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1.
Orv Hetil ; 161(10): 382-388, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32115990

RESUMEN

Introduction: Recently published unfavourable results of endoscopic radical surgery for early-stage cervical cancer compared to open surgery raises the need for auditing treatment results of endoscopic staging surgery for endometrial cancer. Aim: Comparison of progression-free and overall survival (PFS and OS) between endometrial cancer patients treated with laparoscopic (LSC) and open surgical techniques. Method: Retrospective analysis was performed to compare clinicopathological and survival data of endometrial cancer patients who had either laparoscopic or open staging surgery between 2013 and 2019 at the Gynaecological Oncology Unit of the University of Debrecen, Hungary. Distribution of the most relevant prognostic factors were compared with χ2 and t-tests. Frequencies of progressive disease and disease-specific deaths were compared in the Cox-model, while progression-free and overall survival curves were compared with the Kaplan-Meier method. Results: The frequency of endometrioid, serous papillary, mixed Müllerian, adenosquamous and other histological types in the laparoscopic and open groups were similar (p = 0.3356). The frequency of grade 1, 2 and 3 tumours in the endoscopic and open groups showed significant differences (p = 0.0036). Pathological stage-distribution (IA, IB, II, IIIA, IIIB, IIIC1, IIIC2) of endoscopic cases and open cases was also statistically different (p = 0.0048). The mean number of removed lymph-nodes was higher in the open surgery group (14.3 vs. 9,3, p<0.0001). The frequency of recurrence did not show significant difference between the two groups, in contrast to the frequency of disease-specific deaths (2/120 vs. 29/345, p = 0.01; 2/120 vs. 17/345, p = 0.12). In the Cox-model, progression-free survival and overall survival showed a hazard ratio favouring laparoscopic surgery, however, the range of 95% confidence intervals showed no statistical significance (PFS LSC vs. open: HR = 0.36, 95% CI = 0.084-1.538; OS LSC vs. open: HR = 0.603, 95% CI = 0.135-2.693). Conclusion: Progression-free and overall survival of endoscopically staged endometrial cancer is not worse than those of patients staged with open surgery. Orv Hetil. 2020; 161(10): 382-388.


Asunto(s)
Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/cirugía , Histerectomía , Laparoscopía/métodos , Supervivencia sin Enfermedad , Neoplasias Endometriales/patología , Femenino , Humanos , Hungría/epidemiología , Escisión del Ganglio Linfático , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Supervivencia sin Progresión , Estudios Retrospectivos , Resultado del Tratamiento
2.
Wiad Lek ; 73(1): 139-144, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32124824

RESUMEN

OBJECTIVE: The aim: The purpose of this study was to assess the long-term outcomes of restoration of reproductive function after surgical and medical treatment of ectopic pregnancy, taking into consideration the patency of the fallopian tubes and the incidence of uterine pregnancy. PATIENTS AND METHODS: Materials and methods: A two-stage experimental approach was used to address research objectives. In the first stage, a retrospective analysis of 615 histories of patients with ectopic pregnancy has been performed. In a second stage - we examined 140 patients, which were divided into three groups, depending on the type of treatment. The first group consisted of patients with a disturbed ectopic pregnancy, who were treated with laparotomy and tubectomy. The second group included patients with exacerbated ectopic pregnancy, who were operated by laparoscopic access. Lastly, the third group comprised of women with ectopic pregnancy who were treated with methotrexate. The main source of information used for clinical and anamnestic analysis was "medical card-patient" (f. 003 / o). RESULTS: Results: The number of patients diagnosed with ectopic pregnancy increased from 2005 to 2015. In 2005 and 2006, the laparotomy operations were 86.88% and 83.33%, but conservative management only 13,16% and 16,67%, respectively. In 2015, the number of patients treated with methotrexate was more than half (51.35%) compared with 2010 and 2005 increased to 16.97% and 38.19% respectively, and laparotomy operations decreased from 86.88% in year 2005 to 18.92% in year 2015. CONCLUSION: Conclusions: The data showed that in women who underwent medical treatment with cytostatic, the patency of the fallopian tubes was significantly better than after surgical treatment. In cases of interrupted ectopic pregnancy for which laparotomy with the removal of the motor tube was applied, infertility of tubal peritoneal genesis developed in 60% of cases, which is consistent with the existing literature. Statistical analysis of the structure of ectopic pregnancy showed that in 2005 dominated interrupted ectopic pregnancy, due to late diagnostic and hospitalisation, that led to urgent laparotomy operations rather than conservative treatment.


