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1.
Vasc Health Risk Manag ; 16: 497-505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33273819

RESUMO

Introduction: Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube's tissue perfusion and circulation. Patients and Methods: Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test. Results: A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%-28%) and 42% (range, 35%-52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks. Conclusion: Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Fluxometria por Laser-Doppler , Microcirculação , Monitorização Intraoperatória/métodos , Estômago/irrigação sanguínea , Estômago/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Análise Espectral , Resultado do Tratamento
2.
J Vis Exp ; (165)2020 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-33252113

RESUMO

The number of people who are overweight and obese is continually increasing both in the adult and adolescent populations. This coincides with the increased universal phenomenon of type 2 diabetes (T2D) and other metabolic problems. Bariatric surgery, such as SG, is currently one of the most effective and commonly used long-term treatment for obesity and T2D, but the association between them is not completely explored yet. The mechanisms underlying the outcomes seen after bariatric surgery in humans can be investigated based on preclinical animal studies. The SG reduces body weight, glucose levels and many metabolic parameters, and is easy to perform with a low incidence of complications. The goal of this work is to provide a simple method and an uncomplicated preclinical model of bariatric surgery in animals for researchers.


Assuntos
Gastrectomia/métodos , Instrumentos Cirúrgicos , Animais , Peso Corporal , Colesterol/sangue , Diabetes Mellitus Tipo 2/complicações , Teste de Tolerância a Glucose , Hemoglobina A Glicada/metabolismo , Resistência à Insulina , Masculino , Camundongos Endogâmicos C57BL , Estômago/cirurgia , Resultado do Tratamento
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(11): 1088-1096, 2020 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-33212558

RESUMO

Objective: It is yet to be clarified whether pylorus-preserving gastrectomy (PPG) for early gastric cancer will bring the risk of radical tumor resection, whether it will increase the incidence of postoperative complications, and how much is the benefit of the quality of life for patients after surgery, these issues are not clear. This meta-analysis aims to evaluate the efficacy and safety of pylorus-preserving gastrectomy (PPG) for early middle gastric cancer. Methods: The Chinese and English literatures about PPG and distal gastrectomy (DG) for early gastric cancer were searched from PubMed, Embase, The Cochrane Library, Web of Science, CNKI net and Wanfang database. Literature inclusion criteria: (1) Prospective or retrospective cohort study of PPG and DG for early middle-third gastric cancer published publicly; (2) Patients with early middle-third gastric cancer; (3) The enrolled literatures include at least one of the following outcome indicators: the efficacy indicators include gallstone, residual gastritis, bile reflux, delayed gastric emptying, dumping syndrome, reflux esophagitis and overall complication; the long-term prognostic indicators include 5-year survival rate and 5-year tumor recurrence. Literature exclusion criteria: (1) Reviews, case reports, conference summaries and other non-control studies; (2) Repeated published studies, incomplete studies and unextractable studies; (3) The depth of tumor invasion exceeding submucosa. The search time ended in July 2020. The basic information and evaluation indicators included in the article were extracted. The retrospective study was evaluated using Newcastle-Ottawa literature quality evaluation scale. The prospective randomized controlled study was evaluated using Jadad modified scale. Meta-analysis was performed using Review Manager 5.3. Publication bias was assessed using funnel map. Publication bias was tested using Egger tools. Results: A total of 717 literatures were retrieved, and 17 literatures were enrolled finally, including 2 randomized controlled trials and 15 retrospective studies. A total of 2427 patients were enrolled, including 948 in PPG group and 1479 in DG group. The meta-analysis of the efficacy indicators showed that there were significant differences in gallstones incidence (OR=0.42, 95% CI: 0.28-0.65, P<0.001), residual gastritis incidence (OR=0.50, 95% CI: 0.32-0.77,P=0.002), bile reflux incidence (OR=0.30, 95% CI: 0.20-0.45, P<0.001), delayed gastric emptying incidence (OR=2.40, 95% CI:1.67-3.45, P<0.001), and postoperative dumping syndrome incidence (OR=0.28, 95% CI: 0.15-0.51, P<0.001), while there were no significant differences in postoperative overall complications (OR=0.97, 95% CI: 0.69-1.35, P=0.840), reflux esophagitis incidence (OR=0.79, 95% CI: 0.39-1.61, P=0.520) between the two groups. The meta-analysis of the long-term prognostic indicators showed that no significant differences of 5-year survival (OR=1.02, 95% CI: 0.61-1.71, P=0.940) or 5-year tumor recurrence (OR=0.77, 95% CI: 0.36-1.68, P=0.520) were observed between the two groups. Conclusion: The incidences of gallstone, residual gastritis, dumping syndrome, bile reflux are lower after PPG in early gastric cancer, while the postoperative overall complications and long-term survival are comparable between PPG and DG, indicating that PPG is quite safe and feasible.


