183 research outputs found
Videolaparoscopic treatment of paraesophageal hernia
No full text6143 General Surgery
Videolaparoscopic Treatment of Paraesophageal Hernia
Roberta Gelmini, MD, Massimo Saviano, MD
Hiatal hernias are classified into 3 types: sliding hernia (type
I), paraesophageal hernia (type II), and mixed hernia (type
III), which is a combination of type I and II. The
paraesophageal and mixed hernias represent about 5% to 10% of surgically treated hiatal hernias. The surgical treat-
ment of the paraesophageal and mixed hernias is unavoid-
able because of the high risk of severe complications, and it
has to be considered in a high percentage of cases. The
most important technical difficulty in the videolaparoscopic
treatment is represented by the hugeness of the hernial defect
and by the challenging reduction of the stomach into the ab-
domen. A cautious dissection of the hernial sac and dia-
phragmatic cruses and a careful crural repair make the
videolaparoscopic procedure feasible. The operative times
are not prolonged, and the results are similar to those of the
open technique. In the literature, the incidence of complica-
tions, both intra- and postoperative, are not statistically sig-
nificantly different between the laparoscopic and open
technique. Because of the complexity of the laparoscopic
procedure, the minimally invasive access has to be reserved
for surgeons well trained in these techniques. We describe 2
cases: one paraesophageal and one mixed hernia video-
laparoscopically treated with the help, in the second case, of
a Gore-Tex mesh. In both cases, the technical results were
positive. Intra- and postoperative complications did not occur
and, one year after the surgical procedure, both patients
were in good health and recurrence free
Chirurgia videolaparoscopica: tecniche di apprendimento su endotrainer
No full textManuale didattico accompagnato da audiovisivo su supporto VS
Peritoneal adhesions. A review of the literature
No full textLe prime descrizioni di sindromi aderenziali peritoneali nella letteratura medica vengono riportate con dovizia di particolari quali osservazioni autoptiche esiti di peritoniti tubercolari nel XIX secolo in trattati di anatomia patologica.Solo sul finire del XIX secolo, con lo sviluppo della chirurgia addominale legato all’introduzione dell’anestesia e dell’antisepsi, compaiono anche su trattati chirurgici le prime descrizioni di tale patologia quale possibile causa di occlusione intestinale, con precisi riferimenti a diverse ipotesi eziologicheGli Autori, alla luce di una analisi della letteratura, pongono l’accento sull’impatto clinico e socio-economico determinato dalle aderenze peritoneali post-operatorie. In particolare vengono esaminate le sindromi cliniche ed i rischi correlati alla presenza di aderenze peritoneali, le complicanze e le ripercussioni. Numerosi studi sperimentali e clinici hanno portato in questi ultimi anni a comprendere la genesi delle aderenze quale esiti di un processo di riparazione peritoneale nella sede di un traumatismo ove fenomeni locali permettono l’organizzazione di depositi di fibrina tra le superfici peritoneali d’organi e strutture adiacenti, e proprio uno squilibrio tra formazione di fibrina e capacità di fibrinolisi appaiono essere l’elemento patogenetico determinante. La chirurgia video-laparoscopica può risultare oggi utile sia nella diagnosi che nel trattamento di sindromi aderenziali croniche anche se l’approccio mini-invasivo appare ridurre ma non eliminare l’insorgenza di aderenze post-operatorie. Alla luce delle attuali conoscenze patogenetiche in tema di aderenze peritoneali vengono evidenziate le strategie per prevenirne o comunque ridurne lo sviluppo, riconducibili in linea di massima sia a principi di tattica chirurgica sia all’impiego di presidi adiuvanti
. Laparoscopic total colectomy with ileo-rectal anastomosis for polyposis and ulcerative colitis.
No full textObjective of the study: Since the introduction of laparoscopic colorectal surgery, several studies have demonstrated the advantages of mini-invasive segmental colon resections in the treatment of benign and malignant diseases. On the contrary the use of laparoscopy for total colectomy and proctocolectomy is not worldwide accepted first of all because of the technically challenging nature of these procedures. The aim of this report is to show the feasibility and safety of straight laparoscopic total colectomy (LTC) for polyposis (P) and ulcerative colitis (UC).Material and methods: Between January 2006 and June 2007 in our Institution 5 patients underwent to LTC with ileorectal anastomosis plus temporary loop ileostomy for P ( 2 cases) and UC (3 cases). Results: The mean age was 69.2 yrs (62-77) and in all cases the preoperative endoscopy showed the distal rectum almost without signs of disease. Mean operative time was 320 minutes and the estimated mean blood loss was 250 cc. No transfusions were necessary. No conversions occurred. The mean surgical specimen length was 100 cm. and in all acses the margins of resection were disease free. Considering the postoperative course, no morbidity and mortality occurred. The mean hospital stay was 8 days. The temporary ileostomy was suppressed in all patients within three months since the procedure. Conclusions: The analysis of our data highlights that LTC is effective and feasible even if the use of this procedure, because of its complexity, has to be reserved to well-trained laparoscopic surgeons
A didactic model in laparoscopic surgery: the usefulness of endotrainers.
