RESUMO
OBJECTIVE: Despite radical surgery and chemotherapy, most patients with ovarian cancer die due to disease progression. M-Trap is an implantable medical device designed to capture peritoneal disseminated tumor cells with the aim to focalize the disease. This trial analyzed the safety and performance of the device. METHODS: This first-in-human prospective, multi-center, non-blinded, single-arm study enrolled 23 women with high-grade serous advanced ovarian cancer. After primary or interval debulking surgery, 3 M-Trap devices were placed in the peritoneum of the abdominal cavity. 18-months post-implantation or at disease progression, devices were initially removed by laparoscopy. The primary safety endpoint was freedom from device and procedure-related major adverse events (MAEs) through 6-months post-implantation compared to an historical control. The primary performance endpoint was histopathologic evidence of tumor cells capture. RESULTS: Only one major adverse event was attributable to the device. 18 women were free of device and procedure related MAEs (78.3%). However, the primary safety endpoint was not achieved (p = 0.131), primarily attributable to the greater surgical complexity of the M-Trap patient population. 62% of recurrent patients demonstrated tumor cell capture in at least one device with a minimal tumor cell infiltration. No other long-term device-related adverse events were reported. The secondary performance endpoint demonstrated a lack of disease focalization. CONCLUSIONS: The M-Trap technology failed to meet its primary safety objective, although when adjusted for surgical complexity, the study approved it. Likewise, the devices did not demonstrate the anticipated benefits in terms of tumor cell capture and disease focalization in recurrent ovarian cancer.
Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/instrumentação , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/cirurgia , Adulto , Idoso , Carcinoma Epitelial do Ovário/secundário , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/secundário , Estudos Prospectivos , Espanha , Resultado do TratamentoRESUMO
Ovarian cancer surgery endeavours to remove all visible tumour deposits, and surgical technologies could potentially facilitate this aim. However, there appear to be barriers around the adoption of new technologies, and we hope this article provokes discussion within the specialty to encourage a forward-thinking approach to new-age surgical gynaecological oncology.
Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Oncologia/métodos , Neoplasias Ovarianas/cirurgia , Padrões de Prática Médica/tendências , Carcinoma Epitelial do Ovário/epidemiologia , Terapia Combinada/história , Terapia Combinada/métodos , Terapia Combinada/tendências , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Procedimentos Cirúrgicos de Citorredução/tendências , Feminino , Preservação da Fertilidade/métodos , Preservação da Fertilidade/tendências , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/história , Procedimentos Cirúrgicos em Ginecologia/tendências , História do Século XX , História do Século XXI , Humanos , Invenções/tendências , Oncologia/história , Oncologia/tendências , Morbidade , Neoplasias Ovarianas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/história , Procedimentos Cirúrgicos Robóticos/história , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Terapias em Estudo/instrumentação , Terapias em Estudo/métodos , Terapias em Estudo/psicologia , Terapias em Estudo/tendênciasRESUMO
BACKGROUND: Laparoscopic liver resection (LLR) of posterosuperior (PS) segment liver tumors is technically challenging with confusion about optimal patient positioning and trocar placement (i.e., transabdominal vs. transcostal). The aim of this study is to describe our technique and outcomes with LLR of these tumors. METHODS: This is an IRB-approved retrospective review of a prospective database. Between 2005 and 2017, patients with benign and malignant lesions underwent LLR. Perioperative outcomes of PS (segments 4A, 7, and 8) and anterolateral (AL) resections were compared. All patients were operated through intra-abdominal trocars in the supine position. RESULTS: 304 patients underwent LLR for AL (n = 217) and PS (n = 87) segmental lesions. Minor liver resections were performed in 274 patients and major resections in 30. Groups were comparable for age, sex, pathology, and tumor size (mean 4.2 and 3.7 cm for AL and PS). Inflow occlusion was more frequently performed for PS resections, but precoagulation rates were similar. PS resections more frequently required hand assistance (50% vs. 20%, p < 0.001) and conversion to open (18% vs. 7%, p = 0.04). For PS versus AL resections, operative time (253 vs. 205 min, p ≤ 0.001) was longer and associated with more blood loss (307 vs. 211 mL, p < 0.001) and more frequent need for blood transfusion (15% vs. 7%, p = 0.04). However, the rate of negative resection margin, 90-day complication rates, and length of stay were similar between the two groups. CONCLUSION: This study shows that LLR of PS located liver tumors is more challenging compared to AL lesions. Nevertheless, it can be performed successfully in the majority of patients with supine positioning and intra-abdominal trocar placement, without compromising oncologic principles. Liberal uses of hand assistance and inflow occlusion were the technical tips helping us to successfully resect these tumors laparoscopically.
