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Gil Boix JV, Lladó Vidal M, Mena Ribas E, Viadé Julià J, Fanjul Losa FJ, Tofé Povedano S. Minimally invasive offloading osteotomy in the treatment of diabetic foot ulcer: Analysis of 25 patients. Med Clin (Barc) 2024; 162:394-397. [PMID: 38216395 DOI: 10.1016/j.medcli.2023.11.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Diabetes mellitus and its complications are one of the main burdensome health problems at the present time. The diabetic foot is one of the most characteristic complications. MATERIAL, METHODS AND OBJECTIVE The objective of this work is to describe the results and complications obtained in a series of 25 cases of diabetic foot treated by minimally invasive offloading osteotomies. RESULTS Of the total number of interventions, 18 were performed on refractory ulcers with prior conservative treatment, for a mean (±SD) duration of 29.28±18.42 months. The mean follow-up period was 26.46±4.89 months. Weighted pooled rates of response to treatment were as follows: 100% for ulcer healing (with a mean healing time of 22.41±7.01 days), 5.56% for ulcer recurrence, and 16.67% for ulcer transfer. In 7cases, a preventive intervention was performed on areas with pre-ulcerative lesions. Of the total number of cases, only 3presented mild infection in the intervention area. CONCLUSIONS Minimally invasive offloading osteotomy is a technically simple intervention, which presents a high success rate with minimal complications in our series.
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Affiliation(s)
- José Vicente Gil Boix
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Espases, Palma, Baleares, España.
| | - Melchor Lladó Vidal
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Espases, Palma, Baleares, España
| | - Elena Mena Ribas
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Espases, Palma, Baleares, España
| | - Jordi Viadé Julià
- Servicio de Endocrinología y Nutrición, Hospital Universitario Trias i Pujol, Badalona, Barcelona, España
| | | | - Santiago Tofé Povedano
- Servicio de Endocrinología y Nutrición, Hospital Universitario Son Espases, Palma, Baleares, España
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Telecan T, Andras I, Crousen N, Cata ED, Medan P, Stanca DV, Territo A, Coman I, Crisan N. Laparoscopic approach for xanthogranulomatous pyelonephritis and pyonephrosis. Actas Urol Esp 2024:S2173-5786(24)00026-X. [PMID: 38556126 DOI: 10.1016/j.acuroe.2024.03.001] [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: 11/29/2023] [Accepted: 01/17/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Xanthogranulomatous pyelonephritis (XGPN) is a rare form of chronic renal inflammation, caused by long-term obstruction of the urinary tract. Pyonephrosis is a severe suppurative complication of acute obstructive pyelonephritis. Although minimally invasive approaches have many advantages, the safe dissection of the kidney may not be always achievable. MATERIALS AND METHODS We reviewed 27 cases diagnosed with either XGPN or pyonephrosis, who underwent laparoscopic total nephrectomy between October 2016 and March 2022 in our department. All interventions were performed using the Karl Storz 3D laparoscopic system. The surgical approach was standard transperitoneal nephrectomy for the majority of XGPN, while pyonephrosis cases were carried out in a retroperitoneally. All procedures were performed or supervised by the same surgeon. RESULTS The mean operative time was 269.85 minutes (range 145-360). The mean hemoglobin drop after surgery was 1.41 g/dl (range 0.3-2.3 g/dl). Difficult dissection was encountered in 13 cases (48.14%). Nine out of 13 interventions were carried out in a complete intracorporeal fashion, while conversion to open surgery was needed in 4 cases. Vascular complications involving the major blood vessels comprised of one case of inferior vena cava (IVC) tear. Digestive tract-related complications comprised two fistulas of the descending colon and one peritoneal breach. Multiorgan resection was performed in 6 cases. CONCLUSION Total nephrectomy in cases of XGPN and pyonephrosis is a challenging procedure. The laparoscopic approach is feasible, as most complications are resolved intracorporeally. However, it may remain reserved for large-volume centers with experienced surgeons.
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Affiliation(s)
- T Telecan
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - I Andras
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania.
| | - N Crousen
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania
| | - E D Cata
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - P Medan
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - D V Stanca
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
| | - A Territo
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - I Coman
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania
| | - N Crisan
- Servicio de Urología, Universidad de Medicina y Farmacia Iuliu Hatieganu, Cluj-Napoca, Romania; Servicio de Urología, Hospital Municipal Clínico, Cluj-Napoca, Romania
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Martín-Gorgojo V, Burguet Girona S, Muñoz Donat S. Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00068-7. [PMID: 38508375 DOI: 10.1016/j.recot.2024.03.006] [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: 04/06/2023] [Accepted: 12/05/2023] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION AND AIM Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described, referring to the loss of blood diffused into tissues and lost through hemolysis. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. MATERIALS AND METHODS This was a retrospective study of a series of patients who had MIS for OVF. A descriptive analysis of recorded variables was performed, and total blood volume, total bleeding, HBL, and hemoglobine drop were calculated. This was followed by a comparative analysis between HBL (<500ml vs. ≥500ml) and the variables of hospital stay and postoperative evolution. Binary logistic regression models were performed to rule out confounding factors. RESULTS A total of 40 patients were included, 8 men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5ml. An HBL greater than 500ml is found to be an independent risk factor for torpid postoperative evolution (P=0.035), while it does not predict a longer hospital stay (P=0.116). In addition, a higher HBL was observed in surgeries of greater technical complexity and longer surgical time. CONCLUSIONS Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.
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Affiliation(s)
- V Martín-Gorgojo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España; Instituto de Investigación Biomédica INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - S Burguet Girona
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España; Instituto de Investigación Biomédica INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, España
| | - S Muñoz Donat
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España; Instituto de Investigación Biomédica INCLIVA, Hospital Clínico Universitario de Valencia, Valencia, España
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Martin-Gorgojo V, Burguet Girona S, Muñoz Donat S. Hidden blood loss in minimally invasive surgery for osteoporotic vertebral fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00262-X. [PMID: 38101535 DOI: 10.1016/j.recot.2023.12.001] [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: 04/06/2023] [Revised: 09/05/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION AND AIM Minimally invasive surgery (MIS) of the spine prevents the collapse of osteoporotic vertebral fractures (OVF) with lower complication and bleeding rates than open surgery. However, the possibility of hidden blood loss (HBL) has been recently described, referring to the loss of blood diffused into tissues and lost through hemolysis. This study aimed to estimate the postoperative impact of HBL in patients undergoing MIS for OVF. MATERIALS AND METHODS This was a retrospective study of a series of patients who had MIS for OVF. A descriptive analysis of recorded variables was performed, and total blood volume (TBV), total bleeding (TB), HBL, and Hb drop were calculated. This was followed by a comparative analysis between HBL (<500mL vs. ≥500mL) and the variables of hospital stay and postoperative evolution. Binary logistic regression models were performed to rule out confounding factors. RESULTS A total of 40 patients were included, 8 men and 32 women, with a mean age of 76.6 years. The mean HBL was 682.5mL. An HBL greater than 500mL is found to be an independent risk factor for torpid postoperative evolution (p=0.035), while it does not predict a longer hospital stay (p=0.116). In addition, a higher HBL was observed in surgeries of greater technical complexity and longer surgical time. CONCLUSIONS Although MIS techniques have shown less intraoperative bleeding than open surgery, HBL should be diagnosed because it is associated with a torpid evolution. The use of a diagnostic and therapeutic algorithm may help minimize its impact.
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Affiliation(s)
- V Martin-Gorgojo
- Orthopedic Surgery and Traumatology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain; Biomedical Research Institute INCLIVA, Hospital Clínico Universitario de Valencia, C/ de Menéndez y Pelayo, 4, 46010 Valencia, Spain.
| | - S Burguet Girona
- Orthopedic Surgery and Traumatology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain; Biomedical Research Institute INCLIVA, Hospital Clínico Universitario de Valencia, C/ de Menéndez y Pelayo, 4, 46010 Valencia, Spain
| | - S Muñoz Donat
- Orthopedic Surgery and Traumatology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain; Biomedical Research Institute INCLIVA, Hospital Clínico Universitario de Valencia, C/ de Menéndez y Pelayo, 4, 46010 Valencia, Spain
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Carrascosa-Granada A, Garríguez Perez D, Vargas-Jiménez A, Luque Perez R, Martínez-Olascoagoa DO, Pérez González JL, Domínguez Esteban I, Marco Martínez F. [Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis (Part 1): A clinical review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S523-S531. [PMID: 37541343 DOI: 10.1016/j.recot.2023.08.007] [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: 02/28/2023] [Accepted: 05/21/2023] [Indexed: 08/06/2023] Open
Abstract
Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.
