When asked to expand the abbreviation “NSV”, 393 (87.9%) gynaecologists were able to answer correctly as compared to 54 (12.1%) who either gave answers other than “Non/No Scalpel Vasectomy” or did not know what NSV stood for. Out of the 447, 211 (47.2%) gynaecologists had never seen NSV being performed. There were 270 (60.4%) gynaecologists who admitted to not knowing the exact steps of the procedure. Only a minority of participants provided correct answers to questions regarding knowledge about various aspects of NSV such as “type of anaesthesia used” (1.8%), “number of accesses needed to perform NSV” (48.1%), “number of ejaculations to be covered by additional contraceptives after NSV” (18.1%) and knowledge about “facilities in Pune providing training in NSV” (13.2%). Some knowledge parameters are depicted in Table 1.
When a man having had a vasectomy wishes to have his own biologically related children, his choices are to have a vasectomy reversal or to have sperm extraction in conjunction with IVF and ICSI. These choices plus the options of donor sperm, adoption, and remaining without children should be discussed with the couple(46). The initial consultation with the individual or couple should offer the opportunity to obtain a concise health and reproductive history of both the patient and his partner and to examine the man. Chances for success (patency or pregnancy) based on the personal experience of the surgeon, the patient's health history, and the results of examination of the man and the age and reproductive potential of his partner are discussed.
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Background: No Scalpel Vasectomy (NSV) was introduced in India with the aim to increase male participation in family planning methods. But in spite of the best of efforts, it has failed to achieve its goal. The current acceptance of NSV in India has declined from 1 percent (NFHS 3) to 0.3 percent (NFHS 4). This study was done to get an insight regarding knowledge and practice of NSV and elicit the perceived reasons for underutilization of vasectomy in the community.
Most podiatry programs followed a traditional teach- ing structure when teaching scalpel skills with a didactic-style lecture or talk outlining the theoretical and explicit information relevant to using a scalpel sup- plemented by skill demonstration, either in real-time, streaming media or via a recorded medium such as DVD or online video. This teaching approach is consist- ent with evidence that observational learning together with practice is more effective for motor learning than practice alone , and is supported by studies which show that similar areas of the brain activate whilst a stu- dent is observing a particular skill being performed as when they are undertaking that skill themselves [13–16]. The reported mentoring relationships and strategies of students working in pairs provide an alternative avenue for such observational learning. When working in pairs, students are able to watch someone else undertake a learning process, which is believed to facilitate adapta- tion when they are required to perform the same action [17–22]. Such observational learning provides the oppor- tunity for students to continue to maximise learning by engaging in alternative forms of processing, whilst having a break from the cognitive demands of the skilled task . Moreover, the non-treating student can take the responsibility of engaging the patient, allowing the practising student to focus their cogni- tive resources and concentrate on learning and per- forming the skill. Working in pairs may also have an influence on the motivation and competitiveness stu- dents feel for the task, which can have a significant influence on learning outcomes and address psycho- logical issues [18, 20, 22, 23].
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Introduction: Laparoscopic cholecystectomy is the revolutionary new method for the treatment of gallstone disease and has now become the gold standard for the surgical treatment of symptomatic cholelithiasis. The ultrasonically activated (Harmonic) scalpel was designed as a safe alternative to electrocautery for the hemostatic dissection of tissues. This comparative study was undertaken to exhibit the effectiveness and safety of the harmonic scalpel over traditional electrocautery to achieve complete dissection and hemostasis at laparoscopic cholecystectomies.
Between September 2013 to September 2014, 33 patients underwent thyroidectomy (Hemi / Total) performed using Harmonic Scalpel for vessel control included in the study. All patients had routine preoperative workup for their disease and comorbidities evaluation and the same anesthetic and hospital care regardless of the surgical technique performed. A complete preoperative assessment was obtained for all patients. A 3-7 cm skin incision was made. The flaps were raised and then strap muscles were separated in the midline and laterally reflected. The superior thyroid vessels and inferior thyroid vessels and middle thyroid vein, were divided with the HS. For total thyroidectomy the same steps were repeated for removal of the contra lateral lobe. Finally, the wound was irrigated and closed using interrupted 3-0 vicryl sutures to approximate the strap muscles and the platysmal layer. The skin was closed subcutaneously.