Assuntos
Hepatectomia/instrumentação , Laparoscopia/instrumentação , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Instrumentos Cirúrgicos , Adulto , Idoso , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Posicionamento do Paciente , Estudos Retrospectivos , Decúbito DorsalRESUMO
OBJECTIVES: To determine if intraperitoneal (IP) ports placed concurrently with bowel resection during surgical treatment of ovarian cancer is associated with more complications than those ports placed without concurrent bowel resection. METHODS: The medical records of all patients who had an IP port placed at our institution between 2005 and 2016 were reviewed. Two groups were analyzed: IP ports placed with bowel resection (IP-BR) and those without (IP). RESULTS: Of 306 patient charts reviewed, 31% had a surgery with IP port placement and concurrent bowel resection (IP-BR). Demographics were similar except for mean BMI (25.6 IP-BR vs 27.4 IP, pâ¯=â¯0.007). More IP-BR patients had stage IIIC disease (83.3% IP-BR vs 56.9% IP, pâ¯≤0.01). Patients were cytoreduced to R0 in 48.7% IP-BR vs 56.4% IP (pâ¯=â¯0.253). For adjuvant treatment, IV chemotherapy was administered before IP chemotherapy in 90.4% IP-BR (median 2â¯cycles), and 50.3% IP, (median 2â¯cycles, pâ¯<â¯0.01). Ultimately 80.2% IP-BR (median 4â¯cycles) and 77.8% IP (median 5â¯cycles) received IP chemotherapy (pâ¯=â¯0.65). Rates of total IP port complications were similar (19.2% IP-BR vs 23.2% IP, pâ¯=â¯0.397), including IP port infections (0% IP-BR vs 0.7% IP, pâ¯=â¯0.5). Eleven percent of IP-BR patients had a bowel complication (e.g. obstruction or perforation) while IP port was in situ vs 2.7% IP (pâ¯=â¯0.01). Only 2.7% IP-BR and 6% IP discontinued IP chemotherapy due to IP port complication (pâ¯=â¯0.3). CONCLUSIONS: Patients who have IP ports placed concurrently with a bowel resection do not appear to have more complications, nor lower rates of IP chemotherapy administration.
Assuntos
Laparoscopia/instrumentação , Neoplasias Ovarianas/cirurgia , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Neoplasias Ovarianas/tratamento farmacológico , Peritônio/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Instrumentos Cirúrgicos/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: While minimally invasive left pancreatectomy has become more widespread and generally accepted over the last decade, opinions on modality of minimally invasive approach (robotic or laparoscopic) remain mixed with few institutions performing a significant portion of both operative approaches simultaneously. METHODS: 247 minimally invasive left pancreatectomies were retrospectively identified in a prospectively maintained institutional REDCap™ database, 135 laparoscopic left pancreatectomy (LLP) and 108 robotic-assisted left pancreatectomy (RLP). Demographics, intraoperative variables, postoperative outcomes, and OR costs were compared between LLP and RLP with an additional subgroup analysis for procedures performed specifically for pancreatic adenocarcinoma (35 LLP and 23 RLP) focusing on pathologic outcomes and 2-year actuarial survival. RESULTS: There were no significant differences in preoperative demographics or indications between LLP and RLP with 34% performed for chronic pancreatitis and 23% performed for pancreatic adenocarcinoma. While laparoscopic cases were faster (p < 0.001) robotic cases had a higher rate of splenic preservation (p < 0.001). Median length of stay was 5 days for RLP and LLP, and rate of clinically significant grade B/C pancreatic fistula was approximately 20% for both groups. Conversion rates to laparotomy were 4.3% and 1.8% for LLP and RLP approaches respectively. RLP had a higher rate of readmission (p = 0.035). Pathologic outcomes and 2-year actuarial survival were similar between LLP and RLP. LLP on average saved $206.67 in OR costs over RLP. CONCLUSIONS: This study demonstrates that at a high-volume center with significant minimally invasive experience, both LLP and RLP can be equally effective when used at the discretion of the operating surgeon. We view the laparoscopic and robotic platforms as tools for the modern surgeon, and at our institution, given the technical success of both operative approaches, we will continue to encourage our surgeons to approach a difficult operation with their tool of choice.
