hypotension), vasopresin is recommended over norepinephrine because of its lesser vasoconstrictive on pulmonary circulation. Specific pulmonary vasodilators may be also useful to reduce RV afterload in acute RVF settings. Finally, in very difficult patients, it is recommended use of mechanical support. Extracorporeal membrane oxygenation (ECMO), both veno-venous and/or veno-arterial is recommended as the first type of mechanical support. In case of improvement lacking, long-term mechanical support with right ventricular assist device (RVAD) can be established as the temporary support, or as the bridging to transplantation.
Conclusion: Despite of much knowledge's about RVF, this complication still remains a huge problem in perioperative period in cardiac surgery patients. Recognition and treatment must be appropriate and as quick as possible, because prolonged RVF can be deleterious and increase mortality in these patients.
David L Crawford
University of Illinois-College of Medicine, USA
Title: Evolution and literature review of robotic general surgery resident training: 2002-2018
Biography:
David L Crawford has completed his undergraduate degree from Hanover College in Hanover, Indiana. He has received his Doctorate in Medicine at the University Of Louisville School Of Medicine, Louisville, Kentucky; a Surgical Internship and General Surgery Residency at the Abington Memorial Hospital in Abington, Pennsylvania; a Minimal Invasive Surgery Fellowship at Cedars-Sinai Medical Center in Los Angeles, California. He is a Board Certified in General Surgery by the American Board of Surgery. He is an Associate Professor of Clinical Surgery and Chief Section of Minimally Invasive Surgery. He is Co-Creator and Co-Director of the Basic Laparoscopic Skills Course, the Advanced Laparoscopic Skills Course and the Intro to Robotic Surgical Skills Course for the General Surgery Residency. He is the 2008 recipient of the UICOMP ‘Outstanding Teaching Award’ and the 2006 Resident elected UICOMP Department of Surgery ‘Faculty Teaching Award’. Since 2001 to present, he is on the Board of Directors, WD Boyce Council and Boy Scouts of America.
Abstract:
Statement of the Problem: Since no validated robotic surgical curriculum exists, a systematic approach to credentialing and training robotic surgeons using technical skills, evaluation, interventions aimed at the enhancing skill evaluation and standardizing assessment tools for certification needed to be created. Best practices include a preclinical training assessment, didactic sessions, online tutorial and hands on components utilizing simulators and dry labs and cadaveric labs. This pathway was chosen to limit a learning curve of transiting and adopting new skills. The clinical training is a deliberate practice module, focusing on a specific procedure. This allows the learning to acquire skills more efficiently by building on high volume surgeries within the learner’s clinical setting. In turn, the scalable curriculum provides additional insight to the credentialing board of an academic hospital when granting robotic privileges. To accomplish this goal, the research suggests a multi-phase iterative mixed-method design for validating a robotic surgery curriculum utilizing a proficiency-based progression of surgical skill training.
Methodology & Theoretical Orientation: A mixed-method approach is fundamental due to the available data points. A mixed-method study will provide both quantitative data points of reduction of operating room times, skill set acquirement, proficiency to mastery skill set advancement, while also obtaining expert observational data and learning cognitive load analysis. To obtain triangulation and ascertain validity, the study will employ three validated assessment tools, ranging from aerospace to medicine specific. Simulator data will provide quantitative data and cognitive load assessments will provide learner qualitative data points.
Conclusion & Significance: The evolution of a novel robotic surgical platform has been met with challenges regarding user proficiency, patient safety and emerging trends. Only by systematic reassessment of instructional methodologies, will robotics flourish for additional decades to come. Hospital systems, surgical residency programs and patients are now inquiring about surgical proficiency in robotics.
Harry Mc Grath
University Hospital Limerick, Ireland
Title: Artificial intelligence in Anesthesiology
Biography:
Harry Mc Grath completed his Medical Degree at UCC, in Ireland, and has worked in Melbourne Australia in numerous Hospitals including Monash. He is currently working in University Hospital Limerick in the Anaesthetics Department. He has active research interests with University of Limerick, UESTC China, and Peking University in the field of AI and anaesthestics.
Abstract:
The excitement of the second wave of Artificial Intelligence (AI) changing our lives beyond recognition is both exciting and challenging. AI has been around for over three decades, and this new approach of artificial intelligence and due enhancements in technology, both software and hardware has resulted in the fact that human decision making is considered inferior and erratic in many fields no more in medicine. This AI technology has the potential to transform medicine to a level never seen before in terms of efficiency and accuracy but also creating insecurity and allowing the transfer of expert domain knowledge to machines. Machine learning algorithms with access to large data sets can be trained to out perform humans in many aspects. AI effectiveness in accurate diagnosis of various medical conditions and machine learning algorithms has the ability to predict patterns in medical imaging systems and has been well documented for many years. However, applying AI to all areas of medicine such as anaesthetics cannot automatically be assumed to achieve improvements beyond human experts. It is often forgotten that it is "Artificial" intelligence that is being considered. Dangers of blind assumptions and belief in AI algorithms to outperform in areas of finance and industrial sectors have lead to disastrous consequences. Examples of humans working with machine algorithms have resulted in far better performance then depending solely on AI methods by replacing human intelligence. Anaesthetics is a complex medical discipline involving much of cognitive and dexterity based work and assuming AI can easily replace experienced and knowledgeable medical practitioners is a very unreasonable expectation. This paper focuses on the complexity of both AI developments and opportunities of AI in anaesthetics for the future. It will review current advances in AI tools and hardware technologies as well as outlining how these can be used in the field of anaesthetics.