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Pulumati A, Algarin YA, Jaalouk D, Hirsch M, Nouri K. Exploring the potential role for extended reality in Mohs micrographic surgery. Arch Dermatol Res 2024; 316:67. [PMID: 38194123 DOI: 10.1007/s00403-023-02804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/03/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Abstract
Mohs micrographic surgery (MMS) is a cornerstone of dermatological practice. Virtual reality (VR) and augmented reality (AR) technology, initially used for entertainment, have entered healthcare, offering real-time data overlaying a surgeon's view. This paper explores potential applications of VR and AR in MMS, emphasizing their advantages and limitations. We aim to identify research gaps to facilitate innovation in dermatological surgery. We conducted a PubMed search using the following: "augmented reality" OR "virtual reality" AND "Mohs" or "augmented reality" OR "virtual reality" AND "surgery." Inclusion criteria were peer-reviewed articles in English discussing these technologies in medical settings. We excluded non-peer-reviewed sources, non-English articles, and those not addressing these technologies in a medical context. VR alleviates patient anxiety and enhances patient satisfaction while serving as an educational tool. It also aids physicians by providing realistic surgical simulations. On the other hand, AR assists in real-time lesion analysis, optimizing incision planning, and refining margin control during surgery. Both of these technologies offer remote guidance for trainee residents, enabling real-time learning and oversight and facilitating synchronous teleconsultations. These technologies may transform dermatologic surgery, making it more accessible and efficient. However, further research is needed to validate their effectiveness, address potential challenges, and optimize seamless integration. All in all, AR and VR enhance real-world environments with digital data, offering real-time surgical guidance and medical insights. By exploring the potential integration of these technologies in MMS, our study identifies avenues for further research to thoroughly understand the role of these technologies to redefine dermatologic surgery, elevating precision, surgical outcomes, and patient experiences.
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Affiliation(s)
- Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
| | | | - Dana Jaalouk
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Melanie Hirsch
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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2
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Cai D, Ying Y, Fan J, Jin Y, Huang Z, Zhang Y, Zhang S, Chen Q, Gao Z. Robot-assisted resection of benign splenic tumors in children. Langenbecks Arch Surg 2023; 409:18. [PMID: 38147144 PMCID: PMC10751254 DOI: 10.1007/s00423-023-03208-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Robotic surgery is becoming increasingly widely used in the field of pediatric surgery. The present study aimed to evaluate the safety and feasibility of robot-assisted resection of benign pediatric splenic tumors and to discuss the technical points. METHODS A total of 32 patients who were diagnosed with benign splenic tumors and underwent minimally invasive surgery from January 2017 to September 2023 were included in the study. The clinical data including demographic criteria, operative details, and postoperative outcomes were analyzed retrospectively. RESULTS Thirteen patients underwent robot-assisted surgery, and 19 patients underwent laparoscopic surgery. The median operation time was 150 min, with an interquartile range (IQR) of 120 to 200 min for the robot-assisted group and 140 min with an IQR of 105 to 180 min in the laparoscopic group (P = 0.318). Despite four cases in the laparoscopic group (21%) being converted to laparotomy because of intraoperative bleeding, compared with none in the robot-assisted group, there was no significant difference between two groups (P = 0.128). The intraoperative volume of blood loss was significantly less (P = 0.041), and the hospitalization expense was significantly higher (P = 0.000) in the robot-assisted group than for the laparoscopic group. There was no significant difference in patients' age, tumor size, postoperative feeding time, and the postoperative hospitalization time between two groups (P > 0.05). CONCLUSION Robot-assisted benign splenic tumor resection was safe and feasible, and it reduced surgical trauma for the pediatric patient.
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Affiliation(s)
- Duote Cai
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Yan Ying
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Jiani Fan
- Department of Nephrology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang Province, Taizhou, 318054, China
| | - Yi Jin
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Zongwei Huang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Yuebin Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Shuhao Zhang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Qingjiang Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Province, Hangzhou, 310051, China.
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Zhang R, Yan C, Kang C, Chen B, Guo C. Hand-Assisted Laparoscopic Splenectomy with Temporary Splenic Artery Occlusion in Pediatric Patients: The Experience in a Chinese Tertiary Children's Hospital. J Laparoendosc Adv Surg Tech A 2022; 32:1016-1021. [PMID: 35617701 DOI: 10.1089/lap.2021.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The hand-assisted laparoscopic splenectomy (HALS) approach overcomes the difficulties experienced with conventional laparoscopic splenectomy (LS) with added advantages. In this study, we compared the HALS technique with standard LS based on the feasibility and intermediate postoperative outcomes in pediatric patients. Methods: We retrospectively investigated pediatric patients who underwent HALS or LS from October 2013 to May 2021 at the Children's Hospital, Chongqing Medical University. Potential parameters related to HALS or LS were explored, and the intermediate-term clinical outcomes were compared between the two groups. The quality of life and splenic regrowth data were followed up routinely for 12 months after the operation. Results: In total, 39 patients underwent splenectomy (11 for HALS and 28 for LS) and were eligible for this research. Patients who underwent HALS had a greater proportion of focal benign splenic lesions (P < .001) and partial splenectomy (P < .001). The HALS operative time was reduced compared with LS (P = .032). No operation conversion was noted in the HALS group, whereas 4 (14.3%) cases were converted to an open operation (P = .249). For partial splenectomies, favorable outcomes with HALS, including short operative time (P = .001) and reduced blood loss (P = .014), were noted compared with LS. No postoperative mortality was observed. During the follow-up period, a good quality of life and splenic regrowth were noted for most of the patients. Conclusions: Although another incision is necessary, HALS confers the advantages of a minimally invasive technique to manage the fragile spleen, especially in pediatric patients requiring partial splenectomy.
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Affiliation(s)
- Rensen Zhang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
| | - Cailong Kang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Bailin Chen
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
| | - Chunbao Guo
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, P.R. China.,Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,National Clinical Research Center for Child Health and Disorders Chongqing, P.R. China.,China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, P.R. China.,Chongqing Key Laboratory of Pediatrics; Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pediatric Surgery, Chongqing Women's and Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
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Wang RJ, Xiao L, Xu XM, Zhang MM, Xiong Q. Super-Selective Partial Splenic Embolization for Hereditary Spherocytosis in Children: A Single-Center Retrospective Study. Front Surg 2022; 9:835430. [PMID: 35284491 PMCID: PMC8913532 DOI: 10.3389/fsurg.2022.835430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 01/30/2023] Open
Abstract
Background Hereditary spherocytosis (HS) is the most common hemolytic anemia due to erythrocyte membrane defects. Total splenectomy is the most effective treatment for moderate or severe HS. As a conservative alternative, partial splenic embolization (PSE) can preserve part of the spleen's function, thus reducing the risk of overwhelming post-splenectomy infection (OPSI) or sepsis, especially for pediatric patients. However, it is not easy to precisely control the scope of interventional embolization, limiting PSE applications. The present study aims to optimize the PSE procedure on smaller, which is named super-selective PSE (SPSE), to improve the controllability and assess the feasibility and effectiveness of SPSE. Results This study was conducted by retrospectively reviewing clinical data from HS patients treated by surgical treatments, which were diagnosed at the children's hospital of Chongqing medical university from January 2015 to December 2019. Patients were divided into two groups according to their treatment preference: SPSE (16 patients) group and total splenectomy (41 patients) group. The mean proportion range of splenic embolism by SPSE was 82.4%, close to the expected value (70–85%). The average hemoglobin value was increased significantly from 6.85 (5.6–8.0) g/dl before SPSE to 12.4 (10.4–13.3) g/dl after SPSE (p < 0.001). All children after SPSE suffered mild post-embolization syndrome, such as pain, fever, and vomiting, which could easily be controlled with appropriate supportive therapy. Conclusions Super-selective partial splenic embolization is a safe and effective treatment for moderate or severe HS in children. However, with a longer follow-up, more patients further assess the value of SPSE.
