scholarly journals A totally extraperitoneal approach for endoscopic resection of a congenital prepubic sinus through the pubic symphysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masahiro Fukuhara ◽  
Shun Onishi ◽  
Yusuke Yonemura ◽  
Tomoe Sato ◽  
Satoshi Tsutsumi ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Intraoperative Complications ◽  
Pubic Symphysis ◽  
Complete Resection ◽  
Rectus Abdominis ◽  
The Body ◽  
Preperitoneal Space ◽  
Extraperitoneal Approach ◽  
Totally Extraperitoneal ◽  
Good Visibility

Abstract Background A congenital prepubic sinus (CPS) is a rare congenital anomaly in which a duct remnant extends from the skin opening near the pubic symphysis to various parts and the lesions are mostly located in the preperitoneal space. The totally extraperitoneal (TEP) approach is an operational method that provides a good field of view for the preperitoneal space. We report the CPS through the pubic symphysis in which complete resection was achieved by a TEP approach. TEP approach was minimally invasive and achieved satisfactory cosmetic outcome. Case presentation We herein report the case of a 13-year-old boy with a fistula opening near the dorsal penis. He was admitted to our hospital due to fever and lower abdominal pain. Abdominal ultrasonography and computed tomography revealed an abscess inside a fistula lumen on the posterior surface of the rectus abdominis muscles in the midline of the lower abdomen. Under a diagnosis of CPS, which was located in the preperitoneal space, endoscopic resection was performed by a totally extraperitoneal approach. After making an umbilical incision, the rectus abdominis muscle was excised outward to expose the preperitoneal space. A single-port system was placed in the preperitoneal space. Three 5-mm-port trocars were inserted. As the preperitoneal cavity was expanded, a sinus connecting to the pubic symphysis was confirmed. The pubic symphysis did not connect with the bladder. Because the fistula was penetrated with the pubic symphysis, the remaining caudal fistula was removed from the body surface with a small spindle-shaped incision around the fistula opening. Finally, the sinus was completely resected, with confirmation from both the cranial side and dorsal side of the pubic symphysis. We were able to perform complete resection of the CPS with good visibility and without any peritoneal damage. There were no intraoperative complications. His postoperative course was uneventful during the 1-year follow-up. Conclusions The TEP approach may be feasible for the resection of a CPS and may allow safe and secure resection due to good visibility, even in pediatric patients.

scholarly journals 40 cases of Single-incision laparoscopic surgery to totally extraperitoneal herniorrhaphy via umbilical incision under posterior rectus abdominis sheath

2019 ◽  
Author(s):  
Xiaojun Wang ◽  
Yizhong Zhang ◽  
Changlei Qi ◽  
Encheng Zhou ◽  
Haiqiang Zhang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Operative Time ◽  
Single Incision ◽  
Single Port ◽  
Rectus Abdominis ◽  
Preperitoneal Space ◽  
Single Incision Laparoscopic Surgery ◽  
Umbilical Incision ◽  
Totally Extraperitoneal ◽  
Port Device

Abstract Background Since 2008, the first case of Single-incision laparoscopic surgery totally extraperitoneal (SILS-TEP) was reported, there was more than 10 years history on SILS-TEP. Because of difficult to operation, SILS-TEP is popularized slowly. This study investigate the safety and feasibility of SILS-TEP under posterior rectus abdominis sheath. Methods A single 2.5cm long cured incision was made along the lower umbilical border. A 5.0cm size preperitoneal space was created by electrotome or blunt dissection under the posterior sheath and the linea alba. The silica gel sealing sleeve of Iconport single port device was crammthed under the posterior rectus abdominis sheath, then the preperitoneal space was broadened toward lower abdomen in condition of CO2 gas inflation. Conventional laparoscopic instruments were used to complete the operation according to the operation procedure of laparoscopic total extraperitoneal herniorrhaphy. Results SILS-TEP hernia repair was successfully completed in 39 patients. One need an additional ports to complete totally extraperitoneal hernioplasty. Mean operative time was 73.8 minutes (range, 45 to 130 minutes) and 55.2 minutes (range, 34 to 95 minutes) in unilateral indirect hernia and in unilateral direct or femoral hernia, respectively . Mean operative time was 92.3 minutes (range, 65 to 150 minutes) in bilateral hernia. 3 seroma and 5 chronic pain were seen during the 1-6 months follow-up periods, all were treated conservatively. No other major complications. Mean post-operative hospital stay was 2.6 days. Conclusion The operation of SILS-TEP via umbilical incision under posterior rectus abdominis sheath is safe and feasible. The Iconport single-port device has potential advantages in SILS-TEP surgery. Trial registration: The study was registered with the Chinese Clinical Trial Registry (ChiCTR)(www.chictr.org.cn).Registration number:ChiCTR1900023056. Registration date: May 9, 2019.Retrospectively registered.

scholarly journals Links between Inflammation and Postoperative Cancer Recurrence

2021 ◽  
Vol 10 (2) ◽  
pp. 228
Author(s):  
Tomonari Kinoshita ◽  
Taichiro Goto
Keyword(s):  
Clinical Practice ◽  
Cancer Cells ◽  
Cancer Recurrence ◽  
Complete Resection ◽  
The Body ◽  
Cancer Development ◽  
Clinical Settings ◽  
Cancer Type ◽  
Clinical Indicators ◽  
The Status

Despite complete resection, cancer recurrence frequently occurs in clinical practice. This indicates that cancer cells had already metastasized from their organ of origin at the time of resection or had circulated throughout the body via the lymphatic and vascular systems. To obtain this potential for metastasis, cancer cells must undergo essential and intrinsic processes that are supported by the tumor microenvironment. Cancer-associated inflammation may be engaged in cancer development, progression, and metastasis. Despite numerous reports detailing the interplays between cancer and its microenvironment via the inflammatory network, the status of cancer-associated inflammation remains difficult to recognize in clinical settings. In the current paper, we reviewed clinical reports on the relevance between inflammation and cancer recurrence after surgical resection, focusing on inflammatory indicators and cancer recurrence predictors according to cancer type and clinical indicators.

Presigmoid transpetrous approach (partial petrosectomy) combined with subtemporal transtentorial approach for petroclival meningioma

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Fernando Palacios ◽  
◽  
Manuel Lazón ◽  
Eduardo Romero ◽  
Rommel Rodriguez
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Intraoperative Complications ◽  
Brain Magnetic Resonance Imaging ◽  
Complete Resection ◽  
Neurosurgical Procedures ◽  
Resonance Imaging ◽  
Petroclival Meningioma ◽  
Skull Base Neoplasms ◽  
Petroclival Meningiomas

Introduction: Petroclival meningiomas constitute 3 to 10% of meningiomas of the posterior fossa, they originate in the petroclival fissure, in the upper part of the clivus, petrosal apex, and medial to the trigeminal nerve. Resection of these tumors is a neurosurgical challenge. The combined partial petrosectomy approach associated with a sub-temporal approach is a technique described by various authors; however, its performance is considered highly complex. We report the case of a petroclival meningioma operated successfully in our hospital using a combined presigmoid and subtemporal transtentorial transpetrosal approach. Clinical case: 33-year-old female patient with a clinical picture of headache, nausea, and gait disturbance. Brain magnetic resonance imaging showed a large right petroclival tumor (4.2x3.9x3.8cm) that displaced the brainstem and secondary hydrocephalus. The hydrocephalus was treated with a ventricular peritoneal shunt. Then, the tumor was resected using a combined presigmoid and subtemporal transpetrosal approach, a technique that allowed adequate exposure of the tumor, achieving complete resection, without intraoperative complications. Postoperative evolution was favorable, with no sequelae. Conclusion: The combined presigmoid and transtentorial subtemporal transpetrous approach for petroclival meningiomas is an effective and feasible technique to perform in our environment. The support of technology such as Neuronavigation, the ultrasonic aspirator, intraoperative monitoring, and adequate experience in skull base surgery are fundamental factors for the success of this surgery. Keywords: Meningioma, Skull Base Neoplasms, Craniotomy, Neurosurgical Procedures. (Source: MeSH NLM)

Robotic DIEP Flap Harvest through a Totally Extraperitoneal Approach Using a Single-Port Surgical Robotic System

2021 ◽  
Vol 148 (2) ◽  
pp. 304-307
Author(s):  
Jae Hyeok Choi ◽  
Seung Yong Song ◽  
Hyung Seok Park ◽  
Choong Hyeon Kim ◽  
Jee Ye Kim ◽  
...  
Keyword(s):  
Single Port ◽  
Robotic System ◽  
Diep Flap ◽  
Extraperitoneal Approach ◽  
Totally Extraperitoneal

scholarly journals Preoperative Endovascular Embolisation of the Symptomatic Hemangioma in 7th Thoracic Vertebrae: Case Report

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Igor Sekulic ◽  
Aleksandar Jovanovski ◽  
Jelena Stevanovic ◽  
Jelena Boskovic-Sekulic ◽  
Dragan Dulovic ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Surgical Intervention ◽  
Intraoperative Complications ◽  
Mass Effect ◽  
The Body ◽  
Thoracic Vertebrae ◽  
Vertebral Hemangioma ◽  
Worldwide Population ◽  
Magnetic Resonance Imaging Mri ◽  
Control Angiography

Abstract Although, as asymptomatic, they appear in about 10- 12% of the worldwide population, vertebrae hemangiomas are symptomatic in about 0.9-1.2% of all the cases. We showed the case of the symptomatic hemangioma in the 7th thoracic vertebrae in 67 year old patient, that was successfully preoperative embolised. Magnetic resonance imaging (MRI) detected the tumor in the body of 7th vertebrae with mass effect on the anterior aspect of the spinal cord. Multidetector computed tomography (MDCT) imaging describes this tumor as hemangioma that is in the body of the 7th vertebrae and in the both pedicules. We performed selective and supraselective spinal angiography which showed pathological vascularisation of the tumor, and then the tumor was embolised. The control angiography detected the reduction of the tumor blood vessels, as a sign of the successful embolisation. Ten days after embolisation, the patient went through corporectomia of the Th7 and the stabilization of the thoracic spine was performed. Intraoperative blood transfusion in our patient was 930 mL, while expected blood transfusion during the surgical intervention without preoperative embolisation is about 1600 mL. Method of choice in conditions with neurological compressive symptoms caused by vertebral hemangioma is surgery for the decompression of the nerve structures. Embolisation of aggressive vertebral hemangioma is recommended and preoperatively performed for the intraoperative hemorrhage reduction and decreasing of intraoperative complications.

Endoscopic resection of intracranial dermoid cysts

2011 ◽  
Vol 125 (4) ◽  
pp. 423-427 ◽  
Author(s):  
D Schuster ◽  
K O Riley ◽  
J K Cure ◽  
B A Woodworth
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Case Reports ◽  
Complete Resection ◽  
Intracranial Tumour ◽  
Traditional Treatment ◽  
Tumour Removal ◽  
Skull Base Approach ◽  
Transnasal Endoscopic Approach ◽  
Skull Base Defect

AbstractIntroduction:Nasal dermoid cysts are congenital lesions which are often diagnosed in infancy or childhood. However, a small number present in adulthood, and some extend intracranially. Traditional treatment for the intracranial portion of these cysts includes frontal craniotomy.Case reports:Two intracranial dermoid cysts were resected via a transnasal endoscopic approach, using 70° nasal endoscopy for complete visualisation and intracranial tumour removal. We describe our technique for the procedure itself and for reconstruction of the skull base defect.Discussion and conclusion:The endoscopic transnasal skull base approach is an excellent alternative to a traditional frontal craniotomy, to achieve complete resection of intracranial dermoid cysts.

scholarly journals A case report of aponeurotic origin of rectus abdominis

2014 ◽  
Vol 03 (02) ◽  
pp. 84-86
Author(s):  
Challa Ratna Prabha ◽  
Namburu Bhanu Sudha Parimala
Keyword(s):  
Case Report ◽  
Abdominal Wall ◽  
Andhra Pradesh ◽  
Anterior Abdominal Wall ◽  
Pubic Symphysis ◽  
Rectus Abdominis ◽  
General Surgeon ◽  
Pubic Tubercle ◽  
Middle Aged ◽  
Medical College

AbstractRectus abdominis is a long strap like muscle that extends along the entire length of anterior abdominal wall. Normally the rectus abdominis arises by two tendons. The larger lateral tendon attached to the crest of the pubis, pubic tubercle up to pectineal line. The medial tendon is attached to the pubic symphysis. The fleshy fibers of rectus abdominis replaced by aponeurosis below the umbilicus was found during the routine dissections of a middle aged female cadaver at Dr. Pinnamaneni Siddhartha Medical College, Chinnavutapalli, Andhra Pradesh, India. The knowledge of partial or complete absence of rectus abdominis and other anterior abdominal wall musculature is of immense importance for the General surgeon, Anatomist and the Gastroenterologist.

