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Giudicelli G, Gero D, Romulo L, Chirumamilla V, Iranmanesh P, Owen CK, Bauerle W, Garcia A, Lucas L, Mehdorn AS, Pandey D, Almuttawa A, Cabral F, Tiwari A, Lambert V, Pascotto B, De Meyere C, Yahyaoui M, Haist T, Scheffel O, Robert M, Nuytens F, Azagra S, Kow L, Prasad A, Vaz C, Vix M, Bindal V, Beckmann JH, Soussi D, Vilallonga R, El Chaar M, Wilson EB, Ahmad A, Teixeira A, Hagen ME, Toso C, Clavien PA, Puhan M, Bueter M, Jung MK. Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy. Br J Surg 2024; 111:znad374. [PMID: 37981863 PMCID: PMC10771137 DOI: 10.1093/bjs/znad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer.
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Affiliation(s)
- Guillaume Giudicelli
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lind Romulo
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Vasu Chirumamilla
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Pouya Iranmanesh
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Wayne Bauerle
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Amador Garcia
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lisa Lucas
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Anne-Sophie Mehdorn
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dhananjay Pandey
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Abdullah Almuttawa
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
- Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Abhishek Tiwari
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Virginia Lambert
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Beniamino Pascotto
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Marouan Yahyaoui
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Haist
- Department of General and Visceral Surgery, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Maud Robert
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | | | - Santiago Azagra
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Lilian Kow
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Arun Prasad
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Carlos Vaz
- Robotic Surgery Unit, Cuf Tejo Hospital, Lisbon, Portugal
| | - Michel Vix
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
| | - Vivek Bindal
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Jan H Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Soussi
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Arif Ahmad
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Andre Teixeira
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Monika E Hagen
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Minoa K Jung
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
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Reitano E, Riva P, Keller D, Vannucci M, Zappaterra M, Vix M, Mutter D, Marescaux J, Perretta S. Deep sedation versus orotracheal intubation for endoscopic sleeve gastroplasty (ESG): preliminary experience. Surg Endosc 2023:10.1007/s00464-023-10159-x. [PMID: 37277517 DOI: 10.1007/s00464-023-10159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an emerging bariatric procedure currently performed under general anaesthesia with orotracheal intubation (OTI). Several studies have shown the feasibility of advanced endoscopic procedures under deep sedation (DS) without impacting patient outcomes or adverse event rates. Our goal was to perform an initial comparative analysis of ESG in DS with ESG under OTI. METHODS A prospective institutional registry was reviewed for ESG patients between 12/2016 and 1/2021. Patients were stratified into OTI or DS cohorts, and the 1st 50 cases performed in each cohort were included for comparability. Univariate analysis was performed on demographics, intraoperative, and postoperative outcomes (up to 90 days). Multivariate analyses evaluated the relationship between anesthesia type, preclinical and clinical variables. RESULTS Of the 50 DS patients, 21(42%) underwent primary and 29 (58%) revisional surgery. There was no significant differences in Mallampati score across groups. No DS patient required intubation. DS patients were younger (p = 0.006) and lower BMI (p = 0.002) than OTI. As expected, DS patients overall and in the primary subgroup had shorter operative time (p ≤ 0.001 and p = 0.003, respectively) and higher rates (84% DS vs. 20% OTI, p ≤ 0.001) of ambulatory procedures. There were no significant differences in the sutures used between groups (p = 0.616). DS patients required less postoperative opioids (p ≤ 0.001) and antiemetics (p = 0.006) than OTI. There were no significant differences in 3-month postoperative weight loss across cohorts. There was no rehospitalization in either group. In primary ESG cases, we found DS patients were more likely younger (p = 0.006), female (p = 0.001), and had a lower BMI (p = 0.0027). CONCLUSIONS ESG under DS is safe and feasible in select patients. We found DS safely increased rates of outpatient care, reduced use of opioids and antiemetics, and provided the same results of postoperative weight loss. Patient selection for DS may be more clearer for durable weight loss.
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Affiliation(s)
- Elisa Reitano
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Pietro Riva
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Deborah Keller
- Marks Colorectal Surgical Associates, Lankenau Medical Center, Wynnewood, PA, USA
| | - Maria Vannucci
- Department of General Surgery, University of Turin, Turin, Italy
| | - Mathieu Zappaterra
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Michel Vix
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Didier Mutter
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Silvana Perretta
- Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France.
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Aymard S, Leroy-Freschini B, Kaseb A, Marx D, Helali M, Averous G, Betz V, Riehm S, Vix M, Perrin P, Imperiale A. 18F-Fluorocholine PET/CT Compared with Current Imaging Procedures for Preoperative Localization of Hyperfunctioning Parathyroids in Patients with Chronic Kidney Disease. Diagnostics (Basel) 2023; 13:diagnostics13081374. [PMID: 37189475 DOI: 10.3390/diagnostics13081374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Hyperparathyroidism (HPT) in patients with chronic kidney disease (CKD) includes secondary (sHPT) and tertiary hyperparathyroidism (tHPT). Considering that the role of preoperative imaging in the clinical setting is controversial, in the present study we have retrospectively compared pre-surgical diagnostic performances of 18F-Fluorocholine (18F-FCH) PET/CT, cervical ultrasonography (US), parathyroid scintigraphy, and 4D-CT in a group of 30 patients with CKD and HPT (18/12 sHPT/tHPT), 21 CKD G5 including 18 in dialysis, and 9 kidney transplant recipients. All patients underwent 18F-FCH, and 22 had cervical US, 12 had parathyroid scintigraphy, and 11 had 4D-CT. Histopathology was the gold standard. Seventy-four parathyroids were removed: 65 hyperplasia, 6 adenomas, and 3 normal glands. In the whole population, in a per gland analysis, 18F-FCH PET/CT was significantly more sensitive and accurate (72%, 71%) than neck US (25%, 43%), parathyroid scintigraphy (35%, 47%), and 4D-CT (40%, 47%). The specificity of 18F-FCH PET/CT (69%) was lower than that of neck US (95%) and parathyroid scintigraphy (90%), without, however, achieving significance. 18F-FCH PET/CT was more accurate than all other diagnostic techniques when sHPT and tHPT patients were considered separately. 18F-FCH PET/CT sensitivity was significantly higher in tHPT (88%) than in sHPT (66%). Three ectopic hyperfunctioning glands (in three different patients) were all detected by 18F-FCH PET/CT, two by parathyroid scintigraphy, and none by cervical US and 4D-CT. Our study confirms that 18F-FCH PET/CT is an effective preoperative imaging option in patients with CKD and HPT. These findings may be of greater importance in patients with tHPT (who could benefit from minimally invasive parathyroidectomy) than in patients with sHPT, who often undergo bilateral cervicotomy. In these cases, preoperative 18F-FCH PET/CT may be helpful in locating ectopic glands and may guide the surgical choice for gland preservation.
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Affiliation(s)
- Samuel Aymard
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, 67200 Strasbourg, France
| | - Benjamin Leroy-Freschini
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, 67200 Strasbourg, France
| | - Ashjan Kaseb
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, 67200 Strasbourg, France
- Department of Radiology, College of Medicine, University of Jeddah, Jeddah 23890, Saudi Arabia
| | - David Marx
- Department of Medicine C, Hôpital de Sélestat, 67600 Sélestat, France
- Department of Nephrology and Transplantation, Strasbourg University Hospitals, University of Strasbourg, 67000 Strasbourg, France
| | - Mehdi Helali
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, 67200 Strasbourg, France
| | - Gerlinde Averous
- Department of Pathology, Strasbourg University Hospitals, University of Strasbourg, 67000 Strasbourg, France
| | - Valérie Betz
- Department of Nephology, Hôpital de Colmar, 68024 Colmar, France
- AURAL Dialysis Center, 68000 Colmar, France
| | - Sophie Riehm
- Department of Radiology, Strasbourg University Hospitals, 67098 Strasbourg, France
| | - Michel Vix
- Department of General, Digestive, and Endocrine Surgery, IRCAD-IHU, Strasbourg University Hospitals, 67000 Strasbourg, France
| | - Peggy Perrin
- Department of Nephrology and Transplantation, Strasbourg University Hospitals, University of Strasbourg, 67000 Strasbourg, France
| | - Alessio Imperiale
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University of Strasbourg, 67200 Strasbourg, France
- Department of General, Digestive, and Endocrine Surgery, IRCAD-IHU, Strasbourg University Hospitals, 67000 Strasbourg, France
- Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS, University of Strasbourg, 67093 Strasbourg, France
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Carullo J, Bani J, Averous G, Helali M, Heimburger C, Vix M, Imperiale A. Hyperfunctioning Intrathyroidal Parathyroid: a Misleading Preoperative Diagnosis. Nucl Med Mol Imaging 2023; 57:46-50. [PMID: 36643944 PMCID: PMC9832180 DOI: 10.1007/s13139-022-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
Hyperfunctioning parathyroid glands may be rarely located in the thyroidal parenchyma and not identified by imaging or during surgical procedures. We present three patients with primary hyperparathyroidism related to hyperfunctioning intrathyroidal parathyroid retrospectively selected among 732 cases from own Institutional parathyroid PET/CT registry from 2018 to 2022. Intrathyroidal parathyroids showed intense 18F-fluorocholine uptake but a variable echographic pattern, inconstant 99mTc-MIBI uptake, and atypic iodine-contrast enhancement. Although rare, the possibility of an intrathyroidal parathyroid should be considered when no hyperfunctioning gland is found on preoperative imaging and thorough bilateral neck exploration.