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Affiliation(s)
- Rui-jue Wang
- Chongqing Key Laboratory of Pediatrics, Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Li Xiao
- Department of Medical Record Statistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xi-ming Xu
- Department of Medical Record Statistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ming-man Zhang
- Chongqing Key Laboratory of Pediatrics, Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Qiang Xiong
- Chongqing Key Laboratory of Pediatrics, Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- *Correspondence: Qiang Xiong
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Lu Y, Li Y, Yang Y, Shi L, Ding W, Cai H, Duan Y, Chen X, Zhang Y, Nong K. Clinical effect of laparoscopic partial splenectomy for both benign tumours and trauma-10 years of experience at a single institution. ANZ J Surg 2022; 92:471-476. [PMID: 35146892 DOI: 10.1111/ans.17518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/19/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This retrospective study aimed to present our surgical experience in patients with benign tumour or trauma in spleen who underwent laparoscopic partial splenectomy (LPS) and to compare the results with those of patients who underwent an open partial splenectomy (OPS). METHODS We analysed the medical data of patients who underwent LPS or OPS between January 2010 and January 2020. RESULTS In total, 41 patients were enrolled. Nine patients underwent open surgery, 32 patients underwent laparoscopic surgery. The proportion of patients with tumours in the upper pole in LPS group was more than patients in OPS group. No difference was observed in estimated blood loss, allogeneic transfusion, postoperative stay, pathology and complications between LPS and OPS groups. The operation time in the LPS group (137.5 ± 30.8 min) was longer than that in the OPS group (88.3 ± 30.1 min) for patients with splenic traumatic rupture (P = 0.019). CONCLUSIONS LPS is an effective and safe spleen-preserving surgery as OPS. The advantages are small trauma, light pain and quick recovery. It is suitable for patients with benign tumours or trauma confined to one side of the spleen.
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Affiliation(s)
- Yunjie Lu
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Yucheng Li
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Yong Yang
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Longqing Shi
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Wei Ding
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Huihua Cai
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Yunfei Duan
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Yue Zhang
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
| | - Kate Nong
- Department of Hepatopancreatobiliary Surgery, The Third Hospital Affiliated to Soochow University, Changzhou, China
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Jin Y, Hu H, Regmi P, Li F, Cheng N. Treatment options for sclerosing angiomatoid nodular transformation of spleen. HPB (Oxford) 2020; 22:1577-1582. [PMID: 32063479 DOI: 10.1016/j.hpb.2020.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND To summarise the clinical features of Sclerosing angiomatoid nodular transformation (SANT) of the spleen and to compare the efficacy of three different surgical treatments. METHODS We performed a retrospective analysis of patients with SANT of spleen treated at our center from 2009 to 2018. We compared the efficacy and safety of three different types of surgical procedures. ANOVA and the chi-square test were used for statistical analysis. RESULTS A total of 37 patients were included. Most (35/37; 94.6%) were asymptomatic. A number presented as obscure boundary lesions such that malignancy could not be excluded. Open splenectomy was performed for 12 patients, laparoscopic splenectomy for 12 patients and laparoscopic partial splenectomy for 13 patients. Operation time (P = 0.355), blood loss (P = 0.135), length of hospital stay after operation (P = 0.271) and postoperative complications (P = 0.502) were comparable between the three groups. Duration of drainage tube placement was significantly longer in laparoscopic partial splenectomy patients (P = 0.006). Peak platelet count after operation was significantly lower in laparoscopic partial splenectomy patients (P < 0.001). CONCLUSION Laparoscopic partial splenectomy appears to be a technically feasible and therapeutically effective approach for SANT.
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Affiliation(s)
- Yanwen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Hajie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Fuyu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China
| | - Nansheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, PR China.
