RESUMEN
For early-stage non-small cell lung cancer, surgical resection remains the best treatment option. Currently, sublobar resection, including segmentectomy, is recommended in these cases, as it provides a better quality of life with the same oncological outcomes; however, is requires adequate resection margins. Accurate preoperative planning and proper identification of the intersegmental planes during thoracic surgery are crucial for ensuring precise surgical management and adequate resection margins. Three dimensional computed tomography reconstruction and near-infrared-guided intersegmental plane identification can greatly facilitate the surgical procedures. Three-dimensional computed tomography reconstruction can simulate both the resection and resection margins. Indocyanine green is one of the most frequently used and affordable fluorophores. There are two ways to identify the intersegmental planes using indocyanine green: intravenous and transbronchial administration. Intravenous application is simple; however, its effectiveness may be affected by underlying lung disease, and it requires the isolation of segmental structures before administration. Transbronchial use requires appropriate bronchoscopic skills and preoperative planning; however, it also allows for delineation deep in the parenchyma and can be used for complex segmentectomies. Both methods can be used to ensure adequate resection margins and, therefore, achieve the correct oncological radicality of the surgical procedure. Here, we summarise these applications and provide an overview of their different possibilities.
RESUMEN
Introduction The authors introduce the history of liver surgery in Szeged on the occasion of the 100th anniversary of the Surgery Department's establishment. Material and methods After the initiation of liver surgery in Szeged by Professor Karácsonyi 1982 we are treating not only patients with benign and malignant focal liver diseases but also others with surgery required because of complications of portal hypertension. Patients are presented in two periods. Discussion We operated on 46.5% of the patients with malignant and 53.5% of the patients with benign diseases between 1981 and 1991. The surgical spectrum extended to trisegmentectomy. There were 14% of minor and 9.9% of major complications, the mortality was 3.23% which meets international standards. In the second period, 50.5% of the patients were operated on because of malignant and 46.5% of the patients suffered from benign focal diseases from 1992. Among the patients who had been operated on because of liver malignancy, there were 51% metastasis mostly of colorectal cancer, 22% were hepatocellular, 16% were cholangiocellular carcinoma and in 11% were other malignant tumors. In those patients who had been operated on because of benign focal liver diseases, there were 32% cysts, 25% echionococcus cysts, 26% haemangiomas, 8% adenomas, 7% FNH, and 2% because of others. The summarized mortality rate was 1.3%. There were peritoneo-venous shunt implantations in 126 cases because of therapy-refracter ascites. We performed oesophageal transection with a circular stapler after failed endoscopic haemostasis in 50 cases. Conclusion Chances of liver surgery have been basically widened because of the financial investment that is connected to the Department of Surgery's move to a new building. The liver unit in Szeged today can take care of patients in a full spectrum of liver surgery.
RESUMEN
BACKGROUND: Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs). METHODS: We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression. RESULTS: In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence. CONCLUSIONS: Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.
