[Coagulation profile in patients undergoing elective laparoscopic surgery]. / Aktywacja ukladu krzepniecia u chorych operowanych z dostepu laparoskopowego w trybie planowym.

INTRODUCTION: Insuflation abdominal cavity with carbon dioxide during laparoscopic surgery increases abdominal pressure, which may cause stasis of the blood flow in inferior vena cava and common iliac veins. Moreover, reverse Trendelenburg position, in which laparoscopic cholecystectomy is performed, decreases venous return. All of this factors makes episode of venous thromboembilism (VTE), an asymptomatic state that could cause serious complications, more probable. AIM: The aim of the study was to asses influence of pneumoperitoneum during laparoscopic procedures on coagulation state and to asses relation between body mass index (BMI), age of patients undergoing laparoscopic procedures and coagulation profile in the postoperative period. MATERIAL AND METHODS: The study enrolled 35 patients (F:M = 28:7, mean age 48.3 ± 14.6, mean BMI 26 ± 4.5 kg/m2), without VTE risk factors, not undergoing anticoagulant therapy and without abnormal platelet count. Subjects underwent laparoscopic cholecystectomy. Alteration in coagulation profile was assesed on the basis of aPTT, PT and TT results. Blood samples were taken twice: in the day of admission (samle A) and 5 hours after surgery (sample B). Statistical analysys was performed using Wilcoxon signed rank test and Spearman correlation. RESULTS: Mean aPTT, PT and TT value of the A sample was 34.54 ± 6.32s, 1.11± 0.14 INR; 16.35 ± 1.93s respectively. Mean aPPT, PT and TT value of the B sample was 34.4 ± 7.13s; 1.17 ± 0.11 INR; 16.41 ± 1.88s, respectively. Change of PT value pre- and postoperatively was statistical significant (p = 0.0009). There was statistical significant correlation between duration of the surgery and sample B PT and TT values (p = 0.0115 and 0.0218 respectively). No other correlation between BMI, age and sample B values was observed. CONCLUSIONS: Creation of pneumoperitoneum has no influence on shortening of clotting times. Because of early mobilisation, fast discharge and recovery that makes natural anticoaculant prevention available short after surgery, clinical risk of DVT is not high.

The assessment of bladder cancer resectability with bimanual palpation: A prospective study in laparoscopy and open cystectomy patients.

PURPOSE: To evaluate the value of examination under anesthesia (EUA) in the assessment of bladder resectability during cystectomy. MATERIALS AND METHODS: This prospective study included consecutive patients undergoing cystectomy for bladder cancer at a single center between June 2017 and October 2020. EUA was conducted before cystectomy by two urologists who assessed the bladder for limited mobility. One examiner was blinded to the imaging results. Soft tissue surgical margin status in the pathological evaluation of a cystectomy specimen served as a measure of resectability. We used multivariable logistic regression models to assess whether EUA performed by blinded or non-blinded examiners is associated with soft tissue positive surgical margins (PSMs) and to calculate the fraction of new information added by such an examination in addition to selected clinical variables. RESULTS: Among the 134 patients analyzed, limited bladder mobility was indicated by the blinded and non-blinded examiners in 23 (17.2%) and 21 (15.7%) cases, respectively. PSMs were identified in 22 (16.4%) patients, more often in patients with limited bladder mobility as assessed by the blinded (odds ratio [OR] 6.7; 95% confidence interval [CI], 1.9-24.2) and non-blinded examiners (OR 12.9; 95% CI, 2.9-57.5). The fraction of new information added by the blinded and non-blinded examiners was 48.6% and 57.7%, respectively. The enrichment of patients who underwent pure laparoscopic cystectomy (n = 102; 76%) and the inclusion of patients for emergent surgery may limit the generalizability of our findings. CONCLUSIONS: The identification of limited bladder mobility during preoperative EUA yielded prognostic information on surgical margin status. Our findings suggest that EUA has the potential to provide valuable insights in the assessment of bladder resectability. However, further research in a larger cohort of patients is warranted to validate and expand on these findings.

Mild elevation of liver function tests associated with renal cell carcinoma in a multimorbid older patient - a case of Stauffer's syndrome.

We describe a case of a 74-year-old patient with recurrent fever of up-to 38.5°C, nocturnal sweating, weight loss of 4 kg, non-characteristic pain, and elevation of liver function tests (LFTs), who was diagnosed with Stauffer's syndrome. The patient successfully underwent laparoscopic heminephrectomy. The histology was clear-cell carcinoma of the right kidney (cT1a). The abnormalities in laboratory tests, such as Erythrocyte Sedimentation Rate, C-reactive protein, LFTs, α2-globulin, and most clinical symptoms abated 2 weeks post-surgery. We hypothesize that elevated LFTs in renal cell carcinoma patients could help deciding in favour of surgery in cases where the initial decision would be watchful waiting.

Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy--Lessons learned after 500 cases: A retrospective cohort study.

