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1.
Surg Clin North Am ; 100(2): 283-302, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169181

RESUMO

Robotic cholecystectomy is safe and feasible approach and can be combined with common bile duct exploration to address complicated pathology in a single setting. This article summarizes reported outcomes after robotic biliary surgery. A technical overview of robotic multiport and single port cholecystectomy is provided. Last, the approach to benign bile duct disease during robotic cholecystectomy, including reconstruction of the biliary tree, is described.


Assuntos
Doenças Biliares/cirurgia , Colecistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Colecistectomia Laparoscópica , Corantes , Humanos , Verde de Indocianina
2.
Medicine (Baltimore) ; 99(8): e19116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080085

RESUMO

INTRODUCTION: Transitional drainage, which is followed by cholecystectomy plays a key role in the management of acute cholecystitis, especially in high-risk surgical patients. Endoscopic naso-gallbladder drainage (ENGBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients who need temporary drainage. There is a lack of prospective comparison on the relevant outcomes of the two drainage methods during the period of drainage, especially the subsequent cholecystectomy. METHODS: This is a randomized controlled two-arm non-blind single center trial. Patients with acute cholecystitis undergo emergent or early cholecystectomy and need drainage will be randomly assigned to group PTGBD or ENGBD. Pain score is defined as the primary endpoint, whereas several secondary endpoints, such as the rates of technical success, clinical remission, open conversion of cholecystectomy will be determined to elucidate more detailed differences between two groups. The general feasibility, safety, and quality checks required for high-quality evidence will be adhered to. DISCUSSION: This study would provide the first type A evidence concerning the comparison of ENGBD versus PTGBD in surgically high-risk patients with acute cholecystitis, it will be the first trial designed to determine the impact of two drainage methods on not only peri-drainage but also peri-LC. TRIAL REGISTRATION: NCT03701464. Registered on October 10, 2018.


Assuntos
Colecistectomia/métodos , Colecistite Aguda/cirurgia , Endoscopia/métodos , Vesícula Biliar/cirurgia , Adulto , Idoso , Colecistite Aguda/microbiologia , Colecistite Aguda/patologia , Colecistostomia/métodos , Drenagem/métodos , Estudos de Viabilidade , Feminino , Vesícula Biliar/microbiologia , Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Estudos Prospectivos , Indução de Remissão/métodos , Resultado do Tratamento
3.
Pan Afr Med J ; 34: 45, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762912

RESUMO

Hemocholecyst is defined as a hemorrhage into the gallbladder. It is a rare complication of anticoagulant therapies which can progress to spontaneous rupture of the gallbladder with hemorrhagic shock. We report the case of a 75-year old hypertensive, dyslipidemic man with hypertensive heart disease initially hospitalized for left hemiplegia. The patient received antiplatelet and anticoagulant therapy with low molecular weight heparin (LMWH) as prevention strategy. After 5 days of treatment the patient developed hemocholecyst and hemoperitoneum, confirmed by angio-abdominal computerized tomography scan in emergency assessment. The patient underwent cholecystectomy, hemostasis of the gallbladder fossa and evacuation of the hemoperitoneum.


Assuntos
Anticoagulantes/efeitos adversos , Colecistectomia/métodos , Doenças da Vesícula Biliar/diagnóstico por imagem , Hemoperitônio/diagnóstico por imagem , Idoso , Anticoagulantes/administração & dosagem , Doenças da Vesícula Biliar/induzido quimicamente , Doenças da Vesícula Biliar/terapia , Hemoperitônio/induzido quimicamente , Hemoperitônio/terapia , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Ruptura Espontânea , Tomografia Computadorizada por Raios X
4.
Chin Clin Oncol ; 8(4): 34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431033

