7 research outputs found

    Evaluation of transanal haemorrhoidal dearterialization versus stapled haemorrhoidopexy: two-year outcomes

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    Conference Theme: Surgical Outcomes and Clinical Auditin

    Ultra-rapid microwave variable pressure-induced histoprocessing: Description of a new tissue processor

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    We describe a new method of ultra-rapid histoprocessing that reduces the processing times for needle and endoscopic biopsies to 30 min and that of other surgical biopsy tissue blocks of up to 4 mm thick to 120 min. The MicroMED U R M Histoprocessor, which combines microwave irradiation with precise computer control of power, time, temperature, vacuum, and pressure, when used with a 1-step dehydrating/clearing reagent, consistently produces rapidly processed tissues with optimal cytomorphology and improved tissue sectioning properties. Staining properties are excellent with no deleterious effects on routine staining, histochemistry, or immunohistochemistry. This new processing technique represents a major change from conventional tissue processing and eliminates the use of hazardous reagents such as xylene. The ease of application and speed of this technique can significantly reduce turnaround times in diagnostic laboratories

    Carbon Dioxide Embolism Associated with Transanal Total Mesorectal Excision Surgery: A Report From the International Registries

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    BACKGROUND: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. OBJECTIVE: This study aimed to obtain data from the transanal total mesorectal excision registries to identify trends and potential risk factors for carbon dioxide embolus specific to this surgical technique. DESIGN: Contributors to both the LOREC and OSTRiCh transanal total mesorectal excision registries were invited to report their incidence of carbon dioxide embolus. Case report forms were collected detailing the patient-specific and technical factors of each event. SETTINGS: The study was conducted at the collaborating centers from the international transanal total mesorectal excision registries. MAIN OUTCOME MEASURES: Characteristics and outcomes of patients with carbon dioxide embolus associated with transanal mesorectal excision were measured. RESULTS: Twenty-five cases were reported. The incidence of carbon dioxide embolus during transanal total mesorectal excision is estimated to be 480.4% (25/6375 cases). A fall in end tidal carbon dioxide was noted as the initial feature in 22 cases, with 13 (52%) developing signs of hemodynamic compromise. All of the events occurred in the transanal component of dissection, with mean (range) insufflation pressures of 15mm Hg (12\u201320mm Hg). Patients were predominantly (68%) in a Trendelenburg position, between 30\ub0 and 45\ub0. Venous bleeding was reported in 20 cases at the time of carbon dioxide embolus, with periprostatic veins documented as the most common site (40%). After carbon dioxide embolus, 84% of cases were completed after hemodynamic stabilization. Two patients required cardiopulmonary resuscitation because of cardiovascular collapse. There were no deaths. LIMITATIONS: This is a retrospective study surveying reported outcomes by surgeons and anesthetists. CONCLUSIONS: Surgeons undertaking transanal total mesorectal excision must be aware of the possibility of carbon dioxide embolus and its potential risk factors, including venous bleeding (wrong plane surgery), high insufflation pressures, and patient positioning. Prompt recognition and management can limit the clinical impact of such events. See Video Abstract at http://links. lww.com/DCR/A961
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