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1.
J Visc Surg ; 159(1): 21-30, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33349570

RESUMO

PURPOSE OF THE STUDY: To determine the statistical indicators aimed at identifying patients for whom ambulatory colectomy could be proposed without additional risk. PATIENTS AND METHODS: The medical charts of patients who benefited from scheduled colonic or rectal resection during conventional hospitalization stays between 2018 and 2019 were reviewed. Eligibility for ambulatory colectomy was defined by hospital stay≤4 days and absence of any postoperative complication. Patient characteristics were compared, and the results were modeled in the form of a decision-making tree. The effect of an enhanced recovery after surgery (ERAS) protocol for each sub-group was calculated. RESULTS: One hundred and ten (110) patients were selected (41 "eligible" and 69 "non-eligible"). Median age was 73 years (27-95). Nearly 80% of the patients were operated for cancer. In multivariate analysis, age (≥65 years, OR=3.15, CI95%=1.22-8.12), diabetes (OR=3.91, CI95%=1.03-14.8) and indication (sigmoidectomy for diverticulosis, OR=0.21, CI=95%=0.05-0.9) were the only identified independent variables. Likelihood for ambulatory eligibility was 83.3% (<65 years, sigmoidectomy pour diverticulosis, +ERAS=92%-96.9%), 58.3% (<65 years, other indication, +ERAS=63.4%-89.9%), 35.7% (≥65 years without diabetes, +ERAS=40.0%-55.9%) and 8.3% (≥65 years with diabetes, +ERAS=10.0%-20.1%). CONCLUSION: Sigmoidectomy for diverticulosis in a patient under 65 years age represents the best indication for ambulatory colectomy, a procedure that must not be proposed to diabetic patients over 65 years of age. In the other cases (<65 years operated in another indication and non-diabetic≥65 years), ambulatory surgery is possible, pending satisfactory application of the ERAS protocol.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Laparoscopia , Protectomia , Idoso , Colectomia/métodos , Colo/cirurgia , Humanos , Laparoscopia/métodos , Tempo de Internação , Complicações Pós-Operatórias/etiologia
2.
Comput Math Methods Med ; 2022: 9269695, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685898

RESUMO

This study was aimed at exploring the application value of magnetic resonance imaging (MRI) based on image enhancement algorithm in analyzing the placement of drainage tubes in the healing of incisions after hepatobiliary surgery. A total of 70 patients with liver cancer undergoing laparoscopic hepatobiliary surgery were selected, including 34 males and 36 females. According to the detection method of postoperative recovery, they were divided into a group A (conventional MRI detection) and a group B (MRI detection based on Retinex algorithm). Patients were divided into two groups according to whether subcutaneous drainage tubes were placed: group C (no subcutaneous drainage tubes were placed) and group D (subcutaneous drainage tubes were placed), with 35 patients in each group. The results showed that there was no significant difference between group A and group B in tumor residual or recurrence. The detection rate of tumor capsule in group B was significantly higher than that in group A (P < 0.05). The sensitivity, specificity, and accuracy of group A for the detection of recurrent lesions were 63.40%, 86.90%, and 78.60%, respectively; those in group B were 82.70%, 98.50%, and 93.20%, respectively. Therefore, the difference between the two groups was statistically significant (P < 0.05). The incidence of poor wound healing and infection in group C were significantly lower than those in group D (P < 0.05). Therefore, the effect of MRI detection based on image enhancement algorithm was more conducive to the evaluation of postoperative recovery due to the traditional MRI detection. In addition, the drainage tube was helpful to the postoperative wound healing and showed high clinical value.