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Affiliation(s)
| | - D Garríguez Perez
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain
| | - A Vargas-Jiménez
- Departamento de Neurocirugía, Hospital Clínico San Carlos, Madrid, Spain
| | - R Luque Perez
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain
| | - D O Martínez-Olascoagoa
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain
| | - J L Pérez González
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain
| | - I Domínguez Esteban
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain
| | - F Marco Martínez
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain
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Garríguez-Pérez D, Vargas Jiménez A, Luque Pérez R, Carrascosa Granada A, Oñate Martínez-Olascoaga D, Pérez González JL, Domínguez Esteban I, Marco F. [Translated article] The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S458-S462. [PMID: 37543359 DOI: 10.1016/j.recot.2023.08.010] [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] [Accepted: 04/03/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.
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Affiliation(s)
- D Garríguez-Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain.
| | - A Vargas Jiménez
- Servicio de Neurocirugía, Hospital Clínico San Carlos, Madrid, Spain
| | - R Luque Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Cirugía, Universidad Complutense, Madrid, Spain
| | | | - D Oñate Martínez-Olascoaga
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - J L Pérez González
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - I Domínguez Esteban
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - F Marco
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Cirugía, Universidad Complutense, Madrid, Spain
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7
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Garríguez-Pérez D, Vargas Jiménez A, Luque Pérez R, Carrascosa Granada A, Oñate Martínez-Olascoaga D, Pérez González JL, Domínguez Esteban I, Marco F. The role of minimally invasive spine surgery in the treatment of vertebral metastasis: A narrative review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:458-462. [PMID: 37031861 DOI: 10.1016/j.recot.2023.04.002] [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: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Spinal metastases are a very common problem which dramatically affects the quality of life of cancer patients. The objective of this review is to address the issue of how minimally invasive surgery can play an important role in treating this pathology. METHODS A literature review was performed, searching in the Google Scholar, PubMed, Scopus and Cochrane databases. Relevant and quality papers published within the last 10 years were included in the review. RESULTS After screening the 2184 initially identified registers, a total of 24 articles were included for review. CONCLUSION Minimally invasive spine surgery is specially convenient for fragile cancer patients with spinal metastases, because of its reduced comorbidity compared to conventional open surgery. Technological advances in surgery, such as navigation and robotics, improve accuracy and safety in this technique.
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Affiliation(s)
- D Garríguez-Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - A Vargas Jiménez
- Servicio de Neurocirugía, Hospital Clínico San Carlos, Madrid, España
| | - R Luque Pérez
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Cirugía, Universidad Complutense, Madrid, España
| | | | - D Oñate Martínez-Olascoaga
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - J L Pérez González
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - I Domínguez Esteban
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España; Departamento de Cirugía, Universidad Complutense, Madrid, España
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Espin Alvarez F, García-Domingo MI, Cremades Pérez M, Pardo Aranda F, Vidal Piñeiro L, Herrero Fonollosa E, Navinés López J, Zárate Pinedo A, Camps-Lasa J, Cugat Andorrà E. Laparoscopic and robotic distal pancreatectomy: the choice and the future. Cir Esp 2023; 101:765-771. [PMID: 37119949 DOI: 10.1016/j.cireng.2023.04.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/03/2023] [Accepted: 02/21/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach. METHODS Out of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the two techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail. RESULTS The mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8) minutes, respectively (P = NS). No differences were observed in length of hospital stay or conversion rate: 6 (5-34) vs. 5.6 (5-22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (P = NS). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (P = NS). There were no differences in morbidity (Dindo-Clavien ≥ III) between the two groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P = .04). CONCLUSION Minimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - María Isabel García-Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Laura Vidal Piñeiro
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps-Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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Carrascosa-Granada A, Garríguez Perez D, Vargas-Jiménez A, Luque Perez R, Martínez-Olascoagoa DO, Pérez González JL, Domínguez Esteban I, Marco Martínez F. The role of minimally invasive spine surgery in the treatment of vertebral metastasis (part 1): A clinical review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:523-531. [PMID: 37263579 DOI: 10.1016/j.recot.2023.05.007] [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: 02/28/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023] Open
Abstract
Spinal metastases represent a significant burden on the quality of life in patients affected by active oncological disease due to the high incidence of pain syndromes, spinal deformity, and neurological impairment. Surgery plays a decisive role in improving quality of life by controlling pain, restoring neurological function and maintaining spinal stability, as well as contributing to the response to medical therapy. Minimally invasive surgery (MIS) is a treatment option in certain patients with high surgical risk since it has a low rate of complications, intraoperative bleeding, hospital stay, and offers similar results to open surgery. In this review, we present the role of MIS in this pathology and some cases treated in our hospital.
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Affiliation(s)
| | - D Garríguez Perez
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - A Vargas-Jiménez
- Departamento de Neurocirugía, Hospital Clínico San Carlos, Madrid, España
| | - R Luque Perez
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - D O Martínez-Olascoagoa
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - J L Pérez González
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - I Domínguez Esteban
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
| | - F Marco Martínez
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, España
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Navinés-López J, Pardo Aranda F, Cremades Pérez M, Espin Álvarez F, Zárate Pinedo A, Sentí Farrarons S, Galofré Recasens M, Cugat Andorrà E. Robotic liver surgery: A new reality. Descriptive analysis of 220 cases of minimally invasive liver surgery in 182 patients. Cir Esp 2023; 101:746-754. [PMID: 37105365 DOI: 10.1016/j.cireng.2023.04.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/12/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION The level of recommendation of the robotic approach in liver surgery is controversial. The objective of the study is to carry out a single-center retrospective descriptive analysis of the short-term results of the robotic and laparoscopic approach in liver surgery during the same period. METHODS Descriptive analysis of the short-term results of the robotic and laparoscopic approach on 220 resections in 182 patients undergoing minimally invasive liver surgery. RESULTS Between April 2018 and June 2022, a total of 92 robotic liver resections (RLR) were performed in 83 patients and 128 laparoscopic (LLR) in 99 patients. The LLR group showed a higher proportion of major surgery (P < .001) and multiple resections (P = .002). The two groups were similar in anatomical resections (RLR 64.1% vs. LLR 56.3%). In the LLS group, the average operating time was 212 min (SD 52.1). Blood loss was 276.5 mL (100-1000) and conversion 12.1%. Mean hospital stay was 5.7 (SD 4.9) days. Morbidity was 27.3% and 2% mortality. In the RLS group, the mean operative time was 217 min (SD 53.6), blood loss 169.5 mL (100.900), and conversion 2.5%. Mean hospital stay was 4.1 (SD 2.1) days. Morbidity was 15%, with no mortality. CONCLUSION Minimally invasive liver surgery is a safe technique, and in particular, RLS allows liver resections to be performed safely and reproducibly; it appears to be a non-inferior technique to LLS, but randomized studies are needed to determine the minimally invasive approach of choice in liver surgery.
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Affiliation(s)
- Jordi Navinés-López
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Manel Cremades Pérez
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Francisco Espin Álvarez
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alba Zárate Pinedo
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Sara Sentí Farrarons
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Maria Galofré Recasens
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esteban Cugat Andorrà
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
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11
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Fernández-Ananín S, Balagué Ponz C, Sala L, Molera A, Ballester E, Gonzalo B, Pérez N, Targarona EM. Gastroesophageal reflux after sleeve gastrectomy: The dimension of the problem. Cir Esp 2023; 101 Suppl 4:S26-S38. [PMID: 37952718 DOI: 10.1016/j.cireng.2023.05.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 11/14/2023]
Abstract
Sleeve gastrectomy is a safe and effective bariatric surgery in terms of weight loss and longterm improvement or resolution of comorbidities. However, its achilles heel is the possible association with the development with the novo and/or worsening of pre-existing gastroesophageal reflux disease. The anatomical and mechanical changes that this technique induces in the esophagogastric junction, support or contradict this hypothesis. Questions such as «what is the natural history of gastroesophageal reflux in the patient undergoing gastric sleeve surgery?», «how many patients after vertical gastrectomy will develop gastroesophageal reflux?» and «how many patients will worsen their previous reflux after this technique?» are intended to be addressed in the present article.
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Affiliation(s)
- Sonia Fernández-Ananín
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Carme Balagué Ponz
- Unidad de Cirugía Esofagogástrica, Bariátrica y Metabólica, Servicio de Cirugía General y Digestiva, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Laia Sala
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Antoni Molera
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eulalia Ballester
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Berta Gonzalo
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Noelia Pérez
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eduardo M Targarona
- Unidad de Cirugía Gastrointestinal y Hematología, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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12
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Alonso Casado O, Nuñez Mora C, Ortega Pérez G, López Rojo I. Robotic pelvic exenteration in males: systematization of the technique. Cir Esp 2023; 101:555-560. [PMID: 37487944 DOI: 10.1016/j.cireng.2023.03.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/08/2023] [Indexed: 07/26/2023]
Abstract
Male pelvic exenteration is a challenging procedure with high morbidity. In very selected cases, the robotic approach could make dissection easier and decrease morbidity due to the better vision provided and higher range of movements. In this paper, we describe port placement, instruments, minilaparotomy location, and the stepwise sequence of these procedures. We address 3 different situations: total pelvic exenteration with abdominoperineal resection, colostomy and urostomy; pelvic exenteration with colorectal/anal anastomosis and urostomy; and pelvic exenteration with abdominoperineal resection, colostomy and urinary tract reconstruction.
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Affiliation(s)
- Oscar Alonso Casado
- Unidad de Oncología Quirúrgica Digestiva, MD Anderson Cancer Center, Madrid, Spain.
| | | | - Gloria Ortega Pérez
- Unidad de Oncología Quirúrgica Digestiva, MD Anderson Cancer Center, Madrid, Spain
| | - Irene López Rojo
- Unidad de Oncología Quirúrgica Digestiva, MD Anderson Cancer Center, Madrid, Spain
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13
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Pereira Rodríguez JA, López Cano M. EHS guidelines for inguinal hernia repair. The reality of the current situation in Spain. A proposal to standardize its implementation during surgical training. Cir Esp 2023; 101 Suppl 1:S24-S27. [PMID: 37951469 DOI: 10.1016/j.cireng.2023.01.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/21/2023] [Indexed: 11/14/2023]
Abstract
Laparoscopic inguinal hernia repairs are underused in our country and do not fulfil to the recommendations of the European Hernia Society (EHS) guidelines. Thus, it is essential to establish measures that increase its use. We propose that the Spanish Association of Surgeons (AEC) promote these actions and that they should be incorporated into the specialty program. The proposed measures include Standardization of learning; reinforce anatomical knowledge; regulated practices with simulators; promote the use of the open posterior approach; rotations through centers of excellence; accreditation of specialized units and use a registry of activity as quality control.
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Affiliation(s)
- José Antonio Pereira Rodríguez
- Servicio de Cirugía General y Digestiva, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain; Departament de Medicina i Ciéncies de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Manuel López Cano
- Departament de Cirurgia, Universitat Autónoma de Barcelona, Barcelona, Spain; Servicio de Cirugía General y Digestiva, Hospital Vall d'Hebron, Barcelona, Spain
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Morales-Conde S, Balla A, Navarro-Morales L, Moreno-Suero F, Licardie E. Is laparoscopic TAPP the preferred approach for the treatment of inguinal hernia? Technique, indications and future perspectives. Cir Esp 2023; 101 Suppl 1:S11-S18. [PMID: 37951466 DOI: 10.1016/j.cireng.2023.01.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/14/2023] [Indexed: 11/14/2023]
Abstract
The repair of inguinal hernia is one of the most frequently performed surgeries in General Surgery units. The laparoscopic approach for these hernias will be clearly considered as the gold standard, based on its advantages over the open approach. There are no clear advantages of the transabdominal preperitoneal approach (TAPP) over the totally preperitoneal approach (TEP), although it has been shown to be more reproducible, presenting a shorter learning curve, although it presents more possibilities of developing trocar site hernias. Laparoscopic TAPP could be superior to TEP in the following indications: incarcerated hernias, emergencies, previous preperitoneal surgery, previous Pfanestiel-type incision, recurrent hernias, inguinoscrotal hernias and obese, being also a better alternative for females. Robotic TAPP is a safe approach with similar results to laparoscopy; however, it is related to an increase in costs and operating time. The value of this technology for the repair of complex hernias (multiple recurrences, inguino-scrotal or after previous preperitoneal surgery) remains to be determined, since they represent a certain challenge for the conventional laparoscopic approach. On the other hand, robotic repair of inguinal hernias may be a way to reduce the learning curve before addressing complex ventral hernias. Finally, artificial intelligence applied to the laparoscopic approach to inguinal hernia will undoubtedly have a significant impact in the future especially to determine the best the indications for this approach, on the performance of a safer technique, on the correct selection of meshes and fixation mechanisms, and on learning curve.
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Affiliation(s)
- Salvador Morales-Conde
- Unidad de Innovación de Cirugía Mínimamente Invasiva, Servicio de Cirugía General y del Aparato Digestivo del Hospital Virgen del Rocío, Sevilla, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Andrea Balla
- Unidad de Innovación de Cirugía Mínimamente Invasiva, Servicio de Cirugía General y del Aparato Digestivo del Hospital Virgen del Rocío, Sevilla, Spain
| | - Laura Navarro-Morales
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Francisco Moreno-Suero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain
| | - Eugenio Licardie
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Infanta Elena, Huelva, Spain.
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15
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Soriano RM, Barbero JMR, Pradilla G, Henriquez OA. Combined endoscopic endonasal & transoral approach to transpatial lesion involving the infratemporal fossa and masticator space: A case study and literature review. Neurocirugia (Astur : Engl Ed) 2023; 34:87-92. [PMID: 36754753 DOI: 10.1016/j.neucie.2022.11.012] [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] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/15/2022] [Indexed: 02/09/2023]
Abstract
Transpatial skull base lesions involving the infratemporal fossa (ITF) are challenging due to the complex neurovascular structures of the region. Open approaches have traditionally been utilized to access these spaces. We present a 55-year-old woman presented with a mesenchymal mass involving the left ITF and masticator space. A combined endoscopic endonasal transpterygoid approach was performed followed by an endoscopic transoral-transmandibular corridor to access and resect the tumor. The post-operative course was unremarkable with no recurrence during her follow-up. Combined endoscopic approaches for transpatial tumor resection offered sufficient exposure to access safely each space.
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Affiliation(s)
- Roberto M Soriano
- Emory University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Atlanta, GA, United States
| | | | - Gustavo Pradilla
- Emory University School of Medicine, Department of Neurosurgery, Atlanta, GA, United States
| | - Oswaldo A Henriquez
- Emory University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, Atlanta, GA, United States.
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16
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Saavedra-Pérez D, Manyalich M, Domínguez P, Farguell J, Rull R, López-Boado MÁ, Vilaça J, Vidal Ó. Unilateral axilo-breast approach (UABA) with gas insufflation versus open conventional hemithyroidectomy: A prospective comparative study. Cir Esp 2023; 101:107-115. [PMID: 36100055 DOI: 10.1016/j.cireng.2022.09.014] [Citation(s) in RCA: 1] [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] [Received: 12/07/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. METHODS Between August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. RESULTS A total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p < 0.001), at hospital discharge and at 12-month follow-up. CONCLUSION UABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.
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Affiliation(s)
- David Saavedra-Pérez
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain.
| | - Marti Manyalich
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Paula Domínguez
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jordi Farguell
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ramón Rull
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Miguel Ángel López-Boado
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jaime Vilaça
- Departamento de Cirugía General y del Aparato Digestivo, Hospital da Luz Arrábida, Escola de Medicina, Universidade do Minho, Braga, Porto, Portugal
| | - Óscar Vidal
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
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Gómez Hernández MT, Rivas Duarte C, Forcada Barreda C, Jiménez López MF. Usefulness of near-infrared fluorescence for identifying the segmental bronchus in minimally invasive segmentectomy. Cir Esp 2023; 101:51-4. [PMID: 35905869 DOI: 10.1016/j.cireng.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/11/2022] [Indexed: 01/17/2023]
Abstract
Minimally invasive anatomical sublobar resections have gained relevance in recent years mainly due to advances in imaging techniques, screening programs and the increase in second neoplasms. Accurate identification of the segmental or subsegmental bronchus is vital to guarantee optimal results in segmentectomies and subsegmentectomies. Given the complexity and the possibility of anatomical variations, several authors have published different methods to identify the target bronchus. However, these methods have certain limitations. This article describes a new rapid and effective technique, with a low risk of complications and without additional cost, for the identification of segmental bronchi in minimally invasive segmentectomies.
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Noguera Aguilar JF, Gómez Dovigo A, Aguirrezabalaga González J, González Conde B, Alonso Aguirre P, Martínez Ares D, Sánchez González J, Díez Redondo MP, Maseda Díaz O, Torres García MI, Dacal Rivas A, Delgado Rivilla S, Romero Marcos JM, Ramírez Ruíz P, de María Pallarés P, Álvarez Gallego M, Gómez Besteiro I. Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device. Cir Esp 2022:S2173-5077(22)00424-0. [PMID: 36565988 DOI: 10.1016/j.cireng.2022.12.001] [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: 07/26/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Complex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. METHODS We describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. RESULTS 16 patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic Mucosal Resection (EMR) (6.3%), Endoscopic Submucosal Dissection ESD (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0 to 10 (9.43, 9.71, 9.29 and 9.50 respectively). All the investigators have previous experience with transanal devices. CONCLUSIONS The study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.