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Affiliation(s)
- Josefina Carullo
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), 17, Rue Albert Calmette, 670933 Strasbourg, France
- Nuclear Medicine, Sanatorio Allende S.A, Cordoba, Argentina
| | - Jacob Bani
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), 17, Rue Albert Calmette, 670933 Strasbourg, France
| | - Gerlinde Averous
- Pathology, Strasbourg University Hospitals, University of Strasbourg, Strasbourg, France
| | - Mehdi Helali
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), 17, Rue Albert Calmette, 670933 Strasbourg, France
| | - Celine Heimburger
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), 17, Rue Albert Calmette, 670933 Strasbourg, France
- Nuclear Medicine, Hopital Civil de Haguenau, Haguenau, France
| | - Michel Vix
- General, Digestive and Endocrine Surgery, IRCAD-IHU, Strasbourg University Hospitals, Strasbourg, France
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), 17, Rue Albert Calmette, 670933 Strasbourg, France
- Strasbourg University Hospitals, Strasbourg, France
- Molecular Imaging – DRHIM, IPHC, UMR 7178, CNRS/University of Strasbourg, Strasbourg, France
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Imperiale A, Bani J, Bottoni G, Latgé A, Heimburger C, Catrambone U, Vix M, Treglia G, Piccardo A. Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism? Front Med (Lausanne) 2023; 10:1148287. [PMID: 37181366 PMCID: PMC10172498 DOI: 10.3389/fmed.2023.1148287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction To investigate the value of presurgical 18F-FCH PET/CT in detecting additional hyperfunctioning parathyroids despite a positive 99mTc-sestamibi parathyroid scintigraphy in patients with primary hyperparathyroidism (pHPT). Methods This is a retrospective study involving patients with pHPT, positive parathyroid scintigraphy performed before 18F-FCH PET/CT, and parathyroid surgery achieved after PET/CT. Imaging procedures were performed according to the EANM practice guidelines. Images were qualitatively interpreted as positive or negative. The number of pathological findings, their topography, and ectopic location were recorded. Histopathology, Miami criterion, and biological follow-up were considered to ensure effective parathyroidectomy confirming the complete excision of all hyperfunctioning glands. The impact of 18F-FCH PET/CT on therapeutic strategy was recorded. Results 64/632 scanned pHPT patients (10%) were included in the analysis. According to a per lesion-based analysis, sensitivity, specificity, positive predictive value, and negative predictive value of 99mTc-sestamibi scintigraphy were 82, 95, 87, and 93%, respectively. The same values for 18F-FCH PET/CT were 93, 99, 99, and 97%, respectively. 18F-FCH PET/CT showed a significantly higher global accuracy than 99mTc-sestamibi scintigraphy: 98% (CI: 95-99) vs. 91% (CI: 87-94%). Youden Index was 0.79 and 0.92 for 99mTc-sestamibi scintigraphy and 18F-FCH PET/CT, respectively. Scintigraphy and PET/CT were discordant in 13/64 (20%) patients (49 glands). 18F-FCH PET/CT identified nine pathologic parathyroids not detected by 99mTc-sestamibi scintigraphy in 8 patients (12.5%). Moreover, 18F-FCH PET/CT allowed the reconsideration of false-positive scintigraphic diagnosis (scinti+/PET-) for 8 parathyroids in 7 patients (11%). The 18F-FCH PET/CT influenced the surgical strategy in 7 cases (11% of the study population). Conclusion In a preoperative setting, 18F-FCH PET/CT seems more accurate and useful than 99mTc-sestamibi scan in pHPT patients with positive scintigraphic results. Positive parathyroid scintigraphy could be not satisfactory before neck surgery particularly in patients with multiglandular disease, suggesting a need to evolve the practice and define new preoperative imaging algorithms including 18F-FCH PET/CT at the fore-front in pHPT patients.
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Affiliation(s)
- Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, Strasbourg, France
- Molecular Imaging, DRHIM, Institut Pluridisciplinaire Hubert Curien (IPHC), UMR7178, CNRS, University of Strasbourg, Strasbourg, France
- *Correspondence: Alessio Imperiale,
| | - Jacob Bani
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, Strasbourg, France
| | - Gianluca Bottoni
- Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
| | - Adrien Latgé
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, Strasbourg, France
| | - Céline Heimburger
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, Strasbourg, France
- Nuclear Medicine, Hopital Civil de Haguenau, Haguenau, France
| | - Ugo Catrambone
- General Surgery, Ente Ospedaliero "Ospedali Galliera“, Genoa, Italy
| | - Michel Vix
- General, Digestive, and Endocrine Surgery, IRCAD-IHU, Strasbourg University Hospitals, Strasbourg, France
| | - Giorgio Treglia
- Clinic for Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Arnoldo Piccardo
- Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy
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Mayer P, Héroin L, Habersetzer F, Vix M, Pessaux P, Felli E, Mathis G. Combined endoscopic and surgical management of a right intrahepatic bile duct injury during laparoscopic cholecystectomy. Endoscopy 2022; 54:E682-E683. [PMID: 35180791 DOI: 10.1055/a-1743-1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Pierre Mayer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - Lucile Héroin
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - François Habersetzer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France.,Inserm U1110, Institute for Viral and Liver Diseases, LabEx HepSYS, University of Strasbourg, Faculty of Medicine, Strasbourg, France
| | - Michel Vix
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Department of Visceral and Digestive Surgery Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Patrick Pessaux
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Department of Visceral and Digestive Surgery Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Emanuele Felli
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Department of Visceral and Digestive Surgery Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
| | - Guillaume Mathis
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Department of Visceral and Digestive Surgery Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France
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Houy S, Streit L, Drissa I, Rame M, Decraene C, Moog S, Brunaud L, Lanoix J, Chelbi R, Bihain F, Lacomme S, Lomazzi S, Campoli P, Vix M, Mutter D, Paramithiotis E, Dubessy C, Vitale N, Ory S, Gasman S. Dysfunction of calcium-regulated exocytosis at a single-cell level causes catecholamine hypersecretion in patients with pheochromocytoma. Cancer Lett 2022; 543:215765. [PMID: 35680072 DOI: 10.1016/j.canlet.2022.215765] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/13/2022] [Accepted: 05/28/2022] [Indexed: 11/27/2022]
Abstract
Neuroendocrine tumors constitute a heterogeneous group of tumors arising from hormone-secreting cells and are generally associated with a dysfunction of secretion. Pheochromocytoma (Pheo) is a neuroendocrine tumor that develops from chromaffin cells of the adrenal medulla, and is responsible for an excess of catecholamine secretion leading to severe clinical symptoms such as hypertension, elevated stroke risk and various cardiovascular complications. Surprisingly, while the hypersecretory activity of Pheo is well known to pathologists and clinicians, it has never been carefully explored at the cellular and molecular levels. In the present study, we have combined catecholamine secretion measurement by carbon fiber amperometry on human tumor cells directly cultured from freshly resected Pheos, with the analysis by mass spectrometry of the exocytotic proteins differentially expressed between the tumor and the matched adjacent non-tumor tissue. In most patients, catecholamine secretion recordings from single Pheo cells revealed a higher number of exocytic events per cell associated with faster kinetic parameters. Accordingly, we unravel significant tumor-associated modifications in the expression of key proteins involved in different steps of the calcium-regulated exocytic pathway. Altogether, our findings indicate that dysfunction of the calcium-regulated exocytosis at the level of individual Pheo cell is a cause of the tumor-associated hypersecretion of catecholamines.
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Affiliation(s)
- Sébastien Houy
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France
| | - Laura Streit
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France
| | - Inès Drissa
- Univ. Rouen, INSERM, Normandie Univ., Différenciation et Communication Neuroendocrine, Endocrine et Germinale, F-76000, Rouen, France
| | - Marion Rame
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France
| | - Charles Decraene
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France; Centre National de la Recherche Scientifique, Université de Strasbourg, Laboratoire de Neurosciences Cognitives et Adaptatives, F-67000 Strasbourg, France
| | - Sophie Moog
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France
| | - Laurent Brunaud
- Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), INSERM NGERE-U1256, Université de Lorraine, CHRU NANCY, Hôpital Brabois adultes, F-54511, Vandœuvre-lès-Nancy, France
| | - Joël Lanoix
- Institut de Recherche en Immunologie et en Cancérologie (IRIC), Université de Montréal, Montréal, Canada, Département de Médecine, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Rabie Chelbi
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France; Inovarion, F-75005, Paris, France
| | - Florence Bihain
- Département de Chirurgie Viscérale, Métabolique et Cancérologique (CVMC), INSERM NGERE-U1256, Université de Lorraine, CHRU NANCY, Hôpital Brabois adultes, F-54511, Vandœuvre-lès-Nancy, France
| | - Stéphanie Lacomme
- Centre de Ressources Biologiques Lorrain, CHRU Nancy, Hôpitaux de Brabois, F-54511, Vandœuvre-lès-Nancy, France
| | - Sandra Lomazzi
- Centre de Ressources Biologiques Lorrain, CHRU Nancy, Hôpitaux de Brabois, F-54511, Vandœuvre-lès-Nancy, France
| | - Philippe Campoli
- Department of Biopathology, CHRU-ICL, CHRU Nancy, Vandoeuvre-lès-Nancy, France and Faculty of Medicine, Université de Lorraine, F-54511, Vandoeuvre-lès-Nancy, France
| | - Michel Vix
- NHC Strasbourg, Service de Chirurgie Digestive et Endocrinienne des Hôpitaux Universitaires de Strasbourg, Hôpital Civil, F-67000, Strasbourg, France
| | - Didier Mutter
- NHC Strasbourg, Service de Chirurgie Digestive et Endocrinienne des Hôpitaux Universitaires de Strasbourg, Hôpital Civil, F-67000, Strasbourg, France
| | | | - Christophe Dubessy
- Univ. Rouen, INSERM, Normandie Univ., Différenciation et Communication Neuroendocrine, Endocrine et Germinale, F-76000, Rouen, France; Univ. Rouen, INSERM, CNRS, HERACLES, PRIMACEN, F-76000, Rouen, France
| | - Nicolas Vitale
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France
| | - Stéphane Ory
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France
| | - Stéphane Gasman
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, F-67000, Strasbourg, France.
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8
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Bani J, Morland D, Hubelé F, Ignat M, Latge A, Bourahla K, Zalzali M, Vix M, Taïeb D, Imperiale A. Dual-Time-Point 18F-Fluorocholine PET/CT Improves Characterization of Thyroid Nodules in Patients Referred for Primary Hyperparathyroidism: A Proof of Concept Study. Clin Nucl Med 2021; 46:965-970. [PMID: 34524168 DOI: 10.1097/rlu.0000000000003904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Thyroid nodules frequently coexist with primary hyperparathyroidism (pHPT). Because of the increasing use of 18F-fluorocholine (18F-FCH) PET/CT in patients with pHPT, evaluation of its clinical utility for thyroid nodules characterization in this population is of paramount importance. Herein, we investigate the value of dual-point 18F-FCH PET/CT in the diagnosis of thyroid cancer in patients referred for pHPT imaging who have thyroid nodules. PATIENTS AND METHODS All pHPT patients who underwent a dual-time point 18F-FCH PET/CT (at 5 and 60 minutes postinjection) between July 2019 and December 2020 were analyzed. Only those with a thyroid nodule greater than 10-mm and pathological analysis (criterion standard) were included. Nodule-to-thyroid SUVmax ratio was calculated at the 2 study points, as well as the 18F-FCH washout index (WO%). RESULTS Twenty-seven patients (32 nodules) were included in this study. The final diagnoses were as follows: 27 benign nodules including 2 NIFTPs (noninvasive follicular thyroid neoplasm with papillary-like nuclear features) and 5 cancers of follicular origin. Early uptake ratio was significantly higher in malignant lesions than in benign nodules (P = 0.0008). Thyroid cancers were also characterized by a marked 18F-FCH washout index (WO% benign vs cancer: 2.9% ± 4.1% vs 45.5% ± 13.4%, P = 0.0001). Using a WO% threshold of 22.1%, 25/27 benign nodules and 5/5 malignant lesions were accurately classified (sensitivity of 100%, specificity of 92.6%, positive predictive value of 71.4%, and negative predictive value of 100%). The false-positive findings were related to the 2 NIFTPs that share similarities with thyroid cancer. CONCLUSIONS Our preliminary results suggest to perform a dual-time-point PET/CT acquisition protocol in pHPT patients with uncharacterized centimeter thyroid nodules. However, the real impact of these promising results should be assessed by prospective studies on a larger cohort of patients.
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Affiliation(s)
- Jacob Bani
- From the Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, Strasbourg University, Strasbourg
| | | | - Fabrice Hubelé
- From the Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, Strasbourg University, Strasbourg
| | | | - Adrien Latge
- From the Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, Strasbourg University, Strasbourg
| | - Khalil Bourahla
- From the Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe, Strasbourg University, Strasbourg
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Bourcier T, Dormegny L, Sauer A, Nardin M, Becmeur PH, Chammas J, Gaucher D, Ballonzoli L, Speeg C, Liverneaux P, Vix M, Marescaux J, Mutter D. State of the Art in Robot-Assisted Eye Surgery. Klin Monbl Augenheilkd 2021; 238:1290-1293. [PMID: 34571552 DOI: 10.1055/a-1562-2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the advantages that robot-assisted surgery can offer to patient care, its use in ophthalmic surgery has not yet progressed to the extent seen in other fields. As such, its use remains limited to research environments, both basic and clinical. The technical specifications for such ophthalmic surgical robots are highly challenging, but rapid progress has been made in recent years, and recent developments in this field ensure that the use of this technology in operating theatres will soon be a real possibility. Fully automated ocular microsurgery, carried out by a robot under the supervision of a surgeon, is likely to become our new reality. This review discusses the use of robot-assisted ophthalmic surgery, the recent progress in the field, and the necessary future developments which must occur before its use in operating theatres becomes routine.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Léa Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Mathieu Nardin
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Pierre-Henri Becmeur
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Laurent Ballonzoli
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Claude Speeg
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Hautepierre Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Michel Vix
- IRCAD, European Institute of Telesurgery, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | | | - Didier Mutter
- IRCAD, European Institute of Telesurgery, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
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10
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Pizzicannella M, Fiorillo C, Barberio M, Rodríguez-Luna MR, Vix M, Mutter D, Marescaux J, Costamagna G, Swanström L, Perretta S. Endoscopic assessment of morphological and histopathological upper gastrointestinal changes after endoscopic sleeve gastroplasty. Surg Obes Relat Dis 2021; 17:1294-1301. [PMID: 33926844 DOI: 10.1016/j.soard.2021.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/24/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a promising bariatric endoluminal procedure. Restriction and shortening of the stomach are obtained by means of non-resorbable full-thickness sutures, thus inducing the formation of several endoluminal pouches in which food can stagnate. The effect of ESG on the upper gastrointestinal tract has never been investigated. OBJECTIVES This study objectively evaluates endoscopic macroscopic and histopathologic changes within 12-month follow-up (FU) in patients who underwent ESG. SETTING Retrospective study on a prospective database of patients who underwent ESG at our tertiary referral center between October 2016 and March 2019. METHODS All consecutive patients undergoing upper endoscopy (EGD) preoperatively and 6 and 12 months after ESG were included. The upper gastrointestinal tract was evaluated for mucosal abnormalities and biopsies were systematically taken. RESULTS Eighty-six patients were included. EGD results were as follows: esophagitis decreased from 14% preoperatively to 3.6% and 1.2% at 6- and 12-month FU, respectively (P = .001); 19.8% of patients presented preoperatively a type I hiatal hernia <4 cm and showed no size increment or de novo hiatal hernia at 6- and 12-months. The rate of preoperative hyperemic (23.2%) and erosive (3.5%) gastropathy decreased to 9.5% and 1.2% at 6 months and 17.4% and 1.2% at 12 months, respectively. Gastric ulcer (4.7%), duodenal hyperemic mucosa (1.2%) and duodenal micro-ulcerations (2.3%) detected preoperatively were not present at 6- and 12-month EGD. The rate of histopathological disease, which was 68.1% preoperatively, dropped to 29.2% at 12 months, chronic gastritis decreased from 40.3% to 26.4%, acute gastritis from 9.7% to 0%, and acute inflammation on chronic gastritis from 18% to 2.8% (P < .001). CONCLUSION ESG is a safe procedure that does not promote the new onset of macroscopic and histopathologic abnormalities within 1-year follow-up.
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Affiliation(s)
| | - Claudio Fiorillo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuel Barberio
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Michel Vix
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Didier Mutter
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Jacques Marescaux
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, France
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; CERTT Centre for Endoscopic Research Therapeutics and Training, Università Cattolica S. Cuore, Rome, Italy
| | - Lee Swanström
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Silvana Perretta
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute against Digestive Cancer, Strasbourg, France; Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
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11
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Ignat M, Pérouse M, Lefebvre F, Kadoche D, Imperiale A, Swanstrom L, Vix M, Mutter D. Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration. Surg Innov 2021; 28:261-271. [PMID: 33745354 DOI: 10.1177/15533506211001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, P < 2.2 × 10-16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, P = 3.1 × 10-15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan (P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy (P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.
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Affiliation(s)
- Mihaela Ignat
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Madeleine Pérouse
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - François Lefebvre
- Department of Medical Informatics, 27083University Hospital of Strasbourg, Strasbourg, France
| | - Deborah Kadoche
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Alessio Imperiale
- 27083Médecine Nucléaire et Imagerie Moléculaire, ICANS, Strasbourg, France.,Imagerie Moléculaire, DRHIM, Institut Pluridisciplinaire Hubert Curien (IPHC), UMR, CNRS / Unistra, Strasbourg, France
| | - Lee Swanstrom
- 54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Michel Vix
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Didier Mutter
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
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12
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Hamid HKS, Emile SH, Saber AA, Dincer M, de Moura DTH, Gilissen LPL, Almadi MA, Montuori M, Vix M, Perisse LGS, Quezada N, Garofalo F, Pescarus R. Customized bariatric stents for sleeve gastrectomy leak: are they superior to conventional esophageal stents? A systematic review and proportion meta-analysis. Surg Endosc 2020; 35:1025-1038. [DOI: 10.1007/s00464-020-08147-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
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13
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Vix M, Rodriguez M, Ignat M, Marescaux J, Diana M, Mutter D. Postoperative Remote Monitoring with a Transcutaneous Biosensing Patch: Preliminary Evaluation of Data Collection. Surg Innov 2020; 27:320-327. [PMID: 32524900 DOI: 10.1177/1553350620929461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction. Connected systems transmitting vital parameters could well represent a tool to shorten postoperative hospital stay while providing continuous remote patient monitoring and potentially detect the onset of complications. Our aim was to analyze the functionality of a transcutaneous biosensing data collection patch in morbidly obese patients. Materials and Methods. An adhesive patch (The HealthPatch MD™) was applied to patients' chests postoperatively. The patch was connected to a tablet via a bluetooth network to collect the heart rate, respiratory rate, skin temperature, and posture recognition data. The tablet conveyed data to a secure health data central server by means of a WiFi or 3G/4G transmission. Data were stored in a digital health platform to which health care professionals could connect. The evaluation focused on the volume, quality, and security of data transmission. A pilot phase involved 10 patients. Thirty-three additional patients undergoing bariatric surgery were included in the experimental phase. Results. The mean length of stay was 2.28 days (range: 2-5 days). The mean time of patch application was 51 ± 25.2 hours per patient (range: 19-139 hours), totalizing 1,683 hours of recording for the 33 patients included. During this time, a total of 7.562.531 data measurement points were collected and transmitted to the e-health platform via the patch. Two total disconnections and two partial disconnections were observed. The acquisition of patient postural data was unreliable. Conclusions. Connected telemetry for remote postoperative monitoring is promising. However, it is still limited by data transmission problems.