Assuntos
Gastrectomia/métodos , Neoplasias Gástricas , Gastrectomia/efeitos adversos , Gastrectomia/mortalidade , Humanos , Piloro/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estômago/patologia , Estômago/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
5.
PLoS One ; 15(11): e0240188, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206647

RESUMO

OBJECTIVES: Evaluation of intestinal perfusion remains subjective and depends on the surgeon´s individual experience. Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) fluorescence using a near-infrared camera system has been described in different ways and for different indications. The aim of the present study was to evaluate fluorescent imaging (FI) in the quantitative assessment of intestinal perfusion in a gastric tube model in pigs and to compare the results to results obtained with florescent microspheres (FM), the gold standard for tissue perfusion. METHODS: Seven pigs (56.0±3.0 kg), both males and females, underwent gastric tube formation after transection and ligation of the gastric arteries, except the right gastroepiploic artery, to avoid collateral blood flow. After baseline assessment (T0), hypotension (T1) was induced by propofol (Karampinis et al 2017) (< 60 mmHg). Then, propofol was paused to obtain normotension (T2, Mean arterial pressure (MAP) 60-90 mmHg). Finally, hypertension (T3, MAP>90 mmHg) was induced by norepinephrine. Measurements were performed in three regions of interest (ROIs) under standardized conditions: the fundus (D1), corpus (D2), and prepyloric area (D3). Hemodynamic parameters and transit-time flow measurement (TTFM) in the right gastroepiploic artery were continuously assessed. FI, FM and the partial pressure of tissue oxygen (TpO2) were quantified in each ROI. RESULTS: The study protocol could successfully be performed during stable hemodynamics. Flow in the gastroepiploic artery measured by transit time flow measurement (TTFM) was related to hemodynamic changes between the measurements, indicating improved blood flow with increasing MAP. The distal part of the gastric tube (D1) showed significantly (p<0.05) impaired perfusion compared to the proximal parts D3 and D2 using FM. ICG-FI also showed the highest values in D3 and the lowest values in D1 at all hemodynamic levels (T1-T3; p<0,05). CONCLUSION: Visual and quantitative assessment of gastric tube perfusion is feasible in an experimental setting using ICG-FI. This might be a promising tool for intraoperative assessment during visceral surgery in the future.


Assuntos
Verde de Indocianina/administração & dosagem , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Animais , Circulação Colateral , Estudos de Viabilidade , Feminino , Hemodinâmica , Masculino , Modelos Animais , Espectrometria de Fluorescência , Espectroscopia de Luz Próxima ao Infravermelho , Estômago/cirurgia , Suínos
6.
PLoS One ; 15(11): e0241828, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33152029

RESUMO

Anesthesia with desflurane and remifentanil can be maintained with either fixed or titrated desflurane concentration. We hypothesized that the fixed-gas concentration (FG) method would reduce the number of anesthetic titrations without hypnotic and hemodynamic instability compared to the bispectral index (BIS)-guided (BG) method. Forty-eight patients were randomly allocated to the FG or BG groups. In the FG group, desflurane vaporizer setting was fixed at 1 age-corrected minimum alveolar concentration (MAC). In the BG group, desflurane was titrated to target a BIS level at 50. Remifentanil was titrated to maintain a systolic arterial pressure (SAP) of 120 mmHg in both groups. Our primary endpoint was the hypnotic stability measured by the wobble of BIS in performance analysis, and the secondary endpoints included the wobble of SAP, mean BIS value during surgery, and the number of anesthetic titrations. The BIS in the FG group showed significantly less wobble (3.9 ± 1.1% vs 5.5 ± 1.5%, P <0.001) but lower value (33 ± 6 vs 46 ± 7, P <0.001) than BG group. The wobble of SAP showed no difference between groups [median (inter-quartile range), 5.0 (4.1-7.5)% vs 5.2 (4.2-8.3)%, P = 0.557]. The numbers of anesthetic titrations in the FG group were significantly lower than the BG group (0 ± 0 vs 8 ± 5, P<0.001 for desflurane, 13 ± 13 vs 22 ± 17, P = 0.047 for remifentanil). Less wobble in BIS and reduced anesthetic titration without hemodynamic instability during the FG technique may be practical in balanced anesthesia using desflurane and remifentanil anesthesia. Clinical trial: This study was registered at ClinicalTrials.gov (NCT02283866).


