7^th International Conference and Exhibition on Surgery June 21-22,2018 London ,UK

Biography:

Choro Athiphro Kayina is working as a Senior Resident Doctor, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Delhi, India. She graduated from the Regional Institute of Medical Sciences, Imphal, India, and was awarded a gold medal for her Excellence in Obstetrics and Gynecology. She received her MD (Anesthesia) in 2016 from the University College of Medical Sciences, Delhi. Her interest is in Airway Management and Obstetric Anesthesia.

Abstract:

Statement of the Problem: Correct positioning of endotracheal tube (ETT) is necessary to ensure adequate ventilation. Various methods are used for this purpose. Ultrasonography (USG) is a useful, quick and non-invasive method for identification of ETT placement. Three USG methods have been described in literature viz., direct USG visualization of ETT in trachea, “sliding lung sign” and diaphragmatic dome movement. However, the time taken for each of these methods to correctly identify the ETT position has not been previously studied. This study is designed to compare the time taken and the accuracy of detection of position with the three USG methods, conventional auscultation and capnography techniques.

Methodology & Theoretical Orientation: This prospective, randomized controlled trial was conducted on ninety ASA I/II patients, 18–60 years requiring general anesthesia (GA) with tracheal intubation. Patients were randomized on the basis of a computer generated table into three groups depending upon the USG probe position: Group T (tracheal), Group P (pleural) and Group D (diaphragmatic). The time taken for confirmation of ETT placement was recorded.

Findings: Time taken to identify ETT placement was significantly less in Group T compared to the other two groups (p=0.000). The time taken in Group P and Group D was less than that required for confirmation by capnography but was more compared to auscultation.

Conclusion & Significance: All three USG techniques could accurately confirm ETT placement. Real time passage of ETT through the trachea was the fastest amongst the three USG techniques. It was faster than conventional auscultation and capnography techniques. We recommend the use of real time USG visualization of trachea for confirmation of ETT placement especially in trauma victims and patients who are at high risk of aspiration, as it does not require ventilation and hence avoids gastric insufflations in case of accidental esophageal intubation.

Biography:

Alicia Huff Vinyard is a Board Certified General Surgeon and Fellowship Trained Breast Surgical Oncologist at the Georgia Cancer Center in affiliation with the Augusta University Medical Center in Augusta, Georgia, USA. She attended UNC-Chapel Hill where she completed her pre-medical degree. She completed medical school in 2011 at the Georgia Campus of Philadelphia College of Osteopathic Medicine, Pennsylvania, USA. She completed general surgery training at Augusta University. She decided to specialize in breast surgical oncology to help other breast cancer survivors like herself with a special interest in young breast cancer patients and the obstacles they face. She obtained a fellowship in breast surgical oncology at the University of Miami-Miller School of Medicine in Miami, Florida, USA. She is now employed by the Georgia Cancer Center to lead the breast cancer program as the primary breast surgeon.

Abstract:

Background: Lymphedema (LE) is a serious complication of axillary lymph node dissection (ALND) with an incidence rate of 16%. Lymphatic microsurgical preventing healing approach (LYMPHA) has been proposed as an effective adjunct to ALND for the prevention of LE. This procedure however requires microsurgical techniques.

Aim: The aim of this study was to assess the efficiency of simplified-LYMPHA (SLYMPHA) in preventing LE in a prospective cohort of patients.

Methodology: All patients, undergoing ALND with or without SLYMPHA between January 2014 and December 2016 were included in the study. SLYMPHA is a slightly modified and simplified version of LYMPHA. It is performed by the operating surgeon performing the ALND. One or more lymphatic channels identified by reverse arm mapping are inserted using a sleeve technique into the cut end of a neighboring vein. During follow-up visits, tape-measuring limb circumference method was used to detect clinical LE. Demographic, clinical, surgical and pathologic factors were recorded. The incidence of clinical LE was compared between ALND with and without SLYMPHA. Univariate and multivariate analysis were used to assess the role of other factors in the appearance of clinical LE.

Results: 406 patients were included in the study. SLYMPHA procedure was attempted in 81 patients and was completed successfully in 90% of patients. Early complication rates were similar between patients who underwent SLYMPHA and who did not (4% vs. 4.13%; p=0.948). Median follow-up time was 15±13.73 [1-32] months. Patients, who underwent SLYMPHA, had a significantly lower rate of clinical LE both in univariate and multivariate analysis (3% vs 19%; p=0.001; OR 0.12 [0.03-0.5]). Excising >22 lymph nodes and a co-diagnosis of diabetes were also correlated with higher clinical LE rates on univariate analysis, but only excising >22 lymph nodes remained to be significant on multivariate analysis.

Biography:

Young Jun Chai is an Assistant Professor of Surgery at Seoul Metropolitan Government-Seoul National University Boramae Medical Center since 2013. He was educated and trained at Seoul National University. He is a Managing Editor of Journal of Endocrinology (JES), Secretary of Korea Intraoperative Neural Monitoring Society (KINMoS), and Korean Society of Head and Neck Oncology (KSHNS). He is also an Editorial Board of Clinics in Oncology Journal - Head and Neck Oncology; an active Member of International Society of Oncoplastic Endocrine Surgeons (ISOPES), and Intraoperative Neural Monitoring Study Group (IONMSG). His major interest is endocrine surgery of thyroid, parathyroid, and adrenal glands. He is also interested in molecular biology of thyroid cancer and gave oral presentation at the annual meeting of American Association of Endocrine Surgeons (AAES) in 2014 and 2016 respectively. He has published more than 40 SCI(E) papers and 3 textbooks.

