scholarly journals Local Resection by Combined Laparoendoscopic Surgery for Duodenal Gastrointestinal Stromal Tumor

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Motohiko Kato ◽  
Kiyokazu Nakajima ◽  
Toshirou Nishida ◽  
Makoto Yamasaki ◽  
Tsutomu Nishida ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Hemorrhage ◽  
Minimal Invasive ◽  
Local Resection ◽  
Gi Tract ◽  
Duodenal Gist ◽  
Attractive Option ◽  
Laparoscopic Assistance ◽  
Duodenal Resection ◽  
Dissection Technique

Combined laparoendoscopic surgery is a novel surgical method which consists of both endoscopic surgery from inside the gastrointestinal tract and laparoscopic surgery from the outside. We report a case of duodenal GIST, in which combined laparoendoscopic local resection was attempted. The lesion was resected endoscopically using endoscopic submucosal dissection technique under laparoscopic assistance. Laparoscope was used for originating the orientation of the tumor, intra-operative EUS, and monitoring serosal injury from the peritoneal cavity. Postoperative hemorrhage occurred; however, precise orientation of the lesion helped us to manage the patient with minimal invasive reoperation. And thus, the bowel integrity was completely preserved, by avoiding segmental duodenal resection and pancreaticoduodenectomy. This novel, less invasive surgical procedure may become an attractive option for the lesions originating in the anatomically challenging portion of the GI tract for endoscopic or laparoscopic surgery alone.

scholarly journals Hysterectomy for Uterine Disease in 2010: From past to Future

2010 ◽  
Vol 4 ◽  
pp. CMRH.S2980
Author(s):  
Liselotte Mettler ◽  
Wael Sammur ◽  
Thoralf Schollmeyer
Keyword(s):  
Laparoscopic Surgery ◽  
Minimal Invasive ◽  
Reproductive Age ◽  
Uterine Disease ◽  
Submucous Myoma ◽  
First Choice ◽  
Uterine Adenomyosis ◽  
Steep Decline ◽  
The 19Th Century ◽  
Treatment Step

Hysterectomies were unknown in the field of obstetrics and gynaecology until the 19th century. In the 20th century they were perhaps too frequently performed whereas the 21st century has witnessed a steep decline in hysterectomy numbers. It is therefore an opportune time to review the indications for hysterectomies, hysterectomy techniques and the present and future status of this surgical procedure. There is a widespread consensus that hysterectomies are primarily to be performed in cancer cases and obstetrical chaos situations even though minimal invasive surgical technologies (MIS) have made the procedure more patient friendly than the classical abdominal opening. Today, minimally invasive hysterectomies are performed as frequently as vaginal hysterectomies and the vaginal approach is the first choice if the correct indications are given. It is no longer necessary to open the abdomen; this procedure has been replaced by laparoscopic surgery. Laparoscopic and robotic-assisted laparoscopic surgery can also be indicated for hysterectomies in selected patients with gynaecological cancers. For women of reproductive age, laparoscopic myomectomies and numerous other uterine- preserving techniques are applied in a first treatment step of meno-metrorrhagia, uterine adenomyosis and submucous myoma. These interventions are only followed by a hysterectomy if the pathology prevails.

scholarly journals A COMPARATIVE STUDY OF HAEMODYNAMIC AND RECOVERY CHARACTERISTICS OF DESFLURANE VERSUS SEVOFLURANE IN PATIENTS UNDER GOING LAPAROSCOPIC SURGERY

2019 ◽  
pp. 1-2
Author(s):  
Ankita Bhensdadia
Keyword(s):  
Laparoscopic Surgery ◽  
Invasive Surgery ◽  
Minimal Invasive Surgery ◽  
Early Mobilization ◽  
Hemodynamic Instability ◽  
Minimal Invasive ◽  
Blood Gas ◽  
Hemodynamic Stability ◽  
Inhaled Anesthetics ◽  
Care Surgery

Laparoscopic surgeries are minimal invasive surgery very popular now a days as a day care surgery as it provide early mobilization, shorter hospital stay. The main drawback is intra-operative hemodynamic instability due to pneumoperitoneum. Therefore, anesthesiologist must choose anesthetic agent which provide hemodynamic stability and rapid recovery. Inhaled anesthetics with low blood: gas partition contributes to faster induction and emergence from anesthesia. Both Desurane and Sevourane have low blood: gas partition coefcient 0.42 and 0.65 respectively .We conducted the study to know which of these two agents contributes to faster recovery and hemodynamics. CONCLUSION- Desurane and Sevourane provide stable intraoperative hemodynamic, however early and intermediate recovery is signicantly faster in Desurane group than Sevourane grou

scholarly journals Limited Wedge Resection of a Duodenal Gist in a Patient with Intermittent Melena

2021 ◽  
Keyword(s):  
Wedge Resection ◽  
Gi Bleeding ◽  
Gi Tract ◽  
Epigastric Discomfort ◽  
Stromal Tumors ◽  
Upper Gi ◽  
Duodenal Gist ◽  
Upper Gi Endoscopy ◽  
Subepithelial Lesion ◽  
Unexplained Symptoms

Gastrointestinal Stromal Tumors account for 1% - 2% of all gastrointestinal (GI) tract tumors. Among GISTs, duodenal localization occurs in less than 5% and usually presents with upper GI bleeding. A 45-year-old man presented in the outpatient department with complaints of epigastric discomfort, intermittent melena and undocumented weight loss for the preceding 3 months. Initial upper GI endoscopy showed mild duodenitis and no other upper GI pathology. For unexplained symptoms, a CT Scan was performed which demonstrated a well-defined solid lesion along the second part of the duodenum. An endoscopic ultrasound (EUS)-guided biopsy of a subepithelial lesion at D2 was performed. Immunohistochemistry findings were suggestive of GIST. Wedge resection of the duodenal mass was done. Duodenal GIST should be considered as a differential in cases of GI bleeding when other differentials have been ruled out. Limited resection of duodenal GIST should be considered over pancreaticoduodenectomy, in case of small size tumors.

scholarly journals Hand-assisted laparoscopic surgery for left-sided colon and rectal cancer: 10 Years single centre experience

2016 ◽  
Vol 63 (1) ◽  
pp. 23-28
Author(s):  
Rokas Rackauskas ◽  
Audrius Dulskas ◽  
Vygintas Aliukonis ◽  
Narimantas Samalavicius
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Tertiary Care ◽  
Stage Iv ◽  
Operation Time ◽  
Minimal Invasive ◽  
Invasive Technique ◽  
Colon And Rectal Cancer

Introduction. Hand-assisted laparoscopic surgery (HALS) was introduced into clinical practice in the mid-1990s. Although this technique was established as a bridge to total laparoscopic colorectal surgery there are still those who oppose it. In this study we report our 10 year experience of practicing HALS. Methods. This study is a retrospective analysis of prospectively collected data of 426 patients undergoing hand-assisted laparoscopic colorectal surgery for left-sided colon and rectal cancer in a single tertiary care institution, the National Cancer Institute, from January, 2006, to July, 2016. All consenting patients with left sided colon and rectal cancer were included in the analysis. Results. Patient population showed a similar female and male ratio 212 (49.76%) vs. 214 (50.24%). Average age was 64.13 ? 9.92 years (from 26 to 91). Operation time was 108 minutes ? 44.1 min (30 - 320 min). The mean length of the postoperative hospital stay was 6.88, ranging from 2 to 34 days. The pathohistological examination revealed mean lymph node harvest was 16.4 ? 9.61, ranging from 0 to 54. Stage I and II cancer prevailed in the majority of cases, accounting for 129 (30.28%) for each, stage III - 135 (31.69%), and stage IV - 33 (7.74%). Complication rate was 7.27%. Surgical reintervention was required in 10 cases (2.35%). Mortality rate occurred only in two (0.47%) patients. Conclusion. In conclusion, the HALS technique combines the benefits of a minimal invasive technique for the patient and palpatory benefits for the surgeon, which makes surgery for left-sided colon and rectum cancer faster, and with a similar outcome to laparoscopic colectomy.

scholarly journals A Comparative Study of Low Versus Standard Intraperitoneal Pressures in Gynaecological Laparoscopic Surgery

2021 ◽  
pp. 179-185
Author(s):  
Anup R. Patil ◽  
Deepika Dewani ◽  
Kalyani Mahajan ◽  
Neema Acharya ◽  
Arpita Jaiswal ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Low Pressure ◽  
Minimal Invasive ◽  
Intraabdominal Pressure ◽  
Intraperitoneal Pressure ◽  
Organ Systems ◽  
Patient Will ◽  
Standard Pressure

Background: Minimal access surgery in contrast to open surgery has quicker recovery during the postoperative period as well as reduced scores of pain. As a result of increased pressure in the abdominal cavity, laparoscopic surgery  has many implications over a range of organ systems as well as their functioning. Laparoscopic surgery due to increased intraabdominal pressure also has many implications on various organ systems and their functioning. To overcome the consequences of increased intrabdominal pressure, a number of trials have been formulated to compare low- versus standard-pressure pneumoperitoneum. Aim: The aim of this study was to assess the effectivity of low intraperitoneal pressures v/s  standard intraperitoneal pressure during laparoscopic hysterectomies. Study Design: Experimental study  Materials and Methods: 40 cases with uncomplicated symptomatic benign uterine pathologies who were posted for laparoscopic hysterectomy were selected out of which 20-20 cases were randomized into low and standard pneumoperitoneum groups.  Results: In patients in whom low pressure pneumoperitoneum is employed are better recovered in terms of pain than standard pressure pneumoperitoneum. This means hospital stay can be shortened in low pressure pneumoperitoneum groups which will be more economical and comfortable for patients. Conclusion: Laparoscopic hysterectomy can be done at 10 mmhg with the benefits of : Optimum visualization with low pressure Reduction in post operative pain helping the patient for early ambulation so that patient will get back to routine work and normal life earlier, it is the main purpose of minimal invasive surgery.

The Effects of Repeat Laparoscopic Surgery on the Treatment of Complications Resulting from Laparoscopic Surgery

2012 ◽  
Vol 78 (9) ◽  
pp. 926-932
Author(s):  
Chih-Yuan Fu ◽  
Chi-Hsun Hsieh ◽  
Chun-Han Shih ◽  
Yu-Chun Wang ◽  
Ray-Jade Chen ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Laparoscopic Approach ◽  
Invasive Procedure ◽  
Operative Management ◽  
Postoperative Hemorrhage ◽  
Biliary Complications ◽  
Postoperative Peritonitis ◽  
Minimally Invasive Procedure ◽  
Management Of Complications ◽  
Complications Of Laparoscopic Cholecystectomy

Laparoscopic surgery is frequently applied in the operative management of appendicitis and symptomatic cholelithiasis because it is a minimally invasive procedure. There are, however, some complications of laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) that result in the need for reoperation. In the current study, we examine the effects of repeat laparoscopic surgery on the treatment of complications arising from LC/LA. From April 2005 to March 2011, we examined a cohort of patients who had received LC or LA and experienced complications that required reoperations. We focused on patients with postoperative hemorrhages, postoperative peritonitis, early postoperative small bowel obstructions (EPSBO), and biliary complications (after LC) who were treated through a repeat laparoscopic approach. The general demographics of the patients, their postoperative complications, procedures for selecting the appropriate reoperation method, and repeat laparoscopic findings are described in detail. During the 6-year period examined, 1608 patients received LC and 1486 patients received LA at the hospitals participating in this study. In patients with complications requiring reoperation, the repeat laparoscopic approach was performed successfully (without the need for further laparotomy) in 50 per cent of the patients with postoperative hemorrhage (2 of 4), 50 per cent of the patients with postoperative peritonitis (2 of 4), 75 per cent of the EPSBO patients (3 of 5), and 50 per cent the of patients with biliary complications (1 of 2). The repeat laparoscopic approach is an appropriate method for the management of complications arising from laparoscopic surgery. In patients with postoperative hemorrhage, laparoscopic hemostasis and hematoma evacuations can be performed while maintaining stable hemodynamics. In addition, laparoscopic approaches are also feasible for selective post-LC ductal injuries, EPSBO, and unconfirmed diagnoses of peritonitis after laparoscopic surgery.

Presentation and Management of Gastrointestinal Stromal Tumors of the Duodenum

2006 ◽  
Vol 72 (8) ◽  
pp. 719-723 ◽  
Author(s):  
Robert D. Winfield ◽  
Steven N. Hochwald ◽  
Stephen B. Vogel ◽  
Alan W. Hemming ◽  
Chen Liu ◽  
...  
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Stromal Tumors ◽  
Incidental Finding ◽  
Case Reports ◽  
Complete Removal ◽  
Gastric Gist ◽  
Stromal Tumors ◽  
Duodenal Gist ◽  
Median Size ◽  
Duodenal Resection

Duodenal gastrointestinal stromal tumors (GIST) have been described primarily in isolated case reports. In order to learn more about duodenal GIST, a retrospective review of patients with GIST managed at a single institution between 2000 and 2005 was conducted. Thirty-eight GIST of the stomach and small bowel were analyzed. Eight (21%) were duodenal GIST. The median size of duodenal GIST (6.0 cm) and small bowel GIST (6.3 cm) was larger than the median size of gastric GIST (3.0 cm). The most common presentation of duodenal GIST was bleeding (50%) which was similar to other small bowel GIST (49%) but different from gastric GIST which were most commonly an incidental finding (62%). Two patients (25%) with duodenal GIST had a history of neurofibromatosis. The duodenal GIST were located in the 2nd (n = 5, 63%) and 3rd portion of duodenum (n = 3, 37%). Seven of 8 patients underwent complete resection of duodenal GIST. Pancreaticoduodenectomy was the most common operation performed (n = 5); 2 patients were treated with partial duodenal resection. No patients undergoing pancreaticoduodenectomy (n = 5) were found to have lymph node metastases. No patients received neo-adjuvant or adjuvant therapy with Imatinib. Following resection, 2 patients have recurred (12 and 48 mo.), 4 patients are without disease (1, 6, 6, and 24 mo.), 1 patient died postoperatively. Duodenal GIST are relatively rare tumors that present most commonly with gastrointestinal bleeding. Duodenal GIST are associated with neurofibromatosis. Many duodenal GIST require pancreaticoduodenectomy for complete removal.

scholarly journals The development of laparoscopic technology in light of cholecystectomies performed between 1994 and 2007

2009 ◽  
Vol 150 (48) ◽  
pp. 2189-2193
Author(s):  
Péter Lukovich ◽  
Tímea Vanca ◽  
Dániel Gerő ◽  
Péter Kupcsulik
Keyword(s):  
Laparoscopic Surgery ◽  
Gastrointestinal Surgery ◽  
Minimal Invasive ◽  
Chi Square ◽  
Female Ratio ◽  
Surgical Method ◽  
Male Female Ratio ◽  
Significance Levels ◽  
Gallstone Spillage ◽  
Laparoscopic Techniques

The spread of laparoscopy has required surgeons to familiarize with a completely new surgical method and by today this method has clearly become of major importance in gastrointestinal surgery. The evolution of laparoscopic cholecystectomy offers many good lessons to learn for the purposes of advanced laparoscopic surgeries and surgeons may benefit from this experience in any process of introducing new minimal invasive techniques. Methods and Material: We have made a retrospective analysis of the data of the cholecystectomies made in the 1st. Department of Surgery, Semmelweis University, right after laparoscopy had become a widely spread, routine surgical method (1994) as well as 13 years later (2007). The data have been processed using the SPSS 16.0 application package. Significance levels have been established with the chi-square probe. Results: Within the analyzed timeframe we could clearly see a growing use of laparoscopic techniques (52.09% vs. 90.13%) with a growing number of cases (263/304), unchanged average age (~53.5 years) and constant male/female ratio (75/25%). The BMI increased moderately (26.5 vs. 27.6), but the frequency of laparoscopic interventions on extremely obese patients grew (BMI: 25–30 37.93% vs. 44.39%, 30–35 13.79% vs. 20.6% 35–40 6.89% vs. 5.82% and 40 \lt; 0% vs. 1.34%) while the postoperative hospitalization decreased dramatically from 5.9 days to 2.3. In year 1994, patients spent on the average 2.9 days in hospital after a laparoscopic surgery, while in year 2007 nearly 25% of the patients left the hospital 1 day after surgery. The duration of a laparoscopic surgery decreased from 78 minutes to 53, and the occurrence of intraoperative bleeding, gall bladder perforation and gallstone spillage also decreased. The conversion ratio increased from 2.7% to 4.9%. In 3% of the laparoscopic cholecystectomies (10 patients) only 3 ports were used during surgery. Discussion: As surgeons have come to master the new technique, the previous relative and absolute pros and cons have been revised and at present 90% of cholecystectomies are made using laparoscopy. The data collected in the analysis of laparoscopic techniques can be used to research, learn and eventually introduce Natural Orifice Transluminal Endoscopic Surgery.

scholarly journals Port site complications following laparoscopic surgeries: a prospective study

2018 ◽  
Vol 5 (2) ◽  
pp. 598
Author(s):  
Madan Mohan Mudgal ◽  
Pradeep Kumar Kothiya ◽  
Naveen Kushwah ◽  
Raghvendra Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Hypertrophic Scar ◽  
Minimal Invasive Surgery ◽  
Minimal Invasive ◽  
Port Site ◽  
Age Group ◽  
Site Infection ◽  
Visceral Injury ◽  
Verres Needle ◽  
A Prospective Study

Background: Port site complications are bothersome complications which undermine the benefits of minimal invasive surgery, not only does it add to the morbidity of the patient but also spoil the reputation of the surgeon. Aims and objective of the study was to determine the morbidity associated with the port site complications in laparoscopic surgery and to identify risk factors for complications.Methods: Three hundred patients having age between 15-50 years admitted for elective laparoscopic procedure were studied. All the patients had preoperative workup and general anaesthesia was given with endotracheal intubation. The patients were observed for any port-site complication during operation and in the immediate and postoperative till three months.Results: Female preponderance (77.34%) was observed with maximum patients belonging to age group of 41-50 years (31.7%). Majority of the patients were in the BMI range of 18.5-25kg/m2 (53.33%). In 54.66% and45.33% patients Verres needle and Hasson’s (Open) method was used to create pneumoperitoneum. Cholecystectomy was the indication in 80% patients. Port site morbidity was observed in 8.67% patients. As an early port site complication, bleeding, surgical site infection, emphysema and visceral injury was observed in 6, 8, 4 and 1 patient respectively. As a late port site complication, 4 and 3 patients developed hernia and hypertrophic scar respectively.Conclusions: Port site complications are least in elective laparoscopic surgery.

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