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1.
Medicine (Baltimore) ; 100(35): e26996, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477129

RESUMO

ABSTRACT: To reveal the role of the postoperative choledochoscopy in treating the residual calculi in the caudate lobe (CL) of the liver.We recruited 66 patients with T-tube/percutaneous transhepatic cholangioscopy tract who still had residual gallstones in the CL at least 6 weeks after the operation. Imaging examinations determined the gallstones' locations in the patients, and all of them underwent the postoperative choledochoscopic examination through the T-tube/percutaneous transhepatic cholangioscopy tract for therapeutic intervention.Among the 66 patients, the residual gallstones were mostly located in the Spiegel lobe (48/66, 72.7%), and the residual gallstones that located in the origin of the CL bile branches were successfully determined in the 57 patients (57/66, 86.4%), the remaining 9 patients were unclear because the proximal ducts were severely narrow or even atresia. The mean frequency of the postoperative choledochoscopy was 3.6 (range, 1-10) times. There were 9 patients with complications, and no mortality occurred. In the origin-proved 57 patients, 6 patients failed to remove the gallstones altogether, and the final residual gallstone clearance rate was 77.3% (51/66). There was no significant difference between the Spiegel lobe and the other parts of the CL in determining the bile duct's origins, gallstone clearance rate, and complications. However, the frequency of choledochoscopy in the other parts of the CL was more than in the Spiegel lobe.The postoperative choledochoscopy, an essential method for treating the residual gallstones in the CL, commands high efficiency for calculi extraction and fewer complications. The main reasons for failing to remove the residual gallstones are that the bile duct's origins could not be determined, and the distal bile ducts are atretic in the CL.


Assuntos
Sistema Biliar/diagnóstico por imagem , Coledocolitíase/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema Biliar/anormalidades , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 100(35): e27042, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477135

RESUMO

ABSTRACT: To investigate the feasibility, safety, and outcomes of three-dimensional (3D) laparoscopic vaginoplasty with a rectosigmoid colon flap for vaginal reconstruction.Following appropriate preoperative patient counseling, 17 consecutive patients underwent vaginoplasty using a 3D laparoscopic system. Perioperative and postoperative outcomes were retrospectively evaluated.Between September 2016 and February 2020, 17 patients underwent 3D laparoscopic vaginoplasty with a rectosigmoid colon flap. Of them, 15 (88%) were transgender female patients, and 2 (12%) were cisgender female patients with congenital deformities. Among the 15 transgender patients, 12 (80%) underwent de novo surgeries and 3 (20%) underwent re-do surgeries. The mean age at the time of operation was 33.0 years, and the mean total operation time was 529 ±â€Š128 minutes. The initial intraoperative mean vaginal depth was 15.2 ±â€Š1.3 cm, and the 30-day readmission rate was 5.9% (1/17 cases). The mean follow-up duration was 24.8 months.Perioperative and postoperative outcomes suggest that 3D laparoscopic rectosigmoid colon vaginoplasty is a potentially acceptable, effective, and safe method for vaginal reconstruction.


Assuntos
Laparoscopia/métodos , Cirurgia de Readequação Sexual/métodos , Retalhos Cirúrgicos/cirurgia , Vagina/cirurgia , Adulto , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Cirurgia de Readequação Sexual/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Vagina/fisiopatologia
3.
Medicine (Baltimore) ; 100(34): e27012, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449473