RESUMO

High-grade dysplasia (HGD) of the gallbladder has been proven to be an intermediate step in the pathogenesis from normal mucosa to invasive carcinoma. There is paucity of definitive data concerning the associated risk and optimal management of isolated HGD of the gallbladder involving the cystic duct margin following cholecystectomy. A previously healthy 44-year-old man underwent laparoscopic cholecystectomy for suspected symptomatic gallstones. The gross examination of the gallbladder did not show any discrete masses or lesions, and histopathologic evaluation revealed several proximal foci of HGD with involvement of the cystic duct margin. Subsequent magnetic resonance cholangiopancreatography (MRCP) showed central intra-hepatic ductal dilation, likely post-operative, with no evidence of malignancy. Patient underwent additional surgical exploration with laparoscopic excision of the cystic duct stump and intra-operative cholangiogram. The additionally resected stump showed mild chronic inflammation and reparative fibrosis without dysplasia. A follow-up MRCP two years later showed regression of the previously described dilation and no new lesions were detected. The patient remains disease-free until the present date. Isolated HGD of the gallbladder is an uncommon occurrence but can rarely involve the cystic duct margin. These patients are to be thoroughly investigated for associated carcinoma in other parts of the gallbladder. Additional studies are needed to better understand the long-term risk associated with premalignant lesions of the gallbladder to achieve optimal care and outcome for these patients.


Assuntos
Colecistectomia/métodos , Ducto Cístico/patologia , Vesícula Biliar/patologia , Adulto , Humanos , Masculino
5.
Am Surg ; 85(7): 761-763, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405424

RESUMO

The operative experience of present-day surgical residency training has evolved as a result of the contributions of laparoscopic surgery. Some traditional open procedures are now more descriptive and less of a familiarity to many general surgery residents (GSRs). The aim of this study was to investigate how open operative experience compares with laparoscopy for GSRs. A retrospective, multicenter, consecutive cohort study of all patients undergoing surgical intervention involving the appendix and gallbladder identified from the ACS-NSQIP database over a 2.5-year period. All GSR postgraduate year-level operative experience was recorded. Of 777 procedures, 13 laparoscopic appendectomy conversions to open (4.3%) by Rocky-Davis (15%) or lower midline (84.6%) incisions were performed versus 285 that remained laparoscopic (95.6%). Fifty (10.4%) open cholecystectomies (38 open + 10 conversions + 2 common bile duct (CBD) exploration), 27 (5.6%) laparoscopic cholecystectomies with cholangiogram, and 402 (83.9%) laparoscopic cholecystectomies were performed. Twenty-nine different GSRs participated in procedures. Eighty-five (10.9%) operations were performed with multi-postgraduate year levels. Surgical residents have an unequal operative experience for case-specific open procedures. A competency-based system to demonstrate a resident's hands-on surgical skills is fundamental to residency training and should be considered for specific types of low-volume open surgical cases.


Assuntos
Apendicectomia/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistectomia/métodos , Laparoscopia/educação , Colecistectomia Laparoscópica/educação , Competência Clínica , Humanos , Internato e Residência/estatística & dados numéricos , Estudos Retrospectivos
6.
World J Surg ; 43(10): 2561-2570, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31286186

RESUMO

BACKGROUND: The 2016 Dutch national guidelines on handling of a removed gallbladder for cholelithiasis proposes a selective histopathologic policy (Sel-HP) rather than routine policy (Rout-HP). The aim of this study was to determine the current implementation of the present guideline and the daily practice of Sel-HP. METHODS: Surgeons who were engaged in gallbladder surgery in the Netherlands and were involved in local hospitals' gallbladder protocols completed a questionnaire study regarding gallbladder policy, between December 2017 and May 2018. Data were analyzed using standard statistics. RESULTS: A 100% response rate was obtained (n = 74). Approximately 64% of all gallbladders (n = 22,500) were examined microscopically. Sixty-nine (93.2%) hospitals confirmed they were aware of the new guidelines, and 56 (75.7%) knew the guideline was adjusted in favor of Sel-HP. Half of the hospitals (n = 35, 47.3%) had adopted a Sel-HP, and 39 (52.7%) a Rout-HP. Of the 39 hospitals who had a Rout-HP, 36 were open to a transition to a Sel-HP although some expressed the need for more evidence on safety or novel guidelines. CONCLUSIONS: The current implementation of the 2016 Dutch guideline advising a selective microscopic analysis of removed gallbladders for gallstone disease is suboptimal. Evidence demonstrating safety and cost-effectiveness of an on demand histopathological examination will aid in the implementation process.