No full textLiterature data show as operative time and incidence of complication after laparoscopic surgery are strictly related with the training and the experience of surgeons. During a correct formative path for minimal-invasive surgeons, the training using simulators is mandatory because it permits to get practice in new techniques and to familiarize with unusual and developing equipments and instruments from which depends the correct execution of surgical procedures.The Authors present a didactic model of training in laparoscopic surgery using endotrainers. The simulators are shaped to reproduce the abdominal cavity and their top is a membrane useful to carry out pneumoperitoneum and trocars introduction. In the inner, synthetic anatomical models or animal organs can be used to reproduce the main steps of surgical procedures avoiding the use of living animals; it permits to elude the bureaucratic and economic limits related to the use of them. Besides exercises based on the use of ordinary objects as peas and beans, rubber bands or matches are useful to develop the basic gesture, the orientation in a bi-dimensional space and the eye-hand coordination. These exercises are prevalently directed to inexperienced surgeons at the beginning of a training program.In this video is presented a consecutive series of exercises which represents the progression of a training program in laparoscopy beginning from easy “games”, going through procedures of increasing difficulty and finishing with performing the most complex surgical steps. In particular, exercises performed on anatomic models permit to reproduce the main steps of abdominal and pelvic surgery and the use of the same instrumentation utilized in the operating room, allow to obtain the necessary technical competence. The aim of the program is to progressively acquire the right coordination and accuracy in the bimanual gestures and suturing and knotting techniques. The described exercises want to be a incentive for the diffusion of the use of simulators in the training programs for residents and inexperienced surgeons even if the use of endotrainers can be costructive every time. It represent a helpful support to further improve the training in laparoscopic techniques, shortening the learning curve and reducing operative times and complications
Laparoscopic total colectomy with ileo-rectal anastomosis for polyposis and ulcerative colitis. Eur Surg Res 2009;43:104
No full textIntroduction: Since the introduction of laparoscopic colorectal surgery, several studies have demonstrated the advantages of mini-invasive segmental colon resections in the treatment of benign and malignant diseases. On the contrary the use of laparoscopy for total colectomy and proctocolectomy is not worldwide accepted first of all because of the technically challenging nature of these procedures. The aim of this report is to show the feasibility and safety of straight laparoscopic total colectomy (LTC) for polyposis (P) and ulcerative colitis (UC).Material and methods: Between January 2006 and June 2007 in our Institution 5 patients underwent to LTC with ileorectal anastomosis plus temporary loop ileostomy for P ( 2 cases) and UC (3 cases). Results: The mean age was 69.2 yrs (62-77) and in all cases the preoperative endoscopy showed the distal rectum almost without signs of disease. Mean operative time was 320 minutes and the estimated mean blood loss was 250 cc. No transfusions were necessary. No conversions occurred. The mean surgical specimen length was 100 cm. and in all acses the margins of resection were disease free. Considering the postoperative course, no morbidity and mortality occurred. The mean hospital stay was 8 days. The temporary ileostomy was suppressed in all patients within three months since the procedure. Conclusions: The analysis of our data highlights that LTC is effective and feasible even if the use of this procedure, because of its complexity, has to be reserved to well-trained laparoscopic surgeons
Laparoscopic Ileo-Colic Resection with Radiofrequency Device in Crohn Disease
No full textObjective:
Since the introduction of laparoscopic colorectal surgery, several studies have demonstrated the advantages of
mini-invasive segmental colon resections in the treatment of benign diseases. Laparoscopic ileo-colic resection in
complicated Crohn’s disease is often difficult. The presence of fistula, abscess, and inflammation could make the dissection
challenging. The use of a radiofrequency vessel-sealing system device both in dissection and vessel ligation, as a unique
instrument, seems to make the procedure easier with a low rate of conversion. The aim of this report is to show the feasibility
and safety of laparoscopic ileo-colic resection with a radiofrequency device.
