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    Impact of insufflator/aspirator versus exclusive insufflator during robotic radical prostatectomy: a comparative prospective cohort study
    (2023)
    Hugo Otaola-Arca  
    ;
    Orlando Mejías
    ;
    Juan Cristóbal Bravo
    ;
    Rodrigo Pinochet
    ;
    Pablo Bernier
    <jats:sec> <jats:title>Background:</jats:title> <jats:p>New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, <jats:italic toggle="yes">P</jats:italic>&lt;0.05) and major complications (4.2% and 0.6%, <jats:italic toggle="yes">P</jats:italic>&lt;0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (<jats:italic toggle="yes">P</jats:italic>&lt;0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.</jats:p> </jats:sec>
      8Scopus© Citations 3
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      25Scopus© Citations 3
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    Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study
    (2021)
    Gaston Camino-Willhuber
    ;
    Alfredo Guiroy
    ;
    Mariano Servidio
    ;
    Nelson Astur
    ;
    Fernando Nin-Vilaró
    <jats:sec><jats:title>Study Design:</jats:title><jats:p> Multicentric retrospective study, Level of evidence III. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay. </jats:p></jats:sec>
      2Scopus© Citations 16
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    Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine
    (2022)
    Juan P. Cabrera
    ;
    Charles A. Carazzo
    ;
    Alfredo Guiroy
    ;
    Kevin P. White
    ;
    Joana Guasque
      9Scopus© Citations 4
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      1Scopus© Citations 9
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    Scopus© Citations 2  13  1
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    Scopus© Citations 731  3