Assuntos
Procedimentos Cirúrgicos de Citorredução , Laparoscopia , Pancreatectomia , Neoplasias Pancreáticas , Pancreatite Crônica/cirurgia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pancreatectomia/efeitos adversos , Pancreatectomia/instrumentação , Pancreatectomia/métodos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias PancreáticasRESUMO
For men experiencing lower urinary tract symptoms (LUTS) refractory to medical therapy, there have been numerous developments in the treatment options offered for benign prostatic hyperplasia (BPH) in the recent years. Transurethral resection of the prostate (TURP) has remained the reference standard for men with prostates sized 30 cc-80 cc, while open prostatectomy is universally guidelines-recommended in the absence of enucleation, for men with prostates larger than 80 cc-100 cc. While these techniques are effective, they have the potential for bleeding complications requiring transfusions, electrolyte abnormalities such as TURP syndrome, and often require prolonged hospitalization. GreenLight photoselective vaporization (GL-PVP) with the XPS LBO-180W system offers a minimally invasive treatment that can be carried out on essential any sized prostate gland. In addition, the GL-PVP procedure can be done as a same day discharge surgery requiring no overnight hospital admission and allows patients to continue any necessary anti-coagulants given the significantly reduced risks of bleeding complications or TURP syndrome. In 2005, the anatomic vaporization-incision technique (VIT) using the XPS LBO-180W system was described to address larger prostate volumes. VIT combines principles of traditional GL-PVP and enucleation techniques to identify the reference surgical capsule early-on into the surgery and resect portions of prostate adenoma without the need for tissue morcellation. Early studies comparing anatomic VIT to standard PVP outcomes demonstrated significant improvements of IPSS and uroflowmetry parameters, along with statistically significant greater PSA reduction at 6 months, particularly in prostate volumes greater than 80 cc. The objective of this article is to detail our surgical approach to the anatomic GreenLight laser vaporization-incision technique using the XPS LBO-180W system, based on extensive personal experience with both enucleation and vaporization techniques using various laser technologies. Standardization of the VIT based on proper cystoscopy, knowledge of prostate anatomy with preoperative ultrasound, and routine technique is essential to developing consistent, reproducible and optimal surgical outcomes.
Assuntos
Adenoma/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Terapia a Laser/métodos , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/cirurgia , Cor , Cistoscopia , Procedimentos Cirúrgicos de Citorredução/instrumentação , Humanos , Terapia a Laser/instrumentação , Masculino , Seleção de Pacientes , Cuidados Pós-OperatóriosRESUMO
OBJECTIVE: Electrically neutral argon plasma (PlasmaJet™) technology is a surgical option that helps to get an aggressive cytoreduction in selected patients with ovarian cancer because it can be directly applied by the surgeon to treat the tissue surface [1,2]. Upper abdominal surgical procedures are an important part of the surgery in these patients [3], there is a 22% complications rate when they are performed [4]. We present a surgical approach to ovarian cancer debulking using PlasmaJet™. METHODS: Case history and operative technique: 51 women supported for ovarian cancer Stage IIIC-IV were operated with systematic use of the PlasmaJet device at the Regional Institute Bergonié Cancer Center of Bordeaux, France between June 2012 and June 2014. 41.2% (n=21) patients underwent a Primary Debulking Surgery (PDS) and 58.8% (n=30) underwent an Interval Debulking Surgery. 78.4% (n=40) of the 51 patients studied had a complete cytoreduction. We present the case of a woman diagnosed with a mucinous ovarian carcinoma FIGO stage IVA, who underwent a PDS. Complete cytoreduction to no macroscopic disease was achieved, this included diaphragmatic and abdominal peritoneal stripping. RESULTS: No post-operative complications were found in this case. 15.7% (n=8) of patients undergoing diaphragmatic stripping with the PlasmaJet required a pleural drain. It is a safe structured procedure, which could be performed to achieve optimal surgical results for patients with ovarian cancer. CONCLUSIONS: PlasmaJet™ helps the surgeon to perform a peritoneal stripping of the upper abdominal areas and appears to enable the surgeon to remove more disease without increased morbidity, pushing the cytoreduction/morbidity tradeoff.
Assuntos
Adenocarcinoma Mucinoso/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Diafragma/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/cirurgia , Adenocarcinoma Mucinoso/secundário , Coagulação com Plasma de Argônio/instrumentação , Procedimentos Cirúrgicos de Citorredução/instrumentação , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Peritoneais/secundárioRESUMO
OBJECTIVES: Complete cytoreduction of ovarian cancer often requires excision or ablation of bowel serosa implants. Both argon beam coagulator (ABC) and thermal plasma energy (TPE) (PlasmaJet; PlasmaSurgical, Roswell, Ga) have been used to ablate bowel serosa implants. Our objective was to identify comparable power settings as well as determine the rate of bowel perforation, depth of thermal injury, and extent of inflammatory response with ABC versus TPE in a porcine model. MATERIALS AND METHODS: Nine pigs underwent vaporization of small bowel and colon serosa according to assigned treatment group (TPE vs ABC) and settings (ABC: 30, 50, and 70 W; TPE: Cut 10U, 20U, and 30U and Coagulation 10U, 20U, and 30U). Animals underwent necropsy with blinded histomorphologic evaluation on days 0, 3, and 10 postprocedure to assess for presence of bowel perforation, depth of thermal injury, and extent of inflammatory response. RESULTS: At necropsy, bowel perforation was not identified in any animals. Depth of treatment with ABC in the porcine colon was variable and unrelated to power settings whereas TPE was associated with a consistent treatment depth of 1.0 mm regardless of location or power. Treatment with ABC resulted in greater tissue coagulation and desiccation as well as increased rates of mucosal necrosis, especially at higher settings (>50 W). Treatment with TPE primarily resulted in tissue ablation and minimal mucosal necrosis at low settings (Coag 10U-20U). The inflammatory response associated with TPE treatments was interpreted as biologically benign, and less than that observed with the ABC regardless of treatment settings. CONCLUSIONS: Both ABC and TPE effectively ablate bowel serosa in a porcine model. The TPE seems to result in a more predictable tissue effect with less inflammatory response, especially when used at low power settings such as Coag 10U or 20U. These characteristics are appealing for ablation of bowel serosa implants during ovarian cancer surgery and warrant further investigation.
Assuntos
Procedimentos Cirúrgicos de Citorredução/instrumentação , Intestino Delgado/cirurgia , Fotocoagulação a Laser/instrumentação , Terapia a Laser/instrumentação , Gases em Plasma/uso terapêutico , Animais , Coagulação com Plasma de Argônio/efeitos adversos , Coagulação com Plasma de Argônio/instrumentação , Coagulação com Plasma de Argônio/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Mucosa Intestinal/cirurgia , Fotocoagulação a Laser/efeitos adversos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Modelos Animais , SuínosRESUMO
PURPOSE: To determine the number of runs with blades up (BU) using the JetStream Navitus to achieving optimal debulking in a porcine model of femoropopliteal artery in-stent restenosis (ISR). METHODS: In this porcine model, 8 limbs were implanted with overlapping nitinol self-expanding stents. ISR was treated initially with 2 blades-down (BD) runs followed by 4 BU runs (BU1 to BU4). Quantitative vascular angiography (QVA) was performed at baseline, after 2 BD runs, and after each BU run. Plaque surface area and percent stenosis within the treated stented segment were measured. Intravascular ultrasound (IVUS) was used to measure minimum lumen area (MLA) and determine IVUS-derived plaque surface area. RESULTS: QVA showed that plaque surface area was significantly reduced between baseline (83.9%±14.8%) and 2 BD (67.7%±17.0%, p=0.005) and BU1 (55.4%±9.0%, p=0.005) runs, and between BU1 and BU2 runs (50.7%±9.7%, p<0.05). Percent stenosis behaved similarly with no further reduction after BU2. There were no further reductions in plaque surface area or percent stenosis with BU 3 and 4 runs (p=0.10). Similarly, IVUS (24 lesions) confirmed optimal results with BU2 runs and no additional gain in MLA or reduction in plaque surface area with BU3 and 4. IVUS confirmed no orbital cutting with JetStream Navitus. There were no stent strut discontinuities on high-resolution radiographs following atherectomy. CONCLUSION: JetStream Navitus achieved optimal tissue debulking after 2 BD and 2 BU runs with no further statistical gain in debulking after the BU2 run. Operators treating ISR with JetStream Navitus may be advised to limit their debulking to 2 BD and 2 BU runs to achieve optimal debulking.
Assuntos
Aterectomia/instrumentação , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular/cirurgia , Artéria Poplítea/cirurgia , Stents , Angiografia , Angioplastia com Balão , Animais , Procedimentos Cirúrgicos de Citorredução/instrumentação , Modelos Animais de Doenças , Oclusão de Enxerto Vascular/diagnóstico por imagem , SuínosAssuntos
Neoplasias dos Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Carcinoma in Situ/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Procedimentos Cirúrgicos de Citorredução/instrumentação , Eletrocoagulação/instrumentação , Endoscópios , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Biópsia , Carcinoma in Situ/diagnóstico por imagem , Carcinoma in Situ/patologia , Colangiografia/métodos , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Dermatoses do Pé/cirurgia , Dermatoses da Mão/cirurgia , Onicomicose/cirurgia , Procedimentos Cirúrgicos de Citorredução/instrumentação , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodosRESUMO
About 80 % of all women affected by ovarian cancer present with advanced stage disease at the time of diagnosis. Achieving complete cytoreduction is complicated when many small tumor spots are found. Yet, complete cytoreduction is the most important determinant of survival.Application of a thermal plasma energy device to standard surgical instruments may help achieve complete cytoreduction. The 'PlasmaJet® Device' (Plasma Surgical, Inc., Roswell, GA, USA) is an electrically neutral device which emits a high-energy jet of argon plasma for direct tissue effects. We performed a literature review to investigate whether the use of the 'PlasmaJet® Device' in surgery of advanced stage ovarian carcinoma (FIGO IIIB-IV) is effective and safe.The primary outcome was the proportion of complete cytoreductions. The secondary outcomes were: complication rate, proportion of colostomies applied, histological findings, disease-free survival and overall survival.Five case series or reports were found, including a total of 77 patients with FIGO stage IIIC-IV ovarian cancer in whom the PlasmaJet® device was used for primary or interval debulking. Complete cytoreduction was obtained in 79% of the patients. Apart from one pneumothorax after extensive surgery, but no harm or additional complications related to the use of the PlasmaJet® Device were reported. Data on disease-free survival or overall survival were not reported.These findings suggest that the PlasmaJet® Device is an efficient and safe innovative surgical device for debulking surgery with encouraging results. We have proposed an RCT in which we will compare feasibility, safety and effectiveness aspects of the use of the PlasmaJet® versus conventional electrosurgery in advanced stage epithelial ovarian cancer (FIGO IIIB-IV).
Assuntos
Carcinoma Epitelial do Ovário/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias Ovarianas/cirurgia , Carcinoma Epitelial do Ovário/diagnóstico , Carcinoma Epitelial do Ovário/mortalidade , Procedimentos Cirúrgicos de Citorredução/instrumentação , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/mortalidade , Prognóstico , Resultado do TratamentoRESUMO
BACKGROUND: An open-label, single-arm study was conducted to assess the safety of a cryosurgery unit named CRYO2 for debulking at the site of obstruction or stenosis. PATIENTS AND METHODS: In order to treat central airway tumor-related stenosis, debulking at the stenotic site of the airway was performed using CRYO2 under general or local anesthesia. The primary endpoint was the incidence of moderate to massive hemorrhage. RESULTS: Incidence of moderate to massive hemorrhage during surgery was 3.8% (1/26) (95% confidence interval(CI)=0.1-19.6%). Technical success was 96.2% (25/26), with a 95% confidence interval of 80.4-99.9%. CONCLUSION: CRYO2 for debulking at the site of obstruction or stenosis can be performed safely.
Assuntos
Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos de Citorredução , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Criocirurgia/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Neoplasias do Sistema Respiratório/complicações , Neoplasias do Sistema Respiratório/diagnóstico , Neoplasias do Sistema Respiratório/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Rhinophyma is a cosmetically deforming disease characterized by nodular overgrowth of the lower 2/3 of the nose and is considered the end stage of acne rosacea. AIMS: Review the spectrum of procedural techniques for treatment of rhinophyma with a focus on the advantages and disadvantages of each modality. METHODS: A comprehensive literature search was conducted using the search terms "rhinophyma," "treatment," and "surgery" in PubMed. Case reports, case series, and small retrospective trials using procedural techniques for management of rhinophyma were included for review. Animal studies, non-English articles, and reports of medical treatment of rhinophyma were excluded. RESULTS: There are currently no prospective, randomized controlled studies evaluating procedural management of rhinophyma. The most commonly employed treatments include scalpel excision, resection with heated knives, dermabrasion, electrosurgery and lasers, specifically carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG). The main complication associated with complete excision of rhinophymatous tissue is excessive scarring. To correct for this adverse effect, partial or tangential excision with preservation of underlying adnexal structures is now the accepted technique, irrespective of the chosen modality. CONCLUSION: There is no accepted gold standard for management of rhinophyma, and each modality succeeds in maintaining hemostasis, reducing scarring and achieving satisfactory cosmesis to different degrees. There is a conflicting data on the theoretical risk of recurrence with partial excision due to incomplete removal of tissue. Further studies evaluating this risk and alternate methods of prevention are required.
Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Procedimentos Cirúrgicos Dermatológicos/métodos , Rinofima/cirurgia , Rinoplastia/métodos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Dermabrasão , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Eletrocirurgia , Humanos , Lasers de Gás/uso terapêutico , Recidiva , Rinoplastia/instrumentaçãoRESUMO
Peritoneal carcinomatosis is the natural course of gastrointestinal, gynecologic, and primary peritoneal neoplasms. In recent years, our understanding of carcinomatosis has changed; it is no longer considered a disseminated condition, but rather a disease confined to the peritoneum. Thus, the combination of cytoreductive surgery and intraperitoneal chemotherapy has become the cornerstone of control of peritoneal metastases. Traditionally, intraperitoneal chemotherapy is delivered in the form of liquid solutions. However, a new mode of chemotherapy delivery to the abdominal cavity has arisen as an alternative to the conventional method. In Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC), the liquid solution is aerosolized into a spray, potentiating the distribution and penetration of the chemotherapeutic agent intraperitoneally. The present study aims to describe a novel form of this innovative surgical technique performed for the first time in Brazil, in a modification of the technique originally described for PIPAC: delivery through a single-port device.
A carcinomatose peritoneal é a evolução natural das neoplasias gastrointestinais, ginecológicas e primárias do peritônio. Nos últimos anos, a carcinomatose passou a ser considerada uma doença confinada ao peritônio, e não mais uma doença disseminada. Desta forma, a associação de citorredução cirúrgica associada à quimioterapia intraperitoneal se tornou o ponto chave no controle das metástases peritoneais. Tradicionalmente, a quimioterapia intraperitoneal é aplicada utilizando soluções líquidas. Uma nova modalidade de infusão da quimioterapia na cavidade abdominal surge como uma alternativa ao método tradicional. A chamada PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) transforma a solução terapêutica líquida em um spray aerossolizado, potencializando a distribuição e penetração da quimioterapia intraperitoneal. Este relato tem por objetivo descrever essa nova técnica cirúrgica inovadora, realizada pela primeira vez por um monoportal no Brasil, alterando a forma descrita originalmente para a aplicação da PIPAC.
Assuntos
Antineoplásicos/administração & dosagem , Procedimentos Cirúrgicos de Citorredução/normas , Cuidados Paliativos/normas , Neoplasias Peritoneais/cirurgia , Aerossóis/administração & dosagem , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Humanos , Salas Cirúrgicas/normas , Cuidados Paliativos/métodos , Neoplasias Peritoneais/secundário , PressãoRESUMO
BACKGROUND: Most retrosternal goiter surgical removal can be performed via a transcervical approach. However, it is often a challenging procedure, which might include sternotomy. METHODS: We describe a surgical technique using a microdebrider for intracapsular volume reduction that precedes an extracapsular thyroidectomy, thereby avoiding the need for sternotomy, with decreased morbidity and risk. The procedure is described in detail with 2 representative cases and a summary of our experience in 26 cases. RESULTS: Twenty-six patients with retrosternal goiters are included in our cohort. None of the patients needed a sternotomy, and no major or permanent complications occurred. The average length of hospital stay was 4.30 days after total thyroidectomy and 2.57 days after hemithyroidectomy. CONCLUSION: The use of a microdebrider for intracapsular volume reduction thyroidectomy is extremely helpful for transcervical removal of retrosternal goiters in selected cases, and avoids the need for sternotomy, which is especially beneficial in elderly patients, and those with comorbidities for whom sternotomy should be avoided.