Assuntos
Colecistectomia/métodos , Colelitíase/cirurgia , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Países Baixos , Guias de Prática Clínica como Assunto
7.
J Surg Res ; 244: 278-290, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302326

RESUMO

BACKGROUND: The advent of transvaginal natural orifice transluminal endoscopic surgery (transvaginal NOTES) aims to minimize surgical trauma and reduce recovery time. MATERIALS AND METHODS: Clinical trials comparing transvaginal NOTES and traditional laparoscopy were identified by searching EMBASE, MEDLINE, and Web of Science (from 2004 to March 2018). Major outcomes evaluated were risk of postoperative complications and secondary outcomes were pain on postoperative day (POD) 1, POD2, and POD3, time needed for full recovery, risk of intraoperative complications, the duration of surgery, and hospital stay. The results of the meta-analysis are presented as standardized mean difference (SMD) and risk difference (RD) with 95% confidence intervals (CIs). RESULTS: Thirteen trials with 1340 patients were identified. There were no statistical differences for risk of complications between transvaginal NOTES and traditional laparoscopy (intraoperative complications: RD -0.01, 95% CI -0.03 to 0.01; P = 0.37; postoperative complication: RD -0.02, 95% CI -0.05 to 0.01; P = 0.148). The pain score was lower in transvaginal NOTES on POD1 (SMD: -0.71, 95% CI: -1.30 to -0.11, P = 0.019), on POD2 (SMD -0.41, 95% CI -0.75 to -0.07; P = 0.018), and on POD3 (SMD -0.43, 95% CI -0.63 to -0.23; P < 0.001). Patients in transvaginal NOTES needed much shorter time to fully recover after surgery (SMD -1.36, 95% CI -1.84 to -0.87; P < 0.001). In addition, patients underwent transvaginal NOTES had less pain and shorter time of recovery. CONCLUSIONS: It is recommended that patients have cholecystectomy, adnexectomy, and appendectomy using transvaginal NOTES as it is safe and minimally invasive.


Assuntos
Complicações Intraoperatórias/epidemiologia , Laparoscopia/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Vagina , Apendicectomia/métodos , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Ensaios Clínicos como Assunto , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Cirurgia Endoscópica por Orifício Natural/métodos , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Salpingo-Ooforectomia/efeitos adversos , Salpingo-Ooforectomia/métodos , Índice de Gravidade de Doença , Fatores de Tempo
8.
Medicine (Baltimore) ; 98(30): e16010, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348226

RESUMO

INTRODUCTION: Nowadays laparoscopic cholecystectomy is considered as criterion standard for surgical treatment of acute calculous cholecystitis. During the last few years, there has been growing interest about the robotic approach. Several authors have reported the superiority of robotic cholecystectomy, associated with a lower percentage of conversion especially in patients with intraoperative diagnosis of acute or gangrenous cholecystitis. We report 3 case reports of moderate acute cholecystitis successfully treated by robotic cholecystectomy. PATIENT CONCERNS: Three patients presented moderate acute calculous cholecystitis with leukocytosis, fever, nausea, vomiting, and pain. DIAGNOSIS: Three patients of our study population had clinical and laboratory suspicion of moderate acute calculous cholecystitis verified by abdominal ultrasound examination, which found out cholelitiasis in all 3 cases. Final diagnosis was confirmed by intraoperative findings and histopathological examination, with two empyematous cholecystitis and one perforated cholecystitis. INTERVENTIONS: All patients underwent robotic cholecystectomy with the da Vinci Robotic Surgical System. The entire procedure required a mean operation time of 128 minutes and the average blood loss was 60 mL, without any intraoperative complications. OUTCOMES: In all 3 cases postoperative period was uneventfull. All the patients were discharged within 24 hours and no readmissions were reported during a 30 days' follow-up. CONCLUSIONS: Robotic cholecystectomy for ACC is feasible and safe. Several studies have demonstrated that robotic approach reduces the risk of conversion to open surgery in case of acute or gangrenous cholecystitis. Our results are in line with current literature. In fact, we have successfully treated 2 patients with empyematous acute cholecystitis and 1 with gangrenous cholecystitis with a totally robotic approach, without any complications or need of conversion to open surgery. In conclusion, our results confirm that it is the time to include robotic surgery in the emergency setting.