Abstract:

Background: Fine needle aspiration (FNA) is the procedure of choice for evaluating thyroid nodules and FNA may be required even for nodules with very low suspicion of malignancy if they are larger than 2 cm. However, avoiding unnecessary FNA is important to reduce complications related to FNA and to reduce medical expenses. In this study, we developed an image analysis model using deep learning algorithm and evaluated if the algorithm could predict which nodules would have benign FNA results.

Methodology: Ultrasonographic images of thyroid nodules with FNA cytology or surgical pathologic results were retrospectively collected at Boramae Medical Center, Seoul, Republic of South Korea. The images of the nodules were put into the Inception-V3 network model, pre-trained with ImageNet database for fine-tuning. A total of 1,358 images of the nodules (670 benign, 688 malignant) were used for the algorithm development, and the algorithm was trained to predict a nodule as benign or malignant.

Results: Total 55 nodules (34 benign, 21 malignant) from SMG-SNU Boramae Medical Center, and 100 nodules (50 benign, 50 malignant) from Kuma Hospital, Kobe, Japan were used for internal and external test sets. For internal test set, of the 21 FNA malignant nodules, 20 were predicted as malignant by the algorithm (sensitivity, 95.2%). Of the 22 nodules algorithm called benign, 21 were FNA benign (negative predictive value, 95.5%). For external test set, of the 50 FNA malignant nodules, 47 were predicted as malignant by the algorithm (sensitivity, 94.0%). Of the 31 nodules algorithm called benign, 28 were FNA benign (negative predictive value, 90.3%).

Conclusions: The deep learning algorithm had a high sensitivity and negative predictive value despite an unrealistically high percentage of FNA suspicious for malignancy nodules tested. Using deep learning algorithm may assist clinicians in selecting those nodules that are most likely to be benign and avoid unnecessary FNA.

Biography:

Shalini Nalwad is a Director and Co-founder ICATT International Health Solutions Pvt Ltd, India. Graduated from Mysore University and obtained Fellowship in anaesthesia from College of Anaesthetist Ireland and Membership from Royal College of   Anaesthetist. She is associated with Europe’s leading Air ambulance company, has retrieved patients from 5 countries, 2 continents in 72 hours and has undeterringly air-lifted patients from Libya in midst of the turmoil. She has started ICATT an air ambulance company in India in 2014. Has set up guidelines and protocols for the organ air-lifting and has been extensively involved in the organ air-lifting operations. She has made International and National presentations on HEMS, ECMO, Aviation Medicine at Doha, Cairo, Singapore. She is an ECMO specialist from Leicester Glenfield hospital UK June 2015.

Abstract:

Aeromedical transfers are exponentially increasing worldwide. Aeromedical transfers are expensive and potentially dangerous (to the patient and the team) and should not be undertaken unless necessary indications could be for the specialist intervention, on-going support not available at the referring hospital, investigations, lack of staffed intensive care beds or repatriation to the home country or town. All transfers are done on intensive care society guidelines UK/ AAGBI (Association of Anesthetist Great Britain Ireland) All transfers are done bed to bed. Our team lands a night before and assesses the patient and takes over the ICU care, intervene and optimize the patient for air lifting. Despite these transfers are being inter-facility they are more like primary transfers or may be even pre-hospital depending on the referring hospital. Our transfers are both domestic and International. Types of transfers are level 0 to level 4, and we do organ, patient, surgical team, surgical instruments or any medical related transfers.

We do get involved in the end to end logistics for the organ air-lift from deciding the retrieval time to the cross-clamping to creating the green corridors. We have been involved in the International ECMO transfer and was presented in the SWAC 2017 Doha and published in the Qatar medical journal.

Qualities and the talents of the aeromedical team are many, decision making at 40,000 feet, with limited support, out of comfort zone, crisp communication, possibly multi-linguistic, rapport with the aviation team, team work, role sharing, multi-tasking and out of box thinking along with the other factors like jet-lag, exhaustion, boredom.

Conclusion: Each transfer is perplexing due to the diverse factors involved like the pre-transfer condition of the patient, cultural variation, financial, immigration clearance, tarmac clearance, language, relatives, and equipment. Knowledge cannot be limited to medical only and cannot always be conventionally adhered to the AAGBI or Intensive Care Society UK guidelines.

Biography:

Ahmad Nadeem Qamar is a British doctor of Pakistani origin, currently working as a consultant anaesthetist in Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. He did bachelor of medicine and bachelor of surgery from Punjab Medical College, Faisalabad, Pakistan in 1986. After initial anaesthetic training, he cleared the membership examination of College of Physicians and Surgeons in 1992. After coming to England for further training, he did Senior House Officer rotation in London Deanery and Specialist Registrar rotation in Cambridge Deanery and passed the Fellowship of Royal College of Anaesthetists in 2001. He worked as locum consultant in England and then in 2006 I came to Saudi Arabia to continue my professional career. His research interest includes Fluid therapy, Sedation and Regional anaesthesia.

Abstract:

Perioperative fluid management is a key component in the care of surgical patients, and each additional litre given in the operating room would cause a 32% increase in the risk of postoperative complications, length of hospital stay, and costs. Thus the anesthesiologist’s practice can make the difference. Current practice of fluid infusion should be re-evaluated, as major abdominal surgery with minimal blood loss can be given any amount of fluid from (700 ml–5400 ml) in four hours, simply because it’s according to an individual provider habits that are hard to justify and continuous apathy is unaccepted. After prolonged preoperative fasting, healthy patients remain euvolemic, and insensible perspiration is shown to be 0.5–1 ml/kg/hour. Even during large abdominal surgery, excessive volumes are infused to compensate loss to the third space, which does not exist. Currently taught methods of intraoperative management in which intravenous fluids are given, based on generalized formula relying on body weight per unit time and modified by perceived magnitude of surgical trauma are not supported by physiological principals. The heart is an endocrine gland that secretes atrial natriuretic peptide (ANP) and the circulating blood volume is only 25–30% of total blood volume as well as 0.8–1.2 of the plasma volume is lining the blood vessels and forms the endothelial glycocalyx that can be distorted by ANP released by hypervolemia. Urine output should not be the driving force of fluid administration. During induction of anesthesia, a starting bolus volume is necessary to compensate for both hypovolemia of the fasting patient and vasodilatation. This has been considered as a good practice for years, but may be inappropriate and the foundation to postoperative complication even before surgery starts. Increased mortality and morbidity was associated with the most commonly used normal saline due to hyperchloraemic acidosis. There is no rational to replace 1 ml blood loss by 3–4 ml of crystalloid infusion. Our aim is to discuss the current conceptions that need urgent correction so that fluid infusion can support the patients’ physiological parameters and improve patients’ outcome.

Biography:

Fabiano Calixto Fortes de Arruda pursued MBA in Health Management, a Master’s Degree in Health Sciences and works in Goiania, Goias, Brazil as Chief of Department of Plastic Surgery and Burn Unit of Hugol. He has his expertise in plastic surgery, working with academic and practice. He is interested in plastic surgery aesthetic and reconstructive surgery. He has done studies in the areas of plastic surgery development. He has many chapters of books and scientific articles and has published books on financial aspects.

Abstract:

Statement of the Problem: The theme quality of life is commonly studied by surgeons, but the quality of life of surgeons is not so well known. Long work hours, technical challenges and high stakes outcomes are hard practice that become worse quality of life and development of burnout. A study from American College of Surgeons suggests that 40% of surgeons experience burnout and 30% experience symptoms of depression.

Methodology & Theoretical Orientation: An electronic search encompassing MEDLINE, SCiELO, Embase databases were completed using search terms: quality of life, burnout, surgeon, surgical specialty. Inclusion criteria: full manuscript in English, Spanish and Portuguese, from January 1987 to December of 2017, with surgical medical specialties related with quality of life and burnout. Studies with students or residents were excluded.

Findings: The majority of studies in this area are cross sectional. Some studies are associating female sex with increased risk of burnout, depression and lesser career satisfaction, but not found statistically significant difference for poorer quality of life. We found some studies with 16 surgery fields. Hours worked per week were statistically significant predictor of surgeon burnout, psychiatric morbidity, diminished career satisfaction and decreased work life balance. Some studies found inverse relationship between income and attending burnout.

Conclusions & Significance: Studies about burnout and quality of life are not so common but it shows us that changes in lifestyle is needed to conquest heath and quality. Burnout and Quality of life vary across all specialties, so it is necessary to know each field adequately for a surgeon to increase an optimized quality of life.

Biography:

Alberto Montori MD Emeritus Prof. of General Surgery University of Roma “Sapienza” Italy. FACS ( HON) ISS/SIC (HON) FASGE. G.BERCI, SAGES lifetime achievement, EAES lifetime achievement. IFSES recognition. Former president of SIED, SICE ESGE, EAES, UEG. His main interets in clinical practice is surgical digestive activities, new technology applied to surgery, minimally invasive surgery. Former professor and chairman of 3rd surgical clinic at University of Roma “Sapienza” visiting professor at Thomas Jefferson Medical School College (Philadelphia). He has received many awards and recognitions from scientific associations all over the world.

Abstract:

The Surgical Art is a discipline based on performing technical procedures following the anatomy-surgical principles! However, it is my opinion that the new tools represent a tremendous educational mean in surgical practice and training. Any “image” obtained by so many instruments and the possibility to perform many operations through the instruments (even robotically in to the scope) etc. can be done by surgical hands which knows better than other specialists the surgical principles. In addition to that we must consider all the advanced endoscopic procedures were invented by Surgeons and they are surgical procedures: this is the term which must be used and not “operative” or “therapeutic” used by some specialist who have nothing to do with surgery. The general surgery will change the way to operate (using different instrumentations) remain in my mind, even in the future, Surgery Never Die! I am convinced about this not because I am Surgeon ( trained in a surgical environment) even if I was one of the Surgeon who believed in new technologies applied to Surgery and practically used them every day in O.R. in my last 50 years of clinical practice.The development of Surgery during the last three millennium was tremendous! We had many surgical input from Chinese Surgery, Indian, Jewish, Egyptian, and Mesopotamian; I was particularly linked to the Mycenae-Greek-Roman culture but I never forget that the Surgery was officially recognized by the King of the Assiro- Babylonians, Hammurabi who lived between 1948-1905 B.C.After all these amount of years Surgery became an Art and today represent one the most important Academic Sciences and its importance is recognized from everyone involved in Medicine. There is someone who try to define Surgery mechanical manipulation of tissue the Surgeons are not interested in screening just treatment! This is not true!

Biography:

L Renee Hilton, MD, is a Board Certified General Surgeon and is a Fellowship trained in both bariatric and minimally invasive surgery. She is the Director of Bariatric Surgery and the Center of Obesity and Metabolism at Augusta University Medical Center. She is an Assistant Professor at the Medical College of Georgia. She completed her general surgery residency at Jackson Memorial Hospital and then fellowship in bariatric and minimally invasive surgery at Yale University. She has been involved in numerous research projects involving obesity and foregut motility and is currently serving as the Principal Investigator on two trials at Augusta University Medical Center. She specializes in laparoscopic procedures for obesity, including gastric bypass, sleeve gastrectomy, and revisions of prior bariatric surgery. She is dedicated to helping individuals with morbid obesity reach healthier weights and improve their quality of life.