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We performed the hemithyroidectomy and total thyroidectomy in 130 patients with thyroid benign and malignant nodules, from January 2017 to March 2019. Among them, 15 patients who were associated with tox- ic goiter and who underwent complete thyroidectomy or total thyroidectomy with lateral neck dissection were excluded. Thus, a total of 115 patients were included in the study population. Institutional ethical board approval and preoperative informed consent from all patients were obtained. All patients were explained in the price and functions of harmonic scalpel and then harmonic scalpel was used only in patients with permission to use it. According to the use of harmonic scalpel, the patients could be divided into two groups, prospectively: the conventional technique (CT) group of tying and knots (hemithyroidectomy, n=40; total thyroidectomy, n=07) and the harmonic scalpel (HS) group (hemithyroidecto- my, n=60; total thyroidectomy, n=08). All patients were examined about age, gender, operation time, postop- erative drainage (duration and volume), hospital stay, and postoperative complication including bleeding, recurrent laryngeal nerve palsy, and hypoparathyroid- ism. Operation time was defined as the time between skin incision and skin closure. Vacuum drains were placed in all patients, and postoperative drainage was estimated every morning. When the drainage volume was less than 20 mL per 24 hours, the suction device was removed. All patients who were removed suction device were discharged from the hospital the next day. In the patients who underwent total thyroidectomy, a series of serum calcium levels were obtained every postoperative day until patients were discharged. All the patients with serum calcium levels of less than 2.10 mmol/L (reference range, 2.10-2.60 mmol/L) during the first 3 postoperative days were considered as having hypocalcemia and received oral calcium carbonate and vitamin D3 supplementation. If serum calcium levels returned to normal within 6 months, hypoparathyroid- ism was classified as transient, and in the other cases, it was classified as permanent. Surgical technique All patients had the same anesthetic and hospital care and the patients were positioned and draped in the conventional manner. About 5 cm incision was made over the level of the thyroid isthmus. After elevation of subplastysmal flaps, the strap muscles were separated in the midline and laterally reflected. The superior and inferior thyroid vessels were then divided either with the
The following finding of the study was consistent with the study conducted by Oduy OO, (2006) which is a cross-sectional study to determine men’s knowledge and attitude to family planning at Ganmo, a sub-urban community on the outskirts of Ilorin, Nigeria. The study employed an interviewer who has administered a semi- structured questionnaire to elicit information from 360 men in the households. Only males above the age of 15 years and residents in the community were selected for the interview. Nearly all the men (96.5%) were aware of the family planning methods and a majority of them were aware of some common methods of family planning method e.g. Oral Contraceptive Pills (OCPs) (72.5%), Injectables (69.2%), Condoms (86.6%) and Traditional methods (70.6%). Knowledge of other alternative female methods was low e.g. Norplant (17.5%), IUCD (26.3%), Diaphragm (39.8%), Vaginal cream (30.2%), Vaginal tablet (37.8%) and Vaginal sponge (16.8%), and Tubal Ligation (51.3%). Knowledge of male controlled family planning methods like Withdrawal (49.6%), Rhythm or periodic abstinence (54.6%) and Vasectomy (28.6%) was also poor. The finding revealed that men had limited knowledge and unfavourable attitude towards Vasectomy. This study shows positive correlation between the level of knowledge and attitude regarding Vasectomy.
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Twenty normal male New Zealand Big Eared White Ra- bbits, aged 5 - 6 months, weighting 2.1 - 3.7 kg, were ob- tained from the Experimental Animal Centre, Huazhong University of Science and Technology (HUST). The animals were allowed to acclimate to their new surroun- dings for at least 1 week. Then the rabbits were marked according to their weight and divided into two groups (vasectomy and sham operated groups) randomly. The animal experiment was approved by the Institutional Re- view Board at Huazhong University of Science and Te- chnology.