Assuntos
Drenagem , Laparoscopia , Algoritmos , Feminino , Humanos , Aumento da Imagem , Imageamento por Ressonância Magnética , Masculino
3.
J Coll Physicians Surg Pak ; 32(6): 701-705, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35686399

RESUMO

OBJECTIVE: To evaluate the effect of antrectomy in which resection was started from 2 cm or closer to the pylorus on % excess weight loss (EWL), nausea, vomiting, and complication rates. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Antalya Training and Research Hospital, from April 2018 to December 2018. METHODOLOGY: Patients in whom laparoscopic sleeve gastrectomy (LSG)were done starting at a level of 2 cm or closer to pylorus were included in the study. Patients were divided into one of the two groups based on the distance between the pylorus and the resection margin: group 1 having resection ≤10 mm and group 2 at 11-20 mm. Above mentioned parameters were compared in both groups. RESULTS: Ninety-two patients were included. Postoperative nausea and vomiting rates were similar in both groups. At the end of the first year, % EWL was 82.9% and 73.5% in groups 1 and 2 (p=0.003). CONCLUSION: Starting antrectomy at a distance of 2 cm or less from the pylorus is safe and effective. Starting antrectomy at a distance of 1 cm or less from the pylorus in LSG provides effective weight loss without increasing complications. KEY WORDS: Bariatric surgery, Antrectomy, Laparoscopic sleeve gastrectomy, Complications.


Assuntos
Laparoscopia , Obesidade Mórbida , Gastrectomia , Humanos , Obesidade Mórbida/cirurgia , Piloro/cirurgia , Resultado do Tratamento , Perda de Peso
4.
BJS Open ; 6(3)2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35694967

RESUMO

BACKGROUND: Lateral pelvic lymph node dissection (LPLND) is an option in the treatment of rectal cancer and may reduce local recurrence/improve disease-free survival. Advancements in minimally invasive technology have improved the ability to identify anatomy and neurovascular structures that may help in LPLND. The aim of this retrospective study was to evaluate the technical feasibility and oncological safety of laparoscopic LPLND compared with the open LPLND. METHOD: Between July 2010 and July 2019, patients from three tertiary referral hospitals who underwent LPLND with total mesorectal excision for primary rectal cancer were included. Baseline patient characteristics, perioperative outcomes, pathologic results, recurrence, and survival were compared between the laparoscopic and open groups. RESULTS: There were 126 and 70 patients in the laparoscopic and open groups respectively. The laparoscopic group had less estimated blood loss (100 ml versus 300 ml, P < 0.001) and lower transfusion rate (0.8 per cent versus 10.0 per cent; P = 0.003) but longer operating times (318 min versus 270 min, P = 0.004). The laparoscopic group had fewer wound infections (1.6 per cent versus 10.0 per cent, P = 0.011) and neuropathy (0 per cent versus 4.3 per cent, P = 0.044). Lateral pelvic recurrence rate was 7.6 per cent in the laparoscopic group and 19.6 per cent in the open group (P = 0.053). Recurrence-free survival (72.2 per cent versus 63.5 per cent; P = 0.190) and overall survival (93.3 per cent versus 85.0 per cent; P = 0.118) were not significantly different. CONCLUSION: Laparoscopic LPLND was associated with improved perioperative outcomes and non-inferior oncological outcomes.


Assuntos
Laparoscopia , Neoplasias Retais , Humanos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Metástase Linfática , Neoplasias Retais/patologia , Estudos Retrospectivos
5.
Gulf J Oncolog ; 1(39): 47-55, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35695346

RESUMO

AIM: Combined surgery for colorectal cancer with synchronous liver metastases (CRCSLM) is addressed to selected patients. Technically, by conventional surgery this simultaneous approach raises a problem of adequate access. The purpose of this study is to assess the feasibility and safety of the laparoscopic approach in combined surgery. METHODS: From August 2016 to January 2020 a monocentric prospective comparative study was conducted. Short and long-term outcomes of simultaneous laparoscopic surgery (SLS) were evaluated. Short-term outcomes of SLS were compared to those of laparoscopic colorectal surgery alone (LCRS). RESULTS: Forty patients were included in each arm. In SLS group, the median age was 62.5 years. Hybrid surgery was performed for 60% of patients, down staging laparoscopic surgery for 22.5% of patients and totally laparoscopic surgery for 10% of patients. The conversion rate was 7.5%. Mean operating time was 323 minutes. Overall morbidity rate was 27.5%. Multivariate analysis showed that anemia (p = 0.046) and number of liver resections (p = 0.018) were independent factors of morbidity. Ninety-five percent of colorectal resections were R0, 90% of liver resections were R0. The mean length of hospital stay was 5.1 ± 2.58 days. The recurrence rate was 22.5%. Median diseasefree survival was 27 months. There was no difference in short-term outcomes between the two arms except for operating time which was longer in SLS arm (p < 0.0005). CONCLUSION: Laparoscopy is feasible in combined surgery in selected patients. Minor liver resection may be associated with laparoscopic colorectal surgery without increasing morbidity.


