Common surgical procedures

This chapter addresses common surgical procedures. These include laparotomy; diagnostic laparoscopy; inguinal hernia repair; appendicectomy; cholecystectomy; perforated peptic ulcer repair; haemorrhoidectomy; and excision of pilonidal sinus. Laparotomy is a surgical incision into the abdominal wall to gain access into the abdominal cavity. Minimal invasive surgery aims to cause at least surgical trauma as possible to patients compared to ‘conventional’ open surgery. Benefits include shorter hospital stay, less pain, quicker functional recovery, and superior cosmesis. Pneumoperitoneum induction is the primary step in performing laparoscopy surgery. The chapter then studies stoma formation; small bowel resection and anastomosis; right hemicolectomy; wide local excision of breast lesion; femoral embolectomy; and below knee amputation.

Methods of Reconstruction for Distal Aortic Dissection

The modern approach to the correction of aortic dissection involves the most complete reconstruction of the entire pathologically altered segment of the vessel, which is often impossible due to the vastness of the lesion and the associated severity of surgery. Reduction of intraoperative trauma can improve survival in the immediate postoperative period, and the completeness of reconstruction to reduce the number of complications and relapses in the long term. In this chapter, the methods of reconstruction of the aorta in case of distal dissection from a conventional open surgery to endovascular techniques, or usage of their combination for minimization of surgical trauma, are reviewed.

Laparoscopic single port radical nephrectomy challenges: a case presentation

Renal cell carcinoma accounts 2 % of global cancer diagnoses and death. In Malaysia, its occurrence is found in 1.9 in 100,000 patients and more predominantly in male with ratio male to female of 2.75:1 in 2006. Radical nephrectomy has been proven to give the best chance of cure and long term survival. Throughout the years, conventional open surgery has evolved to single port laparoscopic surgery. It has its own advantages, difficulties and cases selections criteria. We report a successful case of Laparoscopic single port surgery in a renal cell carcinoma patient with underlying prostate carcinoma.

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Background After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical diseases. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have led to the development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Patients who undergo TOEPVA at our institution between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Results Seven patients were operated successfully by this technique, none of which required conversion to conventional open surgery. Two patients required atropine and one patient required ephedrine during insufflation. Conclusion After induction of anesthesia with propofol, remifentanil, and rocuronium and anesthesia managed by desflurane co-administered with continuous infusion of remifentanil provide feasible and safe anesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anesthetist has a great value to improve patient management.

Outcome of One-Stage Percutaneous Endoscopic Debridement and Lavage Combined with Percutaneous Pedicle Screw Fixation for Lumbar Pyogenic Spondylodiscitis

Background This study assessed the therapeutic effect of one-stage percutaneous endoscopic debridement and lavage (PEDL) combined with percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar pyogenic spondylodiscitis. Methods From March 2017 to October 2019, 25 patients diagnosed with pyogenic spondylodiscitis underwent PPSF followed by PEDL in our department. Biopsy specimens were examined for microorganisms and evaluated histopathologically. Clinical outcomes were assessed by physical examination, routine serological testing, visual analogue scale (VAS), Oswestry Disability Index (ODI), and imaging studies. Results All operations were successful, with no severe surgical complications in any patient and excellent incision healing. Causative bacteria were identified in most cases; Staphylococcus aureus was the most prevalent. The mean follow-up was 25.0 ± 3.8 (range: 20–32) months. Inflammatory markers showed that infection was controlled. The VAS and ODI improved significantly. At the last follow-up, magnetic resonance imaging showed that the infected lesions had disappeared. Conclusion PEDL supplementing PPSF may be useful for patients with single-level lumbar pyogenic spondylodiscitis, as it is minimally invasive, especially for patients who cannot undergo conventional open surgery due to poor health or advanced age.

Safe Introduction of New Technologies and Techniques in Minimally Invasive Colorectal Surgery

In the past 20 years, colorectal surgery has experienced important advances as a result of new technologies that have increasingly transformed conventional open surgery into maximal usage of minimally invasive approaches. While many tools are being developed to change the way that operations are being performed, quality must not suffer. We describe here some of the aspects to pursue to achieve optimal and safe outcomes while utilizing minimally invasive techniques such as robotic surgery, transanal total mesorectal excision, as well as the role of immunofluorescence.

Video-assisted Thoracic Surgery for Congenital Diaphragmatic Hernia Compared With Conventional Open Surgery in Infants

BackgroundThis study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants.MethodsWe retrospectively analysed the clinical data of 109 children with CDH who underwent surgical treatment at the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019. According to the surgical method, the children were divided into an open group (62 cases) and a thoracoscopy group (47 cases). We compared the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay, postoperative CCU admission time and other surgical indicators as well as the recurrence rate, mortality rate and complication rate of the two groups of children.ResultsThe index data on the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Compared with the number of incision infections, pulmonary infections, atelectasis, pleural effusion and chylothorax between the two groups, the number of children in the open group was greater than that in the thoracoscopy group, and the total postoperative complication rate (51.61%) was higher than that in the thoracoscopy group (44.68%). The recurrence rate of the thoracoscopy group (8.51%) was higher than that of the open group (3.23%). In the open group, 2 patients died of respiratory distress after surgery, and no patients died in the thoracoscopy group.ConclusionsThoracoscopic surgery and open surgery can effectively treat CDH. Open surgery has advantages in patients with unstable haemodynamics, large diaphragm defects and abdominal malformations. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications, but there is a risk of recurrence. The choice of surgical method should be determined by the characteristics of diaphragmatic lesions and the experience of the clinician.