scholarly journals Laparoscopic splenectomy: case series of 24 patients

2016 ◽  
Vol 18 (3) ◽  
pp. 49
Author(s):  
Vikal Chandra Shakya ◽  
Bishesh Paudyal
Keyword(s):  
Hemolytic Anemia ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Hereditary Spherocytosis ◽  
Splenic Vein ◽  
Case Series ◽  
Excessive Bleeding ◽  
Hematological Diseases ◽  
The Mean ◽  
Surgery Department

Introduction and Objective: Splenectomy has mostly been performed by open surgery. Laparoscopy seems to be a meaningful alternative to open technique.Materials and Methods: This study was done in patients presenting to hematology and surgery department of Civil Service Hospital who underwent laparoscopic splenectomy from January 2013 to November 2015Results: There were 24 patients (16 females, 8 males). The diagnoses were idiopathic thrombocytopenic purpura in 19, hereditary spherocytosis in 2, @hemolytic anemia in 2, b-hemolytic anemia in 1. The mean operative time was 130+49 minutes. The mean postoperative stay was 5+2.11 days. Laparoscopic splenectomy could be completed in 21 patients. Rest 3 needed conversion to open (causes being excessive bleeding form splenic vein, splenic tear, and excessively low platelet counts). Three patients needed additional pfanneinsteil/lumbar incision to retrieve the spleen.Conclusion: Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, more so if spleen is of normal or mildly enlarged; and could be an advantageous alternative to open splenectomy.

scholarly journals Challenges and Results of Laparoscopic Splenectomy for Hematological Diseases in a Developing Country

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Vikal Chandra Shakya ◽  
Bikram Byanjankar ◽  
Rabin Pandit ◽  
Anang Pangeni ◽  
Anir Ram Moh Shrestha ◽  
...  
Keyword(s):  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Hereditary Spherocytosis ◽  
Developed Countries ◽  
Beta Thalassemia ◽  
Hematological Diseases ◽  
Alpha Thalassemia ◽  
Steroid Dependent ◽  
The Mean ◽  
Surgery Department

Introduction. Though, in developed countries, laparoscopy is now a gold standard for splenectomy, we are lacking in this aspect in the eastern world. Splenectomy has mostly been performed by open surgery in our region. This is our effort to introduce laparoscopic splenectomy in our country.Methods. This is a retrospective cohort study done in patients presenting to hematology and surgery department of our hospital who underwent laparoscopic splenectomy for hematological diseases from January 2013 to December 2016.Results. There were 50 patients (38 females, 12 males). The diagnoses were idiopathic thrombocytopenic purpura in 31, (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 9, alpha-thalassemia in 3, beta-thalassemia in 2, autoimmune hemolytic anemia in 4, and isolated splenic tuberculosis in 1. Average platelet counts preoperatively were62000±11000/mm3 (range 52000-325000/mm3). The mean operative time was130±49minutes (range 108-224 min). The mean postoperative stay was4±2.11days (range 3-9 days). Laparoscopic splenectomy could be completed in 45 (90%) patients.Conclusion. Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, especially if spleen is normal or only mildly enlarged, and is an advantageous alternative to open splenectomy. Absence of ideal resources has not limited our progress in minimal access approach.

scholarly journals Radical prostatectomy outcomes in renal transplant recipients: a retrospective case series of Thai patients

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kun Sirisopana ◽  
Pocharapong Jenjitranant ◽  
Premsant Sangkum ◽  
Kittinut Kijvikai ◽  
Suthep Pacharatakul ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Renal Transplant ◽  
Operative Time ◽  
Case Series ◽  
Urinary Continence ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Estimated Blood Loss ◽  
The Mean

Abstract Background The incidence of prostate cancer in renal transplant recipients (RTR) is similar to the general population. Radical prostatectomy (RP) is the standard of care in the management of clinically localized cancer, but is considered complicated due to the presence of adhesions, and the location of transplanted ureter/kidney. To date, a few case series or studies on RP in RTR have been published, especially in Asian patients. This study aimed to evaluate the efficacy and safety and report the experience with RP on RTR. Methods We retrospectively reviewed data of 1270 patients who underwent RP from January 2008 to March 2020, of which 5 patients were RTR. All available baseline characteristics, perioperative and postoperative data (operative time, estimated blood loss (EBL), complications, length of hospital stay, complication), pathological stage, Gleason score, surgical margin status, and pre/postoperative creatinine were reviewed. Results Of the 5 RTR who underwent RPs (1 open radical prostatectomy (ORP), 1 laparoscopic radical prostatectomy (LRP), 2 robotic-assisted laparoscopic radical prostatectomies (RALRP), and 1 Retzius-sparing RALRP (RS-RALRP)) prostatectomy, the mean age (± SD) was 70 (± 5.62) years. In LRP and RALRP cases, the standard ports were moved slightly medially to prevent graft injury. The mean operative time ranged from 190 to 365 min. The longest operative time and highest EBL (630 ml) was the ORP case due to severe adhesion in Retzius space. For LRP and RALRP cases, the operative times seemed comparable and had EBL of ≤ 300 ml. All RPs were successful without any major intra-operative complication. There was no significant change in graft function. The restorations of urinary continence were within 1 month in RS-RALRP, approximately 6 months in RALRP, and about 1 year in ORP and LRP. Three patients with positive surgical margins had prostate-specific antigen (PSA) persistence at the first follow-up and 1 had later PSA recurrence. Two patients with negative margins were free from biochemical recurrence at 47 and 3 months after their RP. Conclusions Our series suggested that all RP techniques are safe and feasible mode of treatment for localized prostate cancer in RTR.

scholarly journals Laparoscopic splenectomy: how minimal can we make it?

2022 ◽  
Author(s):  
Adetokunbo Fadipe ◽  
David Wilkinson ◽  
Robert Peters ◽  
Catherine Doherty ◽  
Nick Lansdale
Keyword(s):  
Length Of Stay ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Hereditary Spherocytosis ◽  
Surgical Trauma ◽  
Cell Disease ◽  
Median Length ◽  
Post Operative Pain ◽  
Age At Surgery ◽  
Splenic Size

Abstract Aims Laparoscopic splenectomy (LS) is routinely performed in children, however, a large spleen in a small child can pose significant operative challenges. We instigated a highly standardised surgical and anaesthetic approach to LS to minimise surgical trauma and enhance recovery. The aim of this study was to assess the outcomes of this programme. Methods Prospective study of all LS’s performed 2018–2021. Surgical approach was via one 10 mm and three 5 mm ports. Early hilar control was accomplished with Hem-o-loks. Splenic retrieval via the 10 mm incision used finger morcellation within an Espiner EcoSac. Anaesthesia utilised a standardised regime of agents and bupivacaine was infiltrated to the splenic bed and wound sites. Post-operative opiates were minimised. Data are presented as median [IQR]. Results Twenty consecutive children were included. Indications for LS were hereditary spherocytosis (n = 12), sickle cell disease (n = 6), beta-thalassaemia (n = 1) and splenic haemangiomatosis (n = 1). Age at surgery was 101 months [75–117] and weight 30 kg [21–37]. Splenic size was 13.4 cm [12–14.4]. Operative time was 178 min [156–185]. There were no open conversions and no significant intra or post-operative bleeding. One patient developed pancreatitis. Median post-operative pain score was 1 [1–3]. Median length of stay was 2 days [2–3]. Conclusion LS is feasible, safe and efficient in smaller children with large spleens. This standardised programme of anaesthesia and surgery based around a core team reliably results in few complications, good analgesia and short length of stay.

scholarly journals The Revolving Door Flap: Revisiting an Elegant but Forgotten Flap for Ear Defect Reconstruction