Asunto(s)
Embarazo Ectópico , Trompas Uterinas , Femenino , Humanos , Laparoscopía , Laparotomía , Metotrexato , Embarazo , Estudios Retrospectivos
3.
Medicine (Baltimore) ; 99(9): e19323, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118762

RESUMEN

BACKGROUND: Low intra-abdominal pressure (IAP) and deep neuromuscular blockade (NMB) are frequently used in laparoscopic abdominal surgery to improve surgical space conditions and decrease postoperative pain. The evidence supporting operations using low IAP and deep NMB is open to debate. METHODS: The feasibility of the routine use of low IAP +deep NMB during laparoscopic surgery was examined. A meta-analysis is conducted with randomized controlled trials (RCTs) to compare the influence of low IAP + deep NMB vs. low IAP + moderate NMB, standard IAP +deep NMB, and standard IAP + moderate NMB during laparoscopic procedures on surgical space conditions, the duration of surgery and postoperative pain. RCTs were identified using the Cochrane, Embase, PubMed, and Web of Science databases from initiation to June 2019. Our search identified 9 eligible studies on the use of low IAP + deep NMB and surgical space conditions. RESULTS: Low IAP + deep NMB during laparoscopic surgery did not improve the surgical space conditions when compared with the use of moderate NMB, with a mean difference (MD) of -0.09 (95% confidence interval (CI): -0.55-0.37). Subgroup analyses showed improved surgical space conditions with the use of low IAP + deep NMB compared with low IAP + moderate NMB, (MD = 0.63 [95% CI:0.06-1.19]), and slightly worse conditions compared with the use of standard IAP + deep NMB and standard IAP + moderate NMB, with MDs of -1.13(95% CI:-1.47 to 0.79) and -0.87(95% CI:-1.30 to 0.43), respectively. The duration of surgery did not improve with low IAP + deep NMB, (MD = 1.72 [95% CI: -1.69 to 5.14]), and no significant reduction in early postoperative pain was found in the deep-NMB group (MD = -0.14 [95% CI: -0.51 to 0.23]). CONCLUSION: Low IAP +deep NMB is not significantly more effective than other IAP +NMB combinations for optimizing surgical space conditions, duration of surgery, or postoperative pain in this meta-analysis. Whether the use of low IAP + deep NMB results in fewer intraoperative complications, enhanced quality of recovery or both after laparoscopic surgery should be studied in the future.


Asunto(s)
Cavidad Abdominal/fisiopatología , Bloqueo Neuromuscular/efectos adversos , Presión/efectos adversos , Cavidad Abdominal/irrigación sanguínea , Humanos , Complicaciones Intraoperatorias , Laparoscopía/métodos , Bloqueo Neuromuscular/métodos
4.
Zhonghua Fu Chan Ke Za Zhi ; 55(2): 112-119, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32146740