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Affiliation(s)
- José Francisco Noguera Aguilar
- Servicio de Cirugía General & Aparato Digestivo del Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - Alba Gómez Dovigo
- Servicio de Cirugía General & Aparato Digestivo del Hospital QuirónSalud A Coruña, La Coruña, Spain.
| | | | - Benito González Conde
- Servicio de Digestivo del Complejo Hospitalario Universitario, A Coruña (CHUAC), La Coruña, Spain
| | - Pedro Alonso Aguirre
- Servicio de Digestivo del Complejo Hospitalario Universitario, A Coruña (CHUAC), La Coruña, Spain
| | | | - Javier Sánchez González
- Servicio de Cirugía General & Aparato Digestivo del Hospital Universitario Río Ortega, Valladolid, Spain
| | | | - Olga Maseda Díaz
- Servicio de Cirugía General & Aparato Digestivo del Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Maria Ignacia Torres García
- Servicio de Cirugía General & Aparato Digestivo del Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | - Andrés Dacal Rivas
- Servicio de Digestivo del Hospital Universitario Lucus Augusti (HULA), Lugo, Spain
| | | | | | - Pablo Ramírez Ruíz
- Servicio de Digestivo, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | | | - Mario Álvarez Gallego
- Servicio de Cirugía General & Aparato Digestivo, Hospital Universitario La Paz, Madrid, Spain
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Morales-Conde S, Licardie E, Alarcón I, Balla A. Indocyanine green (ICG) fluorescence guide for the use and indications in general surgery: recommendations based on the descriptive review of the literature and the analysis of experience. Cir Esp 2022; 100:534-554. [PMID: 35700889 DOI: 10.1016/j.cireng.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/26/2021] [Indexed: 06/15/2023]
Abstract
Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery. The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Eugenio Licardie
- Unit of General and Digestive Surgery, Hospital Quironsalud Sagrado Corazón, Sevilla, Spain.
| | - Isaias Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain.
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Sevilla, Spain; UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Civitavecchia, Rome, Italy.
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Gómez-Hernández MT, Fuentes MG, Novoa NM, Rodríguez I, Varela G, Jiménez MF. "Obesity paradox" has not an impact on minimally invasive anatomical lung resection. Cir Esp 2022; 100:288-294. [PMID: 35598956 DOI: 10.1016/j.cireng.2022.05.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/18/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The paradoxical benefit of obesity, the 'obesity paradox', has been analyzed in lung surgical populations with contradictory results. Our goal was assessing the relationship of body mass index (BMI) to acute outcomes after minimally invasive major pulmonary resections. METHODS Retrospective review of consecutive patients who underwent pulmonary anatomical resection through a minimally invasive approach for the period 2014-2019. Patients were grouped as underweight, normal, overweight and obese type I, II and III. Adjusted odds ratios regarding postoperative complications (overall, respiratory, cardiovascular and surgical morbidity) were produced with their exact 95% confidence intervals. All tests were considered statistically significant at p<0.05. RESULTS Among 722 patients included in the study, 37.7% had a normal BMI and 61.8% were overweight or obese patients. When compared with that of normal BMI patients, adjusted pulmonary complications were significantly higher in obese type I patients (2.6% vs 10.6%, OR: 4.53 [95%CI: 1.86-12.11]) and obese type II-III (2.6% vs 10%, OR: 6.09 [95%CI: 1.38-26.89]). No significant differences were found regarding overall, cardiovascular or surgical complications among groups. CONCLUSIONS Obesity has not favourable effects on early outcomes in patients undergoing minimally invasive anatomical lung resections, since the risk of respiratory complications in patients with BMI≥30kg/m2 and BMI≥35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research (IBSAL), Spain
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Álvarez-Baena L, Hervías M, Ramos S, Cebrián J, Pita A, Hidalgo I. Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:259-265. [PMID: 35643760 DOI: 10.1016/j.redare.2021.05.010] [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] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 05/28/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Lateral thoracotomy is replacing traditional median sternotomy for atrial septal defect (ASD) closure in children in order to improve cosmetic outcomes. Continuous paravertebral block has been described as an effective and safe analgesic technique in children. The aim of this study is to assess pain management by continuous perfusion of local anesthetic through a thoracic paravertebral catheter (PVC) in a pediatric population after thoracotomy closure of ASD, and its effectiveness in a fast-track program. METHODS Descriptive cross-sectional study. Analgesic effectiveness, perioperative and safety-related data were analyzed in 21 patients who underwent thoracotomy closure of ASD with PVC. In the postoperative period, patients received continuous perfusion of bupivacaine 0.125% and fentanyl (1 mcg.ml-1) at 0.2 ml.kg-1.h-1 through the PVC. RESULTS The median of mean pain scale score for each patient was 1.5. All patients were extubated in the operating theatre. No patient with PVC required opioid rescue. The median length of stay in the Pediatric Intensive Care Unit was 48 hours. There were 3 adverse events related to PVC: 1 due to malposition and 2 due to accidental removal. No other complications or cases of local anesthetic toxicity were recorded. CONCLUSIONS PVC provides effective, safe, opioid-saving analgesia in the postoperative period of ASD closure by thoracotomy in the context of a fast-track protocol.
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Affiliation(s)
- L Álvarez-Baena
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain.
| | - M Hervías
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
| | - S Ramos
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
| | - J Cebrián
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
| | - A Pita
- Servicio de Cirugía Cardiaca, Sección de Cirugía Cardiaca infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Hidalgo
- Servicio de Anestesiología y Reanimación, Sección de Anestesiología Pediátrica, Hospital General Universitario Gregorio Marañón. Madrid, Spain
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22
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Serra-Aracil X, Gil-Barrionuevo E, Martinez E, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Puig-Divi V, Navarro-Soto S. Combined endoscopic and laparoscopic surgery for the treatment of complex benign colonic polyps (CELS): Observational study. Cir Esp 2022; 100:215-222. [PMID: 35431169 DOI: 10.1016/j.cireng.2022.03.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/12/2020] [Indexed: 06/14/2023]
Abstract
PURPOSE Combined endoscopic and laparoscopic surgery (CELS) has emerged as a promising method for managing complex benign lesions that would otherwise require major colonic resection. The aim of this study was to describe the different techniques and to evaluate the safety of CELS, assess its outcomes in a technique that is scarcely widespread in our environment. METHOD Observational retrospective study, short-term outcomes of patients undergoing CELS for benign colon polyps from October 2018 to June 2020 were evaluated. Postoperative outcomes, length of hospital stay and pathological findings were evaluated. RESULTS Seventeen consecutive patients underwent CELS during the study period. The median size of the lesion was 3.5 cm (range 2.5-6.5 cm), the most frequent location was the cecum (10 from 17). Most patients treated with CELS underwent an endoscopic-assisted laparoscopic wedge resection (11 from 17). In four patients this resection was combined with another CELS technique, and two patients underwent an endoscopic-assisted laparoscopic segment resection. The success rate of CELS in our series was in 14 from 17 (82.4%). The median operative time was 85 min (range 50-225 min). The median hospital stay was 2 days (range 1-15 days). One patient experienced an organ/space surgical site infection which did not require further intervention. Four lesions were shown to be malignant by postoperative pathology study. CONCLUSION CELS is a safe and multidisciplinar technique that requires collaboration between gastroenterologists and surgeons. It can be considered as an alternative to colonic resection for complex benign colonic polyps.