In addition, the study revealed that the drawback in people opting for vasectomy is the perceived non- reversibility of the procedure. Vasectomy was a desir- able choice when a family considers that they were no longer interested in having children since it was consid- ered a permanent method. The need to have children following the procedure makes the procedure unattract- ive for couples who are uncertain about future need to have more children. This particular findings supports a previous study that revealed that after 10 years, about 2% of vasectomized men have a reversal operation be- cause of a desire to have children, usually in a new rela- tionship. The chance of a reversal request is increased in men who had a vasectomy at a young age and in those without children . However, this reversal pro- cedure are not without some setbacks as some studies have reported that reversal procedures affect the quality of semen that the man produces though not much has been done in that direction. It appears that the majority of men after vasectomy reversal have reduced semen quality, and sometime additional artificial reproductive techniques are needed to achieve conception .
study of men in the Group Health Cooperative of Puget Sound in 1996. They used mailed questionnaires and medi- cal records to collect data on vasectomy status, potential confounding variables, and factors related to detection of prostate cancer, such as hospitalization, routine physical examination, digital rectal exam, and prostate ultrasound. Potential confounding variables analyzed were marital sta- tus, race, religion, occupation, education, income, children, tobacco use, alcohol use, physical activity, BMI, and history of genitourinary diseases, sexually transmitted infection, and cancers (specifically prostate cancer). Overall, they reported no association between prostate cancer and vasectomy, age at vasectomy, or time since vasectomy. There did seem to be a positive association between risk of prostate cancer and vasectomized men with a positive family history of prostate cancer. This could be due to detection bias, that is, an increase in screening for prostate cancer in vasectomized men with a family history. In the same year, Ewings and Bowie 43 and
Because of limited data on vasectomy complications asso- ciated with different methods, the cost associated with potential complications was not included in the analysis. No data on complications were collected from the clinics. Because large-scale capital costs were not included, the costs presented may underestimate the cost of maintain- ing a vasectomy programme. Costs presented represent the cost of providing a vasectomy but do not include the opportunity costs of the real estate, maintenance of the infrastructure (e.g., building, lights, and furniture), or additional capital costs associated with a vasectomy pro- gramme. Capital costs have been eliminated from at least one other reproductive health service cost analysis . The reasons cited include lack of good information on governmental services, sensitivity to assumptions, and projected low marginal costs for adding additional serv- ices due to clinics not operating at full capacity. As noted in the background, cost estimates for vasectomies in other countries have varied widely. These differences are likely due to differences in costing methodology that may or may not include additional capital costs and full represen- tation of training, represent private rather than public
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mis and vas deferens have been categorized and graded to determine the likelihood of systemic patency (Belker et al., 1991). At the time of surgery, the presence of sperm within the vasal fluid is an indication to proceed with vasovasostomy. It is more controversial if one should perform vasovasostomy or vasoepididymostomy when isolated sperm heads are found. Commonly, the absence of spermatozoa from the bilateral vas is associ- ated with a 31% pregnancy rate following vasovasostomy (Belker et al., 1991). However, no comprehensive evalua- tion of vasal fluid following the creation of a secondary blockage within the epididymis after vasectomy has been reported to our knowledge. We sought to better define the immediate and short-term microscopic changes in the testicular vasal fluid that occurred following vasectomy and subsequent epididymal obstruction, through use of a randomized animal model cohort.
Molecular surgery to remove the pathological cells and tissues in situ by gene transfer could be an important part of molecular medicine. Molecular synovectomy using gene scalpels simpli- fies the current problems of gene delivery, gene target and gene expression regulation involved in human gene therapy. Because the induction of apoptosis in inflammatory synovio- cytes is the main goal for intra-articular gene transfer, a tran- sient, localized, immune tolerant and dose dependent gene transfer may be achieved by direct intra-articular injection of apoptosis inducers carried by a suitable vector, controlled to infect only synovial cells but not chondrocytes in cartilage. In this study, we have established that the inflammatory synovium from RA patients can be effectively reduced in vivo in a RA- SCID mouse model by repeated, locally administered adeno- virus vector mediated FasL gene transfer, strongly supporting the gene scalpel concept.