INTRODUCTION: Although laparoscopic adrenalectomy is considered relatively safe, the results of treatment vary depending on the profile of the hospital. We would like to present our experience with laparoscopic surgery of the adrenals. METHODS: We conducted a retrospective cohort study of consecutive patients operated for adrenal tumours in the years 2003-2014. The study group included 175 (35%) men and 325 (65%) women. The entire group was divided into 4 cohorts of 125 consecutively operated patients. Primary outcomes were operative measures (operative time, its correlation with tumour size, blood loss, conversion rate, use of peritoneal drainage). Secondary outcomes were the intra- and postoperative complications (using the Clavien-Dindo classification), histological type of the tumours and length of hospital stay. RESULTS: There were no differences between groups in terms of the size and location of the tumour. The mean operative time in each group was 85.7; 83.7; 89.6; 104.6 min (p < 0.001). The operative time correlated to the size of the tumour. There were no differences in the conversion rates as well as in the blood loss. However, it was observed that the complication rate was declining in subsequent subgroups (14.4%, 11.2%, 8% and 5.6%, respectively, p = 0.013). Length of hospital stay was 4.9 days, 3.9 days, 2.9 days, 2.4 days, respectively (p < 0.001). CONCLUSION: The results of laparoscopic adrenalectomy depend not only on the experience of the single surgeon, but on the whole team involved in perioperative care. In high volume centers with extensive experience in surgery of adrenals, this technique may provide an alternative to open surgery, also in selected cases of malignant tumours.

Laparoscopic cholecystectomy in the treatment of gallbladder polypoid lesions--15 years of experience.

UNLABELLED: Due to the constant increase of public health awareness and widespread "cancerophobia", the progressively larger number of incidentally diagnosed gall-bladder polyps became the source of anxiety, which leads patients and physicians to undertake therapeutic decisions, despite the absence of symptoms. The majority of gall-bladder polyps are benign. It is estimated that only 3 to 5% of polyps are malignant. Currently, there is lack of randomized control trials based on which the clear-cut criteria of qualification of patients with gall-bladder polyps for surgical procedure can be created. The aim of the study was to analyze gall-bladder polyps in patients who underwent laparoscopic cholecystectomy in the 2nd Department of General Surgery, Jagiellonian University Collegium Medicum. MATERIAL AND METHODS: The retrospective study was conducted on 5369 patients who underwent laparoscopic cholecystectomy in the 2nd Department of General Surgery, Jagiellonian University Collegium Medicum with special attention to 152 (2.8%) patients in whom gall-bladder polyps were diagnosed preoperatively. Qualification criteria for surgery, surgical treatment results, and histopathological examination results were also analyzed. RESULTS: Amongst the 5369 patients qualified for laparoscopic cholecystectomy, 152 (2.8%) were diagnosed with gall-bladder polyps during the preoperative ultrasound examinations. Postoperative histopathological examinations of 41 (27%) patients confirmed the presence of gall-bladder polyps. In 102 (67%) patients, only gall-stones were diagnosed without previously described polyps during the ultrasound examination. Analysis of the histopathological examination results revealed the presence of benign lesions in 35 (23.35%) patients. In 5 (3%) patients the presence of an adenoma, and in one (0.65%) the presence of adenocarcinoma were confirmed. CONCLUSIONS: Based on the conducted study and previous personal experience in the treatment of patients with gall-bladder polyps, we believe that due to the potential risk of neoplastic transformation, patients with polyps larger than 10 mm in diameter and polyps of proven rapid growth should be qualified for laparoscopic cholecystectomy. Indications for surgical treatment also seem reasonable in case of patients with present polyps and coexisting right upper quadrant pain, even though the above-mentioned is connected with gall-bladder deposits.

Cystic adrenal lesions - analysis of indications and results of treatment.

UNLABELLED: Cysts are a rare pathology of adrenal glands. As the development of new diagnostic techniques takes place, the occurrence of adrenal cystic lesions has been rapidly increasing. The majority of them are solid adrenal lesions, but localized fluid collections are also more frequently diagnosed. In case of solid adrenal lesions, there are straight indications for surgery, but on the other hand there are no clear guidelines and recommendations in case of adrenal cysts. The aim of the study was to analyze surgical methods and evaluate treatment effects in patients who were qualified for laparoscopic adrenalectomy due to adrenal cystic lesions. METARIAL AND METHODS: Identical criteria were used to qualify patients with solid and cystic lesions of the adrenal gland for surgery. Out of the whole number of 345 patients who underwent laparoscopic surgery for adrenal tumors, 28 had adrenal cysts. 16 of them (57%) were women and 12 (43%) men. The average age of the studied group was 46.4 years (25-62 years). The average cyst diameter in CT was 5.32 cm (1.1-10 cm). Most of the lesions were hormonally inactive (22 patients), but in 6 cases increased level of adrenal hormones was observed. RESULTS: Pathological analysis revealed 4 (14%) pheochromocytomas and 2 (7%) dermoid cysts. In case of 22 (79%) patients, the postoperative material was profiled by pathologists as insignificant according to potential neoplasmatic transformation risk: 5 (17.5%) - endothelial vascular cysts, 3 (11%) endothelial lymphatic cysts, 7 (25.5%) pseudocysts, 3 (11%) simple cysts, 2 (7%) bronchogenic cysts, 1 (3.5%) - cortical adenoma and 1 (3.5%) cyst was of myelolipoma type. CONCLUSIONS: Based on the performed research and previous experience in treating patients with adrenal lesions we can conclude that application of the same evaluating algorithm for both cystic and solid lesions is valid.