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Affiliation(s)
- Xavier Serra-Aracil
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain.
| | - Esther Gil-Barrionuevo
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Eva Martinez
- Departamento de Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Laura Mora-López
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Pallisera-Lloveras
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Sheila Serra-Pla
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Valenti Puig-Divi
- Departamento de Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Salvador Navarro-Soto
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
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Territo A, Diana P, Gaya JM, Gallioli A, Piana A, Breda A. Robot-assisted kidney transplantation: State of art. ARCH ESP UROL 2021; 74:970-978. [PMID: 34851312] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Nowadays, Robotic assistedkidney transplantation (RAKT) is considered a lessinvasive alternative to the Open Kidney Transplantation(OKT) with several advantages such as image magnification,3D vision and articulated instruments and with arelatively short learning curve for an experienced surgeon.RAKT has shown comparable outcomes with theOKT literature data in terms of surgical and functionalresults. RAKT may decrease the complication rate, meanhospital stay, postoperative pain, and also improve aestheticoutcomes. The aim of this study was to perform asystematic review of the literature on this novel approachof KT. MATERIALS AND METHODS A systematic review was performed in accordance with the Preferred ReportingItems for Systematic Reviews and Meta-Analyses (PRISMA)statement. The search was conducted using the databases PubMed/Medline, including as outcomes: (1) indications, (2) step-by-step technique for RAKT, (3) RAKT in special cases (4) surgical and functional outcomes,and (5) future perspectives in RAKT. RESULTS The indications for RAKT are expanding, sothat including obese recipients, graft with multiple vesselsand graft from deceased donor. To date, the two absolute contraindications to RAKT are patients unfitfor pneumoperitoneum and presenting advanced atheromatic plaques where vessel clamping could result challenging. As far as the outcomes, the surgical and functional results are in line with the OKT experience.Complication rate is low in RAKT, particularly in terms of arterial and venous thrombosis (1%), lymphocele (3%),ureteral stricture (2%), and wound infection (0.3%). Arobotic assisted kidney auto-transplantation (RAKAT) has been recently described, as novel approach in case of complex proximal benign ureteral stenosis. Despite great advances in this field, some limits still need to be approached such as the modality to main tain the graft to a constant low temperature ( <20 ºC) and to find the proper location of arteriotomy in advanced atheromatic disease without the tactile feedback. CONCLUSION The present review has confirmed that RAKT is as safe and feasible as OKT with comparable surgical and functional results. Complication rate is lower in RAKT than OKT and the indications are expanding quickly. Furthermore, new technologies are being introduced in order to improve the surgical performances and to expand more the indications for robotic surgery.However, a prospective randomized study in order to compare RAKT versus OKT is still required.
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Affiliation(s)
- Angelo Territo
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
| | - Pietro Diana
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain. Department of Urology. Humanitas Clinical and Research Institute IRCCS. Rozzano. Italy
| | - Josep M Gaya
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
| | - Andrea Gallioli
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
| | - Alberto Piana
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain. Department of Urology. Humanitas Clinical and Research Institute IRCCS. Rozzano. Italy. Department of Urology. San Luigi Gonzaga Hospital. University of Turin. Orbassano. Italy
| | - Alberto Breda
- Fundació Puigvert. Autonomous University of Barcelona. Barcelona. Spain
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Daneri-Allis GM, Violante-Mejía J, Villa-Benites A, Anaya-Prado R, Zepeda-Ochoa JD. Assisted dorso-lumbar instrumentation with O-arm neuronavegation and minimally invasive surgery: clinical-surgical outcome. Cir Cir 2021; 89:595-602. [PMID: 34665175 DOI: 10.24875/ciru.20000784] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the clinical-surgical outcomes after dorso-lumbar instrumentation using O-arm assisted neuronavigation and minimally invasive surgery. METHOD In this retrospective cohort, 104 patients who underwent dorso-lumbar instrumentation with the use of O-arm from September 2013 to May 2020 were studied. Variables investigated included: symptoms, number of screws, levels approached, bleeding, surgical time, hospital stay, complications and clinical improvement after the surgical procedure. RESULTS The most frequent symptoms were: unilateral or bilateral radiculopathy of the pelvic extremities, paresthesia, mechanical low back pain and progressive decrease in strength. A total of 542 screws were placed, with the lumbar spine being the site with the highest prevalence. The average bleeding, surgical time, and hospital stay was: 50 ml, 160 minutes, and 24 hours, respectively. The most frequent complications were: Residual neuropathy, dura mater tear and surgical site infection. Clinical improvement at 24 hours, 4 weeks and 6 months was achieved in: 77.3%, 86.5% y 94.8% of the patients, respectively. CONCLUSIONS Neuronavigation with the use of O-arm along with mini-open surgery approach results in good clinical-surgical outcomes in the correction of complex disorders of the dorso-lumbar spine.
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Affiliation(s)
| | | | | | - Roberto Anaya-Prado
- Dirección de Educación e Investigación. Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
| | - José D Zepeda-Ochoa
- Servicio de Neurocirugía.,Dirección de Educación e Investigación. Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
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Espin Alvarez F, García Domingo MI, Cremades Pérez M, Herrero Fonollosa E, Navinés López J, Camps Lasa J, Pardo Aranda F, Cugat Andorrá E. Highs and lows in laparoscopic pancreaticoduodenectomy. Cir Esp 2021; 99:593-601. [PMID: 34420909 DOI: 10.1016/j.cireng.2021.08.001] [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: 05/12/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (PD) is not widely accepted, and its use is controversial. Only correct patient selection and appropriate training of groups experienced in pancreatic surgery and laparoscopy will be able to establish its role and its hypothetical advantages. METHODS Out of 138 pancreatic surgeries performed in a two-year period (2017-2019), 23 were laparoscopic PD. We evaluate its efficacy and safety compared to 31 open PD. RESULTS There were no cases of B/C pancreatic or biliary fistula, nor any cases of delayed gastric emptying in the laparoscopic group, but hemorrhage required one reoperation. The conversion rate was 21% (five cases): one due to bleeding, and the remainder for non-progression. The converted patients showed no differences compared to those completed by laparoscopy. There were no differences between laparoscopic and open PD in surgical time, postoperative complications, reintervention rate, readmissions or mortality. R0 resection in tumor cases was 85% for laparoscopy and 69% in open surgery without statistical significance. The postoperative hospital stay was shorter in the laparoscopic PD group (eight vs. 15 days). CONCLUSIONS In a selected group, laparoscopic PD can be safely and effectively performed if carried out by groups who are experts in pancreatic surgery and advanced laparoscopy. The technique has the same postoperative results as open surgery and is oncologically adequate, with less hospital stay. Proper patient selection, a step-by-step program and a lax and early conversion prevents serious operating accidents.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - María Isabel García Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain.
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Judith Camps Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Esteban Cugat Andorrá
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Spain; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, Spain
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Panach-Navarrete J, Valls-González L, Negueroles-García M, Castelló-Porcar A, Martínez-Jabaloyas JM. [Pediatric ureteral ectopia: Solutions for several issues.]. ARCH ESP UROL 2021; 74:627-632. [PMID: 34219067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The treatment of the ectopic ureter in the pediatric patient must be individualized in each caseMETHOD: Description of clinical cases, therapeutic management and evolution of patients. RESULTS We present four pediatric patients with ectopic ureters who underwent surgery. We describe a case of laparoscopic nephroureterectomy, one of laparoscopic uretero-ureterostomy, one of bilateral ureteral reimplantation and another of unilateral reimplantation. The discussion about the diagnosis and different surgical treatments of each case is deepened. CONCLUSIONS We present four cases of pediatric patients with ectopic ureters, treated by different surgeries. We present how was the preoperative diagnosis and the importance of individualizing the surgical treatment in eachc ase. Aspects recently described in the context of ureteralectopy, such as diagnostic evaluation by MRI or the role of minimally invasive techniques in treatment, should be taken into account in its management.
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Affiliation(s)
- Jorge Panach-Navarrete
- Servicio de Urología. Hospital Clínico Universitario de Valencia. Facultat de Medicina i Odontología. Universitat de València. Valencia. España
| | - Lorena Valls-González
- Servicio de Urología. Hospital Clínico Universitario de Valencia. Facultat de Medicina i Odontología. Universitat de València. Valencia. España
| | - María Negueroles-García
- Servicio de Urología. Hospital Clínico Universitario de Valencia. Facultat de Medicina i Odontología. Universitat de València. Valencia. España
| | - Ana Castelló-Porcar
- Servicio de Urología. Hospital Clínico Universitario de Valencia. Facultat de Medicina i Odontología. Universitat de València. Valencia. España
| | - José María Martínez-Jabaloyas
- Servicio de Urología. Hospital Clínico Universitario de Valencia. Facultat de Medicina i Odontología. Universitat de València. Valencia. España
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Gundogan E, Kayaalp C, Gokler C, Gunes O, Bag M, Sumer F. Natural orifice specimen extraction versus transabdominal extraction in laparoscopic right hemicolectomy. CIR CIR 2021; 89:326-333. [PMID: 34037617 DOI: 10.24875/ciru.20000321] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCCIÓN La extracción de muestras de orificio natural (NOSE) para resecciones colorrectales, que mejoran aún más las ventajas de la cirugía mínimamente invasiva, se utilizan cada vez con mayor frecuencia. En este estudio, nuestro objetivo fue comparar los métodos de extracción de muestras de nariz y transabdominales en casos de resecciones de colon derecho totalmente laparoscópicas. MÉTODOS Se incluyeron datos de 52 pacientes que se sometieron a cirugía laparoscópica de colon derecho entre 2013 y 2019. La extracción de muestras transabdominales se realizó en 35 pacientes, mientras que 17 pacientes fueron sometidos a NOSE. Se compararon datos demográficos, hallazgos operativos, resultados patológicos y datos de seguimiento. RESULTADOS Las mujeres (94% frente a 28%, p = 0,0001), comórbidas (76% frente a 40%, p = 0,01) y antecedentes de cirugía abdominal previa (75% frente a 23%, p = 0,001) fueron más altas en el grupo NOSE . Todas las otras características preoperatorias de los grupos fueron comparables. La pérdida de sangre intraoperatoria, el tiempo de operación y las tasas de complicaciones fueron similares en ambos grupos. La escala VAS postoperatoria (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) y los puntajes cosméticos fueron mejores en el grupo NOSE (10 vs. 7, p = 0.0001). Los resultados oncológicos fueron similares después de un seguimiento medio de 27.4 ± 20.5 (1-77) meses. CONCLUSIÓN El método NOSE después de la resección laparoscópica del colon derecho fue un método más ventajoso en términos de cosméticos y dolor postoperatorio que la extracción de muestras transabdominales. INTRODUCTION Natural orifice specimen extraction (NOSE) for colorectal resections, which further enhance the advantages of minimally invasive surgery, are being used increasingly more often. In this study, we aimed to compare NOSE and transabdominal specimen extraction methods in cases of totally laparoscopic right colon resections. METHODs Data of 52 patients who underwent laparoscopic right colon surgery between 2013 and 2019 were included in the study. Transabdominal specimen removal was done in 35 patients, while 17 patients underwent NOSE. Demographic data, operative findings, pathological results, and follow-up data were compared. RESULTS Female (94% vs. 28%, p = 0.0001), co-morbid (76% vs. 40%, p = 0.01), and previous abdominal surgery history (75% vs. 23%, p = 0.001) were higher in the NOSE group. All the other pre-operative features of the groups were comparable. Intraoperative blood loss, operation time, and complication rates were similar in both groups. Post-operative visual analog scale (2.8 ± 1.2 vs. 4.5 ± 2.4, p = 0.001) and cosmetic scores were better in the NOSE group (10 vs. 7, p = 0.0001). Oncologic results were similar after a mean follow-up of 27.4 ± 20.5 (1-77) months. CONCLUSION The NOSE method following laparoscopic right colon resection was a more advantageous method in terms of cosmetics and post-operative pain than transabdominal specimen extraction.