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Affiliation(s)
- Michel Vix
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, France
| | - Maylis Rodriguez
- Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France
| | - Mihaela Ignat
- Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,IRCAD, Research Institute against Digestive Cancer, France
| | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, France
| | - Didier Mutter
- IHU-Strasbourg, Institute of Image-Guided Surgery, France.,Department of Digestive and Endocrine Surgery, 36604University Hospital of Strasbourg, France.,IRCAD, Research Institute against Digestive Cancer, France
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14
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Magisson J, Sassi A, Kobalyan A, Burcez CT, Bouaoun R, Vix M, Jeandidier N, Sigrist S. A fully implantable device for diffuse insulin delivery at extraperitoneal site for physiological treatment of type 1 diabetes. J Control Release 2020; 320:431-441. [DOI: 10.1016/j.jconrel.2020.01.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 12/22/2022]
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15
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Pizzicannella M, Lapergola A, Fiorillo C, Spota A, Mascagni P, Vix M, Mutter D, Costamagna G, Marescaux J, Swanström L, Perretta S. Does endoscopic sleeve gastroplasty stand the test of time? Objective assessment of endoscopic ESG appearance and its relation to weight loss in a large group of consecutive patients. Surg Endosc 2020; 34:3696-3705. [DOI: 10.1007/s00464-019-07329-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
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16
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Dali-Youcef N, Vix M, Costantino F, El-Saghire H, Lhermitte B, Callari C, D'Agostino J, Perretta S, Paveliu S, Gualtierotti M, Dumeny E, Oudot MA, Jaulin A, Dembélé D, Zeisel MB, Tomasetto C, Baumert TF, Doffoël M. Interleukin-32 Contributes to Human Nonalcoholic Fatty Liver Disease and Insulin Resistance. Hepatol Commun 2019; 3:1205-1220. [PMID: 31497742 PMCID: PMC6719754 DOI: 10.1002/hep4.1396] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder due to increased accumulation of fat in the liver and in many cases to enhanced inflammation. Although the contribution of inflammation in the pathogenesis of NAFLD is well established, the cytokines that are involved and how they influence liver transformation are still poorly characterized. In addition, with other modifiers, inflammation influences NAFLD progression to liver cirrhosis and hepatocellular carcinoma, demonstrating the need to find new molecular targets with potential future therapeutic applications. We investigated gene signatures in 38 liver biopsies from patients with NAFLD and obesity who had received bariatric surgery and compared these to 10 control patients who had received a cholecystectomy, using DNA microarray technology. A subset of differentially expressed genes was then validated on a larger cohort of 103 patients who had received bariatric surgery for obesity; data were thoroughly analyzed in terms of correlations with NAFLD pathophysiological parameters. Finally, the impact of a specific cytokine, interleukin‐32 (IL32), was addressed on primary human hepatocytes (PHHs). Transcript analysis revealed an up‐regulation of proinflammatory cytokines IL32, chemokine (C‐X‐C motif) ligand 9 (CXCL9), and CXCL10 and of ubiquitin D (UBD), whereas down‐regulation of insulin‐like growth factor‐binding protein 2 (IGFBP2) and hypoxanthine phosphoribosyltransferase 1 (HPRT1) was reported in patients with NAFLD. Moreover, IL32, which is the major deregulated gene, correlated with body mass index (BMI), waist circumference, NAFLD activity score (NAS), aminotransferases (alanine aminotransferase [ALAT] and aspartate aminotransferase [ASAT]), and homeostasis model assessment of insulin resistance (HOMA‐IR) index in patients. Consistent with an instrumental role in the pathophysiology of NAFLD, treatment of control human hepatocytes with recombinant IL32 leads to insulin resistance, a hallmark metabolic deregulation in NAFLD hepatocytes. Conclusion:IL32 has a critical role in the pathogenesis of NAFLD and could be considered as a therapeutic target in patients.
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Affiliation(s)
- Nassim Dali-Youcef
- Laboratoire de Biochimie et Biologie Moléculaire, Pôle de Biologie Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France.,Department of Functional Genomics and Cancer Institut de Génétique et de Biologie Moléculaire et Cellulaire/CNRS UMR 7104/INSERM U 1258/Université de Strasbourg Illkirch France
| | - Michel Vix
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Federico Costantino
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Houssein El-Saghire
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg Strasbourg France
| | - Benoit Lhermitte
- Department of Pathology Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Cosimo Callari
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Jacopo D'Agostino
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Silvana Perretta
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Stefan Paveliu
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Monica Gualtierotti
- Service de Chirurgie Digestive et Endocrinienne Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Edith Dumeny
- Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Marine A Oudot
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg Strasbourg France
| | - Amélie Jaulin
- Department of Functional Genomics and Cancer Institut de Génétique et de Biologie Moléculaire et Cellulaire/CNRS UMR 7104/INSERM U 1258/Université de Strasbourg Illkirch France
| | - Doulaye Dembélé
- Microarray and Sequencing Platform Institut de Génétique et de Biologie Moléculaire et Cellulaire/CNRS UMR 7104/INSERM U 1258/Université de Strasbourg Illkirch France
| | - Mirjam B Zeisel
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg Strasbourg France
| | - Catherine Tomasetto
- Department of Functional Genomics and Cancer Institut de Génétique et de Biologie Moléculaire et Cellulaire/CNRS UMR 7104/INSERM U 1258/Université de Strasbourg Illkirch France
| | - Thomas F Baumert
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg Strasbourg France.,Service d'Hépato-Gastroentérologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
| | - Michel Doffoël
- Service d'Hépato-Gastroentérologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg Strasbourg France
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Ignat M, Lindner V, Vix M, Marescaux J, Mutter D. Intraoperative Probe-Based Confocal Endomicroscopy to Histologically Differentiate Thyroid From Parathyroid Tissue Before Resection. Surg Innov 2018; 26:141-148. [PMID: 30466375 DOI: 10.1177/1553350618814078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Frozen section is the standard method to histologically distinguish parathyroid tissue from thyroid tissue during endocrine neck surgery. Frozen section can be time-consuming and costly. Its drawback is that it is to be performed only after the removal of a suspected pathological tissue. This study demonstrates the use of probe-based confocal laser endomicroscopy (pCLE) to confirm histology prior to tissue resection. DESIGN A prospective, single-institution, nonrandomized study was conducted. No sample size calculation was performed for this observational trial. The primary objective was the description of histological rendering of normal and pathological tissues through pCLE. Real-time in vivo fluorescence microscopy imaging was performed with the CystoFlex UHD probe after intravenous injection of 2.5 mL of 10% fluorescein sodium. RESULTS Eleven patients with hyperparathyroidism and thyroid conditions were included. A total of 104 videos showing thyroid, parathyroid, adipose tissue, muscle, laryngeal nerve, and lymph nodes were recorded. Videos were compared with visual information and pathological samples (when sampling was indicated). Thyroid tissue could be identified based on the presence of colloid follicles (intensely fluorescent area surrounded by a small ridge of low-fluorescence epithelial cells) including the pathognomonic aspect of resorption vacuole. Parathyroid tissue could be identified based on a regular, "diamond-shaped" capillary network encompassing parathyroid chief cells. Blinded reinterpretation of pCLE videos demonstrated an 89.3% sensitivity and a 90% specificity as compared with histology in tissue recognition. CONCLUSION This pilot study describes representative renderings of intraoperative pCLE to nontraumatically differentiate thyroid, parathyroid, and lymph nodes before surgical removal.
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Affiliation(s)
- Mihaela Ignat
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Michel Vix
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
| | | | - Didier Mutter
- 1 University Hospital of Strasbourg, Strasbourg, France.,2 IRCAD/IHU: Institute of Image-Guided Surgery, Strasbourg, France
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Vix M, Mutter D, Marescaux J. Video-Assisted Exploration of the Four Parathyroid Glands for Primary Hyperparathyroidism. VideoEndocrinology 2018. [DOI: 10.1089/ve.2018.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michel Vix
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Didier Mutter
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Jacques Marescaux
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
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Soares RV, Perretta S, Ignat DM, Vix M, Swanstrom LL. Technical steps for removal of duodenojejunal bypass liner (endobarrier device). Gastrointest Endosc 2016; 84:1063. [PMID: 27311653 DOI: 10.1016/j.gie.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/02/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Renato V Soares
- Institut Hospitalo-Universitaire, Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - Silvana Perretta
- Institut Hospitalo-Universitaire, Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - Dana Mihaela Ignat
- Institut Hospitalo-Universitaire, Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - Michel Vix
- Institut Hospitalo-Universitaire, Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - Lee L Swanstrom
- Institut Hospitalo-Universitaire, Institut de Recherche contre les Cancers de l'Appareil Digestif, Strasbourg, France
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Ignat M, Vix M, Imad I, D'Urso A, Perretta S, Marescaux J, Mutter D. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg 2016; 104:248-256. [DOI: 10.1002/bjs.10400] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Robust data on quality of life (QoL) after different techniques of bariatric surgery are sparse. This RCT compared excess weight loss (EWL) and QoL after sleeve gastrectomy versus Roux-en-Y gastric bypass (RYGB).
Methods
Obese patients were assigned randomly to RYGB or sleeve gastrectomy. The primary outcome measure was EWL. Secondary outcomes included QoL, co-morbidity, adverse events, vitamin and glycolipid status. QoL was assessed before and annually after surgery, using the Moorehead–Ardelt Quality of Life Questionnaire II (M-A-QoLQII) and Gastrointestinal Quality of Life Index (GIQLI).
Results
One hundred patients were enrolled, 45 in the RYGB group and 55 in the sleeve gastrectomy group. Mean postoperative EWL at 1, 2, 3 and 5 years was 80·4, 79·8, 83·0 and 74·8 per cent respectively after RYGB, and 83·0, 77·8, 66·3 and 65·1 per cent after sleeve gastrectomy (P = 0·017). Mean M-A-QoLQII score before surgery and at 1, 2, 3 and 5 years after operation was 0·5, 1·6, 1·7, 2·1 and 1·4 respectively after RYGB, and 0·3, 1·7, 1·5, 1·5 and 1·2 after sleeve gastrectomy. Mean GIQLI score before and at 1, 2, 3, 5 years after RYGB was 96·4, 113·8, 113·3, 113·4, 111·7, compared with 90·7, 113·9, 114·5, 113·1 and 113·0 for sleeve gastrectomy. The improvement was significant compared with preoperative values (P < 0·001 for M-A-QoLQII and GIQLI), with no difference between groups (P = 0·418 and P = 0·323 respectively). RYGB resulted in higher readmission rates (P = 0·002) and length of hospital stay (P = 0·006) than sleeve gastrectomy.
