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Transanal total mesorectal excision (taTME) has improved the laparoscopic dissection for rectal cancer in the narrow pelvis. Although taTME has more clinical benefits than laparoscopic surgery, such as a better view of the distal rectum and direct determination of distal resection margin, an intraoperative urethral injury could occur in excision ta-TME. This study aimed to determine the feasibility and efficacy of the ta-TME with IRIS U kit surgery. This retrospective study enrolled 10 rectal cancer patients who underwent a taTME with an IRIS U kit. The study endpoints were the safety of access (intra- or postoperative morbidity). The detectability of the IRIS U kit catheter was investigated by using a laparoscope-ICG fluorescence camera system. Their mean age was 71.4±6.4 (58-78) years; 80 were men, and 2 were women. The mean operative time was 534.6 ± 94.5 min. The coloanal anastomosis was performed in 80%, and 20% underwent abdominal peritoneal resection. Two patients encountered postoperative complications graded as Clavien-Dindo grade 2. The transanal approach with IRIS U kit assistance is feasible, safe for patients with lower rectal cancer, and may prevent intraoperative urethral injury.
Assuntos
Estudos de Viabilidade , Complicações Pós-Operatórias , Neoplasias Retais , Cirurgia Endoscópica Transanal , Uretra , Humanos , Neoplasias Retais/cirurgia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Uretra/lesões , Uretra/cirurgia , Cirurgia Endoscópica Transanal/métodos , Cirurgia Endoscópica Transanal/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Duração da Cirurgia , Protectomia/métodos , Protectomia/efeitos adversos , Complicações Intraoperatórias/prevenção & controle , Complicações Intraoperatórias/etiologia , Reto/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Laparoscopia/métodos , Laparoscopia/efeitos adversosRESUMO
INTRODUCTION AND IMPORTANCE: The laparoscopic posterior approach adapts the advantages of Kugel hernioplasty, making it possible to perform it at the new layer even if the inguinal hernia is recurrent following the anterior approach, producing a high level of completion. However, in laparoscopic surgery for recurrent inguinal hernia using posterior approaches, dissecting the extraperitoneal space is difficult. Robotic surgery may enable precise dissection, even if the space is severely adhered. Here, we report a robotic approach after extraperitoneal approach for recurrent inguinal hernia, which developed after Kugel hernioplasty. CASE PRESENTATION: A 78-year-old Japanese man, who underwent left inguinal hernia repair (Kugel hernioplasty) 2 years ago, presented with recurrent reducible left inguinal swelling. A peritoneal incision was created above the deep inguinal ring to treat the primary right inguinal hernia. The pressure in the left inguinal region revealed a spermatic cord lipoma protruding from the internal inguinal ring as a recurrent inguinal hernia of the abdominal cavity. CLINICAL DISCUSSION: Robotic transabdominal preperitoneal repair for recurrent inguinal hernia is effective, especially after posterior approach Kugel hernioplasty, in which dissection of the extraperitoneal space is difficult. In the present case, the peritoneal flap was conserved without removing the direct Kugel patch. CONCLUSION: Kugel hernioplasty, which is a posterior approach, would result in severe extraperitoneal space adhesion. Essentially, a new and previously unused approach is preferable to the previous approach in patients with recurrent inguinal hernias. Robotic approach is effective for recurrent inguinal hernias even if the space was severe adhesion.
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INTRODUCTION AND IMPORTANCE: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an extremely rare benign lesion. CASE PRESENTATION: Here, we describe the case of a 52-year-woman who was diagnosed with sclerosing angiomatoid nodular transformation of the spleen. Abdominal contrast-enhanced CT revealed a solid lesion in the splenic hilum that was slowly enhanced between the portal venous and equilibrium phases incidentally. Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed FDG accumulation within the mass, with a maximum standardized uptake value (SUVmax) of 2.57. Based on these findings, the patient was scheduled for laparoscopic splenectomy. The total operating time was 193 min, and the intraoperative blood loss was 20 ml. The resected specimen was 9.0 × 8.4 × 5.6 cm and dark brown in colour with a large central stellate fibrotic scar. CLINICAL DISCUSSION: Pathological examination revealed nodular angioma lesions and the proliferation of fibrotic interstices and inflammatory cells. We could diagnose the SANT by the only HE staining without Immunohistochemical staining. CONCLUSION: Although SANT is a rare benign lesion, which is difficult to definitively diagnose based on preoperative imaging findings alone, it should be considered in cases of solitary splenic lesions, and we recommend performing LS and subsequent histological examination for the diagnosis of this disease.
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INTRODUCTION AND IMPORTANCE: Calcifying fibrous tumor (CFT) is a rare benign mesenchymal lesion that has been occurred in the gastrointestinal tract, especially occurs most commonly in the stomach and the small and large intestines. CASE PRESENTATION: 74-year-old woman was admitted to our hospital with complaints of epigastric discomfort. Whole-body computed tomography (CT) revealed a 2.2-cm mass with a 1.2-cm low-density area at the anterior wall in the gastric cardia and lesser omentum; however, no abnormal uptake at the same site was noted on positron emission tomography (PET). We performed laparoscopic tumor resection of the two sites. The postoperative course was good without complications. Histopathological findings revealed collagen fibrous granulation connective tissue and psammomatous calcification. Subsequently, the patient has been relapse-free for 6 months. CLINICAL DISCUSSION: CFT is a rare benign tumor that commonly occurs in soft tissues, such as the subcutaneous extremities and neck. In particular, development from the stomach and lesser omentum has never been reported. Our case was incidentally found on a general examination. In our case, CT showed a low-density area, MRI showed a low-intensity area, and PET examination showed no uptake; it was difficult to establish a preoperative diagnosis. Therefore, in our case, laparoscopic tumor resection was performed, with GIST as the differential diagnosis. CONCLUSIONS: We herein reported a rare gastric and lesser omentum CFT that was successfully treated by laparoscopic surgery. For curative treatment of CFT, complete surgical resection is necessary.