RESUMEN

Objective: To investigate the surgical complications in the treatment of stage Ⅰ endometrial cancer by robotic-assisted laparoscopy, the risk degree of Clavein-Dindo complications and the main risk factors affecting the occurrence of surgical complications. Methods: A retrospective case-control study was conducted in the First Affiliated Hospital of Zhengzhou University from October 2014 to June 2019. The patients were divided into robotic-assisted laparoscopy group and traditional laparoscopy group according to the operation mode, including 131 cases in robot group and 290 cases in traditional laparoscopy group. To compare the complications during and after operation and the risk degree of complications between the two groups by Clavein-Dindo classification standard, the age, body mass index (BMI), comorbidities, past history of pelvic surgery, American Society of Anesthesiologists (ASA) grade, preoperative anemia, number of pelvic lymph node resection, number of abdominal aortic lymph node resection, the total number of lymph node resection, operation time, surgical methods (robot surgery or traditional laparoscopic surgery) and other clinicopathological data were analyzed by logistic regression analysis. Results: (1) Complications of operation: the incidence of operative complications (including intraoperative and postoperative complications) in robot group was significantly lower than that in traditional laparoscopy group [(20.6%, 27/131) vs (34.8%, 101/290); χ(2)=8.620, P=0.003)]. The incidence of intraoperative complications in robot group was lower than that in traditional laparoscopy group [1.5% (2/131) vs 6.2% (18/290); χ(2)=4.368, P=0.037]. The incidence of intraoperative vascular injury in robot group was significantly lower than that in traditional laparoscopy group [0.8% (1/131) vs 5.2% (15/290); χ(2)=4.798, P=0.022]. The incidence of postoperative complications in robot group was also lower than that in traditional laparoscopy group [19.1% (25/131) vs 28.6% (83/290); χ(2)=4.303, P=0.038], but the incidence of postoperative lymphatic leakage in robot group was higher than that in traditional laparoscopy group [10.7% (14/131) vs 5.2% (15/290); χ(2)=4.279, P=0.039]. (2) Clavein-Dindo classification: the incidence of Clavein-Dindo Ⅰ, Ⅲ, Ⅲ, Ⅳ and Ⅴ grade between two groups were respectively 3.8% (5/131) vs 11.0% (32/290), 13.7% (18/131) vs 14.5% (42/290), 3.1% (4/131) vs 8.6% (25/290), 0 (0/131) vs 0.3% (1/290), 0 (0/131) vs 0.3% (1/290), and the incidence of grade Ⅰ (χ(2)=5.684, P=0.015) and Ⅲ (χ(2)=4.361, P=0.037) complications were statistically significant. The incidence of severe complications in robot group (grade Ⅲ and above) was lower than that in traditional laparoscopy group [3.1% (4/131) vs 9.3% (27/290); χ(2)=5.179, P=0.023]. (3) Analysis of influencing factors of surgical complications: univariate analysis showed that BMI (χ(2)=15.801, P=0.000), preoperative anemia (χ(2)=14.299, P=0.000), total number of lymph node resection (χ(2)=10.425, P=0.001), surgical methods (χ(2)=8.620, P=0.003) were related to the occurrence of surgical complications of endometrial carcinoma. Multivariate analysis showed that BMI (OR=0.289, 95%CI: 0.097-0.864, P=0.026), preoperative anemia (OR=0.309, 95%CI: 0.129-0.740, P=0.008), the total number of lymph node resection (OR=0.624, 95%CI: 0.403-0.966, P=0.034) and surgical methods (OR=3.491, 95%CI: 1.030-11.840, P=0.045) were independent risk factors for surgical complications of endometrial carcinoma. Conclusions: Compared with traditional laparoscopic surgery, robot-assisted laparoscopic surgery has fewer complications and lower incidence of severe complications. BMI, preoperative anemia, the total number of lymph node resection and surgical methods are independent risk factors for the occurrence of surgical complications of stage Ⅰ endometrial cancer.


Asunto(s)
Neoplasias Endometriales/cirugía , Laparoscopía , Escisión del Ganglio Linfático/métodos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios de Casos y Controles , China/epidemiología , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/patología , Femenino , Humanos , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 99(10): e19474, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150110

RESUMEN

The modified Blumgart method for pancreaticojejunostomy has been shown to reduce the rate of postoperative pancreatic fistula (POPF) in open surgery. We describe a modified Blumgart method using LAPRA-TY suture clips to facilitate laparoscopic pancreaticojejunostomy.We prepared a double-armed 4-0 nonabsorbable monofilament, which was ligated using the LAPRA-TY clip at the tail end, 12-cm in length. Next, the U-suture was placed through the pancreatic stump and the seromuscular layer of the jejunum. We performed duct-to-mucosa suturing with a 5-0 absorbable monofilament. After completing the duct-to-mucosa suturing, as a final step we placed the sutures through the seromuscular layer of the jejunum on the ventral side and tightly secured the thread with the LAPRA-TY clips. We performed laparoscopic Blumgart pancreaticojejunostomy during pancreaticoduodenectomy in 39 patients. We compared the surgical outcomes of 19 patients who underwent Blumgart pancreaticojejunostomy using the LAPRA-TY clips (LAPRA-TY group) with 20 patients undergoing surgery not using the LAPRA-TY clips (conventional group).The rate of clinically relevant postoperative pancreatic fistula in the LAPRA-TY group was 21.1%, which did not differ significantly from the rate of the conventional group. However, the mean time of pancreaticojejunostomy in the LAPRA-TY group was 56.2 min (range, 39-79 min), which was significantly shorter than that of the conventional group (69.7 min; range, 53-105 min, P < .001).Although the modified Blumgart pancreaticojejunostomy using LAPRA-TY suture clips did not improve the pancreatic fistula rate, it allowed for shorter operative times. Thus, this procedure lends itself to positive surgical and patient outcomes.


