1,720,982 research outputs found
How I do it: laparoscopic treatment of common bile duct stones
Full text linkThe standard treatment for patients with symptomatic gallstones is laparoscopic cholecystectomy (LC). In patients undergoing LC the prevalence of common bile duct (CBD) stones ranges between 8% and 15% and it increases with advancing age, reaching up to 60% in elderly patients. Every patient who is candidate for LC should be evaluated for the presence of CBD stones and these should be treated if the diagnosis is confirmed. In the literature, the procedure of choice for CBD stones treatment is still debated. In many centers, pre- or postoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) and LC (two-stage endo-laparoscopic management) is considered standard practice instead of open choledocholithotomy and cholecystectomy. Laparoscopic single-stage management of gallstones and CBD stones has demonstrated equivalent outcomes to the two-stage endo-laparoscopic approach in randomized controlled trials but with shorter hospital stay and fewer interventions. Moreover, the two-stage endo-laparoscopic management of CBD stones and gallstones may be associated with a higher additional procedures rate, and possibly increased costs, as compared to single-stage laparoscopic management. Another option is single-stage endo-laparoscopic management of gallstones and CBD stones, performing ERCP/ES during the same LC anesthesia (so called, "Rendez-Vous" procedure). Excluding patients with cholangitis, who should be managed by emergency ERCP with ES and stones removal, in the elective setting the ultimate choice for one procedure or the other largely depends on the local resources and expertise that are available in the individual center, notwithstanding the scientific evidence in favour of single-stage laparoscopic management. The authors report the surgical techniques that they follow during LC for CBD exploration and stones' removal by laparoscopic trans-cystic or choledochotomy approach
Laparoscopic adjustable silicone gastric banding (LASGB) for the treatment of morbid obesitiy
No full textMorbid obesity is a serious disease that is responsible for several co-morbid conditions. Increased risks of hypertension, adult onset diabetes mellitus, dyslipidemia, pulmonary disease (Pickwickian syn- drome), musculo-skeletal disorders, gallbladder disease, deep vein thrombosis, venous stasis ulcers, and increased prevalence of certain types of cancers (uterine, breast, colon carcinoma) have been reported, ( together with severe psychological and social disability.' Nonsurgical treatment options including various combinations oflow-calorie or very-low-calorie diets, behavior modification, exercise, and drug therapy may achieve acceptable transient weight reduction but fail to maintain reduced body weight in most patients.
Technique of transanal endoscopic microsurgery (TEM)
No full textEarly stages of rectal cancer, well and ~oderately differentiated, have a l~w r~te of regional spread a~d therefore may be treated by conservative therapy. 1-3 Transanal Bnrloscopic MIcrosurgery (TEM)was In- troduced into clinical practice' by G. Buess in 1983.This technique allows for the local treatment of be- nign lesions and the early stages of rectal cancer through a modified rectoscope, yielding good exposure of the operative field with-three-dimensional vision; mucosectomy and full thickness excision procedures can be performed. TEM benefits are the same as other minimally invasive techniques: less pain, reduced morbid- ity, faster recovery time, and an absence of skin scars. In the present paper, the authors report the technique and the results of the experience of 89TEM procedures for the treatment of rectal tumor
Quality of life and anorectal function after transanal surgery for rectal cancer. A literature review
No full textL’obiettivo della presente revisione della letteratura è quello di analizzare i risultati in termini di qualità di vita e funzione anorettale dopo Transanal Endoscopic Microsurgery (TEM) e Trans-Anal Minimally Invasive Surgery (TAMIS) nel trattamento dei tumori del retto. Gli autori hanno condotto una revisione della letteratura attraverso il database PubMed usando le seguenti parole chiave: “quality of life”, “rectal cancer”, “transanal surgery”, “TEM” e “TAMIS”. RISULTATI: Sei e cinque studi, rispettivamente, sono stati inclusi riguardanti la TEM a la TAMIS per un totale di 619 pazienti con un follow up fino a 5 anni. La qualità di vita e la funzione anorettale sono state valutate mediante questionari e manometria anorettale in quattro studi su undici. Nella valutazione postoperatoria della funzione anorettale e della qualità di vita i pazienti hanno riportato modificazioni temporanee (da 3 settimane fino a 36 mesi) ma non effetti a lungo termine. Non ci sono state differenze nei risultati funzionali postoperatori tra la chirurgia con piattaforma rigida (TEM) o morbida (TAMIS). Alcuni studi riportano qualche alterazione alla manometria postoperatoria che comunque non viene confermata dai questionari. DISCUSSIONE: Durante la TEM e la TAMIS, il rischio di danno dei nervi pelvici autonomi, che può compromettere le funzioni urinarie e sessuali, e il rischio di danni allo sfintere con la necessità di confezionare una stomia, sono molto bassi. CONCLUSIONE: La qualità di vita e la funzione anorettale dopo TEM e TAMIS per il trattamento dei tumori del retto sono buoni, senza sequele postoperatorie ad un follow up a medio termine.AIM: The aim of the study is analyze the results after Transanal Endoscopic Microsurgery (TEM) and Trans-Anal Minimally Invasive Surgery (TAMIS) for rectal cancer in terms of Quality of Life (QoL) and anorectal function. MATERIAL OF STUDY: The authors have conducted a review of the literature through the PubMed database using the following keywords: "quality of life", "rectal cancer", "transanal surgery", "TEM" and "TAMIS". RESULTS: Six and five studies were included on TEM and TAMIS, respectively, for a total of 619 patients with a follow up of up to five years. QoL and anorectal function were evaluated by questionnaires and anorectal manometry in four out of eleven studies. At postoperative evaluation, patients reported temporary changes (from 3 weeks to 36 months) but no long-term effects on anorectal function and QoL. There were no differences in the postoperative functional outcome between surgery with rigid (TEM) or soft (TAMIS) devices. Some of the studies reported postoperative changes at manometry that were not clinically confirmed by the questionnaires. DISCUSSION: During TEM and TAMIS the risk of pelvic autonomic nerves damage, that may compromise urinary and sexual function and the risk of permanent sphincter damage with the need to perform a stoma, are very low. CONCLUSIONS: Quality of life and anorectal function after TEM or TAMIS for the treatment of rectal tumors are good with no postoperative sequelae at mid-term follow up. KEY WORDS: Quality of Life (QoL), Rectal cancer, Transanal surgery, Transanal Endoscopic Microsurgery (TEM), Trans-Anal Minimally Invasive Surgery (TAMIS)
Clinical application of three-dimensional (3-D) vision systems and virtual reality helmets in video-assisted surgery
No full textThoraco-Iaparoscopic surgery presents a series of technical difficulties linked mainly to the necessity of acquiring proper motor coordination and spatial reconstruction of an operative field that is seen from a distance on a two-dimensional video monitor, in the absence of any direct tactile feedback. In an effort to improve the motor coordination of the operating surgeon and of the surgical team, many apparatuses have recently become available on the market that allow the reproduction of a 3-Dimage on a video monitor. Such apparatuses have technical characteristics that are substantially diverse in technology and provide signifi- cantly different end results
Endo-SPONGE pulley system for the treatment of chronic anastomotic leakage after rectal resection. A case report
No full textAIM: Anastomotic leakage (AL) after anterior rectal resection unresponsive to diverting ileostomy is difficult to manage. Endoscopic vacuum-assisted (E-VAC) wound closure system is a new approach based on co-axial sponge positioning under endoscopic control. If the abscess is not co-axial, however, endoscopic positioning is not feasible. Aim is to report an original method of sponge positioning.CASE EXPEFUENCE: A 62-year-old woman with chronic AL after anterior rectal resection for cancer was referred. AL had been treated with diverting ileostomy without healing. Due to the peri-rectal abscess anatomy, standard E-VAC positioning was not possible. A combined endoscopic-interventional radiology procedure for Endo-SPONGE (R) (B. Braun Aesculap AG, Germany) positioning was thus employed. Under general anesthesia, a guidewire was passed after small counter-incision on the left gluteus and through the left levator muscle, reaching the anastomotic dehiscence and rectal lumen through the chronic abscess. The guidewire was retrieved through the anus and connected to a long silk thread. By retracting the trans-gluteal guidewire, the silk thread was pulled through the abscess to exit from the gluteal skin incision. A tailored Endo-SPONGE (R) was then connected to the trans-anal silk thread. By pulling on the gluteal silk thread, the sponge was positioned inside the abscess. The silk thread remained in place under a medication for sponge replacements.DISCUSSION AND RESULTS: Twelve Endo-SPONGE replacements under sedation were required until AL completely resolved after 35 days.CONCLUSION: When traditional endoscopic sponge insertion into AL is not possible, this original "pulley system" proved effective for sponge introduction and replacement
Laparoscopic adrenalectomy by the anterior transperitoneal approach: results of 108 operations in unselected cases
No full textA prospective randomized study with a 5 years minimum follow-up of tem vs laparoscopic total mesorectal excision after neoadjuvant therapy
No full textRandomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy.
No full textTreatment of rectal cancer by transanal endoscopic microsurgery: review of the literature.
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