Materials and Methods:
Between January 2009 and December 2010 at our institution, 13 patients underwent to
laparoscopic ileo-colic resection with a radiofrequency device for complicated Crohn’s disease.
Results:
The mean age was 42.3 years, and the preoperative endoscopy showed an ileocecal valve of distal ileum stenosis or
fistula. Mean operative time was 166 minutes, and the estimated mean blood loss was 100cc. No conversions occurred. In all
cases but one, the margins of resection were disease free. Two postoperative complications occurred: 1 anastomotic
dehiscence and 1 intestinal perforation, both surgically treated. No mortalities occurred. The mean hospital stay was 8 days.
Conclusions:
The analysis of our data highlights that laparoscopic ileo-colic resection with a radiofrequency device is
effective and feasible even if this procedure, because of its complexity and for the intrinsic characteristics of the disease, has
to be reserved for well-trained laparoscopic surgeons and does not eliminate the risk of postoperative complications
Laparoscopic treatment of paraesophageal and mixed diaphragmatic hernias report of two cases
No full textHiatal hernias are classified into 3 types: sliding hernia (type I), paraesophageal hernia (type II) and mixed hernia (type III), that is a combination of type I and II. The paraesophageal and mixed hernias represent about 5-10% of the surgically treated hiatal hernias. The surgical treatment of the paraesophageal and mixed hernias is unavoidable because of the high risk of severe complications and it has to be considered in a high percentage of cases. The most important technical difficulty in the video-laparoscopic treatment is represented by the hugeness of the hernial defect and by the challenging reduction of the stomach into the abdomen. A cautious dissection of hernial sac and diaphragmatic cruses as well as a careful crural repair make the videolaparoscopic procedure feasible. The operative times are not prolonged and the results are similar to the open technique ones. In literature, the incidence of both intra and postoperative complications doesn't exhibit statistically significant differences between laparoscopic and open techniques. Because of the complexity of the laparoscopic procedure, the minimally invasive access has to be reserved to surgeons who are well trained in those techniques. In this paper we describe 2 cases: one of paraesophageal hernia and the other of mixed hernia which were videolaparoscopicaUy treated with the help, in the second case, of a Gore-Tex mesh. In both cases the technical results were positive. Intra and postoperative complications didn't occur and, one year after the surgical procedure, both patients were in good health and recurrence-free
Day surgery laparoscopic cholecystectomy: initial experience in 43 consecutive patients
No full textAim: Analyze the results of an early experience in day-case LC (laparoscopic cholecystectomy) in a single laparoscopic unit, in terms of clinical outcome, unexpected admissions, readmissions, patients satisfaction.
Materials and Methods: During three years, 200 consecutive patients underwent LC. Emergency procedures (32pts) and patients scheduled for cholecystectomy plus other surgical procedures (21pts) were excluded. Thus, 147 patients underwent elective LC and 43 were scheduled for DSLC (day-surgery laparoscopic cholecystectomy).
Results: 6 patients (13,9%) were considered not eligible for a same day discharge and admitted to the inpatients ward for overnight observation. The re-admission rate was 2,3% and 41 patients (95,3%) were completely satisfied.
Discussion: Patients satisfaction was complete in 95,3% of cases, related to a correct preoperative information and the reduction in hospital costs amounted approximately to 41%. Despite the evidence of feasibility and safety of the day-case procedure, the Italian cultural background is nowadays inadequate for a clean acceptance of the DSLC. The provision of adequate staff education and training prior to full DSLC introduction is mandatory to the success of this organizational model.
Conclusions: LC can be performed safely in an outpatient setting if there’s a careful education of patients and the surgical and anesthesiologist team is well-trained. Besides, good results can be achieved considering inclusion criteria. For the admission to be kept to a minimum, postoperative pain and nausea management has to be carefully planned such as discharge criteria evaluated.
For selected patients, day-case LC is feasible and safe and can provide a reduction in hospital costs
Enforcing Cooperative Storytelling: First Studies
No full textIn this paper, we describe the first prototype of a system called StoryTable, aimed at supporting a group of children in the activity of storytelling. The system is based on a special multi-user touchable device (the MERL DiamondTouch) and it was designed with the purpose of enforcing collaboration between children. The paper discusses how the main design choices were influenced by the paradigm of cooperative learning and presents two observational studies to assess the effects of the different design choices on the storytelling activit
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