Asunto(s)
Anastomosis Quirúrgica/instrumentación , Laparoscopía/instrumentación , Fístula Pancreática/cirugía , Pancreatoyeyunostomía/instrumentación , Instrumentos Quirúrgicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreaticoduodenectomía , Complicaciones Posoperatorias , Técnicas de Sutura , Resultado del Tratamiento
6.
Chirurgia (Bucur) ; 115(1): 80-88, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32155402

RESUMEN

Adrenalectomy is nowadays a procedure routinely performed by minimally invasive surgery. In this article we aim to describe in depth our technique for laparoscopic and robotic left and right adrenalectomies, by using four cases and discussing the advantages and disadvantages of each technique.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Laparoscopía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias de las Glándulas Suprarrenales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento
8.
Zhonghua Wai Ke Za Zhi ; 58(3): 183-188, 2020 Mar 01.
Artículo en Chino | MEDLINE | ID: mdl-32187922

RESUMEN

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Hipertensión Portal/cirugía , Cirrosis Hepática/cirugía , China , Humanos , Laparoscopía , Esplenectomía
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 208-211, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192295

RESUMEN

Pneumonia caused by 2019-nCoV infection has been reported in Wuhan since December 2019, and spread rapidly across the country. The radical operation of colorectal cancer is semi-elective operation. Patients with colorectal cancer should receive operation as soon as possible after elective operation is resumed in each hospital. 2019-nCoV virus can be transmitted by asymptomatic infectors, and it has been confirmed to be transmitted by droplets and contact. However, fecal-oral transmission and aerosol transmission have not been excluded. Based on our experience with laparoscopic colorectal operation, we propose some surgery strategies for colorectal cancer patients under the corona virus disease 2019(COVID-19) situation: the screening process should be strictly carried out before surgery to reduce the risk of nosocomial infection in the later stage; laparoscopic-assisted surgery is recommended for radical surgery for patients with colorectal cancer; strict aerosol management must be made during the operation; natural orifice specimen extraction surgery and transanal total mesorectal excision are should be performed prudently; scientific and reasonable prophylactic stoma should be done; personnel protection in surgical ward and operation room must be strengthened.


Asunto(s)
Neoplasias Colorrectales , Cirugía Colorrectal , Infecciones por Coronavirus/complicaciones , Laparoscopía , Neumonía Viral/complicaciones , China , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/cirugía , Brotes de Enfermedades , Humanos
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 289-293, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192309

RESUMEN

Objective: To compared the short-term surgical outcomes of the vertical supraumbilical incision with the left lower oblique incision for specimen retrieval in laparoscopic resection for rectal cancer. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) rectal cancer confirmed by colonoscopy and pathological examination; (2) undergoing the operation for the first time; (3) laparoscopic rectal surgery performed by the same surgeon team; (4) age of > 18 years and < 76 years old. According to above criteria, clinical data of 178 consecutive patients scheduled for laparoscopic surgery for rectal cancer at Department of Gastrointestinal Surgery of Renji Hospital between March 2015 and December 2017 were collected. Based on incision site of the mini-laparotomy, patients were classified to the vertical supraumbilical incision group (n=75) and the left lower oblique incision group (n=103). There were no significant differences in baseline data, such as age, gender, body mass index (BMI), tumor diameter, preoperative carcinoembryonic antigen (CEA) level, score of American Society of Anesthesiologists, TNM stage, between the two groups (all P>0.05). Perioperative variables and follow-up data were compared between two groups. Results: Between the vertical supraumbilical incision group and the left lower oblique incision group, the operation time [(131.7±3.7) minutes vs. (138.5±3.5) minutes], operative bleeding volume [(138.9±11.5) ml vs. (154.3±10.3) ml], length of auxiliary incision [(4.0±0.1) cm vs. (4.0±0.1) cm], and distance from anastomosis to dentate line [(3.8±0.1) cm vs. (4.2±0.1) cm] were not significantly different (all P>0.05). As compared to the left lower oblique incision group, patients in vertical supraumbilical incision group had earlier flatus [(62.7±2.3) hours vs. (69.2±1.7) hours, t=2.282, P=0.023], earlier ambulation [(41.9±1.8) hours vs. (46.78±1.42) hours, t=2.131, P=0.032], lower pain VAS scores at postoperative 24 hours (2.0±0.1 vs. 2.4±0.1, t=2.172, P=0.032) and 48 hours (2.7±0.1 vs. 3.0±0.1, P<0.05), and lower incidence of postoperative incisional hernia [6.7% (5/75) vs. 9.7% (10/103), χ(2)=3.942, P=0.042]. However, the postoperative fluids intake time, hospitalization days, pain VAS scores at postoperative 12 hours and postoperative complications (wound infection, anastomotic leakage, urinary retention, intestinal obstruction) were not significantly different between the two groups (all P>0.05). Conclusion: The vertical supraumbilical incision in laparoscopic resection for rectal cancer can reduce the degree of postoperative pain, facilitate early recovery of intestinal function and decrease the incidence of incisional hernia.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Herida Quirúrgica , Humanos , Tempo Operativo , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(3): 294-299, 2020 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-32192310

