scholarly journals Laparoscopic Enucleation of Benign Pancreatic Tumors

2016 ◽  
Vol 8 (4) ◽  
pp. 393-395
Author(s):  
Aida PUIA ◽  
Ion C. PUIA ◽  
Paul G. CRISTEA
Keyword(s):  
Operating Time ◽  
Pancreatic Tumors ◽  
Preoperative Imaging ◽  
High Morbidity ◽  
Endocrine Tumors ◽  
Surgical Morbidity ◽  
Benign Pancreatic Tumors ◽  
Necrotic Pancreatitis ◽  
Benign Pancreatic Tumor ◽  
Laparoscopic Enucleation

Benign pancreatic tumor enucleations have been performed since 1996. Endocrine tumors (ET) are rare yet they represent about 2/3 of the laparoscopic enucleations, a topic still in debate. Preoperative imaging routinely comprises a CT scan but endoscopic ultrasound is mandatory for localizing the tumor and guided biopsy-aspiration. Trocars have to be positioned to avoid “fencing” with the instruments. A Kocher maneuver may be necessary for accessing deep or posterior tumors. Bipolar electrocautery and harmonic scalpel ensure better hemostasis than the monopolar cautery hook. The raw surface can be covered with hemostatics or fibrin glue. The mean operating time is 2 hours. Forced conversions, due mainly to hemorrhage or insufficient exposure, are rare (9%). Pancreatic fistula, the main postoperative complication, affects up to one third of the patients and does not depend on the choice of dissection instruments, management of the remaining cavity or somatostatin use. A risk factor is the location of the tumor at less than 2mm from the main pancreatic duct. Necrotic pancreatitis, pancreatic pseudocyst and duodenal fistula contribute to a surgical morbidity of 60%. Although safe and technically feasible enucleation still has to be considered a low mortality but high morbidity procedure.

Creation of aNovel Preoperative Imaging Review Acronym to Aid in Revision Endoscopic Sinus Surgery

2021 ◽  
pp. 019459982110535
Author(s):  
Omar A. Karadaghy ◽  
Andrew M. Peterson ◽  
Meha Fox ◽  
Jacob White ◽  
Vidur Bhalla ◽  
...  
Keyword(s):  
Full Text ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Preoperative Imaging ◽  
Cochrane Central Register ◽  
Surgical Morbidity ◽  
Screening Criteria ◽  
Ovid Medline ◽  
Full Text Review ◽  
Meta Analyses

Objectives (1) Identify anatomic contributions to chronic rhinosinusitis (CRS) necessitating revision endoscopic sinus surgery (RESS). (2) Create a clinical acronym to guide imaging review prior to RESS that addresses pertinent sites of disease and potential sites of surgical morbidity. Data Sources Ovid MEDLINE, Embase and Medline via Embase.com , Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Review Methods Systematic search was performed using a combination of standardized terms and keywords. Studies were included if they investigated anatomic contributions to persistent CRS requiring RESS or the relationship between anatomic landmarks and surgical morbidity. Identified studies were screened by title/abstract, followed by full-text review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were strictly followed. Results In total, 599 articles met screening criteria, 89 were eligible for full-text review, and 27 studies were included in the final review. The identified anatomic sites of interests are broad; the most frequently cited anatomic region was retained anterior ethmoid cells (22/27 studies), followed by posterior ethmoid cells (14/27 studies). Using the consolidated information, a clinical acronym, REVISIONS, was created: Residual uncinate, Ethmoid cells (agger, Haller, supraorbital), Vessels (anterior and posterior ethmoid), Infundibulum, Septal deviation, I (eye) compartment, Onodi cell, Natural os, and Skull base slope and integrity. Conclusions The REVISIONS acronym was developed as a tool to distill the unique anatomic contributions of primary endoscopic sinus surgery failure into a format that can be easily incorporated in preoperative radiologic review and surgical planning to optimize outcomes and minimize complications.

