Search Results (339)

Background and Clinical Significance: Thyroid cancer is increasing, particularly the differentiated type, with decreasing incidence of the anaplastic type. Anaplastic thyroid carcinoma (ATC) is a rare, aggressive, and often lethal form. It frequently presents with metastatic disease, regional and systemic, with common distant metastasis to the lung, bone, brain, and adrenal, and rarely to other places; Case presentation: A 74-year-old Arab male presented with symptomatic anemia and melena and was admitted for investigation of the cause. The patient was found to have a large retrosternal goiter and gastric tumor. CT scan showed a pedunculated, nonobstructive mass, suggestive of a GIST or leiomyoma. The neck mass presented with compressive symptoms. He underwent a combined neck and abdominal surgical resection based on a multidisciplinary team decision, as prior biopsies were not conclusive. The final pathology report identified similar tumors in the two specimens and suggested an anaplastic thyroid carcinoma as the primary tumor with metastasis to the stomach. Furthermore, the workup, including a PET scan 2 weeks post-surgery, revealed widespread metastases in the bone, lung, and liver, and the treatment was palliative. He was followed up in the outpatient clinic for 4 and a half months post-operatively. The patient developed sepsis and cardiopulmonary arrest and died; Conclusions: ATC can metastasize to many places in the body, including the stomach (as shown in our case), which can cause significant upper gastrointestinal bleeding and anemia. Metastatic ATC carries a poor prognosis; thus, physicians need to keep a high index of suspicion in approaching similar cases. A multidisciplinary approach for the management is of utmost importance for appropriate treatment. This disease’s pathology, behavior, and targeted new treatment modalities must be explored further. Full article

Background: Oroantral communication (OAC) represents a pathological communication between the oral cavity and the maxillary sinus, most commonly occurring after extraction of posterior maxillary teeth. Despite being considered a rare complication, it remains clinically significant due to the risk of chronic sinus pathology. Methods: This study was conducted within the “Arsenie Guțan” Department of Oral and Maxillofacial Surgery at “Nicolae Testemițanu” State University of Medicine and Pharmacy. We evaluated a cohort of 31 patients with OAC treated in an outpatient setting at the Municipal Dental Center in Chișinău during 2022. Results: The first molar was the most frequently involved tooth (45.16%), with molars accounting for 83.88% of cases. Immediate post-extraction diagnosis was achieved in 90.32% of patients. Imaging was required in selected cases, with orthopantomography (OPG) used in 83.87% and computed tomography (CT) in 9.67% of patients. Conclusions: Early diagnosis based on combined clinical and radiographic assessment remains essential for successful management of OAC. Prompt intervention reduces the risk of maxillary sinus infection and chronic fistula formation. Full article

Background: Cryoablation is a minimally invasive technique that is being investigated as an alternative to surgery for early-stage breast cancer. Its potential advantages include outpatient treatment under local anaesthesia, favourable cosmetic outcomes, and possible immunologic synergy. However, its oncologic efficacy and long-term effectiveness are yet to be determined. Methods: We conducted a systematic review in accordance with PRISMA 2020 and the Cochrane Handbook, registered on PROSPERO (CRD420251137549). Databases searched were PubMed/MEDLINE, Scopus, and CENTRAL, from inception to August 2025. Eligible studies included women with unifocal, node-negative invasive ductal carcinoma ≤ 2 cm treated with percutaneous cryoablation. Outcomes of interest were residual disease, ipsilateral breast tumour recurrence, procedural and late complications, and cosmetic or patient-reported outcomes. Results: From 1074 records, 15 unique studies (17 reports) were included, comprising cryoablation-only studies (n = 7), treat-and-resect studies (n = 6), and comparative studies versus surgery (n = 2). Studies containing overlapping pathology validation and comparative components were classified within a single category to avoid duplication. Across treat-and-resect cohorts, complete tumour necrosis was reported in 88–95% of cases, with residual invasive carcinoma (RIC) ranging from 5% to 12%. In cryoablation-only cohorts, IBTR rates ranged from 0% to 4.3%, with follow-up durations spanning 2 months to 8 years. The largest study (ICE3, n = 194) reported a 5-year recurrence rate of 4.3%. Procedural complications were infrequent and self-limiting, most commonly bruising, oedema, or superficial frostbite. No major adverse events were reported. Validated quality-of-life instruments reported high patient satisfaction, with favourable results in selected comparative domains. Most included studies were of moderate methodological quality. Conclusions: Cryoablation appears technically feasible, safe, and cosmetically favourable in well-selected low-risk early-stage breast cancers. Oncologic outcomes are encouraging, with reported local recurrence rates in carefully selected low-risk populations being low, although direct comparison with breast-conserving surgery remains limited by the small number of comparative studies and substantial heterogeneity across the evidence base. Rigorous multicentre randomised trials with long-term follow-up and validated patient-reported outcomes are needed before cryoablation can be considered for routine clinical adoption. Full article

Background: Thanks to its capacity to increase wound healing, NPWD (Negative-Pressure Wound Dressing) showed promising results in breast surgery. The authors developed the NDoCaSco system for select patients that may benefit the most from NPWD after breast oncologic surgery, aiming to improve outcomes in patients at risk for wound dehiscence and breast reconstruction failure. Methods: Patients scheduled for breast oncologic surgery were enrolled between 2022 and 2023. Surgical wound dressing was selected prior to assessing the risk for post-operative complications with the NDoCaSco. Low-risk patients (NDoCaSco score: 15–21) received traditional compressive dressing, while moderate- (NDoCaSco: 8–14) and high-risk (NDoCaSco: 0–7) patients received short-term or long-term NPWD, respectively. Results: Healing time and outcomes were compared to a retrospective control group that underwent the same surgeries between 2019 and 2021 and received traditional compressive wound dressing in all cases. The study population included 739 patients with an average age of 62.3 years (range, 29–95) and a mean BMI of 25.2 kg/m² (range, 16–46). Breast-conserving surgery was performed in 437 cases, and 302 received mastectomy with implant-based reconstruction. A total of 152 patients scored medium (140 cases) or low (12 cases) NDoCaSco and received NPWD. Post-operative complications’ incidence, healing time, and drain removal time were lower in the study group, while scar quality was consistently improved with NPWD when comparing the two middle-risk groups. Conclusions: NDoCaSco helped in identifying patients who benefit the most from NPWD, achieving faster healing and reduction in outpatient visits and hospital admissions, leading to a lower expenditure of resources. Full article

Background/Objectives: Health outcome determinants affecting Human Papillomavirus (HPV) vaccination among the adult female population are scarce in Spain. This study aimed to describe the health outcomes and determinants of HPV vaccination in women 18–65 years attending lower genital tract outpatient clinics across regions of Spain. Methods: This was a cross-sectional, multicenter, non-interventional, descriptive, and comparative nationwide study. Sociodemographic characteristics and health outcomes included obstetric, gynecological and HPV vaccination antecedents, together with patient-reported outcomes related to HPV infection. Statistical analysis included multivariate logistic regression models. Results: Among 2004 adult women recruited, 1907 (95.2%) were eligible for analysis. Vaccine uptake was 48.8%; 81.6% among women who were ever HPV positive (adjusted OR = 2.16 [95% CI: 1.59–2.93], p < 0.001), but 65.9% among women with an active infection, which acted as a negative factor for vaccination (OR = 0.63 [0.45–0.87], p = 0.005), as did increasing age (OR = 0.92 [0.90–0.93], p < 0.001); the higher the age, the lower the adjusted likelihood of being vaccinated. HPV knowledge and adequate physician-provided information were weakly associated with vaccination likelihood. A history of conization (OR = 7.48 [5.34–10.47], p < 0.001), use of contraception (OR = 1.49 [1.13–1.96], p = 0.004), infection with high-risk or unknown-risk HPV genotypes (OR = 1.86 [1.23–2.82], p = 0.003 and OR = 1.68 [1.17–2.42], p = 0.006, respectively), and Spanish nationality (OR = 2.46 [1.68–3.61], p < 0.001) were identified as factors associated with a higher vaccination likelihood. Conclusions: This study found that HPV vaccination uptake is improvable. Previous HPV infection favored vaccination; however, active infection and increasing age acted against vaccination. HPV knowledge and adequate healthcare professional information appeared to favor vaccination, along with, most notably, a history of cervical surgery (conization), contraceptive use, or infection with high-risk or unknown-risk HPV genotypes. Spanish women had a higher likelihood of receiving HPV vaccination than foreign residents. Full article

Background/Objectives: Midurethral sling (MUS) surgery is a standard treatment for stress urinary incontinence in women. Obturator-route MUS procedures reduce retropubic morbidity, but rare concealed hemorrhagic complications can be severe and rapidly progressive. This report describes a complex case of life-threatening hemorrhage, upper urinary tract extravasation, and delayed infection involving a persistent pelvic collection after obturator-route MUS. Methods: We reviewed the clinical course, imaging findings, interventions, and follow-up of a 77-year-old woman who developed severe complications after outpatient obturator-route MUS. A descriptive narrative summary of published hemorrhagic complications after TOT or TVT-O procedures was also performed. Result: On postoperative day 1, the patient presented with left lower abdominal pain, dizziness, vomiting, tachycardia, and severe anemia. Contrast-enhanced computed tomography showed active bleeding from the left obturator artery, an 11.5 cm pelvic hematoma with bladder displacement, and upper urinary tract contrast extravasation at the left renal pelvis and ureteropelvic junction. Emergency transcatheter arterial embolization and left percutaneous nephrostomy were performed, followed by delayed antegrade double-J ureteral stenting. Four months later, she developed E. coli urosepsis with a persistent 7.9 cm paravesical collection. Persistent symptoms despite initial antibiotic therapy required broad-spectrum antibiotics and percutaneous catheter drainage. The drainage fluid was serous, and S. hominis isolated from the drainage culture was interpreted as a contaminant; therefore, the collection was managed as a clinically suspected infection involving a persistent pelvic collection rather than as a microbiologically confirmed infected hematoma. Conclusions: After obturator-route MUS, severe abdominal or pelvic pain, dizziness, tachycardia, hypotension, or abrupt hemoglobin decline should prompt contrast-enhanced CT to evaluate for concealed pelvic arterial bleeding and associated urinary tract extravasation. Early multidisciplinary coordination and follow-up of persistent pelvic collections may be important in complex cases. Full article

Background and Objectives: Patient-reported outcome measures (PROMs) are essential for evaluating outcomes in hand surgery, but the broad range of available instruments complicates selection and increases patient burden due to overlapping content. The Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ), and Patient-Rated Wrist/Hand Evaluation (PRWHE) are the most frequently used PROMs. This study aimed to develop a merged instrument, the Comprehensive Hand Evaluation Form (CHEF), and to test whether CHEF-derived scores are equivalent to the original questionnaires. A secondary objective was to assess equivalence between pain ratings using an 11-item numeric rating scale (NRS) and a visual analogue scale (VAS). Materials and Methods: In this prospective study, adults with chronic atraumatic hand or wrist conditions completed the CHEF in the outpatient clinic and, three days later, the original DASH-G, MHQ-G, and PRWHE-G by mail. Equivalence was evaluated using two one-sided tests with margins set at half the minimal clinically important difference. Completion times were recorded. Results: Of the 100 patients, 57 could be included in the final analysis. Equivalence between CHEF-derived and original scores was demonstrated for PRWHE-G (mean difference −2.0; 90% CI −4.4 to 0.4 within ±7). Equivalence was not demonstrated for DASH-G (mean difference −3.5; 90% CI −5.7 to −1.3; margin ±5) or MHQ-G (mean difference 13.3; 90% CI 10.6 to 15.9; margin ±4.5). Thus, equivalence was achieved for one of three instruments. CHEF completion time was significantly shorter than the combined original questionnaires (median 10 vs. 15 min; p < 0.0001). For pain assessment, equivalence between the numeric rating scale and the visual analogue scale was observed at rest but not during activity. Conclusions: CHEF reduced completion time but achieved score equivalence only for PRWHE-G. These findings suggest that integrated PROM approaches may reduce burden, but do not consistently preserve equivalence across instruments. Full article

Background/Objectives: Myxoid liposarcoma (MLS) is a malignant soft-tissue tumor and the second-most common subtype of liposarcoma, often occurring in the lower limbs of middle-aged patients. Case Presentation: A 38-year-old male patient presented to the ultrasound outpatient clinic with a large mass in the right femoral region. It has been present for 15 years and mostly stable in size. Over the last two years, it has been slowly increasing in size, more rapidly in the previous 10 months, and has started to limit his range of motion. After multiparametric ultrasound and magnetic resonance imaging evaluation, the proposed diagnosis was myxoid liposarcoma. Following imaging workup, the patient was referred to the tertiary sarcoma center, where a biopsy was performed, and pathohistological diagnosis was low-grade myxoid liposarcoma. Contrast-enhanced computed tomography (CT) evaluation of the thorax, abdomen, and pelvis showed no signs of dissemination, and CT angiography showed no signs of vessel infiltration. Plastic surgery and vascular surgery specialists performed the extirpation of the mass with the partial resection of the adjacent sartorius muscle and the complete resection of the great saphenous vein. Subsequent pathohistological analysis of the mass and local lymph nodes showed clear surgical margins and no lymphatic or vascular invasion. The patient is currently under regular surveillance by an oncology specialist and awaiting adjuvant radiotherapy. Conclusions: A multidisciplinary approach is essential in the management of patients with MLS, as it provides a tailored, individualized assessment from diagnosis through treatment to ensure the best possible outcome. Full article

Background: Lumboperitoneal (LP) shunt surgery is an established treatment for idiopathic normal pressure hydrocephalus (iNPH). In Japan, patients undergoing LP shunt surgery are often hospitalized for several days to more than one week after surgery, even in uncomplicated cases, reflecting concerns regarding early complications, cerebrospinal fluid overdrainage, and discharge readiness in older adults. This study evaluated the feasibility and short-term safety of a perioperative optimization pathway for planned short-stay hospitalization after LP shunt surgery. Methods: This single-center retrospective before-and-after cohort study included 15 consecutive patients who underwent elective LP shunt surgery. Six patients were managed using a conventional hospitalization pathway, whereas nine patients were treated under a short-stay pathway targeting discharge after one postoperative night. Key perioperative modifications included a uniform higher initial programmable valve pressure (level 7), structured discharge education, scheduled postoperative analgesia, waterproof wound sealing permitting early showering, and early outpatient follow-up with head computed tomography for staged valve pressure adjustment. The primary outcome was 30-day safety, defined as readmission, reoperation, or major postoperative complications. Results: Baseline characteristics were generally comparable between groups, although the short-stay group was slightly older and had more frequent antithrombotic therapy. Mean hospital length of stay was shorter in the short-stay group than in the conventional group (3.7 ± 2.0 vs. 9.7 ± 0.8 days; median, 3 vs. 9.5 days). Orthostatic headache requiring valve adjustment occurred in three conventional cases but in none of the short-stay patients. No patients in the short-stay group required readmission or reoperation within 30 days. Conclusions: In this pilot before-and-after study, a short-stay LP shunt pathway incorporating perioperative optimization and individualized discharge decision-making was feasible and was not associated with an apparent increase in early adverse events. These findings should be interpreted as exploratory and may support further evaluation of short-stay management strategies for selected patients undergoing LP shunt surgery in Japan. Full article

Background: Cemented fixation remains the standard for total knee arthroplasty (TKA), with Palacos^® R considered the gold standard bone cement. However, more cost-efficient alternatives, like Biomet Bone Cement^® (BBC), require evaluation to confirm comparable outcomes. This retrospective 5-year study compares the clinical safety, performance, and radiographic outcomes of BBC versus Palacos-R in primary TKA, highlighting BBC’s potential as a comparable, cost-effective option amid the increasing cost of outpatient surgeries. Methods: This is a single-center, retrospective study of 128 consecutive patients undergoing primary TKA, evaluated over 5 years. The first 64 patients received Palacos-R, and the subsequent 64 patients received BBC. Radiographic outcomes, including cement gaps, radiolucency, periprosthetic osteolysis, and subsidence, were assessed using the Knee Society Radiographic scheme at immediate post-operative, 6-month, 1-year, 3-year, and 5-year intervals. Clinical outcomes were measured using the Knee Society Score (KSS) and the University of California Los Angeles Activity (UCLA) score. Statistical analyses included chi-square, Fisher’s exact tests, and t-tests (p < 0.05). Results: Cement gaps were significantly higher in the Palacos-R cohort at immediate postop (p = 0.0002) and 1-year (p = 0.0003), with no significant difference at 3 and 5 years. Radiolucency was non-progressive (<2 mm) in both cohorts. KSS was significantly higher in the Palacos-R group at 6 months, 1 year, and 3 years (p < 0.001), but equivalent at 5 years (p = 0.42). UCLA scores showed no differences. No revisions were required in either cohort. Conclusions: While BBC demonstrated comparable radiographic stability and clinical outcomes to Palacos at 5 years with no revisions in either cohort, the absence of preoperative KSS and UCLA scores is a major limitation that prevents adjustment for baseline function and limits interpretation of the early postoperative KSS differences. Full article