2020 ◽  
Vol 53 (01) ◽  
pp. 064-070
Author(s):  
Anupam Golash ◽  
Sudipta Bera ◽  
Aditya V. Kanoi ◽  
Abhijit Golash
Keyword(s):  
Learning Curve ◽  
Operative Time ◽  
Donor Site ◽  
Case Series ◽  
Senior Author ◽  
Revolving Door ◽  
Harvest Technique ◽  
Flap Design ◽  
Mean Dimension ◽  
The Mean

Abstract Background The revolving door flap, although well described in the literature, is not widely used in general plastic surgery practice. The flap has been used for anterior auricular and conchal defects and is considered elegant for its unique flap design and peculiarity of flap harvest. However, due to its use for a very specific purpose and unique flap harvest technique that may be difficult to grasp, the flap is not very popular in reconstructive practice. Objectives This study aims to evaluate the understanding and learning curve of the revolving door flap, assess surgical outcome, and reemphasize its utility and elegance in reconstruction of ear defects. Methodology This is a case series of nine surgeries performed between January 2014 and 2018. Three cases were performed by the senior author and six cases by two junior authors. Patients were observed for complications and aesthetic outcomes. Results The mean dimension of the flaps was 27.22 mm × 22.78 mm. The mean operative time was 56.56 minutes (standard deviation 22.50, standard error of the mean 7.5). Flap congestion was noted in three cases postoperatively which resolved completely by the second week. Major “pinning” of the ear was noted in four cases. Conclusion Though infrequently performed, the revolving door flap has an easy learning curve once the proper harvest technique and flap movement has been grasped. The flap harvest is convenient, safe, and yields predictable results. Not only is total or partial flap loss extremely rare, the flap is sensate, color match is good, auricular contour is maintained, and the donor site can be closed primarily and remains well hidden.

scholarly journals Outcomes and component-positioning in total knee arthroplasty may be comparable between supervised trained surgeons and their supervisor

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Kazumi Goto ◽  
Yozo Katsuragawa ◽  
Yoshinari Miyamoto
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Operative Time ◽  
Case Series ◽  
Level Of Evidence ◽  
Ankle Angle ◽  
Total Knee ◽  
The Mean ◽  
Hip Knee Ankle Angle

Abstract Purpose There are concerns that malalignment in total knee arthroplasty (TKA) occurs with less experienced surgeons. This study investigates the influence of surgical experience on TKA outcomes. Materials and methods Nineteen patients (38 knees) who underwent bilateral TKA between 2011 and 2015 were included. A supervisor performed knee replacements associated with lower Knee Society Scores (KSS); trainee surgeons operated on the other knee. Knees were categorized into two groups: operations by the supervisor (group S) versus operations by trainee surgeons (group T). Range of motion (ROM), KSS, operative time, hip–knee–ankle angle, and femoral and tibial component angle were evaluated. Results The mean operative time was 92.5 min in group S and 124.2 min in group T (p < 0.01). The mean postoperative maximal flexion was 113.2° in group S and 114.2° in group T (not significant). The mean postoperative KSS was 92.9 in group S and 93.9 in group T (not significant). No significant differences between groups in terms of proportion of inliers for the hip–knee–ankle angle, femoral component angle, or tibial component angle were observed. Conclusions Although operative time was significantly longer for trainee surgeons versus the supervisor, no significant differences in ROM, KSS, or component positioning between supervisor and trainee surgeons were observed. Level of evidence IV (retrospective case series design).