Assuntos
Colecistectomia/métodos , Colecistite Aguda/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia
9.
World J Gastroenterol ; 25(26): 3313-3333, 2019 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-31341358

RESUMO

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sistema Biliar/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colecistectomia/instrumentação , Duodenoscópios , Endossonografia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Derivação Gástrica/instrumentação , Derivação Gástrica/métodos , Humanos , Laparoscopia/instrumentação , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção
10.
Intern Med ; 58(19): 2809-2817, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243200

RESUMO

Pancreatobiliary maljunction (PBM) is a rare congenital malformation, often associated with adenocarcinoma. However, PBM accompanying gallbladder carcinosarcoma has rarely been reported. A 72-year-old woman was referred to our hospital, complaining of abdominal pain. Computed tomography showed a polypoid mass in the gallbladder. Endoscopic retrograde cholangiopancreatography showed PBM, and aspirated bile demonstrated elevated levels of pancreatic-type amylase (26,780 U/L) and cancer cells. Extended cholecystectomy was performed. Histologically, the tumor had adenocarcinoma, squamous cell carcinoma and sarcoma components. Despite the large tumor size (84 mm) and intra-vessel cancer permeations, this patient has been healthy for 73 months since the surgery.


Assuntos
Carcinossarcoma/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , /complicações , Idoso , Carcinossarcoma/complicações , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia/métodos , Feminino , Seguimentos , Neoplasias da Vesícula Biliar/complicações , Humanos , Laparotomia/métodos , Imagem por Ressonância Magnética , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ultrassonografia
11.
Anticancer Res ; 39(6): 2927-2933, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177131

RESUMO

BACKGROUND/AIM: The aim of this study was to assess the 3-year health status of cholecystectomy patients by the RAND-36 Survey. PATIENTS AND METHODS: Initially, 110 patients with symptomatic gallstone disease were randomized to undergo either minicholecystectomy (MC) (n=58) or laparoscopic cholecystectomy (LC) (n=52). RAND-36 survey was performed preoperatively, 4 weeks, 6 months and 3 years following surgery. RESULTS: RAND-36 scores improved in several RAND-36 domains in MC and LC groups with a similar postoperative course over the 3-year study period. In addition, at the 3-year follow-up telephone interview, no significant differences in patient-reported outcome measures between MC and LC patients were shown. The linear mixed effect model was used to test the overall significance of the RAND-36 survey during a 36-month follow-up period and the overall p-values were statistically significant in vitality, mental health (0.03), role physical and bodily pain domains. CONCLUSION: During the three years following cholecystectomy, four RAND-36 domains remained significantly higher, indicating a significant positive change in quality of life. RAND-36-Item Health Survey is a comprehensive test for analyzing long-term outcome and health status after cholecystectomy.


Assuntos
Colecistectomia/métodos , Cálculos Biliares/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Adulto , Idoso , Colecistectomia/psicologia , Feminino , Cálculos Biliares/psicologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Distribuição Aleatória , Resultado do Tratamento
12.
Medicina (Kaunas) ; 55(5)2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31100960

