ABSTRACT
In adult patients, laparoscopic surgery, using a robot system (Da Vinci, Intuitive Surgical, Mountain View, California), has been recently introduced into surgical practice. To investigate the feasibility of the system in paediatric surgery, laparoscopic fundoplications as well as cholecystectomies have been performed. In July 2000 we used the robot system for the first time on an 11-year-old girl with gastro-oesophageal reflux, and since that time on 7 other children. Altogether 5 Thal and 3 Nissen procedures have been carried out. The average age was 12 years, with a range of 7 to 16 years. All operations were performed without complications and without conversion to open surgery. The medium operating time was 146 min with a range of 105 to 180 minutes. Compared to conventional laparoscopy, the 3-dimensional high-quality vision, the advanced instrument movements and the ergonomic position of the surgeon seems to enhance surgical precision. In our opinion, the use of the robot system is feasible and safe in paediatric surgery. The technique is limited due to the fact that instruments adapted to the size of small children are not yet available.
Subject(s)
Gastroesophageal Reflux/surgery , Laparoscopy/methods , Robotics/instrumentation , Adolescent , Child , Female , Fundoplication , Humans , Male , Treatment OutcomeABSTRACT
The aim of this prospectively performed study was to evaluate the accuracy of macroscopic intraoperative lymph node staging by the operating surgeon. 65 patients with histologically proven gastric carcinoma and without previous abdominal operations were included. Carcinomas of the cardia and malignant lymphomas were excluded. Due to the study protocol the surgeon evaluated the lymph node status before beginning the resection. For exact exploration of the compartments II and III the omental bursa had to be opened through the gastrocolic ligament and the lesser omentum had to be cut off from the liver. The resection itself consisted of en bloc total gastrectomy, D2 lymphadenectomy and removal of the lesser and the greater omentum. The operation was completed by the removal of the spleen if necessary. The surgeon thought 85.2% of the N0-patients to be N > 0 and overlooked lymphatic occupation of compartment I in 8.8%, of compartment II in 14.3% and of compartment III in 50%. The histological examination of the resection specimen showed that the surgeon's impression concerning the extent of the lymph node occupation of the complete situs was correct in only 16.9%. The allocation of the macroscopically determined lymph node status to the TNM scheme was correct in 33.8%. It should be concluded from the study that intraoperative macroscopic staging procedures as a basis for therapeutic decisions are to be avoided strictly.
Subject(s)
Lymph Node Excision , Lymph Nodes/pathology , Stomach Neoplasms/pathology , Adult , Aged , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Observer Variation , Omentum/pathology , Omentum/surgery , Stomach Neoplasms/surgery , Treatment OutcomeABSTRACT
Over 16 years 60 girls underwent surgery for ovarian disease. A total of 23 girls suffered from ovarian tumors, as was confirmed by surgery and histological examination in 18 cases. In five girls ultrasound, CT, and MRT examinations showed tumors, which later turned out to be ovarian cysts; in two cases a tumor was found despite the preoperative diagnosis of an ovarian cyst. A total of 15 patients underwent total resection of the ovary, two partial tumor resections and one exploratory laparotomy. Histological findings: eight teratomas, three dysgerminomas, two endodermal sinus tumors, one cystadenoma, one thecalutein cell tumor, one Sertoli cell tumor, one germinal cell tumor, and one angiofibroma. Five tumors were malignant. Surgery and histological examinations are necessary to exclude ovarian tumors.
Subject(s)
Ovarian Neoplasms/congenital , Adolescent , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Imaging , Female , Humans , Infant , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Ovariectomy , Ovary/pathology , PrognosisABSTRACT
Between October 1984 and June 1987 in 45 patients (9 males, 36 females) pre- and postoperatively the immunocompetent cells in the peripheral blood were measured using OKT- and LEU-11-antigens. 20 patients suffered from malignant and 25 patients from benign diseases. For statistical analysis, H-test according to Kruskal and Wallis was used. Preoperatively, the total account of T-lymphocytes was decreased in patients with thyroid carcinomas, but showed no differences compound to patients with benign diseases postoperatively. No differences were observed in lymphocytic subpopulations in all groups. Parallely, in 50 patients (14 males, 36 females) immunocompetent cells were counted in the resected specimens. There were investigated 29 carcinomas and 21 benign thyroid lesions using the LEU-antigens. Between the group with malignant diseases and that with benigne lesions of the thyroid, no statistically significant differences were observed.