Conclusion
RYGB and sleeve gastrectomy resulted in equivalent, long-standing QoL improvement. RYGB resulted in more stable weight loss but was associated with higher readmission rates. Registration number: NCT02475590.
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Affiliation(s)
- M Ignat
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - M Vix
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | | | - A D'Urso
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - S Perretta
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - J Marescaux
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
| | - D Mutter
- Department of Digestive and Endocrine Surgery, Research Institute Against Digestive Cancer (IRCAD), Institute of Image-Guided Surgery (IHU), University Hospital of Strasbourg, Strasbourg, France
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Steib A, Degirmenci SE, Junke E, Asehnoune K, Figier M, Pericard C, Rohr S, Letessier E, Brunaud L, Vix M, Zobairi F, Grunebaum L, Toti F. Once versus twice daily injection of enoxaparin for thromboprophylaxis in bariatric surgery: effects on antifactor Xa activity and procoagulant microparticles. A randomized controlled study. Surg Obes Relat Dis 2016; 12:613-621. [DOI: 10.1016/j.soard.2015.08.505] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 08/17/2015] [Indexed: 01/21/2023]
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Imperiale A, Sebag F, Vix M, Castinetti F, Kessler L, Moreau F, Bachellier P, Guillet B, Namer IJ, Mundler O, Taïeb D. 18F-FDOPA PET/CT imaging of insulinoma revisited. Eur J Nucl Med Mol Imaging 2014; 42:409-18. [PMID: 25367749 DOI: 10.1007/s00259-014-2943-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/13/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE (18)F-FDOPA PET imaging is increasingly used in the work-up of patients with neuroendocrine tumours. It has been shown to be of limited value in localizing pancreatic insulin-secreting tumours in adults with hyperinsulinaemic hypoglycaemia (HH) mainly due to (18)F-FDOPA uptake by the whole pancreatic gland. The objective of this study was to review our experience with (18)F-FDOPA PET/CT imaging with carbidopa (CD) premedication in patients with HH in comparison with PET/CT studies performed without CD premedication in an independent population. METHODS A retrospective study including 16 HH patients who were investigated between January 2011 and December 2013 using (18)F-FDOPA PET/CT (17 examinations) in two academic endocrine tumour centres was conducted. All PET/CT examinations were performed under CD premedication (200 mg orally, 1 - 2 h prior to tracer injection). The PET/CT acquisition protocol included an early acquisition (5 min after (18)F-FDOPA injection) centred over the upper abdomen and a delayed whole-body acquisition starting 20 - 30 min later. An independent series of eight consecutive patients with HH and investigated before 2011 were considered for comparison. All patients had a reference whole-body PET/CT scan performed about 1 h after (18)F-FDOPA injection. In all cases, PET/CT was performed without CD premedication. RESULTS In the study group, (18)F-FDOPA PET/CT with CD premedication was positive in 8 out of 11 patients with histologically proven insulinoma (73 %). All (18)F-FDOPA PET/CT-avid insulinomas were detected on early images and 5 of 11 (45 %) on delayed ones. The tumour/normal pancreas uptake ratio was not significantly different between early and delayed acquisitions. Considering all patients with HH, including those without imaging evidence of disease, the detection rate of the primary lesions using CD-assisted (18)F-FDOPA PET/CT was 53 %, showing 9 insulinomas in 17 studies performed. In the control group (without CD premedication, eight patients), the final diagnosis was benign insulinoma in four, nesidioblastosis in one, and no definitive diagnosis in the remainder. (18)F-FDOPA PET/CT failed to detect any tumour in these patients. CONCLUSION According to our experience, CD administration before (18)F-FDOPA injection leads to low residual pancreatic (18)F-FDOPA activity preserving tumoral uptake with consequent insulinoma detection in more than half of adult patients with HH and more than 70 % of patients with a final diagnosis of insulinoma. If (18)F-FDOPA PET/CT is indicated, we strongly recommend combining CD premedication with early acquisition centred over the pancreas.
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Affiliation(s)
- Alessio Imperiale
- Department of Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France
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Marx L, Raharimanantsoa M, Mandala S, D'Urso A, Vix M, Mutter D. Laparoscopic treatment of incisional and primary ventral hernia in morbidly obese patients with a BMI over 35. Surg Endosc 2014; 28:3310-4. [PMID: 25007972 DOI: 10.1007/s00464-014-3607-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/08/2014] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Incisional and ventral hernias are common surgical indications. Their management is associated with significant complications and recurrences in open surgery (15-25%). Since laparoscopy has become a standard in bariatric surgery, there has been a natural trend to treat obese patients with parietal wall defects laparoscopically. The aim of our study was to evaluate the feasibility and the results of the laparoscopic management of parietal wall defects in patients with a BMI >35. MATERIALS AND METHODS A series of 79 patients were included. Data were acquired prospectively and analyzed retrospectively. The surgical procedure was standardized: 3 ports, mesh type (Parietex™ Composite mesh, Covidien, France), fixation with non-absorbable transfascial sutures, and tackers. Complications were evaluated. RESULTS Out of 79 patients (29 men, 50 women), 43 had umbilical and 36 had ventral hernias. Mean age was 52.4 years, and mean BMI was 40.83 kg/m(2). Mean postoperative hospital stay was 2 days. Postoperative pain evaluated by visual analog scale was 2.86. No intraoperative complications or deaths occurred. Seven postoperative complications occurred (8.86%): two parietal wall hematomas treated by radiological embolization, two significant cases of postoperative pain, one postoperative obstruction, one spontaneously resolved respiratory failure, and one early (day 1) parietal wall defect with immediate reoperation. Postoperative seroma rate was 26.58% (21 patients, all of whom were treated conservatively). Postoperative follow-up was 18.10 months (1-84 months), and recurrence rate was 3.8% (3 patients). DISCUSSION This study confirms the feasibility and safety of the laparoscopic approach for ventral hernias in morbidly obese patients. Recurrence rates (3.8%) appeared lower than the ones observed in the literature (15-25%). Postoperative hemorrhage and port-site hernia are specific complications of this approach. Postoperative hospital stay is low (2 days) as compared to open surgery. Laparoscopic management of parietal wall defects should be considered a standard option in morbidly obese patients.
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Affiliation(s)
- L Marx
- Department of Digestive and Endocrine Surgery, IRCAD/EITS, IHU Strasbourg, NHC - Pôle Hépato-Digestif, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
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Nagao Y, Diana M, Vix M, D'Urso A, Mutter D, Marescaux J. Age impact on weight loss and glycolipid profile after laparoscopic sleeve gastrectomy: experience with 308 consecutive patients. Surg Endosc 2014; 28:803-10. [PMID: 24519024 DOI: 10.1007/s00464-013-3261-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/27/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of age on weight loss and on related glycolipid profile changes at 2-year follow-up after laparoscopic sleeve gastrectomy (LSG). METHODS From 2005 to 2010, a total of 308 consecutive patients undergoing LSG were enrolled. Mean age was 39.7 ± 10.7 years, mean weight was 127.9 ± 24.5 kg, and mean body mass index (BMI) was 45.9 ± 6.8 kg/m(2). Patients were divided into three age groups: young (18-29 years, n = 64), intermediate (30-49 years, n = 183), and senior (50-68 years, n = 61). BMI, excess weight loss (%EWL), and several biochemical examinations for the evaluation of glycolipid profile transition, including homeostasis model assessment for insulin resistance (HOMA-IR), were assessed at 6, 12, and 24 months (M6, M12, and M24) after LSG. RESULTS All three groups had a significant BMI reduction and %EWL at 2 years' follow-up. The young group obtained significantly better %EWL at M6, M12, and M24 (62.6 ± 14.4, 73.4 ± 17.1, and 72.5 ± 18.9 %) compared to intermediate (53.2 ± 18.0, 64.8 ± 19.9, and 66.8 ± 23.0 %) and senior group (48.0 ± 15.5, 54.6 ± 15.3, and 54.4 ± 15.4 %). Fasting serum glucose levels improved significantly in all three groups at all follow-up assessment points (M6, M12, and M24). A significant improvement in HbA1c was also observed in the three groups at M6 and M12, while at M24 only patients in the young and intermediate groups still presented a significantly improved glycemic control. A significantly lower HOMA-IR improvement was observed at M6 in the senior group (2.83 ± 1.86) compared to both young (1.30 ± 0.54) and intermediate (1.43 ± 0.82) groups of patients. Total and low-density lipoprotein cholesterol level was significantly improved only in the young group. CONCLUSIONS An age-dependent trend toward better %EWL and glycolipid profile improvement was observed in young patients after LSG.
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Affiliation(s)
- Yoshihiro Nagao
- Department of General, Digestive and Endocrine Surgery, IRCAD-IHU, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg, France,
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Vix M, Diana M, Liu KH, D'Urso A, Mutter D, Wu HS, Marescaux J. Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass: results of a prospective randomized clinical trial. Obes Surg 2013. [PMID: 23207829 DOI: 10.1007/s11695-012-0827-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aims to report glycolipid changes after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) in the setting of a prospective randomized clinical trial. METHODS One hundred patients were randomly assigned to RYGB (n = 45) and SG (n = 55). Fasting glucose, insulin, glycated hemoglobin (HbA1c%), triglycerides, and serum cholesterol (total, HDL, and LDL) were evaluated at inclusion and after 1, 3, 6, and 12 months. The index for homeostasis model assessment of insulin resistance (HOMA-IR) and β cell function (HOMA-B) were assessed. RESULTS Mean postoperative 1-, 3-, 6-, and 12-month excess weight loss was 25.39, 43.47, 63.75, and 80.38 % after RYGB and 25.25, 51.32, 64.67, and 82.97 % after SG, respectively. Mean fasting glucose and fasting serum insulin were similarly and statistically significantly reduced in both RYGB and SG. Mean HOMA-IR improved in both groups, particularly in case of high preoperative values, and mean HOMA-B improved at 1 year after RYGB. HbA1c% dropped from 5.66 % (SD = 0.61) to 5.57 % (SD = 0.32) after RYGB and from 5.64 % (SD = 0.43) to 5.44 % (SD = 0.43) after SG. Total cholesterol was significantly higher at 1 month (p = 0.04), 3 months (p = 0.03), and 1 year (p = 0.005) after SG as compared to RYGB. LDL cholesterol decreased significantly after RYGB at 1 month (p = 0.03), 3 months (p = 0.0001), and 1 year (p = 0.0004) as compared to SG. HDL cholesterol was increased at 1 year in the RYGB group but not in the SG group. Triglycerides decreased similarly in both groups. CONCLUSIONS Short-term glycemic control was comparable after SG and RYGB. An improved lipid profile was noted after RYGB in patients with abnormal preoperative values.