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7
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Laparoscopic partial splenectomy for splenic lymphangioma: a case report. Surg Case Rep 2020; 6:140. [PMID: 32557234 PMCID: PMC7303252 DOI: 10.1186/s40792-020-00882-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphangioma is a benign malformation of the lymphatic system and is often found in the neck and axilla, the orbit, the mediastinum, etc. However, isolated splenic lymphangioma is a rare disease in young women, and its treatment is controversial. We report a case of laparoscopic partial splenectomy for isolated splenic lymphangioma in a young woman. CASE PRESENTATION An 18-year-old woman with mild epigastralgia was admitted to a nearby hospital. Abdominal ultrasound detected a 6-cm mass confined to the upper pole of the spleen; thereafter, she was referred to our department for surgical treatment. Although a benign tumor, we decided to resect it because of her symptoms. To preserve part of the normal spleen, laparoscopic partial splenectomy was performed with a co-axial approach using four ports and a liver retractor in the lithotomy position. After dissection around the spleen hilum, we identified that the tumor was being fed from the splenic vessels of the upper pole and severed the branch. Postoperatively, the patient showed no complications and was discharged on postoperative day 8 without symptoms. Pathological examination revealed splenic lymphangioma, which is rare in young women. No recurrence was seen 1 year after surgery, and a computed tomography scan showed no problems with the remaining spleen. CONCLUSIONS In our experience of laparoscopic partial splenectomy for a young woman with an isolated splenic lymphangioma, we determined that laparoscopic partial splenectomy is a safe, effective, and valuable option for the treatment of benign splenic tumors.
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8
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Ouyang G, Li Y, Cai Y, Wang X, Cai H, Peng B. Laparoscopic partial splenectomy with temporary occlusion of the trunk of the splenic artery in fifty-one cases: experience at a single center. Surg Endosc 2020; 35:367-373. [PMID: 32052148 DOI: 10.1007/s00464-020-07410-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic partial splenectomy (LPS) for splenic benign space-occupying lesions has been reported by many researchers; however, few studies have described methods to control intraoperative bleeding. Trustworthy experience in LPS with a satisfactory intraoperative hemorrhage control technique is therefore necessary. The current study aims to present our experience in LPS with temporary occlusion of the trunk of the splenic artery for controlling intraoperative bleeding with a large sample of 51 cases and to evaluate the safety, feasibility, and reproducibility of this technique. METHODS Fifty-one patients from August 2014 to April 2019 who underwent LPS in our institution were retrospectively analyzed. Surgical techniques were described in detail. RESULTS All patients had successfully undergone LPS with temporary occlusion of the trunk of the splenic artery. Conversions to open surgery, hand-assisted laparoscopic splenectomies, or blood transfusions were not needed. The operative time was 94.75 ± 18.91 min, the estimated blood loss was 71.13 ± 53.87 ml, and the volume of resected spleen was 34.75 ± 12.19%. The range of postoperative stays was 4-14 days. One female patient (2%, 1/51) suffered from postoperative complications. No perioperative mortality, incision infections, postoperative pancreatic fistulas (POPFs), splenic infarctions, or portal/splenic vein thromboembolic events occurred. CONCLUSION LPS is an effective spleen-preserving surgery. Although there are many other bleeding control methods, temporarily occluding the trunk of the splenic artery was found to be a safe, feasible, and reproducible technique in LPS. The outcomes of this technique and the efficacy of splenic parenchyma preservation are acceptable.
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Affiliation(s)
- Guoqing Ouyang
- Sichuan University, Chengdu, China
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yongbin Li
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Yunqiang Cai
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Xin Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - He Cai
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China
| | - Bing Peng
- Sichuan University, Chengdu, China.
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan Province, China.
- Department of Minimal Invasive Surgery, Shangjin Nanfu Hospital, Chengdu, China.