Background and Objectives: Rapid recovery and patient comfort are key goals in ambulatory surgery. Although sevoflurane anesthesia is widely used, target-controlled infusion (TCI) with propofol and remifentanil has gained attention for its potential benefits. However, comparative data regarding recovery profiles and respiratory safety remain limited. Materials and Methods: In this prospective randomized controlled trial, 51 ASA I–II patients undergoing outpatient gynecologic surgery were assigned to either a TCI group (n = 25) or an inhalation mask (IM) group using sevoflurane and nitrous oxide (n = 26). Primary outcomes included time to postanesthesia care unit (PACU) discharge readiness and patient and surgeon satisfaction. Secondary outcomes included eye-opening time, anesthesia duration, PACU stay, and respiratory adverse events. Results: Time to Aldrete score ≥9 did not differ significantly between groups (p = 0.697). The IM group demonstrated faster eye opening (p = 0.002), while patient satisfaction was higher in the TCI group (p < 0.001). Surgeon satisfaction favored the IM group (p = 0.035). Respiratory depression occurred more frequently in the TCI group (28.0% vs. 0%, p = 0.012). Conclusions: Sevoflurane anesthesia allowed faster emergence, whereas TCI provided greater patient satisfaction but increased respiratory risk. Both techniques are feasible for ambulatory gynecologic surgery when appropriately selected. Trial registration: This study was retrospectively registered at the Clinical Research Information Service (CRIS), Republic of Korea (KCT0011352). Full article

Background: Hypermobile Ehlers–Danlos syndrome (hEDS) can present as a complex interplay of widespread symptomatology and multisystem involvement, posing diagnostic and treatment challenges. Objective characterization of cervical spine and neurovascular findings in hEDS has been limited. Previous studies have emphasized upper cervical spine complications in hEDS, yet the relevance and mechanisms underlying associated symptomatology have not been elucidated. This study examined objective test findings in patients with hEDS at an outpatient neck clinic to explore cervical spine and neurovascular pathology that could contribute to further understanding the clinical profile of a subset of patients with hEDS. Methods: This single-center, retrospective observational study included patients with hEDS aged 20–50 years from 1 January 2022–31 December 2024, at an outpatient neck center. It excluded previous neck surgery, traumatic events, or related injury. Demographic, clinical, and diagnostic data were collected through a retrospective chart review, including measurements from standard clinical diagnostic protocols: digital motion X-ray (videofluoroscopy), cone beam CT, Doppler ultrasound, and tonometry. Results: More than 71% of patients reported ≥29 symptoms. Nearly all patients exhibited co-occurring forward head, decreased depth of curve, ligamentous cervical instability, and decreased internal jugular vein (IJV) and vagus nerve cross-sectional area (CSA). Vagus nerve CSA was found to be significantly smaller than the comparative healthy/normal population. IJV CSA was significantly smaller at C1 than at C4–C5, suggesting evidence of carotid sheath compression at C1. Conclusions: This study offers novel evidence that cervical spine pathology, IJV compression, and vagus nerve degeneration are uniformly prevalent in hEDS, which may contribute to, or be an etiological basis for, the multisystem involvement in a subset of patients with this disorder. These findings provide hypothesis-generating data to inform future mechanistic and therapeutic studies, including exploration of new diagnostic and treatment targets. Full article

Background/Objectives: Non-muscle invasive bladder cancer (NMIBC) is characterized by high recurrence rates, requiring frequent diagnostic and therapeutic interventions. This study evaluates the feasibility, safety, oncological outcomes, and economic impact of implementing an in-office laser bladder tumor fulguration protocol. Methods: A descriptive, longitudinal study was conducted between 2020 and 2025 on 65 patients with recurrent NMIBC. Procedures were performed in an outpatient setting under local anesthesia using a flexible cystoscope and a Holmium:YAG (Ho:YAG) laser. The primary endpoint was recurrence-free survival. Secondary endpoints included complication rates (Clavien–Dindo) and a cost-analysis comparison with conventional transurethral resection of the bladder (TURBT). Results: The mean age was 69.4 years, with 89.2% of patients classified as ASA ≥ 2. After a median follow-up of 20.3 months, the recurrence rate was 33.8%, with 0% progression. Most procedures (95.4%) had no complications; only 4.6% presented Clavien–Dindo grade 1 events. Adjuvant mitomycin C was administered in 93.8% of cases. The cost analysis demonstrated substantial economic advantages, with costs reduced by 89.7% versus the 24 h admission model and 82.1% versus the day-surgery model according to regional health-system tariffs. Conclusions: In-office laser fulguration is a safe, effective, and economically sustainable alternative to traditional TURBT for selected low-risk recurrences. It optimizes hospital resources, minimizes anesthetic risk in comorbid patients, and maintains favorable oncological control. Full article

Objectives: The coronavirus disease 2019 (COVID-19) pandemic caused severe disruptions in healthcare services worldwide; however, its differential effects on surgical utilization have not been fully examined. This study aimed to analyze trends in three major surgery types—cataract, spine, and joint replacement—across regions and healthcare institutions in Korea and to evaluate how the pandemic affected surgical utilization according to surgery type, urgency, and care setting. Methods: The Korean National Health Insurance Service data collected from 2017 to 2021 were used to analyze trends in three major surgery typesacross 17 regions and eight categories of healthcare institutions in Korea. The effects of the pandemic were examined using an interrupted time-series analysis to compare annual growth rates and identify patterns during 2019–2021. Results: Our findings revealed distinct patterns based on the type of surgery. Cataract surgery (+4.8% compared with 2019) and spine surgery (+5.0%) continued to increase in 2020; however, the number of joint replacement surgeries decreased (−2.9%). Metropolitan areas showed greater resilience than rural regions, indicating regional disparities. At the institutional level, outpatient-focused clinics performed cataract surgeries, whereas hospital-based procedures showed variable trends. In addition, the differences correlated with surgical urgency: elective procedures continued to increase, whereas semi-urgent procedures decreased. Conclusions: during the pandemic, surgical utilization varied according to surgery type, urgency, and regional characteristics. These findings provide context-specific evidence for policymakers to prioritize surgical services during health crises and offer strategies to sustain essential surgical care across diverse healthcare settings and regions. Full article

Background/Objectives: Transurethral Laser Ablation (TULA) is fast evolving as a surgical procedure, especially for small or recurrent bladder tumours. It offers a safe alternative for patients who are unsuitable for general anaesthetic (GA) or who cannot obtain timely pre-operative assessments for Transurethral Resection of Bladder Tumour (TURBT). Patients are identified for TULA in ‘Bladder Cancer Surgery Planning Meetings’ (BSPMs) and this significantly reduces their cancer waiting time (CWT). Its effectiveness as a diagnostic and therapeutic tool, including its complications and costs, has been assessed. Methods: All TULA procedures performed at the Trust were studied in two cycles. The first between August 2023 and November 2024, prior to initial audit, and then up to September 2025. Case notes, operation notes, and multidisciplinary team (MDT) outcomes were retrospectively reviewed. All procedures were performed with a flexible cystoscope and ‘cold cup’ biopsies with further ablation and haemostasis using a 1470 nm diode laser at 4 watts and 400 µm laser fibre. Patients were identified for TULA based on tumour size, location, and fitness for general anaesthetic. Results: During the study period, 95 TULA procedures were performed with a follow-up period between 4 weeks and 1 year. A total of 86 patients (90.5%) had local anaesthetic (LA) ± intravenous (IV) sedation, with 50% having LA alone in the second phase of the study; of the remaining patients, 8 had GA (8.4%) and 1 (1.1%) had spinal anaesthetic. None of the cases were considered to have missed a significant finding. One case (1.1%) was complicated, with ongoing bleeding requiring bladder washout under GA. BSPMs were introduced in July 2024 and audited in the first phase of this study. A total of 24 (39%) of patients were identified for TULA. Of those, 7 (29%) were originally scheduled for TURBT and were having difficulties obtaining pre-operative assessment (POA) clearance. Cost figures were provided by the hospital’s accountants. Conclusions: TULA has been implemented with a low complication rate and appropriate sampling. In the next phase, TULA will be rolled out to an outpatient setting, performed exclusively under LA. This will lead to a significant cost reduction. Full article