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Affiliation(s)
- Michel Vix
- IRCAD-IHU, University of Strasbourg, Strasbourg, France.
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Vix M, Liu KH, Diana M, D'Urso A, Mutter D, Marescaux J. Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial. Surg Endosc 2013; 28:821-6. [PMID: 24196556 DOI: 10.1007/s00464-013-3276-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/08/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess postoperative outcomes of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). Short-term results on vitamin D and parathormone (PTH) metabolism are reported. METHODS One hundred patients were randomly assigned to RYGB (n = 45) or SG (n = 55). Vitamin D, PTH, and calcium were assessed at inclusion and after 1, 3, 6, and 12 months (M1, M3, M6, and M12). Eighty-eight patients completed 1-year follow-up. RESULTS Mean postoperative excess weight loss (%EWL) at M1, M3, M6, and M12 was 25.39, 43.47, 63.75, and 80.38 % versus 25.25, 51.32, 64.67, and 82.97 % in RYGB and SG, respectively. Vitamin D values were statistically significantly higher after SG compared to RYGB at M3 (61.57 pmol/L, standard deviation [SD] 14.29 vs. 54.81 SD 7.65; p = 0.01) and M12 (59.83 pmol/L, SD 6.41 vs. 56.15 SD 8.18; p = 0.02). Vitamin D deficiency rate decreased from 84.62 to 35 % at M6 (p = 0.04) and 48 % at M12 (p = 0.01) in the SG group, while there was no significant improvement in the RYGB group. Serum parathyroid hormone (sPTH) level was decreased significantly in the SG group by M3 (44.8 ng/L vs. 28.6; p = 0.03), M6 (44.9 ng/L vs. 25.8; p = 0.017), and M12 (41.4 ng/L vs. 20.5; p = 0.017). Secondary hyperparathyroidism rate was 20.83 and 24 % at M1 (p = 1), 16.67 and 8 % at M3 (p = 0.41), 14.29 and 0 % at M6 (p = 0.08), and 15 and 0 % at M12 (p = 0.23) in the RYGB and SG groups, respectively. CONCLUSIONS Patients after RYGB had a significantly higher postoperative vitamin D deficiency and higher sPTH levels than after SG.
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Affiliation(s)
- Michel Vix
- Department of General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France
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Mutter D, Dallemagne B, Perretta S, Vix M, Leroy J, Pessaux P, Marescaux J. Innovations in minimally invasive surgery: lessons learned from translational animal models. Langenbecks Arch Surg 2013; 398:919-23. [PMID: 24037252 DOI: 10.1007/s00423-013-1115-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/02/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE Animal models are key elements of surgical research and promotion of new techniques. Inanimate models, anatomical specimens, and living animals are all necessary to solve the various problems encountered by the advent of a new surgical technique. The development of Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures is a representative model. METHODS Over 400 experimental procedures were performed in inanimate models, ex vivo tissues and animals to solve all problems faced by the development of NOTES surgery: peritoneal access, gastrotomy closure, exposure, retraction, dissection as well as education to start this new procedure. RESULTS The successive use of all models allows to identify the ideal solution for each problem and to precisely define the safest and most reliable option to apply the new technique in patients. It allowed to perform the first transvaginal and transgastric cholecystectomy in patients in a safe way. CONCLUSION Animal experimentation remains necessary as even sophisticated computer-based solutions are unable to model all interactions between molecules, cells, tissues, organisms, and their environment. Animal research is required in many areas to validate new technologies, develop training, let alone its major goal (namely to avoid using patients for experimentation) which is to be the first "model" for the surgeon.
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Affiliation(s)
- D Mutter
- Department of Digestive and Endocrine Surgery, IRCAD/EITS, IHU, University Hospital of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France,
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D'Agostino J, Wall J, Soler L, Vix M, Duh QY, Marescaux J. Virtual neck exploration for parathyroid adenomas: a first step toward minimally invasive image-guided surgery. JAMA Surg 2013; 148:232-8; discussion 238. [PMID: 23682370 DOI: 10.1001/jamasurg.2013.739] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided surgery. DESIGN Enhanced 3D rendering methods can be used to transform computed tomographic scan images into a model for 3D VNE. In addition to a standard imaging modality, 3D VNE was performed in all patients and used to preoperatively plan minimally invasive parathyroidectomy. All preoperative localization studies were analyzed for their sensitivity, specificity, positive predictive value, and negative predictive value for the correct side of the adenoma(s) (lateralization) and the correct quadrant of the neck (localization). The 3D VNE model was used to generate intraoperative augmented reality in 3 cases. SETTING Tertiary care center. PATIENTS A total of 114 consecutive patients with primary hyperparathyroidism were included from January 8, 2008, through July 26, 2011. RESULTS The accuracy of 3D VNE in lateralization and localization was 77.2% and 64.9%, respectively. Virtual neck exploration had superior sensitivity to ultrasonography (P.001), sestamibi scanning (P=.07), and standard computed tomography (P.001). Use of the 3D model for intraoperative augmented reality was feasible. CONCLUSIONS 3-Dimensional VNE is an excellent tool in preoperative localization of parathyroid adenomas with sensitivity, specificity, and diagnostic accuracy commensurate with accepted first-line imaging modalities. The added value of 3D VNE includes enhanced preoperative planning and intraoperative augmented reality to enable less-invasive image-guided surgery.
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Donatelli G, Costantino F, Dhumane P, Vix M, Perretta S, D' Agostino J, Dallemagne B, Marescaux J. Endoscopic intragastric balloon: a bridge toward definitive bariatric surgical management of a morbidly obese patient with situs ambiguous and midgut malrotation (with videos). Gastrointest Endosc 2012; 75:217-8. [PMID: 21444079 DOI: 10.1016/j.gie.2011.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 01/10/2011] [Indexed: 12/11/2022]
Affiliation(s)
- Gianfranco Donatelli
- Department of Gastrointestinal and Endocrine Surgery, University of Strasbourg, Strasbourg, France
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Rosenthal RJ, Diaz AA, Arvidsson D, Baker RS, Basso N, Bellanger D, Boza C, El Mourad H, France M, Gagner M, Galvao-Neto M, Higa KD, Himpens J, Hutchinson CM, Jacobs M, Jorgensen JO, Jossart G, Lakdawala M, Nguyen NT, Nocca D, Prager G, Pomp A, Ramos AC, Rosenthal RJ, Shah S, Vix M, Wittgrove A, Zundel N. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis 2011; 8:8-19. [PMID: 22248433 DOI: 10.1016/j.soard.2011.10.019] [Citation(s) in RCA: 659] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 10/27/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of >12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida. METHODS Expert panelists were invited to participate according to their publications, knowledge and experience, and identification as surgeons who had performed >500 cases. The topics for consensus encompassed patient selection, contraindications, surgical technique, and the prevention and management of complications. The responses were calculated and defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement). RESULTS Full consensus was obtained for the essential aspects of the indications and contraindications, surgical technique, management, and prevention of complications. Consensus was achieved for 69 key questions. CONCLUSION The present consensus report represents the best practice guidelines for the performance of LSG, with recommendations in the 3 aforementioned areas. This report and its findings support a first effort toward the standardization of techniques and adoption of working recommendations formulated according to expert experience.
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Affiliation(s)
- Raul J Rosenthal
- Department of Surgery, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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Mavrogenis G, Coumaros D, D'Agostino J, Uhl G, Defta D, Vix M. Endoscopic rendezvous technique and esophageal fistulae: sometimes it is worth working in the dark! Endoscopy 2011; 43:1020-1; author reply 1021. [PMID: 22057773 DOI: 10.1055/s-0030-1256884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Philippi N, Vinzio S, Collongues N, Vix M, Boehm N, Tranchant C, Echaniz-Laguna A. [Peripheral neuropathies after bariatric surgery]. Rev Neurol (Paris) 2011; 167:607-14. [PMID: 21514611 DOI: 10.1016/j.neurol.2011.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 11/07/2010] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Peripheral neuropathies sometimes complicate bariatric surgery. PATIENTS AND METHODS We report the detailed clinical, electrophysiological, biological and histological characteristics of five patients who developed peripheral neuropathy after bariatric surgery. RESULTS Three patients presented with small fiber neuropathy, one presented with axonal polyneuropathy, and one with demyelinating polyradiculoneuropathy. All patients had in common prominent neuropathic pain, massive weight loss, and multiple nutritional deficiencies. The pathophysiology of postbariatric surgery polyneuropathies is complex and involves nutritional, infectious and dysimmune mechanisms. CONCLUSION The spectrum of peripheral neuropathies complicating bariatric surgery is wide, and includes pure small fiber neuropathy, axonal polyneuropathy, and demyelinating polyradiculoneuropathy. Treatment is mainly preventive, but sometimes surgical revision is needed.
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Affiliation(s)
- N Philippi
- Département de neurologie, CHU de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Mutter D, Vix M, Dallemagne B, Perretta S, Leroy J, Marescaux J. WeBSurg: An innovative educational Web site in minimally invasive surgery--principles and results. Surg Innov 2011; 18:8-14. [PMID: 21385758 DOI: 10.1177/1553350611398880] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Internet has dramatically changed clinical practice and information sharing among the surgical community and has revolutionized the access to surgical education. High-speed Internet broadcasting allows display of high-quality high-definition full-screen videos. Herein, Internet access to surgical procedures plays a major role in continuing medical education (CME). The WeBSurg Web site is a virtual surgical university dedicated to post-graduate education in minimally invasive surgery. Its results measured through its members, number of visitors coming from 213 different countries, as well as the amount of data transmitted through the provider LimeLight, confirm that WeBSurg appears as the first Web site in surgical CME. The Internet offers a tailored education for all levels of surgical expertise as well as for all types of Internet access. This represents a global multimedia solution at the cutting edge of technology and surgical evolution, which responds to the modern ethos of "always, anywhere, anytime."