Rhabdomyolysis and acute renal failure following minimally invasive spine surgery

2011 ◽  
Vol 14 (6) ◽  
pp. 785-788 ◽  
Author(s):  
Elias Dakwar ◽  
Stephen I. Rifkin ◽  
Ildemaro J. Volcan ◽  
J. Allan Goodrich ◽  
Juan S. Uribe
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Spine Surgery ◽  
Operative Time ◽  
Case Series ◽  
Potential Complication ◽  
Minimally Invasive Spine ◽  
The Mean

Minimally invasive spine surgery is increasingly used to treat various spinal pathologies with the goal of minimizing destruction of the surrounding tissues. Rhabdomyolysis (RM) is a rare but known complication of spine surgery, and acute renal failure (ARF) is in turn a potential complication of severe RM. The authors report the first known case series of RM and ARF following minimally invasive lateral spine surgery. The authors retrospectively reviewed data in all consecutive patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion with the subsequent development of RM and ARF at 2 institutions between 2006 and 2009. Demographic variables, patient home medications, preoperative laboratory values, and anesthetic used during the procedure were reviewed. All patient data were recorded including the operative procedure, patient positioning, postoperative hospital course, operative time, blood loss, creatine phosphokinase (CPK), creatinine, duration of hospital stay, and complications. Five of 315 consecutive patients were identified with RM and ARF after undergoing minimally invasive lateral transpsoas spine surgery. There were 4 men and 1 woman with a mean age of 66 years (range 60–71 years). The mean body mass index was 31 kg/m2 and ranged from 25 to 40 kg/m2. Nineteen interbody levels had been fused, with a range of 3–6 levels per patient. The mean operative time was 420 minutes and ranged from 315 to 600 minutes. The CPK ranged from 5000 to 56,000 U/L, with a mean of 25,861 U/L. Two of the 5 patients required temporary hemodialysis, while 3 required only aggressive fluid resuscitation. The mean duration of the hospital stay was 12 days, with a range of 3–25 days Rhabdomyolysis is a rare but known potential complication of spine surgery. The authors describe the first case series associated with the minimally invasive lateral approach. Surgeons must be aware of the possibility of postoperative RM and ARF, particularly in morbidly obese patients and in procedures associated with prolonged operative times.

scholarly journals Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Cetin Ali Karadag ◽  
Basak Erginel ◽  
Ozgur Kuzdan ◽  
Nihat Sever ◽  
Melih Akın ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Time Rate ◽  
Open Procedure ◽  
Group I ◽  
Longitudinal Length ◽  
The Mean ◽  
Group Ii

Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens.Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). The patients are divided into two groups according to spleen’s longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay.Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P>0.05).Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens.

scholarly journals Laparoscopic management of Hydatid cyst

2016 ◽  
Vol 18 (3) ◽  
pp. 42
Author(s):  
Anang Pangeni ◽  
Vikal Chandra Shakya
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Hydatid Cyst ◽  
Operative Time ◽  
Energy Sources ◽  
Hydatid Cysts ◽  
Laparoscopic Management ◽  
The Mean ◽  
A Prospective Study ◽  
Surgery Department

Introduction and Objective: Hydatid cyst of the liver is a fairly common parasitic condition. We present here a series of 9 patients with hydatid cyst of the liver managed by minimally invasive surgeryMaterials and Methods: It was a prospective study in patients presenting with hydatid cyst of the liver to Surgery Department who were managed laparoscopically from January 2013 to November 2015.Result: There were 9 patients (5 males and 4 females). The mean operative time was 124+32 minutes. One patient developed mild allergy in the form of skin rashes on 3rd postoperative day, and another patient developed cholangitis which resolved on conservative management. There was no conversion.Conclusion: Laparoscopic management of hydatid cysts is possible, and looks promising provided we have advanced energy sources.

scholarly journals Total clipless cholecystectomy by means of harmonic sealing

2015 ◽  
Vol 28 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Almino Cardoso RAMOS ◽  
Manoela Galvão RAMOS ◽  
Manoel dos Passos GALVÃO-NETO ◽  
Josemberg MARINS ◽  
Eduardo Lemos de Souza BASTOS ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Operative Time ◽  
Case Series ◽  
Cystic Artery ◽  
Morbidity Rate ◽  
Pressure Test ◽  
The Mean ◽  
Prospective Case Series ◽  
Laparoscopic Cholecistectomy

BACKGROUND: In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement. AIM: To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver. METHODS: Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation. RESULTS: The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking. CONCLUSION: The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.

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