RESUMO

BACKGROUND: Robotic-assisted gastrectomy has been used for treating gastric cancer since 2002. This meta-analysis was conducted to systematically evaluate the efficacy of Da Vinci robotic distal subtotal gastrectomy (RDG) or laparoscopic distal subtotal gastrectomy (LDG) in patients with gastric cancer. METHODS: We conducted searches in domestic and foreign databases, and collected literature in Chinese and English on the efficacy of RDG and LDG for gastric cancer that have been published since the inception of the database. RevMan 5.4.1 was used for meta-analysis and drawing and Stata14.0 was used for publication bias analysis. RESULTS: A total of 3293 patients in 15 studies were included, including 1193 patients in the RDG group and 2100 patients in the LDG groups respectively. The meta-analysis showed that intraoperative blood loss was significantly lower and the number of resected lymph nodes was higher in the RDG group compared to that in the LDG group. In addition, the times to first postoperative food intake and postoperative hospital stay were shortened, and there was a longer length of distal resection margin and prolonged duration of operation. No significant differences were found between the 2 groups with respect to the first postoperative anal exhaust time, length of proximal resection margin, total postoperative complication rate, postoperative anastomotic leakage rate, incidence of postoperative gastric emptying disorder, pancreatic fistula rate, recurrence rate, and mortality rate. CONCLUSION: RDG is a safe and feasible treatment option for gastric cancer, and it is non-inferior or even superior to LDG with respect to therapeutic efficacy and radical treatment.


Assuntos
Gastrectomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Neoplasias Gástricas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Ensaios Clínicos como Assunto , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/patologia
4.
Medicine (Baltimore) ; 100(32): e26708, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397873

RESUMO

ABSTRACT: Laparoscopic donor hepatectomy (LDH), accepted as a minimally invasive approach, has become increasingly popular for living donor liver transplant. However, the outcomes of LDH remain to be fully clarified when compared with open living donor hepatectomy. Thus, our meta-analysis was designed to assess the efficacy of laparoscopic in comparison with conventional open donor hepatectomy.The PubMed, Cochrane, and Embase electronic databases were searched to identify the articles concerning the comparison of the efficacy of laparoscopic versus open surgery in treatment of living donor liver transplantation updated to March, 2020. The main search terms and medical Subject Heading terms were: "living donor," "liver donor," "minimally invasive," "laparoscopic surgery," and "open surgery." After rigorous evaluation on quality, the data was extracted from eligible publications. The outcomes of interest included intraoperative and postoperative results.The inclusion criteria were met by a total of 20 studies. In all, 2001 subjects involving 633 patients who received laparoscopic surgery and 1368 patients who received open surgery were included. According to the pooled result of surgery duration, the laparoscopic surgery was associated with shorter duration of hospital stay (MD = -1.07, 95% CI -1.85 to -0.29; P = .007), less blood loss (MD = -57.57, 95% CI -65.07 to -50.07; P < .00001), and less postoperative complications (OR = 0.61, 95% CI 0.44-0.85; P = .003). And the open donor hepatectomy achieved a trend of shorter operation time (MD = 30.31, 95% CI 13.93-46.69; P = .0003) than laparoscopic group. Similar results were found in terms of ALT (P = .52) as well as the AST (P = .47) peak level between the 2 groups.LDH showed the better perioperative outcomes as compared with open donor hepatectomy. The findings revealed that LDH may be a feasible and safe procedure for the living donor liver transplantation.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Transplante de Fígado/métodos , Doadores Vivos , Humanos , Duração da Cirurgia , Coleta de Tecidos e Órgãos/métodos
5.
Medicine (Baltimore) ; 100(32): e26773, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397880