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Mutter D, Callari C, D Agostino J, Cahill RA, Forgione A, Vix M, Leroy J, Marescaux J. Expanded clinical experience with 4DDome(R) composite prosthesis in elective open inguinal herniorrhaphy. Surg Technol Int 2010; 19:105-110. [PMID: 20437353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Prosthetic material composition is implicated in the phenomenon of postoperative chronic groin pain that has undermined elective open inguinal herniorrhaphy. Reported herein are our 'all-comers' experiences with a novel dual component mesh (4DDome(R)). A prospective cohort (Phase II) study was performed that involved all patients undergoing elective open inguinal herniorrhaphy during a four-year period. Conventional operative technique was used except for choice of prosthesis. The 4DDome mesh comprises a molded dome-shaped composite (10% polypropylene, 90% poly-L-lactic acid) with a lightweight polypropylene mesh overlay. Short- (1 week) and intermediate-term (18 months) clinical follow-up with examination and symptom questionnaire judged outcome while surgeons rated their approval using a visual analogue scale. One hundred ninety-six patients (mean age, 65.5 years; Mean BMI, 25.5; Mean ASA, 1.8, 178 males) underwent repair of 201 inguinal hernias by six surgeons (three residents). The majority of patients had an indirect hernia (n=119) 93 being combined with a posterior wall defect [Nyhus IIIa], whereas 66 had a direct hernia [Nyhus IIIb], and 11 had a recurrent hernia.) Mean operative time was 44.6 minutes with 92 patients being operated under local anesthesia. Ten patients developed seromas and two had hematomas early postoperatively. Median intermediate-term follow-up is currently 19 (range: 3-72) months for the 147 (75%) patients still available for contact. The incidence of chronic groin pain is 8.8%, whereas there has been one hernia recurrence. Surgeon satisfaction and confidence were high. The 4DDome provides appropriate clinical results and, therefore, appears valid for use in routine practice.
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Affiliation(s)
- Didier Mutter
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
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Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244:741-9. [PMID: 17060767 PMCID: PMC1856597 DOI: 10.1097/01.sla.0000224726.61448.1b] [Citation(s) in RCA: 608] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SUMMARY BACKGROUND DATA Most patients who undergo Roux-en-Y gastric bypass (RYGB) experience rapid resolution of type 2 diabetes. Prior studies indicate that this results from more than gastric restriction and weight loss, implicating the rearranged intestine as a primary mediator. It is unclear, however, if diabetes improves because of enhanced delivery of nutrients to the distal intestine and increased secretion of hindgut signals that improve glucose homeostasis, or because of altered signals from the excluded segment of proximal intestine. We sought to distinguish between these two mechanisms. METHODS Goto-Kakizaki (GK) type 2 diabetic rats underwent duodenal-jejunal bypass (DJB), a stomach-preserving RYGB that excludes the proximal intestine, or a gastrojejunostomy (GJ), which creates a shortcut for ingested nutrients without bypassing any intestine. Controls were pair-fed (PF) sham-operated and untreated GK rats. Rats that had undergone GJ were then reoperated to exclude the proximal intestine; and conversely, duodenal passage was restored in rats that had undergone DJB. Oral glucose tolerance (OGTT), food intake, body weight, and intestinal nutrient absorption were measured. RESULTS There were no differences in food intake, body weight, or nutrient absorption among surgical groups. DJB-treated rats had markedly better oral glucose tolerance compared with all control groups as shown by lower peak and area-under-the-curve glucose values (P < 0.001 for both). GJ did not affect glucose homeostasis, but exclusion of duodenal nutrient passage in reoperated GJ rats significantly improved glucose tolerance. Conversely, restoration of duodenal passage in DJB rats reestablished impaired glucose tolerance. CONCLUSIONS This study shows that bypassing a short segment of proximal intestine directly ameliorates type 2 diabetes, independently of effects on food intake, body weight, malabsorption, or nutrient delivery to the hindgut. These findings suggest that a proximal intestinal bypass could be considered for diabetes treatment and that potentially undiscovered factors from the proximal bowel might contribute to the pathophysiology of type 2 diabetes.
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Affiliation(s)
- Francesco Rubino
- IRCAD-European Institute of Telesurgery, University Louis Pasteur, Strasbourg, France.
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Leroy JL, Mutter D, Forgione A, Inoue H, Vix M, Bailey C, Marescaux J. The new 4DDome prosthesis: an original light and partially absorbable composite mesh for hernia repair. Hernia 2006; 10:401-8. [PMID: 16969587 DOI: 10.1007/s10029-006-0126-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 07/19/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The use of non-absorbable meshes for the repair of inguinal hernias has become standard; however, these meshes have been associated with complications including long-term postoperative pain. To this end, a new partially absorbable composite mesh has been developed, and the aim of this study was to investigate its efficacy in animal and human trials. MATERIALS AND METHODS Sixty male Wistar rats were used to evaluate the behavior of the newly designed composite mesh. Composite meshes were implanted in the extra-peritoneal plane for 2, 4 and 8 weeks and compared to a standard polypropylene mesh. Forty patients with symptomatic inguinal hernias were treated using a new 4DDome designed prosthesis. Follow-up was by clinical and ultrasound examination at 1, 6 and 12 months. RESULTS The animal study demonstrated that the inflammatory reaction associated with the new composite mesh was significantly lower than a standard polypropylene mesh, characterized by a lower macrophage infiltrate (P < 0.001). The mesh did not shrink over the 8-week period, unlike the polypropylene mesh (P < 0.05). The human study showed that there were three minor postoperative complications, no recurrences and the mesh was well tolerated. Follow-up with serial ultrasound showed that at 10 days and 1 month the dome was clearly visible in position; however, by 6 months it had flattened out, been partially absorbed and become incorporated into the repair. CONCLUSION These experimental and clinical studies have validated the concept of the new 4DDome composite mesh. It was well tolerated and was associated with good short-term results. The combination of the dome shape and the new composite mesh means that less polypropylene is required and represents a significant advance in anterior hernia repair.
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Affiliation(s)
- J L Leroy
- IRCAD/EITS, Louis Pasteur University, Strasbourg, France
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Abstract
OBJECTIVES Surgical options for acute diverticulitis with peritonitis include Hartmann's procedure or resection and primary anastomosis with or without a stoma. Initial laparoscopic lavage and drainage can control the acute intra-abdominal sepsis to allow for a delayed definitive procedure in nonemergency conditions. Potential advantages include the avoidance of a laparotomy, stoma and local infections at the origin of dehiscence and incisional hernias. We evaluated this approach in a selected group of patients. METHODS Patients with intra-abdominal pus secondary to diverticular perforation requiring surgery were included in the study. Patients with localized pus amenable to computerized tomography (CT)-guided drainage, faecal peritonitis, severe generalized peritonitis, and those in which the perforation was spontaneously visible were excluded. Standard demographic data, CT findings, intra-operative findings and postoperative outcomes were analysed. RESULTS Ten patients were suitable for the approach. Mean patient age was 60.2 years. Mean body mass index was 28.2 m2/kg. Mean postoperative stay was 8.5 days and uneventful in all patients. One patient re-presented after 3 weeks with acute peritonitis requiring open sigmoidectomy. Six patients successfully underwent laparoscopic sigmoidectomy with primary anastomosis 2-3 months later. Two patients were not re-operated because of comorbidity and one refused surgery. CONCLUSIONS A two-stage totally minimally invasive approach may be a safe alternative strategy for selected cases of acute complicated diverticulitis.
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Affiliation(s)
- D Mutter
- IRCAD, University of Strasbourg, Strasbourg, France
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Abstract
One of the most significant complications of the gastric banding procedure is gastric prolapse. However, pouch necrosis after gastric prolapse is an extremely rare complication. We present the case of a morbidly obese 41-year-old woman who had had a laparoscopic adjustable gastric banding procedure 3 years before. She developed a pouch necrosis after a late gastric prolapse. After failure of conservative treatment, a diagnostic laparoscopy was performed. This resulted in removal of the band and the diagnosis of pouch necrosis. A laparotomy was indicated and a sleeve gastrectomy was performed. A delay in the diagnosis of gastric prolapse can lead to major complications. Initial referral to a specialized center is necessary for proper care of this complication. Failure of conservative treatment mandates early operative intervention.
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Affiliation(s)
- Sorinel Lunca
- IRCAD/EITS, University of Medicine Louis Pasteur, Strasbourg, France
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Rubino F, Zizzari P, Tomasetto C, Bluet-Pajot MT, Forgione A, Vix M, Grouselle D, Marescaux J. The role of the small bowel in the regulation of circulating ghrelin levels and food intake in the obese Zucker rat. Endocrinology 2005; 146:1745-51. [PMID: 15625244 DOI: 10.1210/en.2004-1181] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Circulating levels of ghrelin, a stomach peptide that promotes food intake, rise before and fall after meal. We aimed to investigate whether there is an independent contribution of the small bowel to the regulation of ghrelin and appetite. A duodenal-jejunal bypass (DJB) with preservation of normal gastric volume and exposure to nutrients was performed in 12-wk-old obese Zucker ZDF fa/fa rat. Food intake, weight gain, 48-h fasting, and 24-h refeeding levels of total and acylated ghrelin were measured. The DJB was challenged against gastric banding (GB), diet, and a sham operation in matched animals. Normal controls were age-matched Wistar rats, which underwent either DJB or a sham operation. The Zucker obese animals showed a paradoxical increase of acylated ghrelin levels after refeeding (+30% with respect to fasting levels; P = 0.001), an abnormality that was completely reversed only by the DJB (-30%; P = 0.01) but not after GB, diet, or sham operation. In obese rats, the DJB resulted in significantly less food intake and weight gain compared with both GB (P < 0.05) and sham operation (P < 0.01). In sharp contrast, the DJB did not alter food intake and weight gain in normal rats. The DJB does not physically restrict the flow of food but restores meal-induced suppression of acylated ghrelin and significantly reduces food intake in Zucker obese rats. These findings suggest an independent intestinal contribution to the regulation of the dynamic ghrelin response to eating and the possibility that defective signaling from the proximal bowel could be involved in the pathogenesis of obesity/hyperphagia.
