Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

Uterine leiomyomatosis is one of the most common benign pelvic tumors diagnosed in women aged 25-44 years. Clinically, it is manifested by vaginal bleeding, pelvic pain, infertility, digestive and urinary symptoms. The diagnosis of uterine fibroids requires careful clinical and paraclinical evaluation. Based on these data, the therapeutic decision is conducted in most cases. The treatment of uterine leiomyomatosis involves several procedures, such as: total abdominal hystectomy, total vaginal hystectomy, abdominal myomectomy, vaginal, laparoscopic or hysteroscopic myomectomy. Hysteroscopic myomectomy is currently the preferred procedure for submucosal fibroids. It has multiple advantages: shorter recovery time, reduced pain related to movements, shorter duration procedure and fewer risks. The procedure has few contraindications. The most common complication is recurrence. The treatment of choice for prolapsed pedunculated submucous leiomyoma is vaginal myomectomy. As described, the procedure has multiple advantages and generally has a low recurrence rate.

Cirugía Transanal Miniinvasiva (TAMIS) Caso Clínico

Introducción. La cirugía miniinvasiva transanal es un abordaje que se ha venido desarrollando en la última década como una herramienta muy eficaz en el tratamiento de lesiones de recto medio-bajo, tanto benignas como malignas en etapas tempranas. Consiste en la utilización de un dispositivo que se coloca en forma transanal, que permite a su través realizar una insuflación del recto, e introducir pinzas de laparoscopía para realizar la excéresis completa de lesiones rectales. Éste abordaje cumple con todos los preceptos de la cirugía miniinvasiva. Descripción. Presentamos el caso clínico de una paciente de 68 años, a la cual realizamos mediante TAMIS (TransAnal Miniinvasive Surgery), una resección de espesor total de la pared del recto bajo, incluyendo la cicatriz de un procedimiento endoscópico previo insuficiente. La paciente se realizó, en julio de 2019, una videocolonoscopía (VCC) por una prueba de sangre oculta en materia fecal (FECATEST) positiva, la cual mostró un pólipo sésil de recto de 2,5cm de diámetro a unos 6-8cm del margen anal que se reseca en su totalidad por técnica de piecemeal. El resultado anatomopatológico informó la presencia de unadenocarcinoma con infiltración submucosa de 4 mm de profundidad. Márgenes a menos de 1mm de la lesión. Se solicitó una nueva VCC en diciembre de 2019 que evidencia, a unos 6-8cm del margen anal, sobre cara posterolateral derecha, la cicatriz de la polipectomía previa, sin resurgencias. Resto del colon sin lesiones. Examen proctológico: no se palpa la cicatriz. Con vistas a completar la evaluación de la paciente, se solicitó una resonancia nuclear magnética (RNM) de abdomen y pelvis que informó: área de leve engrosamiento mucoso de 30 mm en cara póstero-lateral izquierda del recto a 5 cm del margen anal. No presenta restricción a la difusión ni realce con contraste que sugiera a actividad tumoral. Mesorrecto sano. No hay otras alteraciones patológicas en el estudio. Marcadores tumorales dentro de rango normal. Se discutió con la paciente las diferentes opciones terapéuticas: control con examen clínico, rectoscopía y RNM o ecografía endorrectal seriadas o, resección de espesor parietal total de la cicatriz para estudio anatomopatológico completo y estadificación de la lesión. Discutidas las ventajas y desventajas de cada opción, la paciente y su familia optaron por la cirugía. Se realizó la misma sin incidentes otorgándole el alta a domicilio a las 24hs de la cirugía. Se controló a la semana, al mes y a los 3 meses permaneciendo asintomática hasta la fecha. Conclusiones. La resección miniinvasiva de lesiones de recto con fines diagnósticos o terapéuticos es una opción segura y confiable. Nos permite obtener una pieza íntegra para su análisis anatomopatológico, lo que otorga una mayor seguridad para la toma de decisiones frente a la estadificación de la lesión.