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9
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Tejero-Pintor FJ, Cuesta-De la Llave C, Rodriguez-Lopez M, Bailon-Cuadrado M, Pacheco-Sánchez D. Laparoscopic hemi-splenectomy: a valid option in selected cases such as epidermoid cyst. Ann R Coll Surg Engl 2018; 101:e73-e75. [PMID: 30482035 DOI: 10.1308/rcsann.2018.0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Splenic cysts are a rare pathology, which can be classified as true (25%) or pseudocysts (75%). Total splenectomy has been the treatment of choice, particularly in recent times with the advent of the laparoscopic approach. However, as the spleen is an organ with multiple immunological functions, the laparoscopic partial splenectomy is an alternative, which is technically difficult but effective. We present a case of a 26-year-old woman with incidental evidence of a splenic cyst in an abdominal ultrasound scan. We performed a laparoscopic partial splenectomy to preserve the function of the spleen because of the patient's youth. Laparoscopic partial splenectomy allows the effective removal of lesions and preservation of splenic function. Although more research is needed to clarify the most effective approach, this case is further evidence that this surgical approach may be beneficial for selected patients.
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Affiliation(s)
- F J Tejero-Pintor
- General and Digestive Surgery Department, Rio-Hortega University Hospital , Valladolid , Spain
| | - C Cuesta-De la Llave
- General and Digestive Surgery Department, Rio-Hortega University Hospital , Valladolid , Spain
| | - M Rodriguez-Lopez
- General and Digestive Surgery Department, Rio-Hortega University Hospital , Valladolid , Spain
| | - M Bailon-Cuadrado
- General and Digestive Surgery Department, Rio-Hortega University Hospital , Valladolid , Spain
| | - D Pacheco-Sánchez
- General and Digestive Surgery Department, Rio-Hortega University Hospital , Valladolid , Spain
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10
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Roy P, Mukherjee R, Parik M. Splenic trauma in the twenty-first century: changing trends in management. Ann R Coll Surg Engl 2018; 100:1-7. [PMID: 30112955 PMCID: PMC6204520 DOI: 10.1308/rcsann.2018.0139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 12/16/2022] Open
Abstract
Over the past three decades, management of blunt splenic trauma has changed radically. Use of improved diagnostic techniques and proper understanding of disease pathology has led to nonoperative management being chosen as the standard of care in patients who are haemodynamically stable. This review was undertaken to assess available literature regarding changing trends of management of blunt splenic trauma, and to identify the existing lacunae in nonoperative management. The PubMed database was searched for studies published between January 1987 and August 2017, using the keywords 'blunt splenic trauma' and 'nonoperative management'. One hundred and fifty-three articles were reviewed, of which 82 free full texts and free abstracts were used in the current review. There is clear evidence in published literature of the greater success of nonoperative over operative management in patients who are haemodynamically stable and the increasing utility of adjunctive therapies like angiography with embolisation. However, the review revealed a lack of universal guidelines for patient selection criteria and diagnostic and grading procedures needed for nonoperative management. Indications for splenic artery embolisation, the current role of splenectomy and spleen-preserving surgeries, together with the place of minimal access surgery in blunt splenic trauma remain grey areas. Moreover, parameters affecting the outcomes of nonoperative management and its failure and management need to be defined. This shows a need for future studies focused on these shortcomings with the ultimate aim being the formulation and implementation of universally accepted guidelines for safe and efficient management of blunt splenic trauma.
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Affiliation(s)
- P Roy
- RG Kar Medical College and Hospital, General Surgery, Kolkata, India
| | - R Mukherjee
- RG Kar Medical College and Hospital, General Surgery, Kolkata, India
| | - M Parik
- RG Kar Medical College and Hospital, General Surgery, Kolkata, India
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Esposito F, Noviello A, Moles N, Cantore N, Baiamonte M, Coppola Bottazzi E, Miro A, Crafa F. Partial splenectomy: A case series and systematic review of the literature. Ann Hepatobiliary Pancreat Surg 2018; 22:116-127. [PMID: 29896572 PMCID: PMC5981141 DOI: 10.14701/ahbps.2018.22.2.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/08/2017] [Accepted: 12/10/2017] [Indexed: 02/06/2023] Open
Abstract
Backgrounds/Aims Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. Methods Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. Results Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5–50%) and in 3% of cases (range, 7–10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5–25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). Conclusions The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.