Abstract:

Gallstone disease is one of the most prevalent disease processes being managed by general surgeons across the country; in some studies as high as 15% of the population will be diagnosed with cholelithiasis annually. Cholelithiasis is even more prevalent in the bariatric patient population due to rapid weight loss and is seen in 30-71% of patients. Both the increase in bariatric procedures being performed each year along with the change in practice at most institutions of no longer performing cholecystectomy at the time of initial surgery presents us with a new surgical problem; how should we manage bariatric patients who present with gallstone disease? Diagnosis of gallstone disease in bariatric patients can be a difficult challenge due to many possible etiologies of abdominal pain; however, like the general population, the most common presenting symptoms of gallstone disease are post-prandial right upper quadrant or epigastric abdominal pain and mild nausea with or without vomiting. Evaluation is similar to that of the general population and includes laboratory testing and multiple imaging modalities. Management of gallstone disease in post-operative bariatric patients largely depends on the type of surgery that they have had and whether their foregut anatomy is altered. The purpose of this paper is to review the current literature as well as our own experience to provide a standard for both diagnosing and managing gallstone disease in patients who have had bariatric surgery. Lastly, it is our opinion and recommendation that any patient with gallstone disease and altered foregut anatomy be managed at a tertiary center where a multidisciplinary team is available. The surgeon involved in the case should be an experienced laparoscopic surgeon in either hepatobiliary or bariatric surgery. These cases are technically challenging and adequate knowledge of the surgical foregut anatomy is required to surgically manage these patients safely. 

Biography:

Jiake Chai has his expertise in diagnosis and treatment of burn sepsis, destructive tissue defects, research and applications of wound repair materials, and management of critical national and military health emergencies. He Executive Committee Member, Regional Representative of South East Asia for International Society for Burn Injuries (ISBI), and a past Chairman of the Chinese Society of Burn Surgery. He has been invited to be the associate managing editor, member editor, and reviewer of 20 respected medical journals. He was invited as keynote speaker or as an overseas faculty member at many international academic conferences, giving speeches 11 times, followed by recognition from international colleagues.

Abstract:

Statement of the Problem: The repair of the defects or deformities in superficial tissues and organs caused by burns, trauma, tumor or infection, which seriously influence the functions and appearances, is a significant clinical complain.

Purpose: The purpose of this study is to describe that skin flaps should be the preferred choice to recovery of both function and appearance.

Methodology & Theoretical Orientation: Local flap, axial pattern skin flap, island pattern skin flap, pre-expanded skin flap and free skin flap in our department was widely used in clinical intervention. The principals of repairing the defects or deformities of superficial tissues and organs, the indications and cautions in application of skin flaps were discussed. As an important part, use of tissue expansion in preparing pre-expanded skin flap was also shown.

Conclusion & Significance: Personalized repairing depending on the age, sex, whole body condition and subjective demand of the patients was emphasized. I hope our experiences would improve the development of repairing of defects or deformities in superficial tissues and organs.

Biography:

Muhammad Aleem has completed his Fellowship in General Surgery from Royal College of Surgeons Edinburgh (UK) and Dublin (Ireland). He has completed his basic and higher surgical training in Republic of Ireland and England. He has special interest in laparoscopic colorectal surgery. He is currently working as a General Surgeon at the Jersey General Hospital Channel Island of UK

Abstract:

Introduction: A continued debate exists regarding the timescale management of cholecystectomies; early versus delayed. On the contrary, delaying a procedure increases the risk of future gallstone related complications and perhaps re-admissions.

Aim of Study: This study looks to identify whether or not cholecystectomy procedures are undertaken using the most recent guidelines available and what this effect has on primary care: Our aim is: to see what proportion of patients are operated on during the initial emergency presentation and how this influences any re-admissions, complications, conversion to open cholecystectomy and total number of bed nights occupied; to examine the local effects of cholecystectomy procedures on primary care. The study will examine waiting times and effects of delayed cholecystectomies in multiple GP attendances.

Methodology: The study identified 100 patients who had undergone a cholecystectomy at Jersey General Hospital. Patients were identified using clinical coding on discharge summaries and operating theatre lists. 91 patients were admitted with cholelithiasis, 72 underwent cholecystectomies. (Reviewed discharge summary and investigations individually). Of all patients presented with acute cholecystitis 47% (17/36) were managed ‘hot’ gall bladders. After exclusions (frail/comorbid, patient choice): the remaining 63% i.e. 4/36 (11%) lap cholecystectomy for acute cholecystitis converted to open- All ‘hot’ gallbladders

Results: No statistical difference in those who developed bile duct injury, conversion to open procedure, operative length, quality of life or significant examples of mortality or morbidity.”

Total hospital stay reduced by 4 days in the early intervention group. Cost saving: £293 per early cholecystectomy. All acute cholecystitis presentations should be managed on initial presentation with laparoscopic/open cholecystectomy. Early laparoscopic surgery vs delayed should have a no-inferior rate of operative complications.

Conclusions: Doing more hot gall bladders in Jersey, which reduces re-presentations. Dedicated emergency list for performing acute (hot) gallbladder.

Biography:

Muhammad Zeeshan Baig is an Oral Surgeon and an Assistant Professor Oral and Maxillofacial Surgery Department Islamabad Medical and Dental College Islamabad, Pakistan.