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Affiliation(s)
- Ersin Gundogan
- Department of Gastrointestinal, Surgery Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal, Surgery Inonu University, Malatya, Turkey
| | - Cihan Gokler
- Department of Gastrointestinal, Surgery Inonu University, Malatya, Turkey
| | - Orgun Gunes
- Department of Gastrointestinal, Surgery Inonu University, Malatya, Turkey
| | - Murat Bag
- Department of Gastrointestinal, Surgery Inonu University, Malatya, Turkey
| | - Fatih Sumer
- Department of Gastrointestinal, Surgery Inonu University, Malatya, Turkey
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Gómez de Antonio D, Crowley Carrasco S, Romero Román A, Royuela A, Sánchez Calle Á, Obiols Fornell C, Call Caja S, Embún R, Royo Í, Recuero JL, Cabañero A, Moreno N, Bolufer S, Congregado M, Jimenez MF, Aguinagalde B, Amor-Alonso S, Arrarás MJ, Blanco Orozco AI, Boada M, Cal I, Cilleruelo Ramos Á, Fernández-Martín E, García-Barajas S, García-Jiménez MD, García-Prim JM, Garcia-Salcedo JA, Gelbenzu-Zazpe JJ, Giraldo-Ospina CF, Gómez Hernández MT, Hernández J, Illana Wolf JD, Jáuregui Abularach A, Jiménez U, López Sanz I, Martínez-Hernández NJ, Martínez-Téllez E, Milla Collado L, Mongil Poce R, Moradiellos-Díez FJ, Moreno-Basalobre R, Moreno Merino SB, Quero-Valenzuela F, Ramírez-Gil ME, Ramos-Izquierdo R, Rivo E, Rodríguez-Fuster A, Rojo-Marcos R, Sanchez-Lorente D, Moreno LS, Simón C, Trujillo-Reyes JC, López García C, Fibla Alfara JJ, Sesma Romero J, Hernando Trancho F. Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived from a Spanish Multicenter Database. Arch Bronconeumol 2021; 58:398-405. [PMID: 33752924 DOI: 10.1016/j.arbres.2021.01.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.
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Affiliation(s)
- David Gómez de Antonio
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España.
| | - Silvana Crowley Carrasco
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Alejandra Romero Román
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Ana Royuela
- Unidad de Bioestadística, Instituto de Investigación Biomédica Puerta de Hierro (IDIPHISA); CIBERESP. Madrid, España
| | - Álvaro Sánchez Calle
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Carme Obiols Fornell
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Sergi Call Caja
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Raúl Embún
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - Íñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - Alberto Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal. Madrid, España
| | - Nicolás Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal. Madrid, España
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Miguel Congregado
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marcelo F Jimenez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, España
| | - Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, España
| | - Sergio Amor-Alonso
- Servicio de Cirugía Torácica, Hospital Universitario Quironsalud Madrid, Madrid, España
| | - Miguel Jesús Arrarás
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología, Valencia, España
| | | | - Marc Boada
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Isabel Cal
- Servicio de Cirugía Torácica, Hospital Universitario La Princesa, Madrid, España
| | | | | | | | | | - Jose María García-Prim
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela , Santiago de Compostela, España
| | | | | | | | - María Teresa Gómez Hernández
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, España
| | - Jorge Hernández
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, España
| | | | | | - Unai Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, España
| | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, España
| | | | - Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Roberto Mongil Poce
- Servicio de Cirugía Torácica, Hospital Regional Universitario, Málaga, España
| | | | | | | | | | | | - Ricard Ramos-Izquierdo
- Servicio de Cirugía Torácica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Eduardo Rivo
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela , Santiago de Compostela, España
| | - Alberto Rodríguez-Fuster
- Servicio de Cirugía Torácica, Hospital del Mar, IMIM (Instituto de Investigación Médica Hospital del Mar), Barcelona, España
| | - Rafael Rojo-Marcos
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, España
| | - David Sanchez-Lorente
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Laura Sánchez Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santader, España
| | - Carlos Simón
- Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | | | | | - Julio Sesma Romero
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
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Gómez-Hernández MT, Fuentes MG, Novoa NM, Rodríguez I, Varela G, Jiménez MF. "Obesity paradox" has not an impact on minimally invasive anatomical lung resection. Cir Esp 2021; 100:S0009-739X(21)00040-3. [PMID: 33637296 DOI: 10.1016/j.ciresp.2021.01.018] [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: 09/16/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The paradoxical benefit of obesity, the 'obesity paradox', has been analyzed in lung surgical populations with contradictory results. Our goal was assessing the relationship of body mass index (BMI) to acute outcomes after minimally invasive major pulmonary resections. METHODS Retrospective review of consecutive patients who underwent pulmonary anatomical resection through a minimally invasive approach for the period 2014-2019. Patients were grouped as underweight, normal, overweight and obese type I, II and III. Adjusted odds ratios regarding postoperative complications (overall, respiratory, cardiovascular and surgical morbidity) were produced with their exact 95% confidence intervals. All tests were considered statistically significant at p<0.05. RESULTS Among 722 patients included in the study, 37.7% had a normal BMI and 61.8% were overweight or obese patients. When compared with that of normal BMI patients, adjusted pulmonary complications were significantly higher in obese type I patients (2.6% vs 10.6%, OR: 4.53 [95%CI: 1.86-12.11]) and obese type II-III (2.6% vs 10%, OR: 6.09 [95%CI: 1.38-26.89]). No significant differences were found regarding overall, cardiovascular or surgical complications among groups. CONCLUSIONS Obesity has not favourable effects on early outcomes in patients undergoing minimally invasive anatomical lung resections, since the risk of respiratory complications in patients with BMI≥30kg/m2 and BMI≥35kg/m2 is 4.5 and 6 times higher than that of patients with normal BMI.
