scholarly journals Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

2021 ◽  
Vol 10 (9) ◽  
pp. 1812
Author(s):  
Iulia Andras ◽  
Angelo Territo ◽  
Teodora Telecan ◽  
Paul Medan ◽  
Ion Perciuleac ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Operative Time ◽  
Vena Cava ◽  
Laparoscopic Approach ◽  
Hepatic Veins ◽  
Combined Approach ◽  
Urological Procedures ◽  
The Mean ◽  
Complications Rate

(1) Introduction: The advent of robotic surgery led to the assumption that laparoscopic surgery would be replaced entirely. However, the high costs of robotic surgery limit its availability. The aim of the current study was to assess the feasibility of the 3D laparoscopic approach for the most complex urological procedures. (2) Materials and methods: We included in the current study all patients who had undergone complex 3D laparoscopic procedures in our department since January 2017, including radical nephrectomy (LRN) using a dual combined approach (19 patients), radical nephroureterectomy (LRNU) with bladder cuff excision (13 patients), and radical cystectomy (LRC) with intracorporeal urinary diversion (ICUD) (21 patients). (3) Results: The mean operative time was 345/230/478 min, the complications rate was 26%/30.76%/23.8% and positive surgical margins were encountered in 3/1/1 patients for the combined approach of LRN/LRNU/LRC with ICUD, respectively. A single patient was converted to open surgery during LRN due to extension of the vena cava thrombus above the hepatic veins. After LRC, sepsis was the most common complication and 8 patients were readmitted at a mean of 15.5 days after discharge. (4) Conclusions: In the era of robotic surgery, laparoscopy remains a plausible alternative for most complex oncological cases.

scholarly journals LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Maurizio Gentile ◽  
Michele De Rosa ◽  
Gabriele Carbone ◽  
Vincenzo Pilone ◽  
Francesca Mosella ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Operative Time ◽  
Randomized Study ◽  
Late Complications ◽  
The Third ◽  
Effective Instrument ◽  
The Mean ◽  
Complications Rate

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12–24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation.

scholarly journals 1019 Quantified Learning Curves for Robotic Gastrointestinal Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Huttman ◽  
M Kiandee ◽  
R Lawrence ◽  
L Paynter ◽  
S Lawday ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Robotic Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Gastrointestinal Surgery ◽  
Learning Curves ◽  
Descriptive Statistics ◽  
Setup Times ◽  
Control Procedure ◽  
The Mean

Abstract Aim Robotic techniques are increasingly being adopted by gastrointestinal surgeons. It is important to understand the learning curves (LCs) for robotic surgery, to protect patients from harm caused by surgeon inexperience. The aim of this study was to summarise reports of the LC for three robotic gastrointestinal procedures: cholecystectomy, oesophagectomy and Roux-en-Y gastric bypass (RYGB). Method Three systematic reviews were conducted by the trainee led RoboSurg Collaborative. Systematic searches identified reports of primary clinical research involving robotic cholecystectomy, oesophagectomy and RYGB. Articles were screened in duplicate by title, abstract and then full text. References to the LC were extracted and coded. Quantifications of the learning curve were summarised using descriptive statistics. Results 259 articles were identified: 56 measured the LC, with 23 (9%) of these calculating the number of cases required to complete the LC. The mean reported number of cases at which the LC plateaued was: 16 for oesophagectomy (N = 6, SD = 3.7), 18 for cholecystectomy (N = 5, SD = 15.1), 34 for RYGB (N = 12, SD = 24.6). The reported LCs often incorporated equipment setup times, and so represents learning of the team as well as the surgeon. These values represent points on the LC that authors deemed their surgeons to have ‘completed’ learning. Definitions for when these points occurred varied greatly but largely fell in to two categories: ‘plateau of operative time’ or ‘matching operating time of laparoscopic control procedure’. Conclusions The heterogeneity in how LCs are defined, measured, and reported highlights the need for a more standardised approach when evaluating novel techniques such as robotics.

scholarly journals The role of laparoscopic approach in bilaterality assessment in patients with unilateral inguinal hernia

2017 ◽  
Vol 4 (6) ◽  
pp. 2047
Author(s):  
Ahmed M. S. M. Marzouk ◽  
Haitham S. E. Omar ◽  
Heba O. E. Ali
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Unilateral Inguinal Hernia ◽  
Frequent Finding ◽  
Ultrasound Assessment ◽  
Group 3 ◽  
The Right ◽  
Unilateral Group

Background: Patients presented with unilateral inguinal hernia are at risk for the possibility of contra-lateral occult hernias; small early-developed hernias may be difficult to be elicited by clinical, imaging assessment and during open repair. This study to evaluate laparoscopic identification of contra-lateral occult hernia with regard to the pre-operative clinical and imaging study.Methods: Retrospective analysis of patients presented in the period of March to December 2015 with unilateral inguinal hernia for which medical and ultrasound imaging assessment were done. Laparoscopic trans abdominal pre-peritoneal (TAPP) approach was done with intraoperative evaluation of the presence of contra-lateral occult hernias.Results: During the study period (27) patients (25 Males and 2 females) presented with unilateral inguinal hernia were clinically evaluated, 18 (66.6%) patients had right sided hernia, 9 (33.33%) had left sided, In all the studied patients routine ultrasound assessment was done and no documented cases of presence of contra-lateral hernia, Intraoperative abdominal exploration successfully Identifies bilateral inguinal hernias in 7 cases (25.9%) with mean age (44.14 years, SD 10.99) compared to (34.97 years, SD 10.51) in the Unilateral group, 3 cases on the left side (16.6% of total right side patients) and 4 cases on the right side (44.4% of total left side patients). operative time for unilateral repair was (Mean 85.8 minutes, SD 18.8), and for discovered bilateral cases (Mean 145.9 minutes, SD 46.8).Conclusions: The presence of occult inguinal hernia is a frequent finding specially in older age group of patients, also in our study we found the percentage of occult hernias are more in patients presented with left side disease. Laparoscopic (TAPP) approach is a useful tool for assessment of the presence of such hernias, and gives the privilege of simultaneous repair in same operation with the advantage of avoiding the patient’s later surgery together with the laparoscopic surgery benefits of less pain, rapid recovery and shorter hospital stay.

scholarly journals Remnant gall bladder and cystic duct stump stone after cholecystectomy: tertiary multicenter experience

2018 ◽  
Vol 5 (11) ◽  
pp. 3478 ◽  
Author(s):  
Samir A. A. Mageed ◽  
Mohammed A. Omar ◽  
Alaa A. Redwan
Keyword(s):  
Retrospective Study ◽  
Cystic Duct ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Biliary Injury ◽  
Endoscopic Retrograde ◽  
Biliary Pain ◽  
The Mean ◽  
Experienced Team

Background: There is no doubt that cholecystectomy relieves pre-surgical symptoms of gallbladder (GB) disease. The persistence of symptoms mainly biliary pain was recorded in 10 - 20% of cases, with variety of causes. Residual GB/cystic duct stump stone is one of the most important un-expected cause. The present study was conducted to study and evaluate those patients, with their surgical treatment.Methods: This retrospective study was conducted on 27 cases with residual GB/cystic duct stump stone. The diagnosis was guided by ultrasound and magnetic resonance cholangio-pancreatography. All cases were managed by using completion cholecystectomy - either open or laparoscopic. All preoperative, operative, and postoperative data were collected.Results: Preoperative endoscopic retrograde cholangio-pancreatography and papillotomy were required in 13 patients whom were presented with obstructive jaundice. Open completion cholecystectomy techniques were done in the majority of cases (21 patients) while laparoscopic approach was feasible in only 6 cases with one conversion (1/6). The mean operative time was (89.57 ± 12.05 and 118.16 ± 12.6 min), and the mean blood loss was (195.5 ± 19.22 and 187.5 ± 23.61 ml) respectively. Intra-operative minor biliary injury occurred in two cases and repaired instantaneously. The mean hospital stay was (4.76 ± 2.81 and 2.33 ± 1.32 days) respectively. All patients were reported to be symptom-free at the follow-up after surgical treatment.Conclusions: Residual GB/cystic duct stump stone is a preventable and correctable cause of post-cholecystectomy complaint. Completion cholecystectomy is a proven treatment of choice to relieve symptoms and avoid complications; furthermore, it can be carried out laparoscopically with experienced team and facilities in spite of difficulties.

scholarly journals Batwing mammoplasty: a safe oncoplastic technique for breast conservation in breast cancer patients with gigantomastia

2020 ◽  
Vol 102 (2) ◽  
pp. 115-119
Author(s):  
TM Manie ◽  
MMG Youssef ◽  
SN Taha ◽  
A Rabea ◽  
AM Farahat
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Operative Time ◽  
Breast Conservation ◽  
Breast Cancer Patients ◽  
Short Operative Time ◽  
Areola Complex ◽  
Major Breast ◽  
The Mean ◽  
Complications Rate

Background Surgical management of breast cancer with gigantomastia can be challenging when planning breast conservation, as major breast reduction is required. Complex oncoplastic procedures can carry an additional surgical risk in this situation. We suggest batwing mammoplasty as a simple and safe oncoplastic procedure for those patients. Materials and methods Fourteen patients with gigantomastia diagnosed with breast cancer were included in this prospective cohort study. All underwent batwing mammoplasty and contralateral symmetrisation procedure between May 2016 and June 2018. Patient satisfaction assessed by the Breast-Q questionnaire. Results All patients had a body mass index above 30kg/m2 with a mean of 36.7kg/m2 (range 31.6–44.9kg/m2). The mean distance from midclavicular point to nipple was 42cm (range 38–50cm). The mean operative time was 83 minutes for procedures done by a single surgeon. Mean specimen weight was 1.2kg (ranging from 1.035–1.63kg). Postoperative complications occurred in 14.2% of patients. Nipple–areola complex viability was not compromised nor sensation impaired. The mean Breast-Q score for patient satisfaction with breasts was 68.6 (range 61–74). The mean score for physiological wellbeing was 77.3 (range 64–84) and the mean score for physical wellbeing was 35 (range 31–40). Conclusion Batwing mammoplasty is a safe and simple oncoplastic procedure in patients who have breast cancer with gigantomastia. It has short operative time and low complications rate. In our cohort of patients, there was no delay in the delivery of adjuvant treatment. The cosmetic outcome was favourable with a high patient satisfaction.

Exercise-induced fall in insulin and hepatic carbohydrate metabolism during muscular work

1989 ◽  
Vol 256 (4) ◽  
pp. E500-E509 ◽  
Author(s):  
D. H. Wasserman ◽  
P. E. Williams ◽  
D. B. Lacy ◽  
R. E. Goldstein ◽  
A. D. Cherrington
Keyword(s):  
Treadmill Exercise ◽  
Vena Cava ◽  
Glucose Production ◽  
Suppressive Effect ◽  
Hepatic Veins ◽  
Gluconeogenesis From Alanine ◽  
Exercise Induced ◽  
Arteriovenous Difference ◽  
Intraportal Infusion

To examine the role of the exercise-induced fall in insulin, dogs were studied during 150 min of treadmill exercise alone (C) or with insulin clamped at basal levels by an intraportal infusion so as to prevent the normal fall in its concentration (IC). To counteract the suppressive effect of insulin on glucagon release, glucagon was replaced intraportally in a separate group of dogs in which insulin levels were clamped (IC + G). In all dogs, catheters were placed in an artery and in the portal and hepatic veins for sampling and in the vena cava and the portal vein for infusion purposes. Glucose production (Ra) and gluconeogenesis were assessed with isotope and arteriovenous difference techniques. In C, insulin fell 5 +/- 2 microU/ml by the end of exercise and was unchanged in IC (delta 0 +/- 2 microU/ml) and IC + G (delta 0 +/- 1 microU/ml). Glucagon rose 54 +/- 11 pg/ml with exercise in C and was unchanged in IC (delta - 4 +/- 11 pg/ml), and normal increments were restored in IC + G (delta 55 +/- 10 pg/ml). Catecholamines and cortisol rose similarly in all groups. Ra increased by an average of 4.0 +/- 0.4, 0.9 +/- 0.3, and 1.8 +/- 0.4 mg.kg-1.min-1 during exercise in C, IC, and IC + G, respectively. Gluconeogenesis from alanine rose by 212 +/- 34, 91 +/- 39, and 184 +/- 47% with exercise in C, IC, and IC + G.(ABSTRACT TRUNCATED AT 250 WORDS)

Ứng dụng dao siêu âm Sonastar trong phẫu thuật cắt gan

2020 ◽  
Author(s):  
Hien Pham Nhu
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Operative Time ◽  
Resection Margin ◽  
Operation Time ◽  
Bile Leakage ◽  
Hepatic Veins ◽  
Early Results ◽  
Solitary Liver ◽  
The Mean

Background: Researching specification and evaluating early results after hepatectomy that it’s used with Sonastar ultrasonic tool. Materials and methods: We prospectively examined data of 19 patients who underwent hepatectomy at Hue Central Hospitalfrom 7/2019to 7/2020. Results: The mean ages was 60,7 ± 10,5 range (19 – 90) and males/females was 6:1.. Patients with solitary liver tumor accounted for 79%; while tumors that have satellite cores accounted for 21% of all cases. 68,4% of all patients have tumor that is more than 5cm in size. Blocking hepatic blood flow by clamping of hepatoduodenal ligament accounts for 57,9%, while right and left hepatic vein clamp accounted for 68,4% and 36,8% respectively. In 78,9% of the cases, surgicel was used to cover the liver resection margin, while the in the remainder 21,5% of the cases, BioGlue was used. Large liver resection (2 and more lobes resected) accounted for 73,7% of all cases. Mean liver resection time was 50 ( 45-110) minutes, mean operation time was 125 (90-280) minutes, mean blood loss amount was 250 (150-650)ml. On average, post-operative time was 8 days (7-23). Post-operative complications was observed in 15,9% of cases, and there was 5,3% deceased. Conclusion: Application of Sonastar ultrasonic tool in hepatectomy reduces blood loss, help better manage hepatic veins, thus reducing complications such as bile leakage. It also helps surgeons manage the liver resection margin, minimalizing recurrences cancer