Abstract:

An 18-year boy reported with a painless swelling on the left side of his lower face for three months. On clinical examination, facial deformity was observed with a swelling of 4cm x 2cm which extended from #32 to #34. The swelling was non-tender, firm and non-fluctuant with no difficulty in mouth opening. #38 and #33 were missing, #73 was retained but displaced. Aspiration revealed straw colored fluid. Enucleation, along with extraction of #33 and #73 followed by curettage was done. Histopathology determined it as calcifying cystic odontogenic tumor. Patient was followed up on 7th day, 4th week, 6th month and 1 year, which revealed adequate healing and no signs of reoccurrence noted. Endodontic treatment of #36 was done. CCOT (calcifying cystic odontogenic tumor) is a rare developmental odontogenic cyst thought to arise from the odontogenic epithelial remnants within the jaw bones or gingival tissue. It may be infiltrative or malignant intraosseous or extra-osseous. An equal distribution in the jaws is seen mostly in the anterior area with a strong predilection for second decade of age. No gender dominance is seen. It presents as a painless slow growing mass unless secondarily infected. When located in the maxilla, it is associated with headaches, epistaxis and nasal congestion. Radiographic evaluation is facilitated with occlusal, OPG and CT scan. Associated dentition may show root resorption, divergence and impactions. The lesion can be well defined uni-locular or multi-locular. The capsule is fibrous having 4 to 10 cells in thickness. Basal cells are cuboidal or columnar with an overlying loosely arranged epithelium mimicking the stellate reticulum in ameloblastomic lesions. Enucleation and curettage is recommended for the cystic variant as tumor debris can lead to reoccurrence. Excision is well-thought-out as treatment of choice for solid variants. The reported prognosis is excellent with less chances of recurrence. All this was seen with the present case.16.20-16:40.

Biography:

Felipe Massignan is a plastic surgeon member of Sociedade Brasileira de Cirurgia Plástica (SBCP) and American Society of Plastic Surgeons (ASPS). He is an enthusiastic medical doctor in his expertise, adding current technical concepts with artistic skills that have been developed since the beginning of his career. He especially distinguishes himself in body contouring plastic surgeries. He has been seeking to improve his professional development in major centers around the world. Currently, he has virtually become a reference in his field by using ultrasound liposuction in high definition.

Abstract:

Statement of the Problem: Historically, many approaches have been used to remove adipose tissue during liposuction. Throughout the natural refinement process, improvements were achieved by refining various aspects of the procedure, such as surgical technique, cannulas and the use of adjuvant devices. In this aspect, it is a walk without a finish line. There are no definitive goals, only goals to overcome. Traditional liposuction still faces the problem of being often a strenuous procedure and considered by some surgeons with as a technique without much refinement. In this sense, any initiative capable of generating load reduction and mechanical stress is a potential optimizer of results. The third-generation ultrasonic device VASER (vibration amplification of sound energy at resonance), is intended to bring greater safety and satisfactory results, especially in the quest for higher definition and superficial liposuction.

Methodology & Theoretical Orientation: A retrospective study was performed by analyzing the medical records of patients who underwent liposuction procedure to improve body contour with the aid of VASER, from January 2015 to June 2017, at the Santa Mônica Hospital Center in Erechim , Rio Grande do Sul, Brazil. Surgical complications were evaluated and compared with the available medical literature.

Conclusion & Significance: The medical literature, as well as our analysis, seems to demonstrate that the use of VASER in liposuction procedures for improving body contouring presents as a safe approach with low rates of complications. The potential risks of using an ultrasonic device, such as overheating leading to tissue ischemia, are mostly believed as result of inappropriate device use.

Biography:

Sharona Ross, MD FACS served in the Israel Defense Forces. She moved to the US to attain her undergraduate degree and received her Medical Degree from the George Washington University School of Medicine. After General Surgery residency training at the University of South Florida, she completed two Fellowships, one in Advanced GI Minimally Invasive Foregut & HPB Surgery and the other in Gastroenterology and Endoscopy.
She is a Professor of Surgery at the College of Medicine, University of Central Florida, USA. She is also the Director of the Advanced GI Foregut and HPB Surgery Fellowship at Florida Hospital Tampa, USA. As the Director of MIS and Surgical Endoscopy at Florida Hospital Tampa, she continues to develop new and innovative techniques to promote the safety and application of minimally invasive laparo-endoscopic single site (LESS) surgery and robotic surgery. She is one of the few surgeons to offer patients robotic complex abdominal operations for malignancies of the esophagus, stomach, pancreas, biliary system, gallbladder, liver and small bowel. She has numerous peer reviewed publications and book chapters to her credit. She is also the Founder and Chair of the International Women in Surgery Career Symposium.

Abstract:

Introduction: As minimally invasive surgery continues to progress; robotic surgery is finding its application for complex abdominal operations. This study was undertaken to document our continued development of proficiency with robotic pancreaticoduodenectomy (PD).

Methodology: With IRB (Institutional Review Board) approval, the first 128 patients undergoing attempted robotic PD (pancreaticoduodenectomy) at a single institution have been prospectively followed. Patient demographics and outcomes were analyzed. Clavien scores of I-IIIb are defined as minimal severity. Operative duration was defined as time from incision to dressing application. Data are presented as median (mean±SD).

Results: 61% of patients were men, of age 69 (68±10.9) years, BMI 26 (27±7.5) kg/m2, and ASA class 3 (3±0.6). 77% of patients were diagnosed with adenocarcinoma. 21% of attempted robotic PD were converted to ‘open’ operations; operations converted to 'open' decreased with time (p<0.05, Figure). Operative duration (424 (425±113.6) minutes) did not change over time. 62% of resections were R0 and 38% of resections were initially R1 that were converted to R0. EBL (estimated blood loss) decreased with time, was minimal in patients undergoing robotic PD, and was greater in patients converted to ‘open’ PD (p<0.05). LOS (Length of stay) was longer for operations converted to ‘open’ PD (8 (12±13.1) days] than those completed robotically (5 (8±8.7) days, p<0.05]. Postoperative complications and in-hospital mortality were lower in operations completed robotically (p<0.05). Overall, 49% of patients experienced postoperative complications (e.g., infection, urinary retention, respiratory insufficiency) the majority of which, 78%, were of minimal severity. Of the procedures completed robotically, 45% of patients experienced postoperative complications with 85% of minimal severity.