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Affiliation(s)
| | - Marta G Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria M Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Israel Rodríguez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research (IBSAL), Spain
| | - Marcelo F Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain; Salamanca Institute of Biomedical Research (IBSAL), Spain
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Serra-Aracil X, Gil-Barrionuevo E, Martinez E, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Puig-Divi V, Navarro-Soto S. Combined endoscopic and laparoscopic surgery for the treatment of complex benign colonic polyps (CELS): observational study. Cir Esp 2021; 100:S0009-739X(20)30427-9. [PMID: 33485609 DOI: 10.1016/j.ciresp.2020.12.013] [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: 09/23/2020] [Revised: 11/18/2020] [Accepted: 12/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Combined endoscopic and laparoscopic surgery (CELS) has emerged as a promising method for managing complex benign lesions that would otherwise require major colonic resection. The aim of this study was to describe the different techniques and to evaluate the safety of CELS, assess its outcomes in a technique that is scarcely widespread in our environment. METHOD Observational retrospective study, short-term outcomes of patients undergoing CELS for benign colon polyps from October 2018 to June 2020 were evaluated. Postoperative outcomes, length of hospital stay and pathological findings were evaluated. RESULTS Seventeen consecutive patients underwent CELS during the study period. The median size of the lesion was 3.5 cm (range 2.5 - 6.5 cm), the most frequent location was the cecum (10 from 17). Most patients treated with CELS underwent an endoscopic-assisted laparoscopic wedge resection (11 from 17). In four patients this resection was combined with another CELS technique, and two patients underwent an endoscopic-assisted laparoscopic segment resection. The success rate of CELS in our series was in 14 from 17 (82,4%). The median operative time was 85 min (range 50-225 min). The median hospital stay was 2 days (range 1-15 days). One patient experienced an organ/space surgical site infection which did not require further intervention. Four lesions were shown to be malignant by postoperative pathology study. CONCLUSION CELS is a safe and multidisciplinar technique that requires collaboration between gastroenterologists and surgeons. It can be considered as an alternative to colonic resection for complex benign colonic polyps.
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Affiliation(s)
- Xavier Serra-Aracil
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España.
| | - Esther Gil-Barrionuevo
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
| | - Eva Martinez
- Departamento de Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
| | - Laura Mora-López
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
| | - Anna Pallisera-Lloveras
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
| | - Sheila Serra-Pla
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
| | - Valenti Puig-Divi
- Departamento de Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
| | - Salvador Navarro-Soto
- Unidad de Cirugía Colorrectal, Departamento de Cirugía General y Ap Digestivo, Hospital Universitari Parc Taulí, Universitat Autonoma de Barcelona (UAB), Barcelona, España
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Zuhdy M, Metwally IH, Elmore U, Roshdy S, Rosati R. Electro-thermal bipolar vessel sealing versus clipping of the inferior mesenteric vessels during minimally invasive proctectomy. CIR CIR 2020; 88:738-744. [PMID: 33254177 DOI: 10.24875/ciru.19001745] [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: 11/17/2022]
Abstract
Introduction The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of electro-thermal bipolar vessel sealers (EBVS) in laparoscopic rectal cancer surgery is weak where most studies are retrospective with non-homogenous patient groups. Methods This is a retrospective cohort study where 40 rectal cancer patients operated by laparoscopic TME or laparoscopic assisted transanal total mesorectal excision were classified in two groups according to approach of inferior mesenteric vessels ligation (EBVS versus Clipping). Results The operative time was significantly longer and the blood loss was significantly more in the EBVS group. However, hospital stay, time to oral, time to starting stoma function, and number of retrieved lymph nodes were not significantly affected by the method of vascular control. Conclusion Both methods for control of vascular pedicle during minimally invasive rectal cancer surgery are safe, as such it is at the discretion of the operating surgeon to which method to use. Prospective well-designed trials are awaited to provide stronger evidence.
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Affiliation(s)
- Mohamed Zuhdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Sameh Roshdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
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García-Jiménez ML, Castro-Diez L, Aguirrezabalaga-González J, Noguera-Aguilar JF. Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture. Cir Esp 2021; 99:222-8. [PMID: 33198944 DOI: 10.1016/j.ciresp.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy.
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Espin Alvarez F, García Domingo MI, Cremades Pérez M, Herrero Fonollosa E, Navinés López J, Camps Lasa J, Pardo Aranda F, Cugat Andorrá E. Highs and lows in laparoscopic pancreaticoduodenectomy. Cir Esp 2020; 99:S0009-739X(20)30236-0. [PMID: 32958225 DOI: 10.1016/j.ciresp.2020.07.005] [Citation(s) in RCA: 2] [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] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (PD) is not widely accepted, and its use is controversial. Only correct patient selection and appropriate training of groups experienced in pancreatic surgery and laparoscopy will be able to establish its role and its hypothetical advantages METHODS: Out of 138 pancreatic surgeries performed in a two-year period (2017-2019), 23 were laparoscopic PD. We evaluate its efficacy and safety compared to 31 open PD. RESULTS There were no cases of B/C pancreatic or biliary fistula, nor any cases of delayed gastric emptying in the laparoscopic group, but hemorrhage required one reoperation. The conversion rate was 21% (five cases): one due to bleeding, and the remainder for non-progression. The converted patients showed no differences compared to those completed by laparoscopy. There were no differences between laparoscopic and open PD in surgical time, postoperative complications, reintervention rate, readmissions or mortality. R0 resection in tumor cases was 85% for laparoscopy and 69% in open surgery without statistical significance. The postoperative hospital stay was shorter in the laparoscopic PD group (eight vs. 15 days). CONCLUSIONS In a selected group, laparoscopic PD can be safely and effectively performed if carried out by groups who are experts in pancreatic surgery and advanced laparoscopy. The technique has the same postoperative results as open surgery and is oncologically adequate, with less hospital stay. Proper patient selection, a step-by-step program and a lax and early conversion prevents serious operating accidents.
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Affiliation(s)
- Francisco Espin Alvarez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - María Isabel García Domingo
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Manel Cremades Pérez
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España.
| | - Eric Herrero Fonollosa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Jordi Navinés López
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - Judith Camps Lasa
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
| | - Fernando Pardo Aranda
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España
| | - Esteban Cugat Andorrá
- Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, España; Unidad de Cirugía de Hepatobiliopancreática, Hospital Universitari Mútua de Terrassa, Universitat de Barcelona, Terrassa, España
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Ramírez-Núñez L, Payo-Ollero J, Comas M, Cárdenas C, Bellotti V, Astarita E, Chacón-Cascio G, Ribas M. Periacetabular osteotomy for hip dysplasia treatment through a mini-invasive technique. Our results at mid-term in 131 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:151-159. [PMID: 32197953 DOI: 10.1016/j.recot.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/26/2019] [Accepted: 01/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Periacetabular osteotomy (PAO) is an accepted and worldwide technique recognized for residual dysplasia treatment and even in unstable hips with limited acetabular coverage. The aim of this study is to analyse the functional, radiological and complication results in patients treated with mini-invasive PAO. MATERIAL AND METHODS We performed a retrospective study in which we analysed 131 cases undergoing mini-invasive PAO at our centre. The degree of joint degeneration was evaluated with Tönnis scale, Wiberg angle, acetabular index (AI), anterior coverage angle (AC), joint space, complications and functional outcome with the Non-Arthritic Hip Score (NAHS) were analysed preoperatively and at the end of follow-up. RESULTS The average age was 32.3±9.5 (SD) years, 102 (77.9%) were female and 29 (22.1%) were male. 7.7±2.8 (SD) years follow up. The radiological parameters improved between the pre-surgical phase and the end of follow-up, Wiberg angle+18.5° (18.3° versus 36.8°, 95% CI 17.3 to 19.7), AC angle+13.5° (26.2° versus 39.7°, 95%CI 11.6 to 15.4) and the AI -11.1° (19.5° versus 8.4°; 95%CI -12.1 to -10,1). In addition, the functional results, with the NAHS scale, improved+31.3 points (60.7 pre-surgical versus 92 at the end of follow-up, 95% CI 28.7 to 33.8). The most common complication was transient lateral femoral cutaneous nerve hypoaesthesia in 10 cases (7%). CONCLUSION The mini-invasive PAO approach is a reproducible technique, it allows restoration of acetabular coverage and provides an improvement in functional scales as confirmed by our series.
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Affiliation(s)
- L Ramírez-Núñez
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España.
| | - J Payo-Ollero
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
| | - M Comas
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España
| | - C Cárdenas
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España
| | - V Bellotti
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España
| | - E Astarita
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España
| | - G Chacón-Cascio
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España
| | - M Ribas
- Instituto Catalán de Traumatología y Medicina Deportiva (ICATME), Hospital Universitario Quirón Dexeus, Barcelona, España
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Delgado-López PD, Roldán-Delgado H, Corrales-García EM. Stereotactic body radiation therapy and minimally invasive surgery in the management of spinal metastases: a change in the paradigm. Neurocirugia (Astur) 2019; 31:119-131. [PMID: 31668627 DOI: 10.1016/j.neucir.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/23/2019] [Revised: 07/26/2019] [Accepted: 08/26/2019] [Indexed: 11/25/2022]
Abstract
The main goal of treatment in spinal metastatic patients is local control of the disease, pain relief and the maintenance of ambulation. Traditionally, wide surgical resection of the tumour followed by adjuvant radiation and/or chemotherapy has been recommended. Currently, single-fraction or hypofractionated stereotactic body radiation therapy (SBRT) yields a one-year local control rate of over 95% with minimum morbidity, even for tumours previously considered radioresistant. In addition, by posterolateral and circumferential decompression and stabilisation of the spinal cord, it is feasible to create a 2 to 3 mm epidural margin between the dura mater and the tumour (separation surgery), enough to deliver safe and ablative doses of SBRT to the vertebrae. As these patients tend to be frail, such interventions should ideally be minimally invasive, thereby reducing surgical aggressiveness and helping to minimise the delay of any systemic therapies.
