RESUMO
Currently, there is a new transanal approach to be used for the excision of selected low-risk rectal cancers and broad-based polyps, the transanal endoscopic surgery using a single-port device. We transferred the single port access surgery (SPA) well-established from laparoscopic surgery as an improvement of the transanal endoscopic microsurgery (TEM). The aim of this article is to give an overview about the technical options and our experiences with different devices. Thirteen patients with selected low-risk rectal cancers or broad-based polyps with dysplasia underwent the SPA modified TEM using the SILS Port (Covidien Norwalk, CT), the TriPort (Olympus KeyMed, Southend, UK) or TriPort+ (Olympus KeyMed, Southend, UK), and laparoscopic instruments. The transanal single port procedure was in all cases completely successful without major complications. The transanal placement of SILS Port (Covidien) and TriPort/TriPort+ (Olympus) was easy to perform; a prior dilatation of the anal sphincter was not necessary. With an excellent view, accurate dissection was possible, all of them are appropriate for transanal single-port device. The postoperative follow-up showed an unremarkable examination. The transanal single port surgery with its benefits is a modified way to replace the TEM procedure. Our first experiences showed comfortable feasibility, less postoperative discomfort, and a reduced risk of damage to the anal sphincter.
RESUMO
BACKGROUND: Single port access (SPA) surgery is a new procedure for minimal invasive surgery using one multichannel port. The authors adapted this technique for transanal surgery as an improvement of the transanal endoscopic microsurgery (TEM). METHODS: A total of 3 patients underwent SPA modified TEM using the SILS port (Covidien) under CO(2) insufflation. This port allows insertion of 2 laparoscopic instruments and a telescope. RESULTS: The operation was completed successfully in all cases. The transanal placement of the SILS port was easy to perform; a prior dilatation of the anal sphincter was not necessary. There were no perioperative or postoperative complications as verified by postoperative observation, rectoscopy, and anal ultrasound. CONCLUSIONS: Transanal single port microsurgery is a feasible and new technique for less invasive and more gentle transanal surgery. By using this new multichannel device TEM surgery was changed in a modified way while preserving the anal sphincter.
Assuntos
Canal Anal/cirurgia , Pólipos Intestinais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Microcirurgia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Single-port access cholecystectomy is a new laparoscopic procedure using only one, transumbilical-placed port. The method has been denominated by some authors as "scarless." We report one of the initial clinical experiences in Europe with this new technique. METHODS: Fourteen patients underwent laparoscopic cholecystectomy using the ASC TriPort. In all cases, a small transumbilical incision was used to insert two 5-mm rigid laparoscopic instruments and a 5-mm 30 degrees telescope via the Triport. Hemostasis control was obtained by using an ultrasonic cutting device (SonoSurg, Olympus), Endo Clips (Covidien), and Lapro-Clips (Covidien). RESULTS: All cases were completed successfully. There were no perioperative port-related or surgical complications. No extra skin incisions were needed. Operative time was longer than in common laparoscopic cholecystectomy. CONCLUSIONS: Transumbilical single-port access cholecystectomy (SPACE) is a feasible technique for operating with less scars and reducing postoperative discomfort at the same time. The transumbilical single-port access for laparoscopic cholecystectomy has multiple benefits, such as better cosmetic results, less wound infections, and less incisional hernias. That is why SPACE is even more appropriate for obese patients. Using one-hand specialized instruments, which are curved at the shaft, and a semiflexible laparoscopic camera (LTFVH, Olympus) will make SPACE more comfortable and more time-saving.
Assuntos
Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Estudos de Viabilidade , HumanosRESUMO
We evaluated the effect of the alveolar recruitment strategy and high positive end-expiratory pressure (PEEP) on hemodynamics in 20 morbidly obese (body mass index 50 +/- 9 kg/m2), intravascular volume-loaded patients undergoing laparoscopic surgery. The alveolar recruitment strategy was sequentially performed with and without capnoperitoneum and consisted of an upward PEEP trial, recruitment with 50-60 cm H2O of plateau pressure for 10 breaths, and a downward PEEP trial. Recruitment and high PEEP did not cause significant disturbances in any hemodynamic variable measured by systemic and pulmonary artery catheters. Transesophageal echocardiography revealed no differences in end-diastolic areas or evidence of segmental abnormalities in wall motion.
Assuntos
Volume Sanguíneo/fisiologia , Hemodinâmica/fisiologia , Obesidade Mórbida/fisiopatologia , Respiração com Pressão Positiva/métodos , Alvéolos Pulmonares/fisiologia , Adulto , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: When performing thoracoscopic surgery in patients with small pulmonary nodules, intraoperative localization can be difficult and time-consuming. The percutaneous localization of suspicious intrapulmonary lesions was evaluated pre-operatively to facilitate the resection of the lesion and to avoid thoracotomy. MATERIALS AND METHODS: Thoracoscopies were performed in 13 patients with intrapulmonary nodules previously localized by CT-scan and flagged percutaneously with a hook-wire. Immediately after the procedure, the patient was transferred to the operating room and thoracoscopic pulmonary wedge resection was performed. RESULTS: All the nodules were properly identified. The time to position the wire was 20-30 min and thoracotomy could be avoided in all patients. The nodules were 0.5 cm - 6 cm in size and situated 1 cm - 4 cm subpleurally. CONCLUSION: Guide-wire identification of an intrapulmonary nodule is a safe, elegant, time-saving and reliable method. The lack of manual examination of pulmonary parenchyma in thoracoscopy is compensated for by precise pre-operative localization.
Assuntos
Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Nódulo Pulmonar Solitário/secundárioRESUMO
BACKGROUND: Bronchogenic cysts are rare congenital cystic lesions of foregut origin. They are the result of abnormal budding of the primitive tracheobronchial tube. Nonparasitic, true splenic cysts are another rare entity that might occur as incidental findings but may lead to deleterious courses in case of ruptures. CASE REPORT: We report here the first case of the uncommon association of a paraesophageal bronchogenic cyst and multiple primary splenic cysts in a 23-year-old woman suffering from dysphagia and chest pain. Successful complete resection of the paraesophageal cyst was performed using an abdominal, transhiatal approach and splenic cysts were subjected to organ-preserving TA stapler resection. CONCLUSION: Thus far there is no proof or genetic indication for a direct association of bronchogenic cysts and multiple splenic cysts, however, the uncommon coincidence of both lesions in our patient might suggest a common origin. Difficulties in preoperative diagnosis, histopathological characteristics and surgical treatment modalities are presented.
Assuntos
Cisto Broncogênico/complicações , Cisto Broncogênico/diagnóstico , Cistos/complicações , Cistos/diagnóstico , Esplenopatias/complicações , Esplenopatias/diagnóstico , Adulto , Cisto Broncogênico/patologia , Cisto Broncogênico/cirurgia , Cistos/patologia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Esplenopatias/patologia , Esplenopatias/cirurgia , Resultado do TratamentoRESUMO
Pneumomediastinum is the presence of air in the mediastinum. Spontaneous pneumomediastinum (SPM) is an infrequent, benign, and self-limiting condition that predominantly affects young males and pregnant females. It is important to distinguish pneumomediastinum symptoms from similar clinical findings that require immediate treatment, such as cardiac tamponade, angina pectoris, dissecting aortic aneurysm, mediastinitis, and pulmonary embolism. This report describes 2 cases of SPM managed at University Hospital Hamburg-Eppendorf during the period 2000 to 2001. Spontaneous pneumomediastinum should be considered whenever there are anamnestic data for retrosternal chest pain that radiates to the neck or back accompanied by dysphagia, dysphonia, dyspnea, and a positive Hamman's sign.