scholarly journals Acinar cell cystadenoma of the pancreatic head

2020 ◽  
Vol 25 (2) ◽  
pp. 145-151
Author(s):  
A. V. Shabunin ◽  
М. М. Tavobilov ◽  
A. A. Karpov ◽  
О. V. Paklina ◽  
G. R. Setdikova ◽  
...  
Keyword(s):  
Acinar Cell ◽  
Clinical Case ◽  
Pancreatic Head ◽  
Immunohistochemical Analysis ◽  
Pancreatic Tumors ◽  
Routine Examination ◽  
Benign Pancreatic Tumors ◽  
Adjacent Structures ◽  
Benign Nature ◽  
Surgical Tactics

Acinar cell cystadenoma is one of the rarest benign pancreatic tumors. A clinical case of acinar cell cystadenoma of the pancreatic head in a 67-year-old patient is presented. The tumor was detected during a routine examination. The patient was undergoing surgery, enucleation of the neoplasm was performed. With a planned histologic examination and immunohistochemical analysis the diagnosis was confirmed. Surgical tactics depend on the location, size of the tumor and position to the adjacent structures. Given the benign nature of tumor, preference should be given to organpreserving interventions.

scholarly journals Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

2020 ◽  
Vol 29 (4) ◽  
pp. 239-244
Author(s):  
Edwin Jonathan Aslim ◽  
Yun Le Linn ◽  
Xinyan Yang ◽  
Glenn Yang Han Ng ◽  
Chui Wan Lee ◽  
...  
Keyword(s):  
Living Donor ◽  
Operating Time ◽  
Surgical Techniques ◽  
Donor Nephrectomy ◽  
Surgical Morbidity ◽  
Living Donor Nephrectomy ◽  
Warm Ischaemia ◽  
Singapore General Hospital ◽  
The Mean ◽  
Time Periods

Background: Laparoscopic living-donor nephrectomy is the current epitome of living kidney donation surgery. We review our experience in living-donor nephrectomies over the last 19 years, transitioning from open surgery to hand-assisted laparoscopy to full laparoscopic techniques. Methods: We retrospectively identified all living-donor nephrectomies performed at our institution from 1976 to 2018. The donors were categorised according to surgical techniques: open (ODN), hand-assisted laparoscopy (HALDN) and full laparoscopy (LDN). We reviewed changes in donor demographics over the years. Surgical outcomes between groups were compared from 2000 to 2018. We also compared the outcomes of LDN between different time periods to evaluate our learning curve. Results: A total of 214 living-donor nephrectomies were performed between 2000 and 2018. The majority were left sided (93%) and had single renal artery anatomy (90%). There were 22 ODN, 20 HALDN and 163 LDN cases. The mean operating time was 84±43, 151±32 and 179±37 minutes for ODN, HALDN and LDN, respectively ( p<0.001). There were no statistically significant differences in mean warm ischaemia times ( p=0.921) and length of hospital stay ( p=0.114) between groups. The overall 30-day surgical morbidity rate was 9.3%, with a major complications rate of 0.9%. The mean warm ischaemia time for LDN was significantly different ( p<0.001) between time periods: 281±260, 184±94 and 140±42 seconds for the periods between 2005–2009, 2010–2014 and 2015–2018, respectively. Conclusion: This study confirms the safety of living-donor nephrectomies performed at our institution, a centre with a modest volume of kidney transplants.

scholarly journals Robotic enucleation of benign pancreatic tumors

2017 ◽  
Vol 3 ◽  
pp. 151-151 ◽  
Author(s):  
Ana Sofia Ore ◽  
Courtney E. Barrows ◽  
Monica Solis-Velasco ◽  
Jessica Shaker ◽  
A. James Moser
Keyword(s):  
Pancreatic Tumors ◽  
Benign Pancreatic Tumors

Morbidity-Associated Factors after Gastrojejunostomy for Malignant Gastric Outlet Obstruction

2007 ◽  
Vol 73 (9) ◽  
pp. 871-875 ◽  
Author(s):  
Heriberto Medina-Franco ◽  
Leonardo Abarca-Pérez ◽  
Nayví España-Gómez ◽  
Noel Salgado-Nesme ◽  
Laura J. Ortiz-López ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Associated Factors ◽  
Outlet Obstruction ◽  
Morbidity And Mortality ◽  
Endoscopic Stenting ◽  
High Morbidity ◽  
Karnofsky Score ◽  
Surgical Morbidity ◽  
Malignant Gastric Outlet Obstruction ◽  
Gastrointestinal Bypass