Robot-Assisted Laparoscopic Fundoplications in Pediatric Surgery: Experience Review

2017 ◽  
Vol 29 (02) ◽  
pp. 173-178 ◽  
Author(s):  
Laurent Fourcade ◽  
Sarah Amar ◽  
Khalid Alzahrani ◽  
Ann-Rose Cook ◽  
Karim Braïk ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pediatric Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Robot Assisted ◽  
Postoperative Rehabilitation ◽  
New Approach ◽  
Open Procedure ◽  
The Mean

Introduction Laparoscopic fundoplicature for gastroesophageal reflux disease has become the gold standard because of the improvement of postoperative rehabilitation compared with the open procedure. The robot-assisted surgery has brought new advantages for the patient and the surgeon compared with laparoscopy. We studied this new approach and the learning curve. Materials and Methods Sixty robot-assisted fundoplicatures were performed in two university pediatric surgery centers. Data of the patients were recorded, including peroperative data (operation length and complications), postoperative recoveries, and clinical evolution. The learning curve was evaluated retrospectively and each variable was compared along this learning curve. Results We observed a flattening of the learning curve after the 20th case for one surgeon. The mean operative time decreased significantly to 80 ± 10 minutes after 20 cases. There were no conversions to an open procedure. A revision surgery was indicated for 4.7% of the patients by a surgical robot-assisted laparoscopic approach. Conclusion The robotic system appears to add many advantages for surgical ergonomic procedures. There is a potential benefit in operating time with a short technical apprenticeship period. The setting up system is easy with a short docking time.

Fibrinogen γ' In the Budd-Chiari Syndrome: Results From a Multicenter Case-Control Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4213-4213
Author(s):  
Jasper Smalberg ◽  
Edith Koehler ◽  
Sarwa Darwish Murad ◽  
Aurelie Plessier ◽  
Juan-Carlos Garcia-Pagan ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Nucleotide Polymorphisms ◽  
Budd Chiari Syndrome ◽  
Single Nucleotide ◽  
Thrombosis Risk ◽  
Chiari Syndrome ◽  
Risk Modifier

Abstract Abstract 4213 Primary Budd-Chiari syndrome (BCS) is a rare disorder characterized by thrombosis of the hepatic outflow tract anywhere from the level of the hepatic veins to the suprahepatic inferior vena cava. Thrombophilic factors or prothrombotic disorders are found in the majority of patients. However, in around 20% of primary BCS patients still no cause can be identified, which highlights the need to further explore the etiology of this disorder. The fibrinogen γ' variant is a thrombosis risk modifier and may thus contribute to BCS. The aim of this study was to determine the role of fibrinogen γ' levels and common variations in the fibrinogen γ gene (FGG) in the etiology of BCS. Patients were recruited from the EN-Vie cohort, consisting of 163 consecutive BCS patients, enrolled in nine European countries between October 2003 and October 2005. Plasma and/or DNA was available from 118 BCS patients (50 males and 68 females; median age 37.9) and 104 healthy controls (43 males and 61 females; median age 36.8). We measured fibrinogen γ' levels by ELISA and genotyped two haplotype-tagging single nucleotide polymorphisms (SNPs): rs2066865 (10034C>T) tagged FGG H2 and rs1049636 (9340T>C) tagged FGG H3. All statistical analyses were adjusted for differences in age and sex. Fibrinogen γ' (0.50 vs 0.42 g/l; p=0.02) and total fibrinogen levels (3.0 vs. 2.8 g/l, p=0.04) were significantly elevated in BCS patients compared to controls. Also the fibrinogen γ'/total fibrinogen ratio, which adjusts for a potential acute phase induced increase of fibrinogen, was significantly elevated in BCS patients (0.17 vs. 0.15; p=0.03). Logistic regression showed a significant association between an increasing fibrinogen γ'/total fibrinogen ratio and risk of BCS (p=0.03). FGG H2 (OR 0.97; 0.96–0.98) and H3 (OR 1.02; 1.01–1.03) were significantly associated with fibrinogen γ'/total fibrinogen ratios. FGG H2 (OR 0.96; 0.64–1.46) and H3 (OR 0.86; 0.62–1.21) were not associated with BCS. In conclusion, fibrinogen γ' levels and the fibrinogen γ'/total fibrinogen ratio are significantly elevated in BCS patients. Common FGG gene variations determine the fibrinogen γ'/total fibrinogen ratio in these patients. We did not observe an association between FGG gene variations and risk of BCS. This study was carried out on behalf of the European Network for Vascular Disorders of the Liver (EN-Vie). Disclosures: No relevant conflicts of interest to declare.

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