Conclusions: Experience with robotic PD led to fewer conversions to ‘open’ and less EBL, but not shorter operative times. Operations converted to ‘open’ had a greater EBL, more postoperative complications, and longer LOS. By 128 attempted robotic pancreaticoduodenectomy, there was notable progress in the standardization of operative conduct; however, there remains room for further improvement. Our experience indicates robotic pancreaticoduodenectomy is practical and efficacious, but with longer operative duration and a notable learning curve.

Biography:

Kenan Yusif Zade holds an MD and PhD Degree from Azerbaijan Medical University, Azerbaijan. He is the Head of Military Hospital of State Border Service, Azerbaijan. His professional fields are general surgery, gastroenterology and invasive endoscopy. In 2007, he founded an Association of Turkish-Azerbaijani Endoscopic Surgeons. He is also the President-elect (2017-2019) of Ambroise Paré International Military Forum (APIMSF). His second education is business management. He holds an MBA Degree from Maastricht School of Management, The Netherlands and EMBA Degree from ADA University, Azerbaijan.

Abstract:

Introduction: In choledocholithiasis subject to the size of the stone and the anatomical structure of the papilla the size of the cross-section in sphincterotomy may vary. Sufficiently large incision in sphincterotomy leads to the increase in the incidence of complications after ERCP as perforation, cholangitis, and pancreatitis.

Materials & Methodology: We performed 77 ERCP (endoscopic retrograde cholangio-pancreatography) operations in patients with a diagnosis of "choledocholithiasis". In the first group (59 patients) we performed standard sphincterotomy incision in 11, 12 or 13 o’clock direction, in the second group (18 patients) - "radial" sphincterotomy. The technique of "radial" sphincterotomy we developed allows to make several lateral incisions in 11, 12 and 13 o’clock directions. Thus, the main incision can be made up to transverse fold, and other radial incisions shall be made below the transverse folds, without going beyond the boundaries of the assumed course of intramural choledoch. Thus, the complete cross section of the incision with additional insections at the radial sphincterotomy becomes 1.5 times larger than the main incision in standard sphincterotomy.

Results: In the first group periampullary diverticulum was 16.7%, while in the second group - 47.4%. Number of stones in the first group – 2.25±0.49, in the second – 2.22±0.32, sizes of the stones – 10.07±4.93 and 19.01±3.31 mm, respectively. In the first group, complications occurred in 3 (5.08%) patients: in 1 of them - post-ERCP pancreatitis, in 2 - bleeding during the session. In the second group, only 1 (5.5%) patient had pancreatitis and other early and late complications. In the first group with 3 patients - the common bile duct stone removal was achieved in two sessions with a few day interval, the remaining - in a single session. In the 2nd group, all patients required only one session. No cases of mortality occurred in any of the groups.

Conclusions: Radial sphincterotomy technique was substantiated from anatomical and mathematical aspects. The proposed technique is a safe way to increase the area of dissected papillae ensuring efficient removal of large stones through such incision.

Biography:

Nawfal Ali Almubarak is Assistant Professor of Anesthesiology, Department of Surgery, College of Medicine at the University of Basrah, Iraq. He is also the Head of Anesthesia and ICU Department at Alfayhaa General Hospital, Basrah, Iraq and a Sponsor of Iraq and Arab Board of Anesthesiology and Intensive Care. He completed his MB, ChB and Diploma in Anesthesiology and FICMS Anesthesiology under the Head of Department of Anesthesiology, Alfayhaa Teaching Hospital, Basrah.

Abstract:

Background: Foot is one of those parts of the body that faces so many problems such as trauma, strain, infection and other pathological conditions. Diabetes mellitus is a multi-systemic disease that affects most organs; the foot is the most vulnerable part of the body involved in the complications of diabetic syndrome. Therefore, the management of this problem is considered as a big dilemma for the anesthesiologist, orthopedic surgeons as well as the patient with regards to surgical treatment, controlling of blood sugar, foot hygiene and promoting the function of limb in the future.

Aim: This prospective study aimed to compare the effectiveness of five nerves ankle block versus popliteal sciatic with adductor canal saphenous block in diabetic foot surgery.

Results: All had full routine pre-operative investigations with Doppler ultrasound study for peripheral circulation. Patients were randomly allocated equally into two groups; group A, are those who had operation under ankle block regional anesthesia, while in group B, anesthesia was done by popliteal sciatic–saphenous adductor canal block. The outcome of this study showed significant difference between the two anesthetic techniques regarding the onset of action and efficiency of 0.75% ropivacaine in popliteal sciatic nerve block (PSNB) in comparison with five nerves ankle block. Almost all the patients and surgeons were satisfied by popliteal sciatic-saphenous adductor canal block in which there was minimal need of sedative and analgesic drugs such as midazolam or ketamine

Conclusion: The results of this study showed that popliteal sciatic–adductor canal saphenous block is more convenient and effective to provide the state of surgical anesthesia with minimal need to adjuvant sedative drugs. Best results could be obtained with the popliteal sciatic-saphenous block with only two injections instead of five; this will minimize the risk of infection as it is too far from the operative site. Also, it is faster in onset of action and provides good post-operative analgesia than ankle block.