The role of miniinvasive surgery in the treatment of early thyroid cancer

Minimally invasive thyroid surgery is a relatively new branch that has begun to develop since the 1990s, it comes in response to an increasing incidence in recent decades of thyroid tumors such as cancers and adenomas. Thin minimally invasive thyroid surgery has 2 main directions: with and without approach in the neck region, and those with approach at the neck are divided into endoscopic and non-endoscopic. Miniinvasive interventions have a number of advantages over the classic ones such as reduction of postoperative pain syndrome and analgesic consumption, respectively, shorter residence time and much better cosmetic results. Not all patients with thyroid tumors can be operated minimally invasively, there are a number of selection criteria: early stage of primary thyroid cancer or adenomas smaller than 3.5 cm in diameter, without capsule penetration or metastases, the volume of the gland should not exceed 50 -60 ml are not allowed overweight patients, patients with severe chronic morbidity, patients with a history of surgery on the neck, patients as short as possible, children and the elderly are not allowed too

Peculiarities of individual miniinvasive surgery in the surgical treatment of nodular pathology of the thyroid gland in children

Peculiarities of individual mini-invasive surgery in the surgical treatment of nodular pathology of the thyroid gland in children. During 40 years in the clinic „Surgery of tumors of the head and neck region” of the Oncological Institute of Republic of Moldova were treated 18549 patients with thyroid nodular pathologies, of which 1078 were children. 105 (9,7%) children were diagnosed with thyroid cancer, 534 (49,5%) – with adenomas, 213 (19,7%) – with toxic nodular goiter, 226 (21%) – with Hashimoto’s stroke. The ratio of affecting girls / boys 6: 1, the most vulnerable age – 9-16 years. The most common morphological forms were papillary and follicular cancer 97 children (92,3%). During 2020, the method of mini-invasive organ-threatening operations in children with thyroid nodular processes was implemented. The main advantages of mini-invasive operations are the following:Intraoperative safety The small cost Minimal postoperative complications.

Laparoscopic liver resections – state of art

Progress had been made in the miniinvasive surgery in the past 30 years. Laparoscopic liver procedures were expanded from limited resections to major resection and complicated procedures. Miniinvasive approach offered better short-time results and similar oncological outcomes compared with open liver surgery. However, it is still challenging to perform some difficult procedures laparoscopically which requires a learning curve and accumulation of experiences in specialized centers.

The structure of ambulatory operative interventions and application of international experience while making a reform of surgical service in Ukraine

Objective. To study the operative interventions structure in ambulatory conditions, possibility of their widening and reformation of ambulatory surgical service using international experience. Materials and methods. There was conducted calculation and a characteristic given of ambulatory operative interventions, performed in polyclinic in 1999 - 2017 yrs, and possible ways of reforming of surgical service, including the ambulatory one, were determined. There were observed 1863 operated patients - women and men ageing 31 - 86 years old. Average duration of disability was 12,6 days. Results. Miniinvasive operative interventions performance make it possible to reduce the stationary stay, i. e. to enhance the hospital bed turnover. Conclusion. Taking into account, that the hospitals’ consulting-diagnostic centres and stationaries, which have occurred as a result of reforming in branch of the health care in Ukraine, constitutes a secondary chain of medical help. Clinically and economically it is expedient to include them into the hospitals, what was mentioned by The Order of Ministry of Health of Ukraine, dated by 05.10.2011 yr. № 646. The presence of departments of miniinvasive surgery in the hospitals structure give possibility to use the hospital beds fund more rationally, to reduce the administrative apparatus, shortening by this way the state economic expanses significantly.

Radio-guided miniinvasive surgery of solitary parathyroid adenoma as a cause of primary hyperparathyroidism

The function of parathyroid gland is affected by a wide spectrum of diseases, among them primary hyperparathyroidism is the most common. In about 85% of the patients a solitary parathyroid adenoma is the cause of the hyperparathyroidism. Surgical removal of pathologically changed gland is a treatment of choice, usually performed by miniinvasive radio-guided parathyroidectomy. In this article the authors review current knowledge, research state, and present some cases of this operation at the Clinic of Otorhinolaryngology and Head and Neck Surgery, Jessenius Faculty of Medicine, Comenius University and University Hospital Martin, Martin, Slovakia.