Intraoperative Ultrasound in Colorectal Surgery

Intraoperative ultrasound (IOUS) in colorectal surgery can be used both in benign and in malignant lesions. In benign cases, such as Crohn’s disease and diverticulitis, it can orient toward the extension of the surgical intervention. In malignant cases, such as colorectal cancer with liver metastases, IOUS/CE-IOUS (contrast-enhanced) improved the intraoperative management of liver metastases by dictating the resection margins in relation to the tumor extension. The IOUS method allows for exact tumor location, intestinal wall visualization, and malignant tumor penetration. The IOUS revealed the tumor and its margin in rectal lesions, making the sphincter-sparing operation easier to perform. In patients with small polyps and early colon and rectum cancers, IOUS works well as a one-of-a-kind intraoperative localization technique. In comparison with IOUS, CE-IOUS offered better detection and resection guidance. Intraoperative ultrasound enables surgeons to easily localize small, non-palpable lesions of the large bowel. Furthermore, it can determine even the aggressive potential of these lesions with high precision.

Social Aspects of Diagnosis and Treatment of Non-palpable Breast Lesions. Important Factor affecting Quality of Life in Cancer Patients undergoing Surgery

Introduction: The social aspect of breast cancer presents a serious problem all the time. Quality of women´s life after surgery must be compared to life before it. Breast cancer treatments today are likely to cause less physical deformity from surgery than two decades ago but are more complex and extend over a longer period of time. Non-palpable breast lesions are findings with non-biologically specified importance, which can be responsible for development of cancer. The authors present the diagnosis and the results of the treatment of patients with non-palpable breast lesions. They were hospitalized at the Department of Surgery in Nitra from Jan uary 2014 untilJuly 2017 and we used the SNOLLmethod or wire guided excision under ultrasound control or digital stereotaxic. Results: From January 2014 until July 2017 there were 122 patients diagnosed with non-palpable breast lesions at the Department of Surgery at our hospital. 76 (62.3%) of these patients were diagnosed with carcinoma. Wire Guided Localization was performed in 99 (81.1%) patients; sentinel node was found in 41 (33.6%) patients using the SNOLL method. From all the patients a reoperation was conducted in 4 cases (3.3%) for close or positive margin status and in 3 cases (2.5%) for false negative perioperative sentinel biopsy. Conclusion: The technique combining 99mTc-MAA (albuminmacro aggregate marked by 99Technecium) and nanocoloid is a reliable localization method for non-palpable lesions and sentinel nodes. SNOLL is a practical and oncological safe technique of excision of a subclinical lesion in combination with sentinel biopsy. This technique brings new visions for the future, especially for quality of life after surgery, changes in body image and sexuality.

Iodine seed localisation of non-palpable lesions in breast surgery − first experience

Surgical therapy of non-palpable malignant breast lesions requires precise preoperative localisation. Recently, radioactive iodine seed localisation has excelled among the number of localisation methods. We present our first experience with this method at our department. We describe the structure of the radioactive iodine seed, the principles of preoperative localisation and peroperative detection of the seed, the specimen transport process, histopathological examination, storage and disposal of the seed, as well as aspects of radiation protection.