scholarly journals The Transplant Surgeon: An Unlikely, Yet Suitably Qualified, Member of The Complex Neuro Endocrine Multi-Disciplinary Team

2019 ◽  
pp. 1-3
Author(s):  
IM Shapey ◽  
S Ball ◽  
A Mastan ◽  
A Summers ◽  
Alexandra Griffiths ◽  
...  
Keyword(s):  
Left Kidney ◽  
Vena Cava ◽  
Resection Margins ◽  
Curative Surgery ◽  
En Bloc ◽  
Surgical Strategies ◽  
Recurrent Tumour ◽  
Vascular Structures ◽  
Preserve Function ◽  
Multi Disciplinary Team

Curative surgery for retro-peritoneal tumours involving vascular structures is challenging and multi-visceral resection is often required to obtain clear resection margins. Abdominal transplant surgeons have considerable experience in all aspects of visceral, vascular and retro-peritoneal surgery. Application of these skills to resect tumours involving vascular structures, and re-implant organs to preserve function is unique. We present the case of a 15- year old girl with a complex retro-peritoneal tumour which was resected en-bloc with the kidneys and vena-cava followed by auto-transplantation of the left kidney. Seven years later, the patient represented with a recurrent tumour which was successfully excised in its entirety. We discuss how innovative surgical strategies can be performed safely on an individualized basis. We highlight the importance of balancing the benefits of the ‘technically possible procedure’ with its risks, along with consideration of the outcomes of treatment and non-treatment alike.

Tumors at the Aortoiliac/Inferior Vena Cava Bifurcation: Preoperative, Anesthetic, and Intraoperative Considerations

2007 ◽  
Vol 73 (5) ◽  
pp. 440-446
Author(s):  
James R. Ouellette ◽  
David V. Cossman ◽  
Karen S. Sibert ◽  
Nicholas P. Mcandrew ◽  
Allan W. Silberman
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Preoperative Planning ◽  
Locally Advanced ◽  
Vena Cava ◽  
Surgical Oncology ◽  
En Bloc ◽  
Retroperitoneal Tumors ◽  
Vascular Structures

Primary and recurrent retroperitoneal tumors can involve the aortoiliac vasculature. They are often considered inoperable or incurable because of the locally advanced nature of the disease or the technical aspects involved in safely resecting the lesion. Safe resection of these lesions requires experience and extensive preoperative planning for success. A retrospective database review of 76 patients with retroperitoneal tumors identified tumors involving major vascular structures in the abdomen and pelvis undergoing resection of tumor en bloc with the aortoiliac vasculature. Preoperative planning and intraoperative technical maneuvers are reviewed. Patients were followed until time of this report. Four patients with retroperitoneal tumors involving the aortoiliac vessels underwent surgery: two patients with sarcoma (one primary and one recurrent), one with metastatic renal cell carcinoma, and one with a paraganglioma. All patients had resection of the aorta and vena cava or the iliac artery and vein. Arterial reconstruction (anatomic or extra-anatomic) was performed in all cases. The patient with renal cell carcinoma also required venous reconstruction to support a renal autotransplant. Veno-venous bypass was required in one patient. Local control was achieved in 3 of 4 cases. Surgery for retroperitoneal tumors involving major vascular structures is technically feasible with appropriate planning and technique. Multiple disciplines are required, including general surgical oncology, vascular surgery, and possibly, cardiothoracic surgery.

scholarly journals Endoscopic Submucosal Hydrodissection with Paradoxical Movement of the Colonoscope Using Hybrid Knife “Traction Mode” for Malignant Polyp in the Cecum

2021 ◽  
Vol 12 (01) ◽  
pp. 051-053
Author(s):  
Felipe Ramos-Zabala
Keyword(s):  
Case Report ◽  
Adverse Events ◽  
Resection Margins ◽  
Submucosal Layer ◽  
Colorectal Tumors ◽  
Malignant Polyp ◽  
En Bloc ◽  
Paradoxical Movement ◽  
Well Differentiated ◽  
Dissection Technique

AbstractThe water-jet hydro dissection technique has been shown to be effective for colorectal tumors. This case report illustrates type T hybrid knife for the elevation of the submucosal layer, cutting the mucosa and dissecting submucosal fibers. ESD was performed using ERBEJET 2 hydrodissection system and hybrid Knife. The resection was completed en bloc within 135 minutes without adverse events. Pathology examination revealed a well-differentiated adenocarcinoma confined to the shallow submucosal layer with free resection margins.

Inflammatory myofibroblastic tumour causing intestinal obstruction in a patient with neurofibromatosis type 1

2021 ◽  
Vol 103 (2) ◽  
pp. e53-e55
Author(s):  
XE Chuang ◽  
DYS Chan ◽  
ML Oon ◽  
S Wang ◽  
CLK Chia
Keyword(s):  
Intestinal Obstruction ◽  
Neurofibromatosis Type 1 ◽  
Bowel Resection ◽  
Neurofibromatosis Type ◽  
Resection Margins ◽  
Soft Tissue Tumours ◽  
En Bloc ◽  
Biological Behaviour ◽  
Rare Tumours

Inflammatory myofibroblastic tumours (IMTs) are rare tumours with unpredictable biological behaviour ranging from benign to locally invasive and rarely, distant metastasis. While neurofibromatosis type 1 (NF1) may manifest with gastrointestinal soft tissue tumours, this is the first report in the literature that describes an IMT occurring in a NF1 patient who presented with intestinal obstruction. Our patient presented with intestinal obstruction secondary to an obstructing terminal ileum mesenteric tumour. En bloc bowel resection was performed, with histology revealing an IMT and an adjacent neurofibroma. The resection margins were clear and the patient was free of recurrence at six months.

scholarly journals Early hemodynamics and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation

2009 ◽  
Vol 24 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Ruy J. Cruz Junior ◽  
Alejandra G. Garrido ◽  
Maurício Rocha e Silva
Keyword(s):  
Vena Cava ◽  
En Bloc Resection ◽  
Experimental Models ◽  
Metabolic Changes ◽  
Therapeutic Modality ◽  
En Bloc ◽  
Systemic Hemodynamic ◽  
Circulating Blood Volume ◽  
Multivisceral Transplantation ◽  
The Impact

PURPOSE: Multivisceral transplantation (MVTx) has been accepted as standard therapeutic modality for patients with short-bowel syndrome associated with irreversible liver failure. Even nowadays, experimental models of MVTx grounds high incidence of intraoperative or early recipient mortality. Despite the known deleterious effects of hepatosplanchnic exenteration the impact of this procedure on systemic hemodynamics and metabolism remains to be determined. METHODS: Nine dogs (20.1±0.5 kg) were subjected to an en bloc resection of all abdominal organs including, stomach, duodenum, pancreas, liver, spleen, small bowel, and colon. A woven double velour vascular graft was interposed between the suprahepatic and infrahepatic vena cava. Systemic hemodynamic were evaluated through a Swan-Ganz catheter, ultrasonic flowprobes, and arterial lines. Systemic O2-derived variables, glucose, and lactate metabolism were analyzed throughout the experiment. RESULTS: Complete abdominal exenteration was associated with significant reduction in cardiac output, and mean arterial pressure (57% and 14%, respectively). Two hours after reperfusion a significant reduction in arterial pH and glucose were also observed. Oxygen consumption remained unaltered during the first two hours of the experiment, with a significant increase of lactate levels (1.4±0.3 vs. 7.6±0.4, p<0.05). Three animals died before the 3 hours of reperfusion were completed. Total abdominal exenteration for MVTx in dogs is associated with early major hemodynamics, and metabolic changes. CONCLUSION: The deleterious hemodynamic alterations observed are probably related with the association of severe acidosis, hyperlactemia, hypoglycemia, and reduction of total circulating blood volume. Close hemodynamic and metabolic monitoring should be provided during experimental MVTx in order to promote an increase in successful rates of this complex and challenging procedure.

scholarly journals A Giant retroperitoneal liposarcoma encasing entirely the right kidney: A case report and a review of nephrectomy indications

