Showing posts with label ureteric injuries. Show all posts
Showing posts with label ureteric injuries. Show all posts

Friday, December 15, 2017

A simple, novel solution to identify and protect ureter during surgery


AllotropeMedical, a Houston based medical startup has devised StimSite, a novel, hand-held, single use device that precisely identifies ureter during surgery; thus, eliminating the need for ureteral stenting.

It is specifically useful in all gynecological, colorectal and oncosurgeries. Gynecological surgery accounts for 50% of all iatrogenic ureteric injuries.

It is estimated that around 3 million surgeries performed in US annually, require an identification of ureter. The rate of ureteric injuries is around 2% with disastrous consequences and the total healthcare burden of this complication is about $3.2B every year.

It is also estimated that about 30% surgical time is spent on identifying the ureter.

The surgeon can simply place the tip of the device in the vicinity of the ureter and with a push of a button, the ureter goes into contraction and the full length of ureter towards kidney and bladder can be identified.

There is no other smooth muscle structure in that anatomical region, so the device specifically identifies ureter only.

The device is single use, battery operated and avoids additional procedures like cystoscopy on the operation table.

Allotrope aims to initially market the device for two high volume procedures, Hyterectomy (750,000 in US) and colon resection (300,000 cases). The current alpha prototype is a hand held, stand alone device that can be used in both open and minimal invasive surgeries. The company plans to enter the Robotic market in future by designing device for their platforms.  

Currently, StemSite is at pre-FDA state, but plans to get FDA clearance through the 510(k) pathway, and entering the marketplace by first quarter of 2019.

Allotrope has recently won second place in MedTech Innovator’s 2017 competition, among 600 startups.


Here is a video by Allotrope showing the functioning of the device. 


Monday, December 7, 2015

Is routine cystoscopy to detect urinary tract injuries at gynecologic surgery feasible ?



Teeluckdharry et al. - Urinary Tract Injury at Benign Gynecologic Surgery and the Role of Cystoscopy: A Systematic Review and Meta-analysis.
Obstetrics & Gynecology, December 2015

This is a recent review and meta-analysis on role of routine use of cystoscopy in benign gynecological surgeries

Why this topic is important?

Injuries to the urinary tract, even if they occur relatively infrequently, can cause significant morbidity. Thus, intraoperative detection and recognition of urinary tract injuries remain very important for patients and gynecologists because they decrease morbidity and result in less litigation. Up to 75% of ureteric injuries are caused by gynecologic surgery and interestingly, most injuries occur during procedures for benign diseases.

What is the aim of the study?

The study aims to derive the rate of routine urinary tract injuries during benign gynecological surgeries and does routine use cystoscopy is a safeguard against them.

The subjects and the study design.

It is a Systematic review with pooled data from 79 studies between January 2004 to August 2014.


Interesting table in the study:

source:http://journals.lww.com/greenjournal/Fulltext/2015/12000/Urinary_Tract_Injury_at_Benign_Gynecologic_Surgery.7.aspx


Main outcome results:

The study got an adjusted ureteric injury rate of 0.3% and a bladder injury rate of 0.8%. The estimated postoperative ureteric injury detection rates per 1,000 surgeries were 1.6 without routine cystoscopy and 0.7 with routine cystoscopy. Postoperative bladder injury detection rates per 1,000 surgeries were 0.8 without routine cystoscopy and 1.0 with routine cystoscopy.
The study found that the proportion of ureteric and bladder injuries detected intraoperatively without routine cystoscopy is approximately 18% and 79%, respectively. However, when cystoscopy is performed, the proportion of ureteric or bladder injuries detected intraoperatively increases to approximately 95%.

What were the study strengths and weaknesses?
The study combines pooled data from a total of 79 studies but the the majority of studies were retrospective  which lowers postoperative injury detection rates.
What are the “practice essentials” learned from the study?
The study concludes that until more evidence is accumulated, the clinicians should learn the skills and maintain a low threshold for performing cystoscopy selectively in any cases in which there is suspicion of ureteric or bladder injury.

References: