Transanal Total Mesorectal Excision: Pneumodissection of Retroperitoneal Structures Eases Laparoscopic Rectal Resection

Autologous Fat Grafting With CO2 Tissue Preparation (Carbo-pneumodissection): A Safe Method for Expanding and Enhancing Recipient Site Capacity and Aesthetic Outcomes

BACKGROUND

Autologous fat grafting (AFG) is commonly used as part of aesthetic and reconstruction procedures, but expanding and enhancing the recipient site capacity remains a major challenge.

OBJECTIVES

The aim of this study was to describe and assess an innovative intraoperative carbon dioxide (CO2) pneumodissection (CPD) recipient site preconditioning procedure intended to improve recipient site capacity and AFG outcomes.

METHODS

From June 2019 to August 2021, 53 patients after mastectomy or lumpectomy (76 breasts) underwent 96 AFG procedures as a separate stage immediately following tissue preconditioning with CPD.

RESULTS

There were no systemic or major local complications. The mean number of AFG procedures required to complete the reconstruction was 1.3 per breast. The vast majority of patients achieved a final satisfactory aesthetic outcome with either 1 or 2 procedures (77.6% and 18.4%, respectively). The volume of fat graft delivered into the recipient site per session following CPD was higher than previous literature reports for all study groups. Furthermore, the CPD procedure was associated with a reduced need for subsequent AFG to complete the reconstruction. The positive effect of CPD, in terms of AFG volume delivered, was even more prominent among scarred irradiated breasts. Despite the large fat graft volumes delivered in our study, only 5.3% of breasts experienced fat necrosis following the procedure.

CONCLUSIONS

CPD constitutes a safe, innovative, intraoperative method to expand and enhance recipient site capacity and fat grafting outcome. CPD allows cavernous expansion alongside preservation of the microcirculation. CPD works for both healthy and compromised tissues, in either reconstructive or aesthetic procedures.

LEVEL OF EVIDENCE: 4

Morphological speculation of the MHPD and related clinical projections

OBJECTIVE

The concept of mesopancreas has been brought into focus nowadays. Studies on membrane morphology of pancreas are clinically significant in determining an ideal surgical route for a "holy plane". In this paper, we aimed to observe the structure of the peripancreatic membranes and its interactions with adjacent tissues; tentatively put forward the proposition of mesohepatopancreaticoduodenum (MHPD) and explore in depth in surgical local resection.

METHODS

33 cadavers were examined in the experiment, including 30 for gross anatomy and 3 for histological observation after transection. The histological characteristics of the membrane covering the pancreas were proved by Masson and Bielschowsky silver staining and further explored in clinical application and testified in a surgical scenario. All above were carried out through traditional procedures.

RESULTS

The anterior surface membrane of the pancreas was intact and the posterior portion expanding to the pancreaticoduodenum enclosed the surface of the duodenum and the pancreatic head, which could be easily isolated from the posterior abdominal wall. The posterior surface membrane around the body and tail wrapped the pancreatic parenchyma, which created a soft-tissue window for the posterior abdominal wall. Then, dense connective tissue adhesions were detected between the celiac artery and the superior mesenteric artery.

CONCLUSIONS

The embryonic origin of the mesopancreas and the surgical procedures were reviewed and inspected based on the proposition of MHPD and above results. We hope that this study could stir up our interest in the advancement of imaging diagnoses and minimally invasive surgical treatment of pancreas.

Evolution of surgery for rectal cancer: Transanal total mesorectal excision～new standard or fad?～

Transanal Total Mesorectal Excision (TaTME) has recently been developed to overcome the difficulties associated with conventional laparoscopic or robotic TME. TaTME has gained popularity and becomes the center of attention among colorectal surgeons globally. The present review aims to update the literature, clarify the current status and perspectives of TaTME. Complete TaTME specimens were obtained in 85-97.1% of the case; the reported circumferential resection margin (CRM) ranged from 1.5% to 8.1%, whereas and distal resection margin (DRM) positive rates ranged from 0% to 3.2%. The conversion rate of TaTME occurred from 0 to 15%, and there was no difference between TaTME and laparoscopic or robotic TME. Intraoperative complications occurred in 5-6% of the case, which compared favorably to laparoscopic TME. The most serious intraoperative complication with this approach was urethral injury, although only small numbers were reported, which was possibly due to under-reporting. Clavien-Dindo I or II postoperative complications occurred in 22-24% of the case, and III or IV in 10-11% of the case, which did not differ between TaTME and laparoscopic or robotic TME. TaTME may be technically easier and more beneficial than laparoscopic, robotic or open TME in male patients with a narrow pelvis; in obese patients with a bulky tumor. At present two randomized controlled trials, COLOR III and GRECCAR, and comparing TaTME with laparoscopic TME are being conducted and their outcomes are awaited. TaTME is a complex procedure, but proved to be feasible, oncologically safe, and effective in difficult cases. Before this new technique is adopted, proper training with Proctor/mentorship is strongly advised. Careful case selection and audit of data are mandatory.

Surgical Outcomes of Rectal Resection: Our 10 Years Experience

Background: Colorectal cancer, one of the most common tumor- and cancer-related deaths worldwide, requires a multidisciplinary management including neoadjuvant chemoradiotherapy and surgery. Laparoscopic surgery for rectal cancer is gaining popularity due to its safety profile and good oncological results, if performed by experienced surgeons in specialized centers. This study describes our 10 years experience in minimally invasive rectal cancer surgery. Methods: We have retrospectively evaluated a series of 140 patients treated with laparoscopic approach for rectal malignant and benign diseases. Results: A total of 134 patients (95.7%) underwent anterior rectal resection, in the remaining 6 cases (4.3%) abdominoperineal amputation was performed. All but 13 cases have been treated with laparoscopic approach, with conversion rate of 5.7%. Postoperative morbidity rate was 8.6% (2 cases of peritoneal bleeding and 10 cases of anastomotic fistulae; in 2 cases, fistula occurred in patients previously treated with chemoradiation). Conclusions: Conventional laparoscopy can provide adequate oncological outcomes even in patients with advanced rectal cancer, with advantages in terms of postoperative hospital stay, recovery time, acceptable operative time, and low complication and conversion rates.