Biography:

Juliet J Ray, MD, MSPH is in her 6th year of General Surgery training at the University of Miami/Jackson Memorial Hospital Program in Miami, Florida, USA. She completed a two year Research Fellowship from 2014-2016 focusing on modulating inflammatory cytokines with hypothermia in addition to clinical outcomes research in trauma/burn, vascular, and general surgery. Her passion lies in surgical innovation in training for residents and medical students. She has over 30 publications in peer-reviewed journals and has presented her research at dozens of national meetings. She will be pursuing fellowship training in Colon and Rectal Surgery after completing her last year of residency.

Abstract:

Objectives: Focused ultrasound (US) is being incorporated across all levels of medical education. While many comprehensive US courses exist, their scope is broad, requiring expert instructors, access to simulation, and extensive time commitment by the learner. We aim to compare learning across levels of training and specialties using a goal-directed, web-based course without live skills training.

Design: A prospective observational study of students and residents from medicine, surgery, and anesthesiology. Analysis compared pre- and post-tests assessing 3 competencies. Individual mean score improvement (MSI) was compared by paired-sample t-tests and MSI between cohorts by ANOVA (Analysis of Variance), with significance set at p≤0.05. McNemar’s test compared those who agreed or strongly agreed with survey items to those who did not before and after intervention.

Setting: The research study was set up at the Jackson Memorial Hospital, Miami. Florida, residency training programs in Medicine, Surgery, and Anesthesiology.

Results: 180 trainees participated. A significant MSI was noted in each of the three competencies in all three cohorts. Students’ (S) MSI was significantly higher than residents’ (R) & interns’ (I) in US “knobology” and window recognition [S=2.28±1.29/5 vs R=1.63±1.21/5 (p=0.014); vs I=1.59±1.12/5 (p=0.032)]; students’ total score MSI was significantly higher than residents [7.60±3.43/20 vs 5.78±3.08/20 (p<0.008)]. All cohorts reported improved comfort in using transthoracic US and improved ability to recognize indications for use. More than 81% of all participants reported improved confidence in performing transthoracic US; more than 91% reported interest in additional training; more than 88% believed course length was appropriate.

Conclusions: Learners across levels of medical training and specialties can benefit from a brief, goal-directed, web-based training with early incorporation producing maximal yield.

Biography:

Walid Saad Alhabashy is an Anesthesia and Critical Care Egyptian Consultant with multiple certifications, including MSc, EDIC, EDAIC, Arab Board of Anesthesiology and FCAI. His main expertise is POCUS in critically ill patients particularly when complex hemodynamic management is the scenario. He finished Master’s Degree in Echocardiography from Austria, Vienna. He has conducted many national and international courses as course Instructor/Director in Egypt, Gulf area and Europe and worked under different societies, e.g. WINFOCUS and SCCM. He is the founder of YouTube Channel “US/ECHO in Anesthesia/ICU” concerned with POCUS teaching. He has built this own way after years of experience in POCUS teaching in both hospitals and education institutions.

Abstract:

Echocardiography is pivotal in the diagnosis and management of the complex hemodynamics of septic shock. Important characteristics are non-invasive, quick, differentiate hypodynamic from hyperdynamic sepsis and, not only, tailor management accordingly, but follow the trends as well to decide when to go up or down on each line of management. Following are three good examples of patients presented with sepsis and shock: Case1: Elderly male with presented with septic shock due to tertiary peritonitis that was previously healthy. Open laparotomy and resection anastomosis presented to ICU with refractory septic shock and severe lactic acidosis on high noradrenaline/adrenaline requirements and anuric. Echocardiography showed: Hyper dynamic left ventricle, Small right ventricle, good systolic functions, Diastolic dysfunction G II “Pseudo normal” , stroke volume variation (SVV) on left ventricular outflow tract (LVOT) showed positive fluid responsiveness. Adrenaline was replaced with vasopressin and IV fluids were delayed. Re-evaluation showed improving Diastolic dysfunction to GI, SVV on LVOT showed fluid responsiveness. one litre of CSL was infused. Eight hours later acid base status was normalized. Patient was stable enough to be extubated next day and discharged to the ward few days later. Post extubation Echocardiography showed normal ECHO study. Case2: 74-year-old man with a history of COPD presents with infective COPD exacerbation with atrial fibrillation. Intubated d.t. worsening shock, lactate/troponin rising With No ECG Ischemic changes. Bedside echocardiography showed AHFREF with RWMA, Hypodynamic left ventricle, full non-collapsing IVC, with low left ventricular end diastolic and systolic volumes with PAOP is 6 mmHg. Patient was treated with noradrenaline 2 mcg/min dobutamine 5 mcg/kg/min. and received a liter of CSL. Stable to be extubated next morning, Anti-failure measures were introduced and patient was discharged from the ICU 3 days later. Case 3: 63 years old lady presented to ED with CAP, previously healthy except for undiagnosed murmur. Fluids 3L failed to improve her hypoperfusion, Vasopressors added which failed to control the shock, she was intubated and mechanically ventilated with worsening shock. Echocardiography showed AHFREF with severe Aortic stenosis and Mitral regurgitation. Improved with Diuretics, Milrinone and weaning down of Noradrenaline. Sepsis with shock is not infrequently complex management with no clinically distinct clue which line to start with first.

Biography:

Mohammed Abdallah Salman, MD from Cairo University pursued Member of the Royal College Surgeons 4 years ago and MSc 6 years ago. He was a Lecturer from the Faculty of Medicine at the same university. He is an Associate FAC, consultant of general and laparoscopic surgery.

Abstract:

Purpose: The aim of the study was evaluation of the effect of the resected gastric volume (RGV) on weight loss after laparoscopic sleeve gastrectomy (LSG).

Patients & Methodology: This prospective study included 40 morbidly obese patients undergoing LSG. Multi Detector Computed Tomography (MDCT) was used to measure preoperative stomach volume and sleeve volume. The actual RGV was measured after surgery. The primary outcome measure was the relation between RGV and percentage of excess body weight loss (%EBWL) after 3 and 6 months respectively. The secondary outcome was early postoperative complications.

