Is Permanent Sacral nerve Stimulation Implantation Under Local Anaesthesia Feasible and Effective?

Background Sacral nerve stimulation (SNS) is a minimally invasive surgical technique that plays an important role in the treatment of disorders of the bladder and bowel. Permanent SNS implantation under local anaesthesia (LA) offers many advantages. Objectives To assess if implantation of permanent sacral nerve stimulation (SNS) under local anaesthesia (LA) is feasible and effective. Patients and Methods Using a prospective database, nine patients who had permanent SNS implantation under LA in our unit were selected and analysed. Results Four patients suffered from underlying cardiovascular disease and LA was deemed more appropriate to minimise perioperative risks. The decision to opt for LA in the other five patients was indicated due to patient preference. The average volume of lignocaine 1% used was 25 millilitres and operative length of time was 36 minutes, with the lead inserted into the right S3 foramen in all patients. Eight patients were discharged on the day of the procedure. Long term follow up revealed that SNS alleviated the symptoms in the majority of the patients, but the benefit gained fluctuated over time. Surgical revision was required in three of these patients, these included replacement of a lead, resiting of the implantable pulse generator, and explantation of the SNS device. Conclusions Implantation of permanent SNS under LA is a viable surgical option, associated with several advantages that apply to both patients and service provision. Performing this surgical procedure under LA avoids the perioperative risks involved with (general anaesthesia) GA and also offers the possibility of SNS treatment for patients in whom GA is medically contraindicated, ultimately widening the breadth of the cohort suitable for SNS treatment. Other potential benefits include reduction in time and costs involved in carrying out the surgery

Global cancer surgery : delivering safe, affordable, and timely cancer surgery

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning

Global cancer surgery: delivering safe, affordable, and timely cancer surgery.

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning