Faculty Bibliography

The objective of this study was to perform a multi-centre and global study evaluating the clinical outcomes and complications associated with of URS for stone disease in patients aged 80 years and above. Retrospective analysis was conducted on patients aged ≥ 80 years who underwent URS for stone disease between January 2014 and December 2024, across 20 centres in 14 countries. A total of 679 patients aged ≥ 80 years underwent ureteroscopy (URS), with a median age of 83 years (IQR 81–86) and a male-to-female ratio of 1.2:1. Most patients were ASA grade 2 (52%) and presented electively (95%), with general anaesthesia used in 77% of cases. The median cumulative stone size was 11 mm (IQR 7–15), and 56% had a single stone. The overall stone-free rate (SFR) was 70% for zero fragments, increasing to 84% when including fragments ≤ 2 mm, and 90% when including fragments ≤ 4 mm. The overall 30-day complication rate was 16%, with major complications (Clavien-Dindo grade ≥ 3) in 2.8% of patients. The most common complication was urinary tract infection (9.4%). One procedure-related death (0.1%) was recorded. Multivariable analysis identified ASA score ≥ 3 (OR 1.60), operative time > 60 min (OR 1.73), and emergency surgery (OR 2.96) as independent predictors of complications. Ureteroscopy can be performed in patients aged 80 years and above with a low risk of major complications and acceptable stone clearance rates. Avoiding both emergency surgery and prolonged operative times can help reduce the morbidity profile.

BACKGROUND: Implantable Dopplers (IDs) are widely used for postoperative free flap vascular monitoring. However, IDs may contribute to free flap complications or failure and better understanding of device malfunctions is needed. METHODS: The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for all reports of ID adverse events from two leading manufacturers (Cook Vascular and Synovis Life Technologies) in free flap surgery from January 2010 to March 2020. Reports were reviewed and categorized. A comparison of reoperations within select categories was performed using Chi-square analysis. RESULTS: = 86), and venous anastomosis with hand-suturing occurred in 30 device malfunctions. CONCLUSION/CONCLUSIONS: This study demonstrates a variety of ID-related malfunctions. One-third of device malfunctions were associated with patient complications, and false-positive Doppler signal loss contributed substantially to the requirement of surgical re-exploration. These are important considerations for surgical teams utilizing IDs in free tissue transfer procedures.

OBJECTIVES/OBJECTIVE:Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in complication type and rate from inpatient surgery. METHODS:Patients who underwent parotidectomy at our institution from 2011 to 2019 were retrospectively reviewed and divided by inpatient or outpatient status. Complications including infection, seroma, salivary fistula, hematoma, and flap necrosis, as well as readmission rates were tabulated. Drain placement, related to tumor size, was also analyzed using a receiver operating curve. RESULTS: = .044). CONCLUSION/CONCLUSIONS:Outpatient parotidectomy is a safe and viable alternative for carefully selected patients.

OBJECTIVES:The present study was developed to evaluate the accuracy of in vivo ultrasound sizing for parotid and submandibular salivary gland calculi, as compared with ex vivo pathology sizing with a standard plastic ruler after extraction. STUDY DESIGN:Retrospective chart review. SETTING:Ultrasound is frequently used to size salivary calculi and make treatment decisions, but the accuracy of measurements from this modality has not been validated. SUBJECTS AND METHODS:We evaluated and reviewed the charts and ultrasound examinations of 167 patients who underwent procedures for the treatment of sialolithiasis involving the parotid and submandibular glands. US examinations were performed between 2009 and 2016 in a tertiary-level hospital setting by the senior author. Measurements were collected from ultrasound evaluation before sialolithotomy, and pathology measurements were taken after removal. Ultrasound measurements in millimeters were compared with the measurements collected with a ruler. The differences were calculated and compared. RESULTS:A total of 167 calculi measurements were compared. Good concurrent validity between pathology and ultrasound measurements was suggested by a Pearson correlation of 0.92 (95% CI, 0.887-0.937). On Bland-Altman plot, correlation of the difference between US and pathology measurements showed a mean difference of 0.095 mm (95% CI, -0.19 to 0.38 mm) with a limit of agreement ranging from -3.59 mm (95% CI, -3.84 to -3.34 mm) to +3.78 mm (95% CI, +3.53 to +4.03 mm). CONCLUSIONS:Ultrasound is an accurate, relatively precise, and minimally invasive imaging tool for salivary gland sialolithiasis. Preoperative size of calculi can be used to guide management and clinical decision making. LEVEL OF EVIDENCE:2C.