Exclusion: Opinion pieces, articles on intestinal surgery and diathermy but not for creation of incisions, articles on intestinal surgery and different cutting modalities (laser, harmonic scalpel) and articles that were not relevant to the PICO question.
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A scalpel is the very sharp knife that is used in surgical and anatomical dissection. Scalpels are either disposable or re- usable. Re-usable scalpels are the ones which may have either attached, resharpenable blades or, non-attached, replaceable blades. Whereas Disposable scalpels have a plastic handle with an extensible blade.These blades used once are discarded entirely.
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Factors affecting choice of vasectomy will vary among people due to sex, education and socioeconomic group. Among the educated group in Nigeria there is a poor and very defective knowledge of the procedure which is significantly higher in males. There is a need to incorporate Family planning into health education at the senior secondary school level. This will increase the awareness and also abolish sex-differential in knowledge. This is true because reports show that men are interested in family planning generally (Salem, 2004) and the low use of vasectomy is not entirely because of men’s resistance to the method, but also because of the failure of many health professionals to make information and services available and accessible (Bunce et al., 2007). There is thus a valid need to include men more in matters of reproductive health and family planning. The women must be encouraged to seek reproductive health services with their husbands because we believe that involving the men in decision making will benefit both the men and women.
Nonetheless, two non-randomized trials have evaluated the effectiveness of scalpel debridement of plantar calluses for reducing pain in people without inflammatory arthritis [19,21]. One case series, consisting of 79 participants, reported a statistically significant median difference of 59.5 mm (on a 100-mm visual analogue scale), an 86% reduc- tion, between pre- and immediately post-intervention pain scores (P < 0.001) . This trial included both younger and older people (ranging from 21 to 90 years). Another study, conducted on 19 older people (aged between 65 and 84 years), found a statistically significant mean pain reduc- tion of 68% (or 25 mm) immediately after scalpel debride- ment (P < 0.001) . In our trial, the mean pain improvement immediately post-intervention in the real de- bridement group reflects a 68% (or 38 mm) reduction on a 100 mm visual analogue scale. However, the sham debride- ment group also experienced a 55% (or 26 mm) pain reduc- tion. Therefore, the overall pain reduction observed for scalpel debridement in our trial is consistent with the previ- ous non-randomized trials, but a substantial amount of the reduction could have been due to confounding non- intervention effects, which are not accounted for in non- randomized trials. Inclusion of a control group to compare the intervention against is clearly important in determining the true effect of an intervention.
bud, leaving at most one trifoliate leaf adjacent to the chosen flower bud for ease of manipulation. Because M. truncatula flowers and their internal floral organs are small, it was not feasible to perform crosses using the naked eye. Hence, we performed crossing under a dissecting microscope; a magnifying glass or a magnifying binocular headset would also work for this purpose. The flower serving as female was mounted horizontally on its side on a dissecting microscope stage oriented so that the tip of the standard petal faced towards the base of the microscope and the opening of the standard petal faced the dominant hand of the person performing the cross (Figure 4A; Additional file 1: Video S1). The flower bud was secured to the microscope stage using cellophane tape on the pedicel. Subsequently, the flower bud was held in place using a set of forceps on the calyx, while another set of forceps was used to gently lift the standard petal to access the underlying keel petal. Using the sharp tip of a scalpel, the keel petal was gently cut at the bottom third of the flower bud and incision was made along the central ridge of the keel petal all the way to the distal end of the flower (Figure 4B). During this process, care was taken to assure that the tip of the scalpel blade cut only the keel petal and did not extend far inside the flower bud so as
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Ideally, vasectomy success is confirmed by semen analy- sis. In many low resource settings, however, semen analy- sis is not readily accessible or available. Protocols commonly used in these settings recommend 10–12 weeks or 15–20 ejaculations as endpoints for when men can begin to rely on their vasectomy for contraception [18,19]. Our data confirm results of two recent studies which also showed that 12 weeks after vasectomy is more reliable than 20 ejaculations as an endpoint and should reduce the risk of failure [7,8]. Our finding that the predic- tive value of one sample at 12 weeks for success at the end of the study was 99.7% has practical implications for vasectomy services. First, it suggests that one semen anal-