RESUMEN

Objective: To assess the anatomic relationship of inferior mesenteric artery (IMA)/inferior mesenteric vein (IMV) with ureter by contrast-enhanced abdominal pelvic CT, in order to provide guidance for vascular management and ureteral protection in laparoscopic rectal surgery. Methods: A retrospective cohort study was conducted. Image data of contrast-enhanced abdominal pelvic CT at Department of Medical Radiography of Peking University First Hospital in November 2018 were enrolled. Exclusion criteria: (1) previous history of abdominal or pelvic surgery; (2) scoliosis deformities; (3) missing images; (4) minors; (5) inferior mesenteric vascular disease or tumor involvement resulting in suboptimal imaging; (6) poor image quality. Finally, contrast-enhanced abdominal pelvic CT data of 249 cases were collected, including 120 males and 129 females with mean age of (60.1±13.4) years. Multi-planar reconstruction (MPR) and maximum intensity projection (MIP) were used to evaluate the anatomic relationship of IMA/IMV with ureter. IMA root location, IMA length, branch types of IMA, distance between major branches, distance between IMA/IMV and ureter at the level of root of IMA, left colic artery (LCA) root, abdominal aortic bifurcation, and sacral promontory were measured and association between IMA/IMV and ureter site was summarized. Results: The distance from IMA root to the aortic bifurcation and sacral promontory was (42.0±8.5) mm and (101.8±14.0) mm, respectively. The length of IMA was (38.5±10.7) mm. The proportion of IMA roots locating at levels of the 2nd, 3rd, and 4th lumbar vertebra was 3.2% (8/249), 79.5% (198/249), and 17.3% (43/249), respectively. The higher the level of the lumbar vertebra, the longer the IMA [length of IMA originating from the 2nd, 3rd, 4th lumbar vertebra level: (42.4±10.9) mm, (39.5±10.4) mm, (33.0±10.9) mm, respectively; F=7.48, P<0.001]. In 111 cases (44.6%), LCA arose independently from IMA (type 1), and the distance between LCA and the first branch of sigmoid artery (SA) was (15.0±7.4) mm; in 56 cases (22.5%), LCA and SA had a common trunk (type 2), with a length of (11.0±8.5) mm; in 78 cases (31.3%), LCA branched with SA at the same point (type 3); LCA was absent in 4 cases (1.6%)(type 4). The length of IMA in LCA-deficient type 4 was (54.8±18.0) mm, which was longer than (38.2±10.5) mm in LCA-presence type (type 1, type 2 and type 3) and the difference was statistically significant (t=-3.11, P=0.002). The distance between the ureter and IMA was the longest at the level of IMA root [(35.7±8.1) mm], was the shortest at the level of the aortic bifurcation [(22.4±6.4) mm], and the distance between the ureter and IMA in different planes was significantly different (F=185.70, P<0.001). The distance between the ureter and IMV was the longest at the level of the sacral promontory [(21.1±9.0) mm], was the shortest at the level of LCA root [(12.0±5.7) mm], whose difference was also statistically significant (F=87.66, P<0.001). Conclusions: CT post-processing techniques including MPR and MIP can efficiently and accurately assess the branch types of IMA and anatomical relationship between IMA/IMV and ureter, and provide insights into laparoscopic rectal surgery for surgeons. IMA/IMV and ureter depart farthest at the level of IMA root. Artery first and plane second strategy in the middle approach of laparoscopic rectal surgery is considerable and feasible.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Uréter , Anciano , Femenino , Humanos , Masculino , Arteria Mesentérica Inferior , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Uréter/cirugía
14.
Magy Seb ; 73(1): 23-28, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32172577