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Desflurano/administração & dosagem , Remifentanil/administração & dosagem , Estômago/cirurgia , Idoso , Período de Recuperação da Anestesia , Pressão Arterial/efeitos dos fármacos , Cálculos da Dosagem de Medicamento , Procedimentos Cirúrgicos Eletivos , Eletroencefalografia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 927-930, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33053985

RESUMO

Segmental gastrectomy is a common function preserving operation, and its combination with sentinel lymph node navigation technology shows a broad prospect in the treatment of early gastric cancer. Commonly anastomosis methods include the follows: (1) Hand-sewn anastomosis: this method is relatively simple, reduces the use of stapler, and can effectively reduce surgical cost. However, laparotomy or small-incision assisted laparoscopic surgery is required to accomplish anastomosis, so the surgical wound is relatively large. (2) Delta anastomosis: this anastomosis is entirely endoscopic, requiring no small incision with less surgical trauma. However, due to the presence of residual cavities in the small curvature of the side-to-side anastomosis, and the possibility of excessive incision of the posterior wall of the stomach, which may shorten the pyloric sleeve, there is an increased risk of gastric stasis after the operation. (3) Hybrid technique: this anastomosis method is safe and effective. However, it requires total endoscopic gastric anterior wall suture, which represents higher requirements for surgeons. Therefore, surgeons experienced in minimally invasive surgeries are recommended to perform this anastomosis. (4) Puncture technique: this anastomotic method is end-to-end anastomosis with low risk of gastric stasis, and is applicable for entirely endoscopic anastomosis. However, the stapler is not typically used for gastrointestinal surgery, which brings certain limitations to clinical promotion. These anastomoses have their own advantages and disadvantages, and their effects on gastric function are also controversial. In conclusion, the development of segmental gastrectomy is still in its infancy, and prospective multicenter randomized controlled trials are awaited to confirm the safety of oncology and standardize the techniques.


Assuntos
Laparoscopia , Neoplasias Gástricas , Estômago/cirurgia , Anastomose Cirúrgica , Gastrectomia , Humanos , Estudos Prospectivos , Neoplasias Gástricas/cirurgia
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 935-938, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33053987

RESUMO

Function-preserving gastrectomy, especially pylorus-preserving gastrectomy (PPG), can improve the quality of life and has been widely recognized. With the development of surgical techniques and equipment, nerve preservation has become a new requirement in the era of "precision medicine", but the preservation of celiac branch of the vagal nerve remains controversial in gastric cancer surgery. Current researches have shown that the preservation of celiac branch of the vagal nerve is safe and feasible in patients with early gastric cancer. Although controversial, nerve preservation may play a role in preventing gallstones, regulating gastric emptying, reducing dumping syndrome, alleviating chronic diarrhea, reducing gastroesophageal reflux, and inhibiting bile reflux. The significance of the celiac branch of the vagal nerve in gastric cancer surgery is worth further attention and exploration to promote the development of function-preserving gastrectomy and improve the quality of life of patients.


Assuntos
Gastrectomia/métodos , Qualidade de Vida , Neoplasias Gástricas , Nervo Vago/cirurgia , Humanos , Estômago/inervação , Estômago/cirurgia , Neoplasias Gástricas/cirurgia
9.
Khirurgiia (Mosk) ; (9): 5-13, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33029996