RESUMO

Background and objectives: Dipeptidyl-Peptidase 4 (DPP-4) is a protein expressed in numerous cells and tissues. Recently it has shown its involvement as a catalyst in the inflammatory response in various pulmonary, autoimmune, intestinal and other pathologies. The objective of this study was to compare the preoperative serum levels of DPP-4 in patients with and without surgical finding of perivesicular inflammation. Materials and methods: a cross-sectional analytical study nested in a prospective cohort, including patients scheduled for elective cholecystectomy, without surgical complications, that were 18-70 years of age, with low cardiovascular risk, without a history of peritonitis, pancreatitis, or jaundice and underwent ERCP protocol, type 2 diabetes mellitus, acute inflammatory (Protein C Reactive < 3 mg/L, leucocytes < 10 1000/mm3), neoplastic, nephrologic or liver disease, the use of anti-inflammatory drugs, steroids and/or antibiotics, the use of pacemakers or metallic implants and without major amputations and whom agreed to participate by providing their informed consent. Ethical and Research register: 45-16. Prior to surgery we compiled anthropometric data and a blood sample to determine the serum levels of DPP-4. The presence of perivesicular inflammation was determined in the surgery. The data was analyzed using the statistical program Rstudio. Results: High BMI values were observed (27.8 ± 6.4); waist circumference (94.7 ± 15.1) and percentage of fat mass (34.7 ± 11.7), showing a cumulative frequency of 65.9% for overweight/obesity. In 27.3% of the interventions, intraoperative perivesicular inflammation findings were reported. The serum levels of DPP-4 were lower in the group of patients with perivesicular inflammation (3947.6 ± 1659.5 vs. 3053.2 ± 1469.6, LC95% of the difference: 160.4-1628.3), being statistically significant (P = 0.018). Conclusions: In the subacute or chronic phases of cholecystitis, there appears to be a constant consumption of DPP-4, which would modulate a better immune response that could be related to the reduction of postoperative complications, so the use of Serum levels of DPP-4 as an early biomarker could improve the diagnostic accuracy of this pathology and the surgical approach.


Assuntos
Colecistectomia/métodos , Dipeptidil Peptidase 4/análise , Inflamação/sangue , Adolescente , Adulto , Idoso , Biomarcadores/análise , Biomarcadores/sangue , Colecistectomia/tendências , Doença Crônica , Estudos de Coortes , Estudos Transversais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Dipeptidil Peptidase 4/sangue , Feminino , Humanos , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Scott Med J ; 64(3): 112-115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31142212

RESUMO

INTRODUCTION: Duplication of gallbladder is a rare congenital condition. We describe a patient who underwent robotic cholecystectomy for duplicated gallbladder with symptomatic gallstones. CONCLUSION: Surgeons performing cholecystectomies must be aware of duplicated gallbladders and robotic cholecystectomy is a feasible option for such patients.


Assuntos
Colecistectomia/métodos , Vesícula Biliar/anormalidades , Vesícula Biliar/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Humanos , Masculino
15.
J Hepatobiliary Pancreat Sci ; 26(8): 348-353, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31125498

RESUMO

BACKGROUND: We examined the utility of transient hepatic attenuation differences (THADs) detected in the arterial phase of computed tomography for the diagnosis of acute gangrenous cholecystitis (AGC). METHODS: We examined 83 consecutive patients who underwent cholecystectomy within 72 h of undergoing three-phase dynamic computed tomography scans for acute cholecystitis between 2009 and 2018 (histopathological examination later confirmed 42 with AGC, 41 without). The THAD volume (cm3 ) was calculated by multiplying the total area of the enhancing lesions (traced on axial images) by the thickness of the scan (0.5-cm slices). We evaluated the sensitivity and specificity of the THAD volume and other computed tomography findings of AGC. RESULTS: The THAD volume was significantly larger in the AGC group than in the non-gangrenous acute cholecystitis group (P < 0.0001). The cutoff value of 78 cm3 , determined using a receiver operating characteristics curve, yielded a sensitivity of 88.1% and specificity of 75.6% for detecting AGC. Multivariate analysis revealed a THAD volume of >78 cm3 to be an independent predictor of AGC. CONCLUSIONS: Acute gangrenous cholecystitis can be diagnosed using THAD volume, resulting in improved treatment and fewer serious complications.