RESUMEN

Introduction: In 2009, Hohenberger translated the concept of total mesorectal excision to colon cancer surgery and he named it complete mesocolic excision (CME). The principle of CME is based on wide mesenteric excision in the embriologic plane to remove mesenteric lymph nodes, central vascular ligation without damage of the peritoneal layer. CME can be performed by laparoscopic and open methods. Aim: To make sure that we are capable of performing right laparoscopic hemicolectomy with similar results to the open method. Results: A cohort of 156 consecutive patients were operated on with malignant right-sided colon tumours from 01.09.2016 to 30.06.2019. 143 curative resections were performed in 63 men and 80 women. The average age of men and women were 71.5 and 72.75 years, respectively. 84 laparoscopic and 59 open operations were performed. 84 patients underwent CME surgery and 56 conventional resections. The average length of the specimen was 22.34 cm in the conventional and 24.97 cm in CME surgery (p = 0.18) and the average lymph node number were 15.4 and 16.9, respectively (p = 0.24). The average duration of the operation was 111 minutes for the conventional and 136 minutes for the CME group (p = 0.0014), while the average length of stay were 7.47 days and 5.65 days (p = 0.0004) respectively for the cases without complications. Conclusion: We are yet in the learning period, but based on the early results, it might be concluded that the operation can be performed by laparoscopic methods as well with similar results to the open operation but with shorter length of stay.


Asunto(s)
Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Mesocolon/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Neoplasias del Colon/patología , Femenino , Humanos , Ligadura , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
15.
Magy Seb ; 73(1): 29-36, 2020 Mar.
Artículo en Húngaro | MEDLINE | ID: mdl-32172578

RESUMEN

Introduction: The raison d'etre of laparoscopic surgery of colonic tumours is supported by many I/a level evidence. There are a lot of excellent early and late results regarding sigmoid and upper third rectum tumours in favour of laparoscopic surgery. There are not many literature proposals like this regarding chemo-irradiated tumours. Material and method: One hundred ninety-six patients received neoadjuvant treatment due to lower and middle third rectum tumours in the Borsod-Abaúj-Zemplén County Hospital between the 1st of January 2006 and the 31st of December 2011. Twelve patients out the 196 were not followed up, so we analysed 184 patients' data. We performed laparoscopic surgery on 67 patients. Conversion happened on 15 patients out of the 67 cases. Open surgery was performed on 117 patients. We strived for the ligation of the inferior mesenteric artery at the origin, the sparing of the autonomic nerves and the precise implementation of TME. The splenic flexure has been taken down during the operations that involved resection. Results: The Dukes stages as well as the, ASA stages were similar in both groups. There was no significant difference in the patients' BMI either. The length of the removed specimens and the tumour size were similar too. The defining factors of recurrence are the involvement of the circumferential resection margin (CRM) and the complete execution of the TME. These were appropriate in our laparoscopic cases, and we did not find a significant difference in between the groups (Chi-square test, p = 0.94). The operation time was similar in the laparoscopic, converted and open surgeries, and there was no significant difference either. The shortest postoperative care time was in the laparoscopic group, but the Mann-Whitney test did not reveal a significant difference. Similarly to literature data, we experienced much less wound-related complications like infections and fever in the laparoscopic group. There was a significant difference in terms of transfusion demand comparing the laparoscopic and open operation groups, to the detriment of the open surgery group (Chi-square test, p = 0.04). We did not find a significant difference in recurrence or survival during follow-up of the patients. Conclusion: In addition to the short-term advantages of laparoscopic surgery, it is a safe procedure for the chemo-irradiated rectum tumours even from an oncological point of view. Both open and laparoscopic surgery requires high-level competency and qualification and these must be performed in centres.


