indigo-carmine and Wounds--Penetrating

The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy.. The study was a retrospective review of 700 consecutive patients who underwent vaginal surgery for anterior and/or apical pelvic organ prolapse with universal intraoperative cystoscopy.. Thirty-seven patients (5.3%) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3%, respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1%. Intraoperative cystoscopy was accurate in 99.3% of cases, with a sensitivity and specificity of 94.4% and 99.5%, respectively. Suture removal relieved ureteral obstruction in 88% of cases. Six subjects (0.9%) had true ureteral injuries.. Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1%. Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.

Topics: Aged; Coloring Agents; Cystoscopy; False Negative Reactions; Female; Gynecologic Surgical Procedures; Humans; Incidence; Indigo Carmine; Intraoperative Complications; Middle Aged; Predictive Value of Tests; Retrospective Studies; Ureter; Ureteral Obstruction; Uterine Prolapse; Vagina; Wounds, Penetrating

Esophageal perforation complicating anterior cervical spine surgery is a potentially fatal complication. Early identification and immediate treatment may lower adverse effects for the patient. The purpose of this study is to assess the efficacy of intraesophageal dye injection to detect an esophageal injury and to test two novel techniques.. Ten cadaveric specimens were dissected using an anteromedial Smith-Robinson approach. Each was sequentially tested by a control and three dye injection techniques: technique A: nasogastric tube alone; technique B: nasogastric tube plus a distally placed Foley catheter; technique C: proximal plus a distally placed Foley catheter. Each technique was tested against esophageal perforations created by needle puncture (21-gauge, 18-gauge, and 14-gauge) and by a 2-mm high-speed burr. Dye visualization was independently graded as present or absent by two authors.. In the control trial, no dye leak was visualized in any of the 10 specimens. In technique A, 0 of 10 21-gauge perforations, 1 of 10 18-gauge perforations, 2 of 10 14-gauge perforations, and 6 of 10 burr perforations were visualized. In technique B, 1 of 10 21-gauge perforations, 8 of 10 18-gauge perforations, 9 of 10 14-gauge perforations, and 9 of 10 burr perforations were visualized. In technique C, 0 of 10 21-gauge perforations, 9 of 10 18-gauge perforations, 10 of 10 14-gauge perforations, and 7 of 10 burr perforations were visualized.. The study suggests that intraesophageal dye injection via nasogastric tube alone should not be relied upon to exclude the presence of esophageal perforation. Two novel techniques showed an improved, though limited, capability of detecting esophageal perforations.

Topics: Cadaver; Coloring Agents; Esophageal Perforation; Humans; In Vitro Techniques; Indigo Carmine; Injections; Wounds, Penetrating