Palliative care of malignant gastric outlet obstruction symptoms is critical for improved quality of life. We reviewed 66 consecutive patients with malignant gastric outlet obstruction who underwent palliative gastrointestinal bypass. The objective was to analyze morbidity and mortality-associated factors of this surgical procedure. Surgical morbidity and mortality were 39 per cent and 31 per cent, respectively. Reintervention was necessary in 16.6 per cent of cases. The only variable associated with surgical mortality was a Karnofsky score less than 80 (P = 0.02). Median survival of patients was 4 months (range, 2.11–5.9 months). Variables associated with shorter survival rates were an advanced stage of the disease and a Karnofsky score less than 80. Nine of 45 (20%) patients who survived after the gastrointestinal bypass surgery were unable to tolerate a normal diet. Palliative gastrojejunostomy in patients with malignant gastric outlet obstruction is associated with high morbidity and mortality; it is necessary to improve nonsurgical options such as endoscopic stenting.

scholarly journals COT-13 THE USEFULNESS OF THE CEREBRAL ANGIOGRAPHY FOR RESECTION OF THE MALIGNANT GLIOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii42-ii42
Author(s):  
Yoshie Matsumoto ◽  
Kuniaki Saito ◽  
Daisuke Shimada ◽  
Tatsuo Amano ◽  
Hiroki Sasamori ◽  
...  
Keyword(s):  
Malignant Glioma ◽  
Cerebral Angiography ◽  
Malignant Gliomas ◽  
Operating Time ◽  
Standard Of Care ◽  
Fusion Imaging ◽  
Preoperative Imaging ◽  
Glioma Surgery ◽  
Anterior Choroidal ◽  
Perforating Arteries

Abstract OBJECTIVE Maximal safe resection is a standard of care (SOC) for treatment of malignant glioma in light of quality of life (QOL) maintenance and better outcomes. This strategy is especially important when vital perforating arteries such as lateral striate arteries (LSA) and anterior choroidal arteries,are involved in tumor and its periphery,as their damage causes serious deterioration in the activities of daily life. Here we report a utility of preoperative cerebral angiography in glioma surgery. METHODS Six cases of perforator-involving malignant gliomas, consisting of five glioblastomas and one anaplastic ganglioma, operated from December 2018 to July 2019 were evaluated with preoperative imaging using sophisticated cerebral angiographic techniques and fusion imaging with MRI. RESULTS In all six cases, perforating arteries passed through or around the tumors. The cerebral angiography revealed the origin of LSA in all patients; one at M1,two at M1-M1 junction, and three at the superior trunk of M2. Anterior choroidal arteries and Heubner’s recurrent arteries were also identified preoperatively. By knowing the precise locations of these perforators,intraoperative resection of vascular-rich malignant gliomas could be performed with precaution of avoiding their unnecessary injury. No symptomatic complications occurred after angiography. Postoperative MRI disclosed a potential embolic infarction in the perforator territory in one patient,which resolved in a few days. CONCLUSIONS Visualization of perforators by angiography was helpful in detailed evaluation of surgical strategy and facilitated safe resection also leading to shortening of operating time. Compared to another modalities,angiography provided the best special resolution for visualization of vital perforating arteries involved in malignant gliomas.

Morbidity of Ventricular Cerebrospinal Fluid Shunt Surgery in Adults: An 8-Year Study

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. 985-995 ◽  
Author(s):  
Anne-Marie Korinek ◽  
Laurence Fulla-Oller ◽  
Anne-Laure Boch ◽  
Jean-Louis Golmard ◽  
Bassem Hadiji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Operating Time ◽  
Shunt Infection ◽  
Csf Leak ◽  
Csf Shunt ◽  
High Morbidity ◽  
Neurosurgical Procedures ◽  
Shunt Surgery ◽  
Shunt Placement