RESUMO

OBJECTIVE: To describe the methodology of laparothoracoscopic Ivor Lewis esophagectomy in surgical treatment of esophageal cancer and compare early outcomes of this procedure with conventional Ivor Lewis surgery. MATERIAL AND METHODS: There were 30 laparothoracoscopic Ivor Lewis esophagectomies followed by non-hardware esophageal-gastric intrapleural anastomosis for esophageal cancer. All procedures have been performed for the period 2016-2019 at the Moscow Regional Research and Clinical Institute (suturing of anastomosis was based on the method of professor A.S. Allakhverdyan). RESULTS: Laparothoracoscopic esophagectomy is characterized by higher surgery time by 136.57 min (p=0.012), less duration of anesthesia and mechanical ventilation by 77.5 min (p=0.042), postoperative ICU-stay by 2.25 hours (p=0.021), blood loss by 550 ml (p=0,000), duration of postoperative fasting by 2 days (p=0.034), hospital-stay by 8 days (p=0.021) compared to open esophagectomy. There were no significant between-group differences in the number of resected lymph nodes (p=0.142). Incidence of esophageal-gastric anastomosis failure is insignificantly higher in the OE group (χ2=1.89; p=0.075). Incidence of pulmonary complications (pneumonia, chylothorax, paresis of the vocal cords, pleural empyema) is less in the LTSE group (p<0.05). Cardiovascular morbidity is significantly lower in the LTSE group (p<0.05). A 30-day mortality rate was similar in both groups (χ2=2.56; p=0.0253). CONCLUSION: Early results of laparothoracoscopic Ivor Lewis esophagectomy are superior to the results of conventional Ivor Lewis surgery in surgical treatment of esophageal cancer.


Assuntos
Esofagectomia , Esôfago/cirurgia , Estômago , Anastomose Cirúrgica , Humanos , Moscou , Estudos Retrospectivos , Estômago/cirurgia
10.
Khirurgiia (Mosk) ; (9): 20-27, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33029998

RESUMO

OBJECTIVE: To develop original technologies that simplify and increase an effectiveness of stomach resection in case of «difficult¼ duodenal ulcers. MATERIAL AND METHODS: Healing of gastroduodenostomy was experimentally observed under tension of anastomosed segments. In the first group (12), gastric resection was performed in a volume of 2/3 without tension of the anastomosed sections using a two-row suture. In the second group (12), stomach resection was accompanied by modeling of tension of the anastomosed sections under a pressure equal to 2.5-3.6 N (245-350 g). In the third group (12), gastric resection was performed in the same fashion as in the second group, but gastroduodenostomy was sutured using a single-row everted seams and hypotraction serous-muscular sutures. The results of Billroth-I gastrectomy using traditional (n=86) (classic double-row Lambert-Albert suture) and developed technologies (n=112) were analyzed in patients with complicated gastric and duodenal ulcers. RESULTS: The obvious advantages of the developed technologies have been experimentally proved for gastric resection under tension of anastomosed sections. There was no inconsistency of gastroduodenostomy, whereas traditional two-row suture was followed by this complication in 58,3% of cases. A favorable course was based on the relatively low inhibition of tissue blood supply in regenerating structures that was manifested by significantly less redox potential. Reduced lipid peroxidation and phospholipase activity in tissue structures along the suture line was also recorded. We obtained the positive clinical results of this approach in patients with complicated course of duodenal ulcer. Billroth-I gastrectomy was performed in all patients. Gastroduodenostomy failure was absent. Overall postoperative morbidity was 6,3%. In case of double-row anastomosis, suture failure occurred in 9,3% of cases, incidence of complications - 57,0%. This procedure was performed for gastric ulcer as a rule. CONCLUSION: The developed technologies greatly simplify resection of stomach and duodenum in the most difficult atypical conditions and ensure physiological Billroth-I surgery. The obvious benefit of this technology is simplified resection per se that makes it accessible to novice surgeons.


Assuntos
Gastroenterostomia , Estômago/cirurgia , Úlcera Duodenal , Gastrectomia , Humanos , Suturas
12.
Sci Rep ; 10(1): 16305, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004919

RESUMO

Omentectomy is conducted for advanced gastric cancer (AGC) patients as radical surgery without an adequate discussion of the effect. This study was conducted to reveal the impact of omentum-preserving gastrectomy on postoperative outcomes. AGC patients with cT3 and 4 disease who underwent total or distal gastrectomy with R0 resection were identified retrospectively. They were divided into the omentum-preserved group (OPG) and the omentum-resected group (ORG) and matched with propensity score matching with multiple imputation for missing values. Three-year overall survival (OS) and 3-year relapse-free survival (RFS) were compared, and the first recurrence site and complications were analysed. The numbers of eligible patients were 94 in the OPG and 144 in the ORG, and after matching, the number was 73 in each group. No significant difference was found in the 3-year OS rate (OPG: 78.9 vs. ORG: 78.9, P = 0.54) or the 3-year RFS rate (OPG: 77.8 vs. ORG: 68.2, P = 0.24). The proportions of peritoneal carcinomatosis and peritoneal dissemination as the first recurrence site and the rate and severity of complications were similar in the two groups. Omentectomy is not required for radical gastrectomy for AGC.


Assuntos
Gastrectomia/métodos , Omento/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Gastrectomia/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estômago/cirurgia , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(40): e22534, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019459

RESUMO

RATIONALE: Foreign bodies are frequently ingested, but only approximately 1% of them cause perforation. Perforations in the lesser curvature of the stomach are exceedingly rare. Here, we report a case of gastric perforation in the lesser curvature caused by a foreign body. The patient presented to the clinic complaining of abdominal skin swelling and reddening with upper abdominal discomfort as the initial symptoms. PATIENT CONCERNS: An 83-year-old female presented with a mass in the middle of the epigastrium for 10 days. Physical examination found an apparent local tenderness and inflammatory mass in the upper abdominal wall. Her body temperature was normal (37.5°C) and the white blood cell count was elevated (8.12 × 10/L [reference value 3.5-9.5 × 10/L]). DIAGNOSES: The ultrasound examination of the abdomen revealed a 4 cm strip-like hyperechoic object entangled in the muscles of the abdominal wall. The computed tomography scan revealed a thin strip of bone-like hyperdense shadow. Intraoperative findings showed a sharp fishbone protruding from the lesser curvature of the stomach into the abdominal cavity, part of which remained in the gastric cavity. The postoperative pathological report revealed chronic suppurative inflammation with abscess and sinus canal formation. INTERVENTIONS & OUTCOMES: The patient underwent a gastric foreign body removal with partial gastrectomy. Anti-inflammatory treatment post-surgery rapidly relieved the patient's symptoms of discomfort in the upper abdomen. At the 1-month follow-up, the patient showed no discomfort in the upper abdomen and the inflammatory mass was no longer present. LESSONS: A foreign body had penetrated through the lesser curvature of the stomach, an area with a flat gastric wall, which occurs infrequently. In such cases, computed tomography is the gold standard for diagnosis of foreign bodies in the digestive tract. Ultrasound can also be used as a supplemental diagnostic technique. It is recommended that people who wear dentures should exercise caution while eating, especially when the food contains bones.


Assuntos
Parede Abdominal/patologia , Corpos Estranhos/cirurgia , Inflamação/etiologia , Pele/patologia , Estômago/cirurgia , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Osso e Ossos , Ingestão de Alimentos , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Alimentos Marinhos , Perfuração Espontânea , Estômago/microbiologia , Estômago/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
14.
Chirurgia (Bucur) ; 115(4): 520-525, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876026

RESUMO

We present the case of a 42-year-old woman diagnosed with a cystic pancreatic lesion, suggestive of a serous cystadenoma of 27/13 mm. The diagnosis was established by the examination of abdominal CT and eco-endoscopy. The patient was referred to the surgery department for treatment. The benign etiology suggested by imaging and the desire to preserve the spleen along with as much of the pancreatic parenchyma, indicated a laparoscopic central pancreatectomy with a anastomosis between the distal pancreatic stump and the stomach. The authors reviewed the national and international publications related to the indications of this minimally invasive surgery.


Assuntos
Cistadenoma Seroso/cirurgia , Pâncreas/cirurgia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Estômago/cirurgia , Adulto , Anastomose Cirúrgica , Cistadenoma Seroso/diagnóstico por imagem , Feminino , Humanos , Laparoscopia , Neoplasias Pancreáticas/diagnóstico por imagem , Resultado do Tratamento
16.
Updates Surg ; 72(4): 1279-1281, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32930976

RESUMO

A robotic approach with radical lymph node dissection for gastric cancers is a safe and effective surgical procedure. However, there are still only a few studies in the reconstruction procedure after gastrectomy and many aspects of the use of the robotic surgical system remain controversial. In Roux-en-Y reconstruction, most institutions are adapted for reconstruction using small laparotomy due to the complicated procedure. We, therefore, developed a new and easy procedure for full robotic Roux-en-Y reconstruction after robotic gastrectomy. We named this procedure "loop reconstruction technique". This article including video shows our loop reconstruction technique with an intracorporeal robot-sewn anastomosis after robotic gastrectomy.