Results: The mean preoperative BMI was 43.5±4.3 kg/m2. The actual RGV was substantially correlated with that estimated by CT (r=0.996, p<0.001). The former was significantly larger with a mean deviation of 17.6 cc (95%CI: 12.2-23.0 kg). The actual and CT-estimated RGV were positively correlated with %EBWL after 3 months (r=0.361, p=0.022 and r=0.471, p<0.001, respectively) and after 6 months (r=0.466, p=0.002 and r=0.553, p<0.001, respectively). Percentage of volume reduction was positively correlated with weight reduction after 3 and 6 months (r=0. 0.525, p=0.001 and r=0.564, p<0.001, respectively).

Conclusions: The resected gastric volume during LSG was significantly correlated with weight reduction after 3 and 6 months of surgery. Sleeve volume was not correlated with early weight reduction. MDCT is a reliable method to measure gastric volume before and after surgery.

Biography:

Ahmed Abdelaatti is currently working as an Anesthesia Registrar, University Hospital Galway (UCHG), Ireland. He has worked as an Anesthesia and Intensive Care Assistant Consultant at the King Abdullah Medical Complex (KAMCJ), Jeddah, KSA, Anesthesia and Intensive Care Registrar at the North West Armed Forces Hospital (NWAFH)), Tabuk, KSA and as an Anesthesia Specialist and Lecturer at the National Hepatology and Tropical Medicine Research Institute at Cairo, Egypt.

Abstract:

Introduction: This case report describes the successful use of combined ultrasound scan (USS) and fiberoptic bronchoscopy in two cases for insertion of a percutaneous dilatational tracheostomy (PDT).

Case Description: Two patients were scheduled for percutaneous dilatational tracheostomy. The first patient was a 56 year old female and the second patient was 63 year old male.

Methods: The patient’s neck was exposed and scanned in the neutral position to determine the need for an extended or regular tracheostomy tube. The neck was then extended, sterilized and draped. Higher frequency linear probe (7.5 MHZ) in a sterile sheath and fiberoptic bronchoscopy were used with two intensivists and a nurse in attendance. The midline structures and cricoid cartilage were identified in out of plane position. The probe was then rotated 90 degrees to obtain a longitudinal view of the cricothyroid cartilage, cricoid cartilage and tracheal rings. The needle was inserted between the 2nd and 3rd tracheal rings using in plane mode, with the goal of placing the puncture site between 11 and 1 o’clock on the bronchoscopy view as close as possible to the midline. The bronchoscope was used to visualize the needle insertion point and to avoid injury to the posterior wall of the trachea.

Discussion: USS of the upper airway can provide important anatomical information that would not be evident upon clinical examination alone. This includes information about the anatomy of the pre- and paratracheal regions and identification of vulnerable structures, such as blood vessels and the thyroid gland, thereby avoiding immediate vascular complications. It also enables the clear visualization of the tracheal rings, thereby facilitating positioning of the tracheal puncture and correct midline placement. Real-time US guidance makes it possible to follow the needle path during tracheal puncture and to determine the final position of the tracheostomy tube. However, intraluminal air prevents the visualization of structures such as the posterior pharynx and the posterior wall of the trachea with USS. Therefore, injury to the posterior wall of the trachea cannot be completely avoided. However, we believe that the combined use of fiberoptic bronchoscopy makes it safer by minimizing injury to the posterior tracheal wall, avoiding false passages and tracheal cartilage rupture.

Biography:

Sharona Ross moved to the US to attain her undergraduate degree and received her Medical Degree from the George Washington University School of Medicine. She completed two fellowships (Advanced GI Minimally Invasive Foregut & HPB Surgery; Gastroenterology & Endoscopy). She is a Professor of Surgery at the College of Medicine University of Central Florida, USA. She is also the Director of the Advanced GI Foregut and HPB Surgery Fellowship, and Director of MIS and Surgical Endoscopy at Florida Hospital Tampa, USA. She has over 80 peer reviewed publications and numerous book chapters.

Abstract:

This video documents a robotic pancreaticoduodenectomy and cholecystectomy undertaken in a 70-year-old man. The patient presented upon transfer with painless jaundice and unintentional weight loss. Preoperative workup included a contrast enhanced CT scan, EGD (Esophagogastroduodenoscopy), Endoscopic ultrasound (EUS) and Fine needle aspiration (FNA) and Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement. An 8 mm trocar was placed through the umbilicus for the robotic camera and two 8 mm robotic ports were placed at the right and left midclavicular lines on the same level as the umbilicus. A fourth 8 mm robotic port was placed at the left anterior axillary line halfway between the level of the umbilicus and the costal margin. Finally, an Advanced Access Gelport® was placed between the midclavicular line and the umbilicus and an AirSeal® Access Port at the right anterior axillary line. The gastrohepatic omentum was opened in a stellate fashion. The Kocher maneuver was undertaken, and the jejunum was transected using a robotic stapling device. The dissection continued along the gastrocolic omentum and the duodenum was transected just distal of the pylorus. The pancreatic neck was divided, and dissection continued along the uncinate process of the pancreas. A cholecystectomy was performed, and the distal common bile duct was transected. A laparoscopic EndoCatch bag was used to extract the specimen through the Advanced Access Gelport®. Reconstruction was initiated with a single-layer hepaticojejunostomy anastomosis followed by a two-layer pancreaticojejunostomy anastomosis. A single-layer duodenojejunostomy was constructed just distal to the pylorus. Finally, a Jackson Pratt drain was placed prior to closure. The patient tolerated the operation well and was discharged on day 3 following postoperation.