RESUMO

ABSTRACT: Delayed recovery (DR) is very commonly seen in the patients undergoing laparoscopic radical biliary surgery, we aimed to investigate the potential risk factors of DR in the patients undergoing radical biliary surgery, to provide evidences into the management of DR.Patients who underwent radical biliary surgery from January 1, 2018 to August 31, 2020 were identified. The clinical characteristics and treatment details of DR and no-DR patients were compared and analyzed. Multivariable logistic regression analyses were conducted to identify the potential influencing factors for DR in patients with laparoscopic radical biliary surgery.We included a total of 168 patients with laparoscopic radical biliary surgery, the incidence of postoperative DR was 25%. There were significant differences on the duration of surgery, duration of anesthesia, and use of intraoperative combined sevoflurane inhalation (all P < .05), and there were not significant differences on American Society of Anesthesiologists, New York Heart Association, tumor-lymph node- metastasis, and estimated blood loss between DR group and control group (all P > .05). Multivariable logistic regression analyses indicated that age ≥70 years (odd ratio [OR] 1.454, 95% confidence interval [CI] 1.146-1.904), body mass index ≥25 kg/m2 (OR 1.303, 95% CI 1.102-1.912), alcohol drinking (OR 2.041, 95% CI 1.336-3.085), smoking (OR 1.128, 95% CI 1.007-2.261), duration of surgery ≥220 minutes (OR 1.239, 95% CI 1.039-1.735), duration of anesthesia ≥230 minutes (OR 1.223, 95% CI 1.013-1.926), intraoperative combined sevoflurane inhalation (OR 1.207, 95% CI 1.008-1.764) were the independent risk factors for DR in patients with radical biliary surgery (all P < .05).It is clinically necessary to take early countermeasures against various risk factors to reduce the occurrence of DR, and to improve the prognosis of patients.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
6.
Medicine (Baltimore) ; 100(33): e26979, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414974

RESUMO

ABSTRACT: To map the distribution of the sites most affected by endometriosis in patients with unilateral ovarian endometriomas.A descriptive case series of 84 patients with unilateral endometriomas undergoing laparoscopy for the treatment of endometriosis. To evaluate the distribution of the sites of endometriosis lesions, the peritoneal compartments were divided into 5 zones: zone 1/the anterior compartment, including the anterior uterine serosa, vesicouterine fold, round ligament, and bladder; zone 2/the lateral compartment, including the left and right ovary, ovarian fossa, tubes, mesosalpinx, uterosacral ligaments, parametrium, and the ureter; zone 3/the posterior compartment, including posterior uterine serosa, the pouch of Douglas, posterior vaginal fornix, and bowel; zone 4 consisting of the abdominal wall; and zone 5 consisting of the diaphragm.Of the 5 zones evaluated, the lateral compartment (zone 2) was the most affected, with 60.7% of the patients having dense adhesions around the left ovarian fossa and 57.1% around the right ovarian fossa. The ovarian endometriomas were more commonly found on the left side (54.8%) compared to the right (45.2%). In the posterior compartment (zone 3), the posterior cul-de-sac was obliterated in 51.2% of the patients. In the anterior compartment (zone 1), there were lesions in the vesicouterine fold in 30.9% of the patients and in the bladder in 19%. Lesions were found in the abdominal wall (zone 4) and diaphragm (zone 5) in 21.4% and 10.7% of patients, respectively.Unilateral endometriomas are important markers of the severity of endometriosis.


Assuntos
Endometriose/classificação , Laparoscopia/estatística & dados numéricos , Útero/anatomia & histologia , Adolescente , Adulto , Endometriose/fisiopatologia , Feminino , Humanos , Laparoscopia/métodos , Ovário/anatomia & histologia , Ovário/fisiopatologia , Útero/fisiopatologia
7.
Medicine (Baltimore) ; 100(33): e27002, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414989