Assuntos
Anastomose em-Y de Roux/métodos , Gastrectomia/métodos , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Humanos , Resultado do Tratamento
17.
Updates Surg ; 72(4): 1273-1277, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32856273

RESUMO

About 4% of patients with stomach cancer diagnosis have synchronous colorectal cancer and some of these patients may require a synchronous surgical resection. So far, only few minimally invasive series of synchronous resections have been described. We investigated the feasibility and safety of the synchronous robotic resection of the right colon and stomach malignancies, trying to identify a standardised and reproducible technique. It is essential to carefully plan the operation and the trocars positioning to minimise the number of robotic dockings and be able to operate comfortably. Herein, we describe our approach, which is safe and effective in terms of minimal invasiveness and oncological radicality. Robotic surgery could be used with even more advantage in complex multi-organ resections, providing the surgeon with a better vision, a more accurate dissection and longer instruments, to offer the patient all the benefits of a minimal invasive surgery.


Assuntos
Adenocarcinoma/cirurgia , Colectomia/métodos , Colo/cirurgia , Neoplasias Colorretais/cirurgia , Gastrectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 648-652, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683824

RESUMO

Different from classical surgical anatomy which only pays attention to the morphology and structure of human organs, modern membrane anatomy focuses on not only the relationship between morphology and structure, but also the biological behavior characteristics of tumors. Membrane antomy is a theoretical system with interpretation on both the structural and disease function, so it has been accepted by more and more gastrointestinal surgeons. However, the theoretical system of gastric membrane anatomy is not mature yet. The stomach and its mesentery have undergone complex rotation and fusion in the process of embryonic development, so that surgeons have different understandings of the gastric membrane anatomy. Therefore, it is easy to cause various confusion and misunderstanding, resulting in deviations between the theory of membrane anatomy and the practice of surgery. In the present study, the mesentery of the stomach is divided into different regions, and the embryonic development process is traced back. The application and compromise encountered in the radical gastrectomy of gastric cancer will be expounded according to the membrane anatomy theory combined with the author's experience of operation.


Assuntos
Gastrectomia/métodos , Mesentério/anatomia & histologia , Mesentério/cirurgia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Mesentério/embriologia , Mesentério/patologia , Estômago/anatomia & histologia , Estômago/embriologia , Estômago/patologia , Neoplasias Gástricas/patologia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 661-665, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683827

RESUMO

Membrane anatomy refers to the fascia and/or serosa enveloping the organs and their blood vessels and hanging on the posterior wall of the body cavity, which emphasizes the entirety and integrity of the membrane during operation. The concept can also be applied to most surgical operations. This article mainly expounds the application of the concept of membrane anatomy in the process of laparoscopic sleeve gastrectomy, which is embodied in the key steps of separating the greater omentum, mobilizing the fundus, mobilizing the posterior wall of the stomach, cutting the greater curvature of the stomach, reinforcing the staple line of the stomach, and suturing the greater omentum with staple line, in order to make the laparoscopic sleeve gastrectomy more accurate and precise with less bleeding, fewer complications and faster postoperative recovery.


Assuntos
Gastrectomia/métodos , Estômago/cirurgia , Fáscia/anatomia & histologia , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Omento/cirurgia , Peritônio/anatomia & histologia , Peritônio/cirurgia , Grampeamento Cirúrgico/métodos , Suturas
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 717-719, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683835

RESUMO

Uncut Roux-en-Y anastomosis is widely used in gastrointestinal reconstruction procedure after radical gastrectomy for distal gastric cancer. However, the proximal jejunal closure point recanalization of the input loop is an important complication of postoperative patients with prolonged time, resulting in pancreatic juice or bile reflux, which can lead to inflammatory lesions of the remnant stomach or esophagus. Poor selection of the location of the closure point during anastomosis causes a large amount of food deposited in the blind loop to be pushed and impacted, resulting in loosened threads or failed U-shaped staples, which may cause recanalization complications. Most scholars believe that the shortening of the jejunal tube closure point to the optimal position of 2 to 3 cm from the residual gastrojejunostomy can significantly reduce food retention, decrease the pressure of the closure point and the incidence of recanalization. At present, the application of new anastomotic techniques and materials such as four-row and six-row U-shaped staples and 7# wire ligation under laparoscopy can prevent the occurrence of recanalization of the closure point. Uncut Roux-en-Y anastomosis is safe and has few complications, and is expected to become one of the best ways of digestive tract reconstruction.


Assuntos
Anastomose em-Y de Roux/métodos , Gastrectomia/métodos , Derivação Gástrica/métodos , Jejuno/cirurgia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Anastomose em-Y de Roux/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Resultado do Tratamento
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