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Affiliation(s)
- Francesco Esposito
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Adele Noviello
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Nicola Moles
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Nicola Cantore
- Department of Hematology and Stem Cell Transplantation, S.G. Moscati Hospital, Avellino, Italy
| | - Mario Baiamonte
- Department of General and Emergency Surgery, Civico Hospital, Palermo, Italy
| | | | - Antonio Miro
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
| | - Francesco Crafa
- Department of Oncological and General Surgery, S.G. Moscati Hospital, Avellino, Italy
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Zheng L, Deng C, Li J, Wang L, You N, Wu K, Wang W. Treatment of hemangioma of the spleen by preoperative partial splenic embolization plus laparoscopic partial splenectomy: A case report. Medicine (Baltimore) 2018; 97:e0498. [PMID: 29703013 PMCID: PMC5944500 DOI: 10.1097/md.0000000000010498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Complete loss of splenic function increases infection and cardiovascular disease risks, so there is growing emphasis on spleen-preserving treatments, such as laproscopic partial splenectomy (LPS). However, LPS carries higher risk for hemorrhage. Sequential splenic embolization can obliterate the perilesional vascular bed while preserving flow through healthy tissue, substantially reducing risk of uncontrolled hemorrhage during LPS. Preoperative partial splenic embolization (PSE) may soften the spleen and reduce its size, which enhances space exposure for laparoscopic operation. Furthermore, immediate LPS guaranties these effects of PSE and prevents abscess, non-traumatic splenic rupture, post-embolization syndrome, and other complications. In light of these advantages, we conducted combined PSE and LPS for a case of hemangioma. PATIENT CONCERNS The patient presented with left abdominal discomfort of >1 year. DIAGNOSES Ultrasound examination at the outpatient clinic identified a space-occupying lesion in the spleen. Contrast-enhanced computed tomography scan of the upper abdomen revealed a hypodense lesion, approximately 33 × 21 mm in size, located in the upper pole of the spleen, suggesting possible hemangioma. INTERVENTIONS The patient was treated by preoperative PSE followed by LPS. OUTCOMES Treatment resulted in only mild intraoperative hemorrhage, fast postoperative recovery, and no recurrence during follow-up. And the postoperative histopathology confirmed splenic cavernous hemangioma. LESSIONS Preoperative PSE combined with LPS is an effective therapy for elective patients that minimizes intraoperative hemorrhage during laparoscopic surgery, reduces surgical risk, and enhances surgical safety.
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Affiliation(s)
- Lu Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Army Medical University, PLA, Chongqing
| | - Changlin Deng
- Department of Hepatobiliary Surgery, No.422 Hospital of People's Liberation Army, Zhanjiang Guangdong, China
| | - Jing Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Army Medical University, PLA, Chongqing
| | - Liang Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Army Medical University, PLA, Chongqing
| | - Nan You
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Army Medical University, PLA, Chongqing
| | - Ke Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Army Medical University, PLA, Chongqing
| | - Weiwei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Army Medical University, PLA, Chongqing
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Ramia JM, de la Plaza Llamas R, López-Marcano AJ, Valenzuela Torres JDC, García Gil JM. Laparoscopic partial splenectomy for a splenic epidermoid cyst. Cir Esp 2017; 95:613-615. [PMID: 28410628 DOI: 10.1016/j.ciresp.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/05/2017] [Accepted: 03/07/2017] [Indexed: 02/07/2023]
Affiliation(s)
- José M Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España.
| | - Roberto de la Plaza Llamas
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Aylhin Joana López-Marcano
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Del Carmen Valenzuela Torres
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
| | - José Manuel García Gil
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España
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Recent Development of Augmented Reality in Surgery: A Review. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:4574172. [PMID: 29065604 PMCID: PMC5585624 DOI: 10.1155/2017/4574172] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
Introduction The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.