RESUMO

BACKGROUND: The purpose of this study was to compare the clinical efficacy of robotic right colectomy (RRC) and laparoscopic right colectomy (LRC) in the treatment of right colon tumor. METHODS: We systematically searched PubMed, Web of science, EMBASE ClinicalTrials.gov and Cochrane Central Register for studies (studies published between January 2011 and June 2020). The included studies compared the clinical efficacy of RRC and LRC in the treatment of right colon tumor, and analyzed the perioperative data. RESULTS: Our meta-analysis included 10 studies involving 1180 patients who underwent 2 surgical procedures, RRC and LRC. This study showed that compared with LRC, there was no significant difference in first flatus passage (weighted mean difference [WMD]: -0.37, 95% CI: -1.09-0.36, P = .32), hospital length of stay (WMD: -0.23, 95% CI: -0.73-0.28, P = .32), reoperation (OR: 1.66, 95% CI: 0.67-4.10, P = .27), complication (OR: 0.83, 95% CI: 0.60-1.14, P = .25), mortality (OR: 0.45, 95% CI: 0.02-11.22, P = .63), wound infection (OR: 0.65, 95% CI: 0.34-1.25, P = .20), and anastomotic leak (OR: 0.73, 95% CI: 0.33-1.63, P = .44). This study showed that compared with LRC, the lymph nodes retrieved (WMD: 1.47, 95% CI: -0.00-2.94, P = .05) of RRC were similar, with slight advantages, and resulted in longer operative time (WMD: 65.20, 95% CI: 53.40-77.01, P < .00001), less estimated blood loss (WMD: -13.43, 95% CI: -20.65-6.21, P = .0003), and less conversion to open surgery (OR: 0.30, 95% CI: 0.17-0.54, P < .0001). CONCLUSIONS: RRC is equivalent to LRC with respect to first flatus passage, hospital length of stay, reoperation, complication, and results in less conversion to LRC.


Assuntos
Colectomia/métodos , Laparoscopia/normas , Procedimentos Cirúrgicos Robóticos/normas , Colectomia/normas , Humanos , Laparoscopia/métodos , Tempo de Internação , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 100(33): e27008, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414993

RESUMO

RATIONALE: Rectal inflammatory myofibroblastic tumor (IMT) is an extremely rare mesenchymal tumor characterized by a mixture of spindle-shaped myofibroblasts or fibroblasts and inflammatory infiltration of lymphocytes and plasma cells. To date, only 8 cases of rectal IMT have been reported. Herein, we report an additional case of rectal IMT in a 28-year-old woman. PATIENT CONCERNS: A 28-year-old woman presented with abdominal pain and hematochezia. DIAGNOSES: Colonoscopy showed a 3.0-cm subepithelial tumor with central ulceration, covered by white exudate in the rectum. Rectal magnetic resonance imaging revealed a 4.0 × 3.0-cm-sized well-defined subepithelial tumor in the right wall of the rectum, with suspicious right perirectal fat infiltration. INTERVENTIONS: Laparoscopic anterior resection was performed. Microscopic examination of the surgical specimen revealed bland-looking spindle cells intermingled with lymphoplasma cells. Immunohistochemistry and fluorescence in situ hybridization showed anaplastic lymphoma kinase positivity and anaplastic lymphoma kinase positivity rearrangement. Rectal IMT was confirmed based on histological, immunohistochemical, and fluorescence in situ hybridization findings. The patient was doing well without evidence of tumor recurrence 1 year after the surgery. LESSONS: Rectal IMT, despite its rarity, should be considered in the differential diagnosis of rectal cancer. Second, an accurate histopathologic diagnosis and complete surgical resection can be the most important approaches to offer a chance for the cure of rectal IMT.


Assuntos
Laparoscopia/métodos , Neoplasias de Tecido Muscular/cirurgia , Reto/anormalidades , Adulto , Feminino , Humanos , Neoplasias de Tecido Muscular/fisiopatologia , Reto/fisiopatologia
9.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248335

RESUMO

Background: Deloyers procedure enables anastomosis of the ascending colon to the rectum following extended resections that prevent usual fashion anastomosis. During the procedure, the right colon is completely mobilized and counterclockwise rotated to allow tension free and well-vascularized anastomosis while preserving the ileocecal valve. The purpose of this manuscript is to report our experience with laparoscopic Deloyers procedure in a hostile abdomen due to adhesions from previous surgeries. Methods: We report the outcomes and our technique of laparoscopic Deloyers procedure in three patients. All patients had a surgical complication necessitating the creation of end colostomy with a short colonic remnant. The bowel status prevented restoration of continuity by the common colorectal anastomosis and laparoscopic Deloyers was elected. Results: The procedure was successful in all patients, with no intra-operative complication and average surgery duration of three hours. Patients had uneventful postoperative recovery with only one case of minor complication and an adequate functional outcome. Conclusion: Laparoscopic Deloyers is safe and allows the restoration of bowel continuity with preservation of ileocecal valve and good functional outcome even in hostile abdomen.


Assuntos
Abdome/cirurgia , Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Laparoscopia/métodos , Reto/cirurgia , Abdome/patologia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aderências Teciduais/etiologia , Resultado do Tratamento
10.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248340

RESUMO

Background: Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS. Objectives: This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures. Method: This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared. Results: All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group. Conclusion: Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.


Assuntos
Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Ovariectomia/métodos , Umbigo/cirurgia , Vagina/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento
11.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248341

RESUMO

Objective: To explore the time characteristics of shoulder pain after laparoscopic gynecological operation. Methods: We conducted prospective clinical observations and literature review. We studied 442 cases of laparoscopic gynecological surgery. We used a visual analogue scale to evaluate the pain of patients at different time points after operation. We searched the English literature of shoulder pain after gynecological laparoscopic surgery. The observation time points of these studies included 12-24 hours or the first day after surgery, and at least one time point before this time point. Results: The total incidence of shoulder pain was 68%. More than 90% of patients begin to feel shoulder pain on the first day after surgery, not on the day of surgery. 26 articles observed the severity of postlaparoscopic shoulder pain (PLSP) at different time points, of which 17 articles found that the intensity of the shoulder pain peaked at 12-24 hours or the first day after operation. Discussion: The occurrence of PLSP presents obvious time characteristics. The incidence and severity of PLSP peaked on the first day or 12-24 hours after operation. To prevent and treat PLSP better, clinicians should make a more in-depth study according to the time characteristics of PLSP.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Dor Pós-Operatória/epidemiologia , Dor de Ombro/epidemiologia , Fatores de Tempo , Adulto , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Incidência , Laparoscopia/métodos , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Dor de Ombro/etiologia
12.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248342

RESUMO

Background and Objectives: There is a dearth of studies on laparoscopic treatment of female groin hernia. Our study assessed the outcome of groin hernia repair in females employing the totally extraperitoneal laparoscopic (TEP) access. Methods: Data of all females who were subjected to laparoscopic groin herniorrhaphy, from August 1998 to February 2020 were retrospectively obtained. Groin hernia repair was routinely started with TEP access. Results: A total of 2,399 patients who underwent laparoscopic groin herniorrhaphy, 254 (10.6%), were females. Most females (n = 191; 75.2%) had single hernia and the remaining (n = 63; 24.8%) had bilateral hernias, making a total of 317 hernias operated. Indirect inguinal hernia was the most common hernia type (72.5%), followed by femoral hernia (17.4%) and direct hernia (10.1%). Prior lower abdominal operations were recorded in 97 (38.2%) patients. Conversion to a laparoscopic transabdominal preperitoneal procedure was performed due to technical difficulties to dissect the preperitoneal space in 17 patients (6.7%) and to open procedure in only one patient (0.4%) with incarcerated femoral hernia in whom an incidental perforation of the small bowel occurred. Intra- and postoperative complications occurred in 12 (4.7%) and 15 (5.9%) patients, respectively. There was no mortality. Most patients (n = 221; 87%) were discharged on the same day of the operation. Hernia recurrence was diagnosed in 6 patients (2.4%). Conclusion: It is concluded that females with groin hernia may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.


Assuntos
Virilha/cirurgia , Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
13.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248343

RESUMO

Introduction: Simultaneous robot assisted colon and liver resections are being performed more frequently at present due to the expanded adoption of the robotic platform for surgical management of metastatic colon cancer. However, this approach has not been studied in detail with only case series available in the literature. The aim of this systematic review was to evaluate the current body of evidence on the feasibility of performing simultaneous robotic colon and liver resections. Methods: A systematic review was performed through PubMed to identify relevant articles describing simultaneous colon and liver resections for metastatic colon cancer. Results: A total of 28 patients underwent simultaneous resections robotically with an average operative time of 420.3 minutes and average blood loss of 275.6 ml. Postoperative stay was 8.6 days on average with all cases achieving negative surgical margins. Conclusions: Robotic simultaneous resection of colorectal cancer with liver metastases is technically feasible and seems oncologically equivalent to open or laparoscopic surgery. Further studies are urgently needed to assess benefits of robotic surgery in the patient population.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Neoplasias do Colo/patologia , Terapia Combinada , Humanos , Laparoscopia/métodos , Neoplasias Hepáticas/secundário , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Duração da Cirurgia
14.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248345

RESUMO

Background and Objectives: Although several large studies regarding patients undergoing minimally invasive repair of incisional hernia are currently available, the results are not particularly reliable as they are based on heterogeneous groups, different surgical techniques, different mesh types, or with a too short follow period. Methods: We conducted a retrospective observational trial, collecting data from patients who underwent laparoscopic repair of a primary abdominal wall or an incisional hernia using the laparoscopic Intraperitoneal Onlay Mesh technique and a single mesh type, i.e., a composite polyester mesh with a hydrophilic film (Parietex CompositeTM mesh - Medtronic, Minneapolis, MN - USA). All patients signed an informed consent. Results: One thousand seven hundred seventy-seven patients were enrolled. The median surgery time was 50 minutes and the median length of hospital stay was 2 days. Intraoperative complications occurred in 12 patients (0.7%), while early postoperative surgical complications occurred in 115 (6.5%); during follow-up, bulging mesh was diagnosed in 4.5% of cases and hernia recurred in 4.3% of patients. An overlap equal or greater than 4 cm resulted as a significant protective factor, while the use of absorbable fixing devices was a risk factor for recurrence (odds ration: 9.06, p < 0.001, 95% confidence interval: 4.19 - 19.57). Conclusions: Minimally invasive treatment of primary and postincisional abdominal wall hernias is a safe, effective, and reproducible procedure. An overlap equal or greater than 4 cm, the use of nonabsorbable fixing devices and a postoperative care and follow-up regime are crucial in order to obtain good results and low recurrence rates.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Adulto , Idoso , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas
15.
Anticancer Res ; 41(8): 3867-3869, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34281847

RESUMO

BACKGROUND: Ultrasonography (US) is widely used for pre-operative detection of liver tumors. However, US does not have high resolution and very small tumors, tumors located near the liver surface, or those in cirrhotic livers are often not detected. CASE REPORT: A 47-year-old woman with a previous surgery for sigmoid colon cancer (T3N1bM0 Stage3b) showed a liver tumor on the surface of segment 2 by contrast-enhanced computed tomography (CT) and gadoliniumethoxybenzyldiethlenetriaminepen-taacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI). However, preoperative US could not identify a tumor lesion at the same site. The most likely preoperative diagnosis was metastasis from her sigmoid colon cancer and laparoscopic liver resection was performed. Intraoperative ultrasonography (IOUS) did not identify the tumor, but it was visualized with indocyanine green (ICG) fluorescence at the surface of segment 2. Laparoscopic liver resection was performed under fluorescence guidance. Pathological examination showed a pseudotumor with negative margins. CONCLUSION: ICG fluorescence imaging can allow visualization of liver tumors that are undetectable on US.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Cirurgia Assistida por Computador/métodos , Feminino , Corantes Fluorescentes , Humanos , Verde de Indocianina , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Ultrassonografia de Intervenção
16.
Anticancer Res ; 41(8): 4151-4155, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34281886