Asunto(s)
Quimioradioterapia/métodos , Laparoscopía/métodos , Neoplasias del Recto/cirugía , Recto/cirugía , Procedimientos Quirúrgicos Electivos , Humanos , Ligadura , Escisión del Ganglio Linfático/métodos , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia , Neoplasias del Recto/patología , Resultado del Tratamiento
16.
Surg Clin North Am ; 100(2): 249-264, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169179

RESUMEN

Robotic-assisted surgery for benign esophageal disease is described for treatment of achalasia, gastroesophageal reflux, paraesophageal hernias, epiphrenic diverticula, and benign esophageal masses. Robotic Heller myotomy has operative times, relief of dysphagia, and conversion rates comparable to laparoscopic approach, with lower incidence of intraoperative esophageal perforation. The use of robotic platform for primary antireflux surgery is under evaluation, due to prolonged operative time and increased operative costs, with no differences in postoperative outcomes or hospital stay. Studies have shown benefits of robotic surgery in complex reoperative foregut surgery with respect to decreased conversion rates, lower readmission rates, and improved functional outcomes.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enfermedades del Esófago/cirugía , Esofagectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Fundoplicación/métodos , Hernia Hiatal/cirugía , Humanos , Laparoscopía/métodos
17.
Surg Clin North Am ; 100(2): 265-281, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169180

RESUMEN

Robotic surgery has rapidly evolved. It is particularly attractive as an alternative minimally invasive approach in liver surgery because of improvements in visualization and articulated instruments. Limitations include increased operative times and lack of tactile feedback, but these have not been shown in studies. Considerations unique to robotic surgery, including safety protocols, must be put in place and be reviewed at the beginning of every procedure to ensure safety in the event of an emergent conversion. Despite the lack of early adoption by many hepatobiliary surgeons, robotic liver surgery continues to evolve and find its place within hepatobiliary surgery.


Asunto(s)
Hepatectomía/métodos , Hepatopatías/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Laparoscopía/métodos
18.
Surg Clin North Am ; 100(2): 303-336, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169182

RESUMEN

Robotic surgery is flourishing worldwide. Pancreatic cancer is the fourth leading cause of cancer death in the United States. Most pancreatic operations are undertaken for the management of pancreatic adenocarcinoma. Therefore, it is essential for all physicians caring for patients with cancer to understand the role and importance of molecular tumor markers. This article details our technique and application of the robotic platform to robotic pancreatectomy. The use of the robot does not change the nature of pancreatic operations, but it is our belief that it will improve patient outcomes and, possibly, survival by reducing perioperative complications.


Asunto(s)
Pancreatectomía/métodos , Enfermedades Pancreáticas/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Yeyunostomía/métodos , Laparoscopía/métodos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/métodos
19.
Surg Clin North Am ; 100(2): 337-360, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169183

RESUMEN

The role of robotics in colon and rectal surgery has been established as an important and effective tool for the surgeon. Its inherent technologies have provided for increased visualization and ease of dissection in the minimally invasive approach to surgery. The value of the robot is apparent in the more challenging aspects of colon and rectal procedures, including the intracorporeal anastomosis for right colectomies and the low pelvic dissection for benign and malignant diseases.


Asunto(s)
Enfermedades del Colon/cirugía , Cirugía Colorrectal/métodos , Enfermedades del Recto/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Colectomía/métodos , Humanos , Laparoscopía/métodos
20.
Surg Clin North Am ; 100(2): 361-378, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32169184

RESUMEN

Urologists have always been leaders in advancing surgical technology and were the first to utilize modern robotic surgery for robotic-assisted laparoscopic radical proctectomy. Surgeon ergonomics, instrument precision, operative time, and postoperative recovery were all objectively improved. In urology, robotic surgery is now used for all intra-abdominal, retroperitoneal, and pelvic procedures and has been expanded to renal transplants and pediatric use. Modern robotic surgery has become an essential part of treating complex urologic disease in the developed world. Urologists continue to lead the way with the latest robotic surgical systems, including the newly approved single port systems.


Asunto(s)
Procedimientos Quirúrgicos Robotizados/métodos , Enfermedades Urológicas/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Cistectomía/métodos , Humanos , Laparoscopía/métodos , Nefrectomía/métodos , Prostatectomía/métodos
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