Assuntos
Neoplasias Colorretais , Laparoscopia , Neoplasias Hepáticas , Colectomia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
6.
BMC Geriatr ; 22(1): 475, 2022 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-35650535

RESUMO

BACKGROUND: As the incidence of gastric cancer increases in elderly patients worldwide, laparoscopic gastrectomy (LG) for elderly patients with gastric cancer is also increasing. However, whether LG is an optimal surgical modality for elderly patients with gastric cancer remains unclear. This study aimed to evaluate the technical and oncological safety of LG for elderly patients ≥ 80 years old with gastric cancer. METHODS: Patients who received curative gastrectomy for gastric cancer from 2003 to 2015 were enrolled in the study. They were divided into the LG in elderly patients aged over 80 years (LG-E) group, open gastrectomy (OG) in elderly patients (OG-E) group, and LG in non-elderly patients < 80 years (LG-NE) group. Patients' demographics and short- and long-term outcomes, such as postoperative complications and 5-year survival rate, were compared between the three groups, retrospectively. RESULTS: The LG-E, OG-E, and LG-NE groups comprised 45, 43, and 329 patients, respectively. In the comparison between the LG-E and OG-E groups, the incidence of distal gastrectomy (DG) and the proportions of patients with pathological tumor stage T1, pathological N0, and final stage I were significantly higher in the LG-E versus OG-E group (89 vs. 56%, 76% vs. 16%, 82% vs. 37%, and 84% vs. 35%, p < 0.01, respectively). Blood loss and the incidence of overall postoperative complications in the LG-E group were significantly lower than those in the OG-E group (40 vs. 240 g, p < 0.01, and 29% vs. 53%, p < 0.05, respectively). Although the 5-year overall survival (OS) rate was not significantly different between the two groups, the 5-year disease-specific survival (DSS) rate was significantly higher in the LG-E group versus OG-E group (93% vs. 78%, p < 0.05). Overall comorbidities were significantly higher in the LG-E group versus LG-NE group, but there were no significant differences in short-term outcomes between the two groups. Further, although the 5-year OS rate was significantly lower in the LG-E group versus LG-NE group (67% vs. 87%, p < 0.01), there was no significant difference between the two groups in 5-year DSS rate. CONCLUSION: LG is technically and oncologically safe for the treatment of gastric cancer in both elderly patients aged ≥ 80 years and the non-elderly and can be an optimal surgical modality for elderly patients with gastric cancer.


Assuntos
Laparoscopia , Neoplasias Gástricas , Idoso , Idoso de 80 Anos ou mais , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
7.
BMJ Open ; 12(6): e061499, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35688582

RESUMO

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most frequently performed procedures in bariatric surgery. In patients with morbid obesity and gastro-oesophageal reflux disease (GORD), LRYGB is the most accepted procedure. For patients with a contraindication for LRYGB or a strong preference for LSG, the Nissen-Sleeve procedure may be a viable new option. The aim of this study is to compare effectiveness of Nissen-Sleeve with LRYGB. METHOD AND ANALYSIS: This is a single-centre, phase III, parallel-group randomised controlled trial in a high-volume bariatric centre in the Netherlands. A total of 88 patients with morbid obesity and GORD will be randomised to evaluate non-inferiority of Nissen-Sleeve versus LRYGB (non-inferiority margin 15%, power 80%, one-sided α 0.025, 9% drop out). Patients with morbid obesity aged 18 years and older with GORD according to the Montreal definition will be included after obtaining informed consent. Exclusion criteria are achalasia, neoplastic abnormalities diagnosed during endoscopy, super obesity (body mass index ≥50 kg/m2), Crohn's disease and medical history of major abdominal surgery. After randomisation, all patients will undergo an upper gastrointestinal endoscopy. Patients in the Nissen-Sleeve arm will undergo a timed barium oesophagram to exclude oesophageal motility disorders. Patients will complete six questionnaires at baseline and every year until 5 years of follow-up. At day 1 postoperative, patients in the Nissen-Sleeve arm will undergo a swallow X-ray to confirm passage. At 1 year, all patients will undergo another endoscopy. The primary outcome is GORD status. Absence of GORD is defined as <8 points on the GORD questionnaire. Secondary outcome measures are long-term GORD improvement; failure rate of procedure; health-related quality of live; weight loss; proton pump inhibitor use; postoperative complications <30 days and >30 days; length of hospital stay; duration of primary surgery; effect on comorbidities; presence and grade of oesophagitis (grade A-D) and/or presence of Barrett's oesophagus and cost-effectiveness. ETHICS AND DISSEMINATION: The protocol was approved by the Medical Research Ethics Committees United (MEC-U), Nieuwegein, on 15 September 2021. Written informed consent will be obtained for all participants in the study. The study results will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NL9789; The Netherlands Trial Registry.


Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Laparoscopia , Obesidade Mórbida , Ensaios Clínicos Fase III como Assunto , Gastrectomia/métodos , Derivação Gástrica/métodos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Humanos , Laparoscopia/métodos , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
BMJ Open ; 12(6): e059919, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-35688587

RESUMO

INTRODUCTION: The use of Bispectral Index (BIS) monitors for assessing depth of sedation has led to a reduction in both the incidence of awareness and anaesthetic consumption in total intravenous anaesthesia. However, these monitors are vulnerable to artefacts. In addition to the processed number, the raw frontal electroencephalogram (EEG) can be displayed as a curve on the same monitor. Anaesthesia practitioners can learn to interpret the EEG in a short tutorial and may be quicker and more accurate thanBIS in assessing anaesthesia depth by recognising EEG patterns. We hypothesise that quality of recovery (QoR) in patients undergoing laparoscopic surgery is better, if propofol is titrated by anaesthesia practitioners able to interpret the EEG. METHODS AND ANALYSIS: This is a multicentre, double-blind (patients and outcome assessors) randomised controlled trial taking place in four Swiss hospitals. Patients aged 18 years or older undergoing laparoscopic procedures with general anaesthesia using propofol and anaesthesia practitioners with more than 2 years experience will be eligible. The primary study outcome is the difference in QoR 24 hours after surgery. Secondary outcomes are propofol consumption, incidence of postoperative nausea and vomiting (PONV) and postoperative delirium.QoR and propofol consumption are compared between both groups using a two-sample t-test. Fisher's exact test is used to compare the incidences of PONV and delirium. A total of 200 anaesthesia practitioners (and 200 patients) are required to have an 80% chance of detecting the minimum relevant difference for the QoR-15 as significant at the 5% level assuming a SD of 20. ETHICS AND DISSEMINATION: Ethical approval has been obtained from all responsible ethics committees (lead committee: Ethikkommission Nordwest- und Zentralschweiz, 16 January 2021). The findings of the trial will be published in a peer-reviewed journal, presented at international conferences, and may lead to a change in titrating propofol in clinical practice. TRIAL REGISTRATION NUMBER: www. CLINICALTRIALS: gov:NCT04105660.


Assuntos
Delírio , Laparoscopia , Propofol , Anestesia Geral/efeitos adversos , Delírio/etiologia , Eletroencefalografia , Humanos , Laparoscopia/efeitos adversos , Estudos Multicêntricos como Assunto , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Propofol/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
J Surg Oncol ; 126(1): 108-115, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35689587

RESUMO

BACKGROUND: Although D2-gastrectomy is the most effective treatment for resectable gastric cancer (GC), it is unclear whether elderly patients have increased risk of morbidity and worse survival. This study aimed to compare the short- and long-term outcomes of older age (OA) patients with those of less advanced age (LAA). METHODS: GC patients undergoing curative gastrectomy were retrospectively analyzed and divided into two groups: OA (>75 years) and LAA (<75 years). Propensity score-matching (PSM) analysis using seven variables was conducted to reduce selection bias. RESULTS: Among 586 patients, 494 (84.3%) were classified as LAA and 92 (15.7%) as OA. OA patients had worse clinical status, higher rates of D1-lymphadenectomy, subtotal gastrectomy, and Lauren type; higher mortality and worse survival. No difference in pathological tumor-node-metastasis (pTNM) stage was observed between groups. Preoperative chemotherapy was performed more frequently in the LAA group. After PSM (92 OA: 92 LAA), all variables included in PSM were matched, and mortality rates and survival became similar between groups. In multivariate analysis, American Society of Anaesthesiologists score III/IV was an independent factor associated with a 90-day mortality after PSM. CONCLUSION: Gastrectomy in elderly GC patients has similar outcomes compared with younger ones. Clinical status and disease stage are more important than the patient's age.


Assuntos
Laparoscopia , Neoplasias Gástricas , Idoso , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do Tratamento
11.
Zhonghua Yi Xue Za Zhi ; 102(22): 1648-1652, 2022 Jun 14.
Artigo em Chinês | MEDLINE | ID: mdl-35692016

RESUMO

Objective: To evaluate the efficacy and safety of laparoscopic surgery for perivascular epithelioid cell tumor (PEComa). Methods: The clinical data of 42 patients with hepatic PEComa diagnosed by pathology in Hunan Provincial People's Hospital from September 2012 to September 2021 were retrospectively analyzed. The patients were divided into the endoscopic group and the open group according to surgical methods. Statistical software was used to compare the differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative pathological data and incidence of complications between the two groups. Results: There were 27 cases in the endoscopic group and 15 cases in the open group. In the endoscopic group, there were 5 males and 22 females, aged (40.0±10.4) years. In the open group, there were 5 males and 10 females, aged (44.5±12.6) years. The operative time of the endoscopic group and the open group was (239±156.2) min and (348±103.0) min, and the postoperative hospital stay was (8.2±2.4) d and (13.7±4.9) d, respectively, the endoscopic group was significantly better than the open group, and the difference was statistically significant (P<0.05). There was no significant difference in intraoperative blood loss, tumor benign and malignant, tumor site, tumor diameter, Ki67 index, postoperative complications such as biliary leakage, incision infection and pleural effusion (P>0.05). During the follow-up period of 2-103 months, one case was lost to follow-up, two cases died in the endoscopic group,one case died in the open group. The 5-year overall survival rate (OS) and disease-free survival rate (DFS) were 80.8% and 83.0%, respectively. Meanwhile,. The 5-year OS and DFS were both 92.3%, the difference was not statistically significant (P>0.05). Conclusions: Laparoscopic treatment of hepatic PEComa has the advantages of short operation time and short postoperative hospital stay, and the incidence of complications, 5-year OS and DFS are not significantly different from that of the open group.


Assuntos
Laparoscopia , Neoplasias de Células Epitelioides Perivasculares , Perda Sanguínea Cirúrgica , Feminino , Humanos , Laparoscopia/métodos , Fígado , Masculino , Estudos Retrospectivos , Resultado do Tratamento
12.
BMJ Case Rep ; 15(6)2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35649627

RESUMO

Duodenal diverticulum perforation is a rare and life-threatening pathology. Perforation secondary to iatrogenic causes is rare, with only 14 cases previously reported. This paper explores a world-first case report on iatrogenic duodenal diverticulum perforation during right laparoscopic nephroureterectomy and a systematic review of all reported cases of duodenal diverticulum perforation in the literature.


Assuntos
Divertículo , Úlcera Duodenal , Perfuração Intestinal , Laparoscopia , Úlcera Péptica Perfurada , Divertículo/complicações , Divertículo/cirurgia , Úlcera Duodenal/complicações , Humanos , Doença Iatrogênica , Perfuração Intestinal/complicações , Perfuração Intestinal/cirurgia , Laparoscopia/efeitos adversos , Nefroureterectomia/efeitos adversos , Úlcera Péptica Perfurada/cirurgia
13.
Am J Case Rep ; 23: e936115, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35651297

RESUMO

BACKGROUND Compared with wedge resection, anatomic segmental resection of liver metastases from primary colon cancer can improve tumor clearance and patient survival. We present the case of a 58-year-old woman with liver metastases from primary colon cancer who underwent laparoscopic cone unit resection for undetectable liver metastasis of segment VII. CASE REPORT The patient was a 58-year-old woman. Giant uterine myoma and advanced sigmoid colon cancer were detected on computed tomography. Two liver metastases (segments IV and VII) were simultaneously detected. The lesion of segment VII (5.0 mm in size) was not detected by echography and was located in the root of the hepatic vein, which connects to the right hepatic vein. However, the echography detected the hepatic vein. Therefore, we set the vein as the landmark of the undetectable liver tumor and planned to perform cone unit resection of segment VII with resection of the hepatic vein laparoscopically. We detected the landmark-set hepatic vein on intraoperative echography and transected the peripheral Glisson VII. Subsequently, the right hepatic vein was exposed from the root to the peripheral side and transected in its root. Cone unit resection was performed without tumor exposure. Operation time and blood loss were 582 min and 200 g, respectively. Pringle maneuver time, including hepatectomy of segments IV and VII, was 146 min. She was discharged on postoperative day 5 with no postoperative complications. CONCLUSIONS This case demonstrated the use of laparoscopic cone unit hepatectomy using an anatomical landmark in a patient with undetectable liver metastasis.


Assuntos
Adenocarcinoma , Laparoscopia , Neoplasias Hepáticas , Neoplasias do Colo Sigmoide , Adenocarcinoma/cirurgia , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia
14.
PLoS One ; 17(6): e0269468, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35666742

RESUMO

BACKGROUND: Intraoperative hypertension and blood pressure (BP) fluctuation are known to be associated with negative patient outcomes. During robotic lower abdominal surgery, the patient's abdominal cavity is filled with CO2, and the patient's head is steeply positioned toward the floor (Trendelenburg position). Pneumoperitoneum and the Trendelenburg position together with physiological alterations during anesthesia, interfere with predicting BP changes. Recently, deep learning using recurrent neural networks (RNN) was shown to be effective in predicting intraoperative BP. A model for predicting BP rise was designed using RNN under special scenarios during robotic laparoscopic surgery and its accuracy was tested. METHODS: Databases that included adult patients (over 19 years old) undergoing low abdominal da Vinci robotic surgery (ovarian cystectomy, hysterectomy, myomectomy, prostatectomy, and salpingo-oophorectomy) at Soonchunhyang University Bucheon Hospital from October 2018 to March 2021 were used. An RNN-based model was designed using Python3 language with the PyTorch packages. The model was trained to predict whether hypertension (20% increase in the mean BP from baseline) would develop within 10 minutes after pneumoperitoneum. RESULTS: Eight distinct datasets were generated and the predictive power was compared. The macro-average F1 scores of the datasets ranged from 68.18% to 72.33%. It took only 3.472 milliseconds to obtain 39 prediction outputs. CONCLUSIONS: A prediction model using the RNN may predict BP rises during robotic laparoscopic surgery.


Assuntos
Aprendizado Profundo , Hipertensão , Laparoscopia , Pneumoperitônio , Procedimentos Cirúrgicos Robóticos , Adulto , Pressão Sanguínea/fisiologia , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Humanos , Hipertensão/etiologia , Laparoscopia/efeitos adversos , Masculino , Pneumoperitônio Artificial/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Adulto Jovem
15.
Rozhl Chir ; 101(5): 251-254, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35667876

RESUMO

INTRODUCTION: Acute appendicitis is one of the most common acute abdominal conditions. One of its complications is postoperative formation of abscesses in the peritoneal cavity or in the retroperitoneal space. Among other things, appendicoliths left in the peritoneal cavity are responsible for this process. Their release from the lumen occurs preoperatively and during the operation. An appendicolith, with the bacteria present on its surface, provides an environment that supports the onset of an infection. CASE REPORT: The authors present a less common case of a retroperitoneal abscess caused by an incarcerated appendicolith. Unusual is the long period between appendectomy and clinical manifestations of the abscess. The patient underwent surgical treatment with abscess evacuation and extraction of the appendicolith. The postoperative course was adequate; wound healing was supported by negative wound pressure therapy. CONCLUSION: During appendectomy, it is necessary to keep in mind the risk of releasing appendicoliths and their role in infectious complications. A conscientious revision of the peritoneal cavity is required, as well as a good surgical technique. If necessary, imaging methods can help to locate the appendicolith in the postoperative period.


Assuntos
Abscesso Abdominal , Apendicite , Apêndice , Laparoscopia , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Abscesso/etiologia , Doença Aguda , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Apendicite/complicações , Apendicite/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
16.
BMC Urol ; 22(1): 81, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668417

RESUMO

OBJECTIVE: To investigate the clinical safety and efficacy of a modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN). METHODS: The clinical data of 38 patients with renal tumors who underwent the modified early unclamping technique in RAPN surgery admitted to the Department of Urology, the Third People's Hospital of Hangzhou and the First Affiliated Hospital of Nanchang University from January 2018 to April 2021 were retrospectively analyzed. The control group consisted of 78 patients with renal tumors who underwent standard clamping during the RAPN surgery completed by the same surgeon during the same period. The perioperative-related indicators and postoperative renal function recovery were analyzed and compared between the two groups. RESULTS: All patients (n = 116) finished the RAPN successfully, and none were transferred to radical or open surgery in either group. The warm ischemia time in the modified early unclamping group was significantly lower than that in the standard clamping group (P < 0.001). After surgery, the renal function index at each time point in the modified early unclamping group was higher than that in the standard clamping group; renal function gradually returned to near preoperative levels after 3 months in both groups. Postoperative follow-up showed no tumor recurrence or metastasis. CONCLUSION: The application of a modified early unclamping technique in RAPN surgery is safe and feasible. Compared with standard clamping, modified early unclamping can significantly shorten the warm ischemia time of kidneys without increasing the volume of intraoperative blood loss and complications, which helps to protect the postoperative renal function of patients.


Assuntos
Neoplasias Renais , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Recidiva Local de Neoplasia/cirurgia , Nefrectomia/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Robótica/métodos , Resultado do Tratamento
17.
Pak J Pharm Sci ; 35(2(Special)): 641-647, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35668565

RESUMO

To evaluate the efficacy of multimodal analgesia of flurbiprofen axetil, nalbuphine hydrochloride and patient controlled intravenous analgesia (PCIA) on inflammatory factor levels and stress response in patients after laparoscopic radical gynecological malignancy surgery. The data of 100 patients admitted to our hospital from May 2019 to May 2020 for laparoscopic radical gynecological malignancy surgery were retrospectively analyzed and they were assigned (1:1) to either an experimental group or a control group according to the alphabetical order of their initials. The experimental group was given preemptive analgesia with flurbiprofen axetil, postoperative analgesia with nalbuphine hydrochloride, and PCIA and the control group was given conventional analgesic measures. The pain scores at 1h, 6h, 12h, 24h and 48h postoperatively in the experimental group were remarkably lower than those in the control group (P<0.001). The experimental group showed significantly lower inflammatory factor levels, pain mediator levels and stress response indexes in the morning before surgery, 1d, and 2d after surgery than the control group (P<0.001). The multimodal analgesia of flurbiprofen axetil, nalbuphine hydrochloride and PCIA can effectively alleviate the stress response and inflammatory response in patients after radical gynecologic malignancy surgery and the patients' pain perception is reduced with a high safety profile.


Assuntos
Flurbiprofeno , Neoplasias dos Genitais Femininos , Laparoscopia , Nalbufina , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Feminino , Flurbiprofeno/análogos & derivados , Flurbiprofeno/uso terapêutico , Humanos , Laparoscopia/efeitos adversos , Nalbufina/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos
18.
Comput Intell Neurosci ; 2022: 6122261, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35669650

RESUMO

Objective: The aim of the study is to explore the clinical efficacy and prognosis factors of joint application of laparoscopic radical resection of colon adenocarcinoma (COAD) and docetaxel therapy in treating COAD of middle and advanced stages. Methods: The clinical data of 103 COAD patients of middle and advanced stages treated in our hospital from July 2016 to July 2018 were selected for the retrospective analysis, all patients received the treatment scheme of combining laparoscopic radical resection of COAD with docetaxel therapy for the observation of short-term efficacy, follow-up was conducted to record their 3-year survival, and relevant factors affecting patient prognosis were analyzed by the logistic regression model. Results: After treatment, the total remission rate of patients was 75.73% (78/103), the total incidence rate of adverse reactions was 16.50% (17/103); patients' level values of various serum tumor markers after treatment were significantly lower than those before treatment (P < 0.001); according to the univariate analysis results, for COAD patients with different tumor diameters, differentiated degrees, TNM stages, perineural invasion degrees, pathological types, and depths of invasion, their modality rates were statistically different (P < 0.05); and the logistic regression analysis showed that tumor diameter ≥5 cm, poor differentiation, TNM stage IV, perineural invasion, pathologically signet-ring cell carcinoma, and T 3-invasion were the independent risk factors affecting patient prognosis (P < 0.05). Conclusion: Combining laparoscopic radical resection of COAD with docetaxel therapy in treating COAD of middle and advanced stages achieves affirmed short-term efficacy, which can reduce patients' level of serum tumor markers and ensure high safety and good survival prognosis. Tumor diameter, differentiated degree, TNM stage, perineural invasion, pathological type, and T 3-invasion are the relevant factors affecting the prognosis of middle and advanced COAD.


Assuntos
Adenocarcinoma , Neoplasias do Colo , Laparoscopia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/metabolismo , Adenocarcinoma/cirurgia , Biomarcadores Tumorais , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Docetaxel , Humanos , Laparoscopia/efeitos adversos , Estudos Retrospectivos
20.
Acta Obstet Gynecol Scand ; 101(7): 705-718, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35661342

RESUMO

INTRODUCTION: The aim of this study was to analyze the available literature by conducting a systematic review to assess the possible effects of nerve-sparing segmental resection and conventional bowel resection on postoperative complications for the treatment of colorectal endometriosis. MATERIAL AND METHODS: Pubmed, Clinical Trials.gov, Cochrane Library, and Web of Science were comprehensively searched from 1997 to 2021 in order to perform a systematic review. Studies including patients undergoing segmental resection for colorectal endometriosis including adequate follow-up, data on postoperative complications and postoperative sequelae were enrolled in this review. Selected articles were evaluated and divided in two groups: Nerve-sparing resection (NSR), and conventional segmental resection not otherwise specified (SRNOS). Within the NSRs, studies mentioning preservation of the rectal artery supply (artery and nerve-sparing SR - ANSR) and not reporting preservation of the artery supply (NSR not otherwise specified - NSRNOS) were further analyzed. PROSPERO ID: CRD42021250974. RESULTS: A total of 7549 patients from 63 studies were included in the data analysis. Forty-three of these publications did not mention the preservation or the removal of the hypogastric nerve plexus, or main rectal artery supply and were summarized as SRNOS. The remaining 22 studies were listed under the NSR group. The mean size of the resected deep endometriosis lesions and patients' body mass index were comparable between SRNOS and NSR. A mean of 3.6% (0-16.6) and 2.3% (0-10.5%) of rectovaginal fistula development was reported in patients who underwent SRNOS and NSR, respectively. Anastomotic leakage rates varied from 0% to 8.6% (mean 1.7 ± 2%) in SRNOS compared with 0% to 8% (mean 1.7 ± 2%) in patients undergoing NSR. Urinary retention (4.5% and 4.9%) and long-term bladder catheterization (4.9% and 5.6%) were frequently reported in SRNOS and NSR. There was insufficient information about pain or the recurrence rates for women undergoing SRNOS and NSR. CONCLUSIONS: Current data describe the outcomes of different segmental resection techniques. However, the data are inhomogeneous and not sufficient to reach a conclusion regarding a possible advantage of one technique over the other.


Assuntos
Neoplasias Colorretais , Endometriose , Laparoscopia , Doenças Retais , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Endometriose/complicações , Feminino , Humanos , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Doenças Retais/cirurgia , Resultado do Tratamento
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