RESUMO

BACKGROUND/AIM: This study aimed to compare laparoscopy with laparotomy and evaluate the effectiveness of a laparoscopic combined retroperitoneal and transperitoneal approach for para-aortic lymphadenectomy in patients with endometrial cancer. PATIENTS AND METHODS: In this single-center retrospective study, patients with endometrial cancer who underwent para-aortic lymphadenectomy between December 2016 and November 2019 were analyzed. The patient's clinical and pathologic data were procured from medical records. Statistical analyses were performed using Fisher's exact and the Mann-Whitney U-tests. RESULTS: A total of 37 and 28 patients were included in the laparoscopic and laparotomy groups, respectively. The laparoscopic group had similar operative time, similar number of resected para-aortic and pelvic lymph nodes, less intraoperative blood loss and complications, lower rate of blood transfusion, and shorter postoperative stay than the laparotomy group. CONCLUSION: Laparoscopic combined retroperitoneal and transperitoneal approach for endometrial cancer is safe and effective compared to laparotomy.


Assuntos
Neoplasias do Endométrio/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Idoso , Aorta , Neoplasias do Endométrio/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Laparotomia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248336

RESUMO

Background: We sought to assess hernia characteristics and classification through comprehensive review of the literature involving broad ligament herniation. Methods: A literature search via MEDLINE and Embase databases was conducted to identify and select broad ligament herniation studies published between January 1, 2000 and September 30, 2020. Extracted data included previous surgical history, previous obstetric history, diagnostic imaging, herniated organ, hernia classification, and repair performed. The reported data has been compared to a unique case of broad ligament herniation that presented to our institution. Results: A total of 44 articles with 49 cases were identified for the study. Eighteen (36.7%) patients had a history of previous abdominal surgery while 29 (59.2%) had a history of previous childbirth. Type I (51.0%) and Type II (18.4%) defects were most commonly reported with most patients reporting only one defect (85.7%) using the Cilley classification. Twenty-nine patients underwent primary laparoscopic repair of the defect while 19 patients underwent exploratory laparotomy. Conclusions: The analysis of previously reported cases adds to the limited literature on broad ligament hernias and highlights the surgical management of this uncommon pathology. It also highlights the need for a broad differential diagnosis when female patients present with pelvic pain or symptoms of small bowel obstruction. The broad ligament should be fully inspected when mesenteric defects are suspected as multiple defects can be present as evidenced by the attached case study.


Assuntos
Ligamento Largo/patologia , Hérnia/diagnóstico , Dor Pélvica/diagnóstico , Adulto , Ligamento Largo/cirurgia , Diagnóstico Diferencial , Feminino , Hérnia/patologia , Herniorrafia/métodos , Humanos , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Laparoscopia/métodos , Laparotomia/métodos , Pessoa de Meia-Idade , Dor Pélvica/patologia
18.
Anticancer Res ; 41(7): 3499-3510, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230145

RESUMO

BACKGROUND/AIM: Esophagectomy is crucial for achieving long-term survival in patients with esophageal cancer, while being associated with a significant risk of complications. Aiming to reduce invasiveness and morbidity, total minimal-invasive esophagectomy (MIE) has been gradually implemented worldwide. The aim of the study was to compare MIE to open Ivor-Lewis esophagectomy (OE) for esophageal cancer or cancer of the gastroesophageal junction (GEJ), in terms of postoperative and oncological outcomes. PATIENTS AND METHODS: Clinicopathological data of patients undergoing oncologic transthoracic esophagectomy (Ivor Lewis procedure) between 2010 and 2019 were assessed. Postoperative outcomes and long-term survival of patients undergoing OE were compared to those after MIE using 1:1 propensity score matching. RESULTS: After excluding hybrid and robotic procedures, 90 patients who underwent MIE were compared with a matched cohort of 90 patients who underwent OE. MIE was associated with lower major postoperative morbidity (31% vs. 46%, p=0.046) and lower 90-day mortality (2% vs. 12%, p=0.010) compared to OE. MIE showed non-inferior 3-year overall (65% vs. 52%, p=0.019) and comparable disease-free survival rates (49% vs. 51%, p=0.851) in comparison to OE. CONCLUSION: Our data suggest that MIE should be preferably performed in patients with esophageal cancer or cancer of the GEJ.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Junção Esofagogástrica/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Pontuação de Propensão , Toracoscopia/métodos , Resultado do Tratamento
19.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248327

RESUMO

Background And Objectives: Spigelian hernias (SH) are a rare variant of abdominal wall defects that require prompt surgical intervention. With the advancement of abdominal wall surgery capabilities, there are several possible approaches of repairing SH. The aim of the study was to present our experience in performing laparoscopic or robotic transabdominal preperitoneal (TAPP) repairs of SH and discuss the advantages of TAPP in such hernias. Methods: Retrospective review of a prospectively maintained database of SH TAPP repairs between February 1, 2015 and February 29, 2020. Data included clinical details, size and location of fascial defect, presence of concomitant hernias, surgery duration, length of stay (LOS), mesh type, mesh size, and fixation method. Follow up visits at 1 month postoperative and telephone survey for pain assessment and subsequent hernia-related treatment. Results: During the study period 16 patients underwent TAPP SH repairs, 13 laparoscopically and 3 robotic. Seven (44%) patients had a concomitant inguinal hernia with 1 patient having bilateral inguinal defects. Mean surgery duration and mean LOS were 78 (range 41 - 120) minutes & 1.6 (range 1 - 3) days, respectively. Immediate postoperative complications included 2 seromas and 1 port-site hematoma. Mean telephone survey follow up was 17 months (range 3 - 49). Mean visual analogue scale scores were significantly lower at follow-up compared to discharge (1.9 vs 0.5, P = 0.0015). Conclusion: Advantages of TAPP SH repair include low postoperative chronic pain, potential low wound complications, intra-abdominal visualization of hernia contents, and repairing of concomitant inguinal hernias simultaneously.


Assuntos
Abdome/cirurgia , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Peritônio/cirurgia , Adulto , Idoso , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
20.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248330

RESUMO

Objective: To investigate outcomes and ascertain the safety and efficacy on patients having total laparoscopic hysterectomy (TLH), stratified by body mass index (BMI), focusing on high-BMI patients. Methods: This was a retrospective cohort study that reviewed 2,266 patients with benign gynecologic diagnoses, early cervical, endometrial, and ovarian carcinoma from September 1996 to October 2017. BMI was from 14.5 to 74.2 and were classified as normal or underweight (<24.9); overweight (25.0-29.9); class I obese (>30.0-34.9); class II obese (35-39.9); or class III obese (>40.0). All patients underwent TLH. Results: Patients' characteristics were similar across all BMI classes except for age, postoperative pathological diagnoses, and whether a cystoscopy was performed. Surgical duration, and estimated blood loss were similar across BMI classes. Overweight and obese class III patients had lower odds of staying >1 day compared to patients of normal BMI (OR = 0.65, P = .015). Obese class II patients had fewer complications compared to normal BMI patients (OR = 0.27, P = .013), but patients from other high BMI categories did not show any difference compared to patients with normal BMI. The rate of unplanned laparotomy was statistically, but not clinically, higher in obese class III patients (1.8% versus .7%, P = 0.011), most often due to large fibroids. The mean reoperation rate was 2.7%, with the lowest rate (.5%) among obese class II patients, and the highest rate (3.9%) among the normal BMI patients. Conclusion: TLH is feasible and safe for obese women, regardless of BMI. Obesity is not a contraindication to good outcomes from laparoscopic surgery.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Histerectomia/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Índice de Massa Corporal , Contraindicações de Procedimentos , Estudos de Viabilidade , Feminino , Doenças dos Genitais Femininos/complicações , Humanos , Histerectomia/métodos , Laparoscopia/métodos , Laparotomia , Pessoa de Meia-Idade , Sobrepeso/complicações , Estudos Retrospectivos , Resultado do Tratamento
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