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Affiliation(s)
- Francesco Rubino
- Institut de Recherche Contre les Canceurs de l'Appareil Digestif-European Institute of Telesurgery, 1 Place de l'Hopital, 67091 Strasbourg, France.
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Bouras G, Lunca S, Vix M, Marescaux J. A case of emphysematous cholecystitis managed by laparoscopic surgery. JSLS 2005; 9:478-80. [PMID: 16381372 PMCID: PMC3015641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Emphysematous cholecystitis is a rare condition caused by ischemia of the gallbladder wall with secondary gas-producing bacterial proliferation. The pathophysiology and epidemiology of this condition differ from that in gallstone-related acute cholecystitis. This report illustrates a case of emphysematous cholecystitis successfully treated by laparoscopic surgery. METHODS An 83-year-old female patient was admitted to the hospital with acute abdominal syndrome. Clinical examination and blood tests suggested acute cholecystitis. Plain radiography revealed a circular gas pattern in the right upper quadrant suggestive of emphysematous cholecystitis. Subsequent computed tomography confirmed the presence of gas in the gallbladder wall and a gas-fluid level within the organ. RESULTS Emergency laparoscopic cholecystectomy was successfully performed during which bubbling of the gallbladder wall was observed. Intraoperative cholangiography revealed no bile duct stones or biliary obstruction. The patient made an unremarkable recovery from surgery with no postoperative complications or admission to the intensive care unit. Pathological analysis revealed full-thickness infarctive necrosis of the gallbladder. Bacterial cultures grew Clostridium perfringens. CONCLUSIONS This case illustrates a typical case of emphysematous cholecystitis successfully treated by laparoscopic surgery. It contributes to suggestions from other reports that this condition can be safely treated by the laparoscopic approach.
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Luncă S, Stănescu C, Bouras G, Vix M, Marescaux J. A difficult case of mediastinal parathyroid adenoma: theoretical and clinical considerations. Chirurgia (Bucur) 2004; 99:563-6. [PMID: 15739675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
About one quarter of patients with primary hyperparathyroidism have ectopic parathyroid tissue. The majority of parathyroid glands can be reached through a cervical approach, but in about 2% of the cases the ectopic gland is in the mediastinum in a location that requires a thoracic approach. Failure to remove ectopic mediastinal parathyroid tissue results in persistent hyperparathyroidism. Reoperative exploration for persistent hyperparathyroidism is often difficult even in the hands of experienced surgeons. Recent advances in preoperative localization techniques and intraoperative parathyroid hormone measurement have improved the rates of successful resection. We present a difficult case of persistent hyperparathyroidism secondary to an ectopic middle mediastinal parathyroid adenoma, which was eventually successfully managed in a specialised unit.
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Affiliation(s)
- S Luncă
- IRCAD, University Hospital Strasbourg, France.
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Navez B, Arenas M, Mutter D, Vix M, Lipski D, Cambier E, Guiot P, Leroy J, Marescaux J. Abordaje laparoscópico en el tratamiento de la colecistitis aguda: estudio retrospectivo en 609 casos. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72192-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Marteil-Oudrer AM, Friess P, Vix M, Gasser B, Jeandidier N, Pinget M. Sarcoma of the thyroid gland: a case report. Ann Endocrinol (Paris) 2002; 63:219-22. [PMID: 12193877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Sarcoma of the thyroid gland is a very uncommon malignant tumor (<1% of thyroid cancers) characterized by severe local course and rapid metastatic dissemination and very poor prognosis. We report the case of an 84-year-old woman hospitalized for expiratory dyspnea, severe malnutrition and swallowing disorders leading to bronchial infection. She had a voluminous (20 cm) extra-thoracic right-neck goiter with a considerable superficial venous pattern that had developed on an old goiter before growing recently. CEA and calcitonin levels were normal. The cervical-thoracic CT demonstrated a partially necrosed heterogeneously hypodense tumor compressing the esophagus and the trachea with displacement of adjacent structures which were not directly invaded. Large areas of necrosis and a probable metastatic image measuring 3 cm in the right median pulmonary lobe were observed. Macrobiopsy disclosed grade 3 sarcoma. Complete resection delivered a 3.170 kg tumor. Histology confirmed the diagnosis of sarcoma without neoplastic extension. Apart from right recurrent palsy, the initial post-operative period was satisfactory and the patient was discharged. Four and a half months later she was rehospitalized with local recurrence with a large metastatis in the right lung. She died two weeks later.
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Affiliation(s)
- A M Marteil-Oudrer
- Service de Médecine Interne, Hôpital R. Ballanger bv. R. Ballanger 93602 Aulnay-sous-Bois, France
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Abstract
OBJECTIVE To show the feasibility of performing surgery across transoceanic distances by using dedicated asynchronous transfer mode (ATM) telecommunication technology. SUMMARY BACKGROUND DATA Technical limitations and the issue of time delay for transmission of digitized information across existing telecommunication lines had been a source of concern about the feasibility of performing a complete surgical procedure from remote distances. METHODS To verify the feasibility and safety in humans, the authors attempted remote robot-assisted laparoscopic cholecystectomy on a 68-year-old woman with a history of abdominal pain and cholelithiasis. Surgeons were in New York and the patient in Strasbourg. Connections between the sites were done with a high-speed terrestrial network (ATM service). RESULTS The operation was carried out successfully in 54 minutes without difficulty or complications. Despite a round-trip distance of more than 14,000 km, the mean time lag for transmission during the procedure was 155 ms. The surgeons perceived the procedure as safe and the overall system as perfectly reliable. The postoperative course was uneventful and the patient returned to normal activities within 2 weeks after surgery. CONCLUSIONS Remote robot-assisted surgery appears feasible and safe. Teletransmission of active surgical manipulations has the potential to ensure availability of surgical expertise in remote locations for difficult or rare operations, and to improve surgical training worldwide.
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Affiliation(s)
- Jacques Marescaux
- IRCAD-EITS (European Institute of Telesurgery), Louis Pasteur University, Strasbourg, France.
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Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D, Cambier E, Guiot P, Leroy J, Marescaux J. Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg 2001; 25:1352-6. [PMID: 11596902 DOI: 10.1007/s00268-001-0122-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Laparoscopic cholecystectomy (LC) is now widely accepted as the modality of choice for the treatment of symptomatic uncomplicated cholelithiasis. The application of the laparoscopic technique in the setting of acute cholecystitis (AC) is more controversial. The precise role as well as the potential benefits of LC in the treatment of the acutely inflamed gallbladder have not been clearly established through large clinical series. The aim of our study was to assess the feasibility, safety, benefits, and specific complications of the laparoscopic approach in patients with AC. A retrospective chart analysis involving the patients admitted to two busy emergency digestive surgical units between October 1990 and December 1997 was carried out. Six hundred and nine patients meeting our criteria for AC were identified and evaluated. Overall complication rate was 15% with 12 postoperative bile leakages (1.97%) and 4 biliary tract injuries (BTI) (0.66%). The overall mortality rate was 0.66%. Local and overall complication rates were significantly correlated with the delay between the onset of acute symptoms and the operation but not the rate of general complications nor deaths. Our results demonstrate the safety and feasibility of LC in the setting of AC. Early cholecystectomy within 4 days is strongly recommended to minimize complications and increase the chances of a successful laparoscopic approach.
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Affiliation(s)
- B Navez
- Department of General and Digestive Surgery, St. Joseph Hospital, Charleroi (Gilly), Belgium.
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Affiliation(s)
- J Marescaux
- IRCAD European Institute of Telesurgery, Louis Pasteur University, 1 Place de l'Hopital, 6700 Strasbourg, France.
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Vix M. [A 73-year-old woman with a voluminous epigastric mass of the left hypochondrium]. J Chir (Paris) 2000; 137:357-60. [PMID: 11119033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- M Vix
- Service d'Urgence, de Chirurgie Digestive et Endocrinienne, H opitaux Universitaires de Strasbourg - Strasbourg
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Marescaux J, Soler L, Mutter D, Leroy J, Vix M, Koehl C, Clément JM. Virtual university applied to telesurgery: from teleeducation to telemanipulation. Stud Health Technol Inform 2000; 70:195-201. [PMID: 10977539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
UNLABELLED PROBLEM/BACKGROUND: In order to improve patient care by minimal invasive surgery (MIS), we perfected a Virtual TeleSurgical University that allows for teleeducation, teleconcertation, surgical planning and telemanipulation, through new Virtual Reality and multimedia systems. TOOLS AND METHODS The organization of this innovative school was federated around three major research programs. First, the TESUS program focused on the teletransmission of medical information, allowing for videoconferencing around the world and telementoring. Next, the WeBS-Surg program is a multimedia continuous surgical education system on internet, that allows for teleeducation and teleconcertation between world experts in MIS. Then, the MASTER program (Minimal Access Surgery by Telecommunications and Robotics) allowed the development of the third millenium Operating room. It included Virtual Reality systems that delineate automatically anatomical and pathological structures of a patients from him CT-scan, and that allow for an interactive surgical planning and force-feed-back simulation. It also included a telesurgical robot named Zeus controlled by surgeons through telemanipulation system. RESULTS Tests and validation shows that all these systems improved all steps of the surgical procedure: preoperatively due to a better continuous education and a computer assisted surgical planning, and peroperatively due to teleconcertation, telementoring and telemanipulation systems. CONCLUSION Revolutionary tools for minimal invasive surgery learning, planning and performing are all ready available. These tools represents the first prototype of the computer assisted tele-robotical surgery that will be the future of surgery.
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