2021 ◽  
Author(s):  
Houssem Harbi ◽  
Amira Akrout ◽  
Mohamed Fourati ◽  
Amine Zouari ◽  
Nozha Toumi
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Margins ◽  
En Bloc ◽  
Retroperitoneal Liposarcoma ◽  
R1 Resection ◽  
The Right

A 68-year-old female was operated for a giant dedifferentiated retroperitoneal liposarcoma (RLS) encasing entirely the right kidney. She had an en-bloc resection of the tumor with right nephrectomy. The en-bloc resection should avoid R1 resection margins. Renal conservation is suggested if the kidney is widely displaced and for elderly patient.

scholarly journals Rare case of a kidney and inferior vena cava abnormalities with extensive lower extremity deep vein thrombosis in a young healthy male

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Muhammad Khalid ◽  
Manisha Nukavarapu ◽  
Rupal Shah ◽  
Timir K. Paul
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Lower Extremity ◽  
Rare Case ◽  
Inferior Vena ◽  
Left Kidney ◽  
Vena Cava ◽  
Healthy Male ◽  
Vein Thrombosis ◽  
Deep Vein

Kidney and inferior vena cava (IVC) abnormalities with extensive deep vein thrombosis (DVT) is a very rare cause of DVT and has a diverse clinical presentation. Computed tomography (CT) angiography is the gold standard for diagnosis and treatment including thrombectomy, thrombolysis and systemic anticoagulation. We present a rare case of active young healthy male admitted with acute onset of right lower extremity pain and swelling who was found to have extensive DVT on doppler ultrasound. CT abdomen showed extensive clot burden involving right common femoral vein extending into internal and external iliac veins associated with IVC hypoplasia and hypoplastic left kidney. Patient underwent urgent thrombectomy, catheter directed thrombolysis and was discharged home in stable condition on oral anticoagulation.

Liver and Vena Cava En Bloc Resection for an Invasive Leiomyosarcoma Causing Budd–Chiari Syndrome, Under Veno-Venous Bypass and Liver Hypothermic Perfusion

2016 ◽  
Vol 24 (2) ◽  
pp. 556-557 ◽  
Author(s):  
Matteo Ravaioli ◽  
Matteo Serenari ◽  
Matteo Cescon ◽  
Carlo Savini ◽  
Alessandro Cucchetti ◽  
...  
Keyword(s):  
Vena Cava ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Budd Chiari Syndrome ◽  
En Bloc ◽  
Venous Bypass ◽  
Hypothermic Perfusion ◽  
Chiari Syndrome

49-Month Survival Following Caval Venectomy Without Nephrectomy in a Dog with a Pheochromocytoma

2012 ◽  
Vol 48 (5) ◽  
pp. 352-358 ◽  
Author(s):  
Pierre J. Guillaumot ◽  
Dominique Heripret ◽  
Bernard M. Bouvy ◽  
Gilbert Christiaens ◽  
Agnes Poujade ◽  
...  
Keyword(s):  
Hind Limb ◽  
Vena Cava ◽  
En Bloc ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clinical Disorders ◽  
Limb Edema ◽  
Thrombus Removal ◽  
The Right

An 11 yr old spayed female Labrador retriever was diagnosed with a right adrenal tumor. At surgery, adhesions to the right kidney were dissected, allowing the right kidney to be preserved. The tumor showed extensive invasion into the suprarenal vena cava. It was felt that thrombus removal via venotomy could not be performed. Instead, the vena cava was ligated caudal to the liver and cranial to the right renal vein. The neoplastic gland was then excised en bloc together with the portion of the invaded caudal vena cava. Hind limb edema had developed preoperatively and increased transiently in the first days postoperatively. The animal was discharged 6 days postoperatively with no other clinical disorders, and hind limb edema resolved over time. Histopathology identified a pheochromocytoma. The dog died 49 mo later. A neoplastic thrombus of the vena cava may require venotomy to allow thrombus removal. Occasionally, removal of the thrombus by venotomy may prove impossible. In such a situation, en bloc removal of the concerned portion of the vena cava may be performed with a good long-term outcome provided that gradual occlusion of the vena cava by the thrombus has allowed time for collateral circulation to develop.

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