Assuntos
Colecistectomia/métodos , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/patologia , Meios de Contraste , Gangrena/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Fatores Etários , Idoso , Colecistite Aguda/cirurgia , Estudos de Coortes , Bases de Dados Factuais , Feminino , Gangrena/patologia , Gangrena/cirurgia , Hospitais Universitários , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento
16.
J Robot Surg ; 13(5): 643-647, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30953270

RESUMO

The objective of this article is to present our experience with the 3-mm instruments using the Senhance surgical robotic system in gynecological and abdominal surgery from July to December 2017 by a retrospective observational study. All patients who underwent a robot-assisted 3-mm laparoscopic procedure with the Senhance surgical robotic system were enrolled. Two separate populations were involved: nine female gynecological patients and five digestive surgery patients. Five cholecystectomies, three annexectomies, four ovarian cystectomies, one myomectomy and one endometriotic nodule resection were performed. For the gynecological cases, the median time spent at the console was 37 min (12-77), while the total duration of the intervention was 81.33 min. All the interventions were performed on an outpatient basis. There were no postoperative complications. The average visual analog scale for pain (VAS) was 2.11 (± 1.91) on D0. For the abdominal surgery cases, the median time was 39 min (21-64). The average total duration of the intervention was 87.4 min (± 36.82). One of the five interventions was performed on an outpatient basis. There was one laparoscopy conversion. No postoperative complications in the 2 weeks following the operation. There are few 3-mm instruments available with the Senhance surgical robotic system, which limits the number of interventions. However, it is possible to perform gynecological interventions with 3-mm instruments on an outpatient basis in complete safety. It is possible to perform cholecystectomies by pairing the use of 3-mm and 5-mm instruments. The recent arrival of new 3-mm instruments will enable a wider range of surgical indications.


Assuntos
Doenças do Sistema Digestório/cirurgia , Doenças dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Colecistectomia/instrumentação , Colecistectomia/métodos , Feminino , França , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Masculino , Estudos Observacionais como Assunto , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Segurança
17.
Medicine (Baltimore) ; 98(11): e14886, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882701

RESUMO

Clinical features and treatment of GB neuroendocrine carcinoma (GB-NEC) are not well understood. This study aimed to analyze clinical outcomes of GB-NEC and verify the oncologic benefit of surgical treatment.From October 1994 to December 2014, the medical records of 31 patients with GB-NEC at a single center were retrospectively reviewed. There were 18 inoperable cases due to distant metastasis, including 7 of best supportive care (Tx.1) and 11 of non-operative palliative treatment (Tx.2). 4 patients received non-curative, palliative resection (Tx.3). Only 9 patients were able to undergo curative-intent resection (Tx.4).Among the 31 patients with GB-NEC, preoperative mean value of carbohydrate antigen 19-9 (CA 19-9) was 74.8 ±â€Š156.1 U/mL and the median overall survival time was 10 months (range 7.0-12.0 months). Of these, 21 (67.7%) patients received systemic treatment. Among 9 patients who underwent curative-intent resection (Tx.4), 9 patients had poorly differentiated cancer cells and 7 patients received radical cholecystectomy. 6 patients had adjuvant treatment including concurrent chemoradiation therapy (CCRT) or chemotherapy alone. The recurrence rate was 88.9%. The median overall survival between 4 groups was as follows: 4.0 (3.0-18.0) months in Tx.1 (n = 7) versus 9.0 (3.0-21.0) months in Tx.2 (n = 11) versus 11.0 (3.0-15.0) months in Tx.3 (n = 4) versus 23.0 (8.0-34.0) months in Tx.4 (n = 9), respectively. Significant differences in median overall survival time existed between Tx.2 and Tx.4; 9 (3.0-21.0) months versus 23.0 (8.0-34.0) months (P = .017).Most GB-NECs show poor biologic behavior. Nonetheless, curative-intent resection could possibly promote longer survival than other treatment modalities for GB-NEC. Efforts to undergo curative resection through early detection and development of adjuvant treatment are needed.