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Affiliation(s)
| | - Héctor Roldán-Delgado
- Servicio de Neurocirugía, Complejo Hospitalario Universitario de Canarias, Tenerife, España
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Simó V, Arredondo J, Hernán C, Jiménez LM, Ielpo B, Fernández J, Villafañe A, Pastor E. Rectal cancer treatment by transanal total mesorectal excision: Results in 100 consecutive patients. Cir Esp 2019; 97:510-516. [PMID: 31351576 DOI: 10.1016/j.ciresp.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/27/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study is to describe and evaluate our clinical short-term surgical results of laparoscopic transanal total mesorectal excision. METHODS Analysis of 100 consecutive patients with mid and lower rectal cancer who underwent transanal total mesorectal excision from November 2013 to September 2018. Main outcomes described are operative data, morbidities, mortality and quality of the specimen. A comparative analysis was done between gender and simultaneous vs. non simultaneous abdominal-perineal surgery. RESULTS Mean patient age was 67 years (56-75), and 67% were male. On MRI, 50% were stage T3 tumors, and 52% had positive nodes. Mean distance of the tumor from anal verge was 4.9±1.3cm. A total of 58% underwent neoadjuvant treatment. Mean operative time was 262±40.7min; it was shorter in females (P<.001) and in simultaneous 2-field surgery. Median specimen distal free margin was 1.5cm (0.5-2.4). A total of 89% of the specimens were with complete mesorectum, with better results when a simultaneous approach was used (P=.047). The mean number of retrieved lymph-nodes was 15.2±11.6, and 26% of patients had positive nodes. Median length of stay was 5.5 days (4-8). Morbidities occurred in 36% of cases, and one patient died. CONCLUSIONS According to our experience, laparoscopic transanal total mesorectal excision is safe and effective with adequate circumferential and distal free margins and high quality of the resected mesorectum specimen. Post-operative morbidity is acceptable, according to the current literature.
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Affiliation(s)
- Vicente Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jorge Arredondo
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España.
| | - Cristina Hernán
- Servicio de Medicina Preventiva, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Luís Miguel Jiménez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Benedetto Ielpo
- Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jesús Fernández
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Amaya Villafañe
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Enrique Pastor
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
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Díez Del Val I, Loureiro González C, Asensio Gallego JI, Bettonica Larrañaga C, Leturio Fernández S, Eizaguirre Letamendia E, Miró Martín M, García Fernández MM, Martí Gelonch L, Aranda Danso H, Barrenetxea Asua J, Estremiana García F, Ortiz Lacorzana J, Farran Teixidó L. Minimally invasive and robotic surgery in the surgical treatment of esophagogastric junction cancer. Cir Esp 2019; 97:451-458. [PMID: 31047649 DOI: 10.1016/j.ciresp.2019.03.013] [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: 02/16/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/24/2022]
Abstract
Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.
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Affiliation(s)
- Ismael Díez Del Val
- Sección de Cirugía esofagogástrica, Hospital Universitario Basurto, Bilbao, España.
| | | | | | - Carla Bettonica Larrañaga
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | | | - Mónica Miró Martín
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Laura Martí Gelonch
- Sección de Cirugía esofagogástrica, Hospital Universitario Donostia, Donostia-San Sebastián, España
| | - Humberto Aranda Danso
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Fernando Estremiana García
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | | | - Leandre Farran Teixidó
- Sección de Cirugía esofagogástrica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Linares Espinós E, Ogaya-Piniés G, Martínez-Salamanca JI. Salvage robot-assisted radical prostatectomy following failed local treatments. ARCH ESP UROL 2019; 72:277-282. [PMID: 30945654] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prostate cancer represents the most commonly diagnosed cancer in men and is the second-leading cause of cancer related death in the United States. Primary treatment for prostate cancer includes radiotherapy or ablative procedures such as cryotherapy, and high-intensity focused ultrasound (HIFU). Unfortunately, a large proportion of these patients, especially with high risk features, may experience disease recurrence within 10 years. Management of recurrent localized prostate cancer is heterogeneous, and radical surgery remains as a salvage option in these patients. The purpose of this article is to offer oncological arguments in favor of salvage robotic radical prostatectomy (sRARP), which could benefit a certain group of patients. Tips and tricks in order to perform a challenging salvage surgery are summarized, as evidence of modern series with acceptable morbidity rates.
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Affiliation(s)
| | - Gabriel Ogaya-Piniés
- Lyx Institute of Urology. Madrid. Spain. Rey Juan Carlos Hospital. Madrid. Spain
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Bordon G, Burguet Girona S. Assessment of related surgical complications of minimally invasive retropleural approach to the thoraco-lumbar spine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:209-216. [PMID: 30606644 DOI: 10.1016/j.recot.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/23/2017] [Revised: 07/16/2018] [Accepted: 10/14/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To review the complications associated with the minimally invasive retropleural approach used in the anterior approach to the thoraco-lumbar spine. MATERIAL AND METHOD We present the MIS surgical technique and the evaluation of data collected prospectively from the initial series of 31 patients undergoing surgery. Pleural opening during the approach, lung complications derived, other surgical complications, time of intervention, intraoperative bleeding, need for transfusion and hospital stay are evaluated. DISCUSSION The mean age of the patients was 58years, the surgical time 225min, and the bleeding 274ml, with a 13% postoperative transfusion. Intraoperatively, pleural opening was detected in 8 cases, of which none had major pulmonary complications during the postoperative period. There were 3 cases of mild pleural effusion, all patients without pleural opening, and one case of haemopneumothorax due to intercostal vessel bleeding that required reoperation. The percentage of intercostal neuralgia was 3%. The mean hospital stay was 6.7days, and 24 of 31 patients were able to initiate early mobilization on the first postoperative day. CONCLUSIONS The retropleural approach allows the surgical treatment of pathologies requiring anterior access to the thoraco-lumbar spine, with a low profile of pulmonary complications, and with the advantages of minimally invasive techniques in terms of less bleeding, early recovery and shorter hospital stay. Nevertheless the learning curve is long.
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Affiliation(s)
- Gerd Bordon
- Unidad de Raquis, Hospital de Manises, Manises, Valencia, España
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Domínguez I, Luque R, Noriega M, Rey J, Alía J, Urda A, Marco F. Adult spinal deformity treated with minimally invasive surgery. Description of surgical technique, radiological results and literature review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:419-26. [PMID: 28888683 DOI: 10.1016/j.recot.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/09/2017] [Accepted: 06/21/2017] [Indexed: 11/22/2022] Open
Abstract
The prevalence of adult spinal deformity has been increasing exponentially over time. Surgery has been credited with good radiological and clinical results. The incidence of complications is high. MIS techniques provide good results with fewer complications. This is a retrospective study of 25 patients with an adult spinal deformity treated by MIS surgery, with a minimum follow-up of 6 months. Radiological improvement was SVA from 5 to 2cm, coronal Cobb angle from 31° to 6°, and lumbar lordosis from 18° to 38°. All of these parameters remained stable over time. We also present the complications that appeared in 4 patients (16%). Only one patient needed reoperation. We describe the technique used and review the references on the subject. We conclude that the MIS technique for treating adult spinal deformity has comparable results to those of the conventional techniques but with fewer complications.
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Encinas de la Iglesia J, Corral de la Calle MA, Fernández Pérez GC, Ruano Pérez R, Álvarez Delgado A. Esophageal cancer: anatomic particularities, staging, and imaging techniques. Radiologia 2016; 58:352-65. [PMID: 27469407 DOI: 10.1016/j.rx.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 03/24/2016] [Revised: 05/30/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.
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Affiliation(s)
| | | | - G C Fernández Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Río Hortega, Valladolid, España
| | - R Ruano Pérez
- Servicio de Medicina Nuclear, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - A Álvarez Delgado
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Sánchez-Gómez LM, Polo-deSantos M, Gómez-Sancha F, Luengo-Matos S. Efficacy and safety of the urolift® system for the treatment of benign prostate hyperplasia symptoms: systematic review. Actas Urol Esp 2015; 39:311-9. [PMID: 25260950 DOI: 10.1016/j.acuro.2014.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 04/30/2014] [Accepted: 05/05/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Interest in having alternatives in the treatment of benign prostate hyperplasia. OBJECTIVES To assess the efficacy and safety of the Urolift® system for treating the symptoms of benign prostate hyperplasia. ACQUISITION OF EVIDENCE Systematic review of the literature through searches on PubMed, Cochrane Library, CRD, Clinical Trials and EuroScