RESUMO
THE AIM OF THE STUDY: Is evaluating the possibility of integrating ICG-fluorescent cholangiography into the general safety system for laparoscopic cholecystectomy to prevent damage to the extrahepatic bile ducts by working out the methodological aspects of navigation technologies. MATERIALS AND METHODS: The analysis of literature data on various approaches to improve the perioperative identification of anatomical structures during laparoscopic cholecystectomy, including the ICG-fluorescent cholangiography, was carried out. This program was implemented during the provision of elective surgical care to 24 patients with cholelithiasis who underwent laparoscopic cholecystectomy with ICG-fluorescent navigation. RESULTS AND DISCUSSION: The developed program included: preoperative assessment of the anatomy of the biliary tree using MRCP; intraoperative technique of safe laparoscopic cholecystectomy with mandatory application of the concept of «critical view of safety¼ (CVS), which allows the most effective identification of the necessary anatomical structures; the use of ICG-fluorescent cholangiography, which allows to improve the control of anatomical structures at all stages of the operations. CONCLUSIONS: The first experience of using ICG-fluorescent cholangiography testifies to the high informative value of the method, the possibility and prospects of integrating the technology into a comprehensive safety system during laparoscopic cholecystectomy.
Assuntos
Colecistectomia Laparoscópica , Humanos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Fluorescência , Verde de Indocianina , Colangiografia/métodos , CorantesRESUMO
AIM: To study surgical features of laparoscopic adrenalectomy in patients with large adrenal neoplasms. MATERIAL AND METHODS: The results of 32 laparoscopic adrenalectomy procedures were analyzed in patients with adrenal neoplasms over 5 cm. The control group consisted of 67 patients with adrenal neoplasms up to 5 cm. RESULTS: There were significant differences in duration of operations (96.3±13.44 min vs. 67.2±11.07 min; p<0.05) and some postoperative variables. Postoperative morbidity was similar (9.4% vs. 7.5%; p>0.05). CONCLUSION: Laparoscopic adrenalectomy for adrenal neoplasms from 5 to 8-9 cm is feasible, effective and safe surgical procedure.
Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Neoplasias das Glândulas Suprarrenais/patologia , Estudos de Viabilidade , Humanos , LaparoscopiaRESUMO
We analyzed the results of treatment of 80 patients of elderly and senile age with strangulated inguinal hernias, which were divided into two groups. From 2011 to 2014 were treated 58 patients (group 2) - in the treatment of this group used the traditional approach without the use of endovideosurgical technologies. From 2015 to 2016, it treated 22 patients (group 1) in the treatment of this group used individual diagnostic and treatment tactics with the use of diagnostic laparoscopy and laparoscopic hernioplasty. In the course of work were developed indications and contraindications to the use of prosthetic hernioplasty and endovideosurgical methods. The proposed algorithm allowed to reduce the level of complications from 27,6% (16) to 4,5% (1) (p<0,05) and local complications from 24,1% (14) to 4,6% (1) (p<0,05), as well as the fatality rate from 10,3% (6) to 0%.
Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia , Idoso , Algoritmos , Humanos , Resultado do TratamentoRESUMO
AIM: To study feasibility, effectiveness and safety of minimally invasive video-assisted parathyroidectomy in patients with primary hyperparathyroidism; to define the advantages and disadvantages of this technique compared with conventional open surgery. MATERIAL AND METHODS: The study includes the results of 33 minimally invasive video-assisted parathyroidectomies performed in patients with primary hyperparathyroidism. The control group included 36 patients who underwent conventional open surgery. RESULTS: There were significantly increased time of surgery in the main group (41.2±12.7 min vs. 28.4±10.9 min, p<0.05), decreased need for postoperative analgesia (1,2±0.3 vs. 1.9±0.5 days, p<0.05) and significantly longer postoperative scar (1.8±0.2 vs. 6.2±0.5 cm, p<0.01). Incidence of complications was similar in both groups (6.1% vs. 8.3%, p>0.05). CONCLUSION: Minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism is feasible, safe and effective intervention that improves early postoperative course and cosmetic outcomes.
Assuntos
Hiperparatireoidismo Primário/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Cirurgia Vídeoassistida , Adulto , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Glândulas Paratireoides/patologia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Federação Russa , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/métodosRESUMO
The article analyses an experience with treatment of 96 patients with acute intestinal obstruction caused by peritoneal commissures. The technique of laparoscopic operations and principles of their realization are described. The observation of these principles is shown to give high effectiveness and safety of endovideosurgical interventions for acute intestinal obstruction. Their advantages consist in minimal invasiveness, short periods of postoperative rehabilitation and little frequency of postoperative complications.
Assuntos
Íleus/cirurgia , Laparoscopia/métodos , Cirurgia Vídeoassistida/métodos , Doença Aguda , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
An analysis of experiences with endovideosurgical sanation of the abdominal cavity was analyzed in 168 patients with diffuse peritonitis which complicated the course of different acute diseases. Relaparoscopy might be programmed and "on request". Programmed laparoscopy allowed adequate sanation of the abdominal cavity in most cases. It was impossible in 11.3% of cases associated with a pronounced commissural process and uncared peritonitis with formed pyogenic abscesses in the abdominal cavity. The indications and contraindications to laparoscopic sanation of the abdominal cavity are described.
Assuntos
Laparoscopia/métodos , Peritonite/cirurgia , Terapia Assistida por Computador/métodos , Cirurgia Vídeoassistida , Doença Crônica , Feminino , Humanos , MasculinoRESUMO
Endovideosurgical hernioplasty was performed in 3020 patients. Complex forms of inguinal hernias were diagnosed in 280 of them. These forms included: bilateral and combined inguinal hernias, inguinoscrotal hernias, sliding hernias, fixed and irreducible inguinal hernias, recurrent inguinal hernias after traditional herniorrhaphy and recurrent hernias after endovideosurgical hernioplasty. Original technical maneuvers are described, indications and contraindications were established, complications and results of treatment of patients with inguinal hernias were analyzed and evaluated. Recommendations are given for the treatment of patients with complex forms of hernias.
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Gravação em Vídeo , Seguimentos , Humanos , Masculino , Implantação de Prótese/instrumentação , Estudos Retrospectivos , Telas Cirúrgicas , Resultado do TratamentoRESUMO
The authors made an analysis of using endovideosurgery in diagnosing and treatment of Meckel's diverticulum and its complications in 18 patients. They describe signs and diagnostic criteria of the disease. Adequate treatment was proved to be possible by laparoscopy.
Assuntos
Laparoscopia/métodos , Divertículo Ileal/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Laparoscopic operations in patients who have undergone earlier "open" operations on abdominal organs are described. Before 1994 open laparoscopy by Hassan was used for penetration into the abdominal cavity. There were 46 such manipulations (2.14% of all 9100 endosurgical operations), in 5 cases of them the conversion to open operation was necessary. From 1994 the optic trocar "Visiport" was used permitting to image tissues in its passage through anterior abdominal wall. 195 operations with optical trocar were performed. All the patients had been operated earlier. Trocar was introduced without damages of abdominal organs in all the cases. Trocar was introduced in the left iliac area, where the comissures were found in 4 cases only. In 147 patients during revision unions of intestinal loops and great omentum with anterior abdominal wall were revealed. In one patient significant comissural process was revealed, so conversion to laparotomy was necessary. In 2 other patients laparotomy was performed because of damage of ileum and ceclim during endoscopic operation. Main criterion of rejection laparoscopic operation in patients operated earlier on abdominal organs is the results of laparoscopy with trocar.
Assuntos
Abdome/cirurgia , Laparoscopia , Cirurgia Vídeoassistida , Apendicectomia , Colecistectomia , Feminino , Humanos , Laparotomia , Masculino , ReoperaçãoRESUMO
In 1992-1994 laparoscopic hernioplasty was performed in 403 patients with inguinal (371) and femoral (32) hernias. Mean duration of hospital-stay 2.3 days, period of incapacity 9.7 days. Complication were encountered in 25 (3.7%) patients, including perforation of the small intestine and commissural ileus for which laparotomy had to be performed. Recurrent hernias occurred in 7 (1.7%) patients in periods of 2 weeks to 1.5 month due to poor fixation of the implant and choice of an inadequate operative method.
Assuntos
Hérnia Femoral/cirurgia , Hérnia Inguinal/cirurgia , Laparoscopia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Fatores de TempoRESUMO
The first experience with using laparoscopic extraperitoneal hernioplasty with implant Prolene" in 300 patients since November 1992 is analyzed. The analysis of the original method of laparoscopic extraperitoneal hernioplasty has shown its efficiency and safety for patients with inguinal hernias (recurrences were noted in 2,3%).
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Laparoscópios , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial , Polipropilenos , Recidiva , Telas Cirúrgicas , Técnicas de SuturaRESUMO
Laparoscopy was used in differential diagnostics of acute appendicitis in 524 female patients. Acute gynecological diseases were diagnosed in 123-of them, inflammatory processes in appendages being most frequent. The laparoscopic technology allowed not only to avoid diagnostic errors in all the cases, but also to take all necessary surgical measures. The effectiveness of laparoscopic operations for acute gynecological diseases was confirmed by the absence of complications and recovery within short terms.
Assuntos
Apendicite/diagnóstico , Apendicite/cirurgia , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/cirurgia , Laparoscopia , Doença Aguda , Adulto , Anestesia Intravenosa , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgiaRESUMO
Laparoscopic technology was applied as diagnostic method in 608 patients, 50 patients have undergone laparoscopic appendectomy. There were no diagnostic errors in laparoscopy application. Laparoscopic technology allowed to perform appendectomy quite safely and without any complications. This method permitted considerably reduce terms of treatment of the acute appendicitis patients and quickly restore their ability to work.
Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Doença Aguda , Adulto , Antibacterianos/administração & dosagem , Apendicectomia/instrumentação , Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico , Diagnóstico Diferencial , Estudos de Avaliação como Assunto , Feminino , Humanos , Cuidados Intraoperatórios , Laparoscópios , Laparoscopia/estatística & dados numéricos , Masculino , Peritonite/prevenção & controleAssuntos
Apendicite/diagnóstico , Laparoscopia , Doença Aguda , Adulto , Apendicectomia , Apendicite/cirurgia , Diagnóstico Diferencial , Emergências , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Reproductive function and treatment results have been analysed for 59 patients aged 17 to 32 years after herniotomy. 28 and 31 of them underwent standard and endosurgical interventions, respectively. The control group consisted of 30 healthy males matched for age. As shown by 6-month follow-up, the endosurgical herniotomy was not associated with such complications as hydroscheocele, hydrocele, testicular atrophy, diminution of blood flow along the testicular arteries. Ejaculate, levels of sex hormones in the blood, cremasteric reflex remained intact. After routine herniotomy there appeared defects in scrotal and testicular microcirculation with partial testicular atrophy in 25% of cases, testicular circulation fell 2.2-2.5-fold, deterioration of spermogram and cremasteric reflex parameters, reduction of serum testosterone were observed.