Assuntos
Procedimentos Cirúrgicos de Citorredução/instrumentação , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/cirurgia , Esternotomia/métodos , Tireoidectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
RATIONALE: Salivary duct carcinoma (SDC) is a rare and aggressive subtype of salivary gland carcinoma that histologically resembles in situ and invasive ductal carcinoma of the breast. We present the first case of advanced SDC of the minor salivary gland arising from the supraglottis and review the literature on the clinicopathologic characteristics and prognosis of SDC. PATIENT CONCERNS: A 59-year-old male patient with progressive difficulty in swallowing and a muffled voice for 2 months. DIAGNOSES: The patient was diagnosed with SDC arising from the supraglottis with extensive tumor invasion into the subsites of the larynx and pharynx. INTERVENTIONS: Due to impending airway obstruction, the patient underwent CO2 laser debulking surgery. In addition to local disease, lymph node and distant metastases were also noted at diagnosis and concurrent chemoradiation therapy was arranged. OUTCOMES: Laryngeal function was preserved and tracheostomy was avoided. The patient has survived for >1 year after the initial diagnosis. LESSONS: SDC is a rare and aggressive subtype of salivary gland carcinoma that histologically resembles in situ and invasive ductal carcinoma of the breast. Here we presented the first case of advanced SDC of the minor salivary gland arising from the supraglottis that was treated with CO2 laser debulking surgery followed by concurrent chemoradiation therapy. Due to their rarity, further studies are required to establish the most effective treatment protocol for advanced SDC.
Assuntos
Carcinoma , Quimiorradioterapia/métodos , Procedimentos Cirúrgicos de Citorredução , Laringe , Ductos Salivares/patologia , Neoplasias das Glândulas Salivares , Glândulas Salivares Menores/patologia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Carcinoma/patologia , Carcinoma/fisiopatologia , Carcinoma/terapia , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Humanos , Laringe/patologia , Laringe/fisiopatologia , Laringe/cirurgia , Lasers de Gás/uso terapêutico , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias das Glândulas Salivares/patologia , Neoplasias das Glândulas Salivares/fisiopatologia , Neoplasias das Glândulas Salivares/terapia , Resultado do TratamentoRESUMO
Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.
Assuntos
Aterectomia/instrumentação , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Endovasculares/instrumentação , Doenças Vasculares Periféricas/cirurgia , Algoritmos , Desenho de Equipamento , Artéria Femoral/cirurgia , Humanos , Salvamento de Membro/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents , Grau de Desobstrução VascularRESUMO
PURPOSE: To determine the complication rate associated with using a single-lumen intravenous access port with a silicone catheter of 9-10Fr size in the intraperitoneal treatment, including hyperthermic intraperitoneal chemotherapy, in ovarian cancer. PATIENTS/METHODS: We reviewed 27 patients who had subcutaneous venous access ports placed for the administration of IP chemotherapy. With four patients, the catheter was implanted during a hyperthermic intraperitoneal chemotherapy-related laparotomy using the closed technique. Each case was categorized as to the number of cycles of IP therapy received. RESULTS: Seven catheter-related complications were noted. These were divided into two categories: six malfunctions (24%) and one infection (4%). Overall, of the patients who had IP catheters placed and received IP chemotherapy, 13 (54.2%) were able to complete the six regimens. Among the four (14.8%) patients who had the catheters planted directly following the HIPEC, one experienced a catheter leak, one an infection and one concluded the treatment successfully; one is still being treated. CONCLUSIONS: A subcutaneous single-lumen intravenous access port with a silicone catheter of a large size (9-10Fr) is related to a lower rate of catheter-related complications than previously reported open-ended Tenckhoff catheter treatment. An additional advantage is the possibility of removing the catheter as an office procedure under local anesthesia. Intraperitoneal chemotherapy following a HIPEC procedure may cause increased occurrence of catheter-related complications. As of 2010 we have been using silicone subcutaneous catheters in our center.