Assuntos
Carcinoma Neuroendócrino/cirurgia , Vesícula Biliar/anormalidades , Adulto , Idoso , Distribuição de Qui-Quadrado , Colecistectomia/métodos , Feminino , Vesícula Biliar/fisiopatologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
18.
J Surg Res ; 240: 109-114, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30925411

RESUMO

BACKGROUND: Splenectomy is often required in the pediatric population as part of the treatment of hematologic disorders and can be performed laparoscopically or open. We evaluated the comparative effectiveness of laparoscopic (LS) and open (OS) splenectomies using the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) data set. METHODS: The NSQIP-P data set was used to identify children who underwent elective splenectomy between January 2012 and December 2016. Thirty-day outcomes between OS and LS, and LS alone and concurrent LS and cholecystectomy were compared using univariate and multivariate analysis. RESULTS: Most of the splenectomies (91%) were performed laparoscopically. There was no difference in overall complications between OS (n = 60) and LS (n = 613), although OS had a higher risk of perioperative transfusion (OR 3.19, 95% CI 1.52-6.69). LS was associated with a shorter median hospital length of stay (2 versus 4 d, P < 0.001) and similar mean operative times compared to OS (120 versus 133 min, P = 0.559). There was no difference in outcomes of children undergoing LS versus LS and concurrent cholecystectomy (n = 129). CONCLUSIONS: LS has become the standard approach for elective splenectomies in the pediatric population and has minimal morbidity, and when indicated, concurrent cholecystectomies do not increase the risk of complications. LEVELS OF EVIDENCE: III.


Assuntos
Procedimentos Cirúrgicos Eletivos/tendências , Doenças Hematológicas/cirurgia , Laparoscopia/tendências , Complicações Pós-Operatórias/epidemiologia , Esplenectomia/tendências , Adolescente , Criança , Pré-Escolar , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Conjuntos de Dados como Assunto , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Esplenectomia/métodos , Resultado do Tratamento
19.
World J Emerg Surg ; 14: 7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30820240

RESUMO

The difficult laparoscopic cholecystectomy remains a surgical challenge for surgeons who must decide between laparoscopic continuation and open conversion. The balance between the lack of open surgery training of young surgeons and the risk of maintaining the laparoscopic approach in difficult laparoscopic cholecystectomy is still an unresolved problem. Furthermore, the time that must be spent in an attempt to complete laparoscopic surgery before conversion is still controversial. The authors in this letter discuss about these and other questions that still require an answer.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistectomia/métodos , Conversão para Cirurgia Aberta/normas , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Humanos
20.
Indian Pediatr ; 56(5): 384-386, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30898989

RESUMO

OBJECTIVE: Aim of this study was to examine the changes in incidence of pediatric cholecystectomies. METHODS: Based on a review of hospital-records, children were divided into two groups regarding year of surgery (Group I: 1998-2007; Group II: 2008-2017) and their characteristics were compared. RESULTS: Number of cholecystecomies increased from 11 to 34. Median age increased from 11 to 15.5 years and mean BMI increased from 19.2 cm/m2 to 23.0 cm/m2. Hereditary spherocytosis decreased from 63.6% to 11.8% (P=0.001) of indications for cholecystectomy, while proportion of cholesterol stones increased from 27.3% to 70.6% (P=0.006). Frequency of laparoscopic cholecystectomy increased from 36.4% to 85.3% (P=0.001). Duration of hospital stay shortened from 8 to 4 days (P=0.008). CONCLUSIONS: Number of pediatric cholecystectomies has significantly increased in the last 20 years, as well as average BMI of the observed population This probably signifies a correlation between rising obesity rates and increase in frequency of symptomatic cholelithiasis in children.


Assuntos
Colecistectomia/tendências , Doenças da Vesícula Biliar/cirurgia , Adolescente , Criança , Colecistectomia/métodos , Colecistectomia Laparoscópica/tendências , Croácia/epidemiologia , Feminino , Doenças da Vesícula Biliar/epidemiologia , Doenças da Vesícula Biliar/etiologia , Humanos , Tempo de Internação/tendências , Masculino , Obesidade Pediátrica/complicações , Obesidade Pediátrica/epidemiologia , Estudos Retrospectivos , Fatores de Risco
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