Abstract BACKGROUND: Cerebrospinal fluid (CSF) shunt procedures have dramatically reduced the morbidity and mortality rates associated with hydrocephalus. However, despite improvements in materials, devices, and surgical techniques, shunt failure and complications remain common and may require multiple surgical procedures. OBJECTIVE: To evaluate CSF shunt complication incidence and factors that may be associated with increased shunt dysfunction and infection rates in adults. METHODS: From January 1999 to December 2006, we conducted a prospective surveillance program for all neurosurgical procedures including reoperations and infections. Patients undergoing CSF shunt placement were retrospectively identified among patients labeled in the database as having a shunt as a primary or secondary intervention. Revisions of shunts implanted in another hospital or before the study period were excluded, as well as lumbo- or cyst-peritoneal shunts. Shunt complications were classified as mechanical dysfunction or infection. Follow-up was at least 2 years. Potential risk factors were evaluated using log-rank tests and stepwise Cox regression models. RESULTS: During the 8-year surveillance period, a total of 14 275 patients underwent neurosurgical procedures, including 839 who underwent shunt placement. One hundred nineteen patients were excluded, leaving 720 study patients. Mechanical dysfunction occurred in 124 patients (17.2%) and shunt infection in 44 patients (6.1%). These 168 patients required 375 reoperations. Risk factors for mechanical dysfunction were atrial shunt, greater number of previous external ventriculostomies, and male sex; risk factors for shunt infection were previous CSF leak, previous revisions for dysfunction, surgical incision after 10 am, and longer operating time. CONCLUSION: Shunt surgery still carries a high morbidity rate, with a mean of 2.2 reoperations per patient in 23.3% of patients. Our risk-factor data suggest methods for decreasing shunt-related morbidity, including peritoneal routing whenever possible and special attention to preventing CSF leaks after craniotomy or external ventriculostomy.

scholarly journals Application of biochemical markers CA 19-9, CEA and C-reactive protein in diagnosis of malicious and benign pancreatic tumors

2013 ◽  
Vol 4 ◽  
pp. 677-683 ◽  
Author(s):  
Jacek A. Śmigielski ◽  
Łukasz Piskorz ◽  
Marcin Wawrzycki ◽  
Przemysław Dobielski ◽  
Małgorzata Pikala ◽  
...  
Keyword(s):  
Biochemical Markers ◽  
Pancreatic Tumors ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Benign Pancreatic Tumors

A Novel Technique for Radiographic Diagnosis of Sarcopenia that Accurately Predicts Postoperative Complications in Lower Extremity Free Flap Patients

2021 ◽  
Author(s):  
Suma S. Maddox ◽  
Patrick A. Palines ◽  
Ryan D. Hoffman ◽  
Denise M. Danos ◽  
Daniel J. Womac ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Traditional Method ◽  
Postoperative Morbidity ◽  
Hounsfield Unit ◽  
Accurate Method ◽  
Preoperative Imaging ◽  
Surgical Morbidity ◽  
Ellipse Method ◽  
Poor Outcomes

Abstract Introduction Sarcopenia is linked to poor outcomes throughout the surgical literature and can be assessed on preoperative imaging to potentially aid in risk stratification. This study examined the effects of sarcopenia on surgical morbidity following lower extremity (LE) reconstruction, and also compared two methods of assessment, one of which is novel (“ellipse method”). Methods A retrospective cohort study of 50 patients receiving free flap-based reconstruction of the LE was performed. Bilateral psoas density and area were quantified at L4 through tracing (“traditional method”) and encircling (“ellipse method”) to calculate Hounsfield unit average calculation (HUAC). Logistic regression and receiving operator curve analysis for the primary outcome of any postoperative complication was used to determine HUAC cutoffs (≤ 20.7 vs. ≤ 20.6) for sarcopenia. Risk of complications associated with sarcopenia was evaluated using Fisher's exact tests. Results Twelve patients (24%) met criteria for sarcopenia via the traditional method and 16 (32%) via the ellipse method. By both methods, sarcopenic patients were older and more often female and diabetic. These patients also had higher American Society of Anesthesiologists scores and lower serum prealbumin levels. The ellipse method was found to be more accurate, sensitive, and specific than the traditional method in predicting postoperative morbidity (p = 0.009). Via the ellipse method, sarcopenic patients were at higher risk for any complication (p = 0.002) and were at a higher risk for a deep vein thrombus or pulmonary embolism via the traditional method (p = 0.047). Conclusion Sarcopenia is associated with greater pre- and postoperative morbidity in LE reconstruction. The novel ellipse method is a simplified and accurate method of assessing sarcopenia that can be easily performed in the clinical setting.

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