scholarly journals Submucosal Injection Solution for Endoscopic Resection in Gastrointestinal Tract: A Traditional and Network Meta-Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Zhang Yu Huai ◽  
Wei Feng Xian ◽  
Luo Chang Jiang ◽  
Wang Xi Chen
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Resection ◽  
Meta Analysis ◽  
Complete Resection ◽  
Analysis Method ◽  
Injection Solution ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Injection ◽  
Complete Resection Rate

Objective. To explore and define the current optimal submucosal injection solution used in ESD and EMR for gastrointestinal tract neoplasms in terms of clinical outcomes and other aspects.Methods. PubMed, Cochrane Library, Embase, and clinical trials register center were searched with terms of “endoscopic resection” and “submucosal injection solution” to identify relevant randomized controlled trials (RCTs). Both direct comparison using traditional meta-analysis method and indirect comparison using network meta-analysis method were performed.Results. A total of 11 RCTs with 1152 patients were included. Meta-analysis showed that, compared with normal saline, other submucosal injection solutions induced a significant increase in terms ofen blocresection rate(I2=0%, OR = 2.11, 95% CI (1.36, 3.26), andP= 0.008)and complete resection rate(I2=0%, OR = 2.14, 95% CI (1.41, 3.24), andP= 0.0003); and there was no significant difference in the incidence of total complications(I2=0%, OR = 0.87, 95% CI (0.59, 1.29), andP= 0.49).Conclusions. Other newly developed submucosal injection solutions significantly increaseden blocresection rate and complete resection rate and decreased bleeding rate and finical cost of endoscopic resection in gastrointestinal tract, while current evidence did not find the difference between them, which need to be explored by further studies.

scholarly journals Predictive Factors for Local Recurrence and Incomplete Resection of Early Gastric Cancer Treated by Endoscopic Resection: A Western Experience

2009 ◽  
Vol 23 (5) ◽  
pp. 357-363 ◽  
Author(s):  
Fábio Yuji Hondo ◽  
Fauze Maluf-Filho ◽  
Humberto Setsuo Kishi ◽  
Ricardo Sato Uemura ◽  
Luciano Okawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Local Recurrence ◽  
Endoscopic Resection ◽  
Predictive Factors ◽  
Predictive Factor ◽  
Lesion Size ◽  
Complete Resection ◽  
Incomplete Resection ◽  
Resection Group

BACKGROUND: Early gastric cancer (EGC) is defined as adenocarcinoma limited to the mucosa or submucosa regardless of lymph node involvement. Local EGC recurrence rates have been described in up to 6% of cases.OBJECTIVES: To evaluate predictive factors for incomplete resection and local recurrence of EGC treated by endoscopic mucosal resection (EMR) that was followed up for at least one year.METHODS: From June 1994 to December 2005, 46 patients with EGC underwent EMR. Possible predictive factors for incomplete endoscopic resection and local recurrence were identified by medical chart analysis. Demographic, endoscopic and histopathological data were retrospectively evaluated. EMR was considered complete or incomplete. Patients from the complete resection group were divided into subgroups (with and without local EGC recurrence).RESULTS: Complete resection was possible in 36 cases (76.6%). Predictive factors for incomplete resection were tumour location (P=0.035), histological type (P=0.021), lesion size (P=0.022) and number of resected fragments (P=0.013). On multivariate analysis, undifferentiated histological type (OR 0.8; 95% CI 0.036 to 0.897) and number of resected fragments (OR 7.34; 95% CI 1.266 to 42.629) were independent predictive factors for incomplete resection. In the complete resection group, a larger lesion size was associated with a higher the number of resected fragments (P=0.018). Local recurrence occurred in nine cases (25%). Use of the cap technique was the only predictive factor for local recurrence in five of seven cases (71.4%) (P=0.006).CONCLUSIONS: A larger lesion size was associated with a higher number of resected fragments. Undifferentiated adenocarcinoma and piecemeal resection were predictive factors for incomplete resection. Technique type was a predictive factor for local EGC recurrence.

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