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Wang L, Xu J, Li F, Zhan H, Liu H, Chen W, Hu S. Partial Splenectomy is Superior to Total Splenectomy for Selected Patients with Hemangiomas or Cysts. World J Surg 2017; 41:1281-1286. [PMID: 28058472 DOI: 10.1007/s00268-016-3794-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superiority of partial splenectomy (PS) as a treatment for benign tumors has not well been confirmed. This study aimed to identify the short- and long-term outcomes of PS, to compare laparoscopic and laparotomic PS, and to demonstrate whether the effects of PS are superior to that of total splenectomy (TS). METHODS Patients with either a hemangioma or cyst who underwent PS or TS from 2009 to 2015 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed. RESULTS A total of 17 patients underwent PS were collected, including 2 men and 15 women with a mean age of 43.9 ± 11.3 years old. Patients who underwent laparoscopic PS (9 cases) had a longer operative time and shorter postoperative hospital stay than those who underwent laparotomy (8 cases). Compared with TS (22 cases), PS significantly decreased the incidence of thrombocytosis, shortened time until drainage removal, and shortened postoperative hospital stay. After an average follow-up of 34.8 months, patients who underwent TS showed a higher incidence of thrombocytosis and splenic vein thrombosis compared with patients underwent PS. CONCLUSIONS PS is technically feasible and provides favorable short- and long-term outcomes for selected patients with either a hemangioma or cyst compared with TS. Laparoscopic PS shows lower morbidity and equal therapeutic efficacy compared with laparotomic PS and can be widely performed.
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Affiliation(s)
- Lei Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Jianwei Xu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Feng Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Hanxiang Zhan
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Han Liu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Wei Chen
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.
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Manciu S, Dragomir M, Curea F, Vasilescu C. Robotic Surgery: A Solution in Search of a Problem—A Bayesian Analysis of 343 Robotic Procedures Performed by a Single Surgical Team. J Laparoendosc Adv Surg Tech A 2017; 27:363-374. [DOI: 10.1089/lap.2016.0323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Simona Manciu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihnea Dragomir
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Fabiana Curea
- Department of Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu,” Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Robotic splenectomy with ex vivo bench surgery and hemi-spleen autotransplant: the first report. J Robot Surg 2016; 11:243-246. [PMID: 27514639 PMCID: PMC5437144 DOI: 10.1007/s11701-016-0635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/31/2016] [Indexed: 01/12/2023]
Abstract
Background We describe our experience with what is, to our knowledge, the first case of robotic assisted ex vivo partial splenectomy with auto-transplantation for a benign non parasitic cyst. Materials and Methods The patient is a 32 year-old female with a giant, benign splenic cyst causing persistent abdominal pain. Preoperative imaging showed a cystic lesion measuring 8.3 × 7.6 cm, in the middle portion of the spleen. Due to the central location of the bulky lesion a partial splenectomy was not feasible. As an alternative to a total splenectomy, a possible reimplantation of hemi-spleen after bench surgery was offered. We proceeded with a robotic total splenectomy and bench hemisplenectomy, preserving the lower pole and a portion of the middle segment of the organ. A robotic reconstruction of the splenic vessels was then performed intra-abdominally. The reperfusion was optimal. Results The total operative time was 305 min, with 78 min of robotic time. Postoperative ultrasound confirmed a patent arterial and venous flow. The postoperative course was uneventful and the patient was discharged on postoperative day 4. The pathology report was consistent with epithelial cyst of the spleen. The patient is doing well at 6-month follow-up. Conclusions The optimized vision and dexterity provided by the robotic system allowed a safe and precise reconstruction of the splenic vessels, even in a deep and narrow operative field. Partial splenectomy with autotransplantation of the organ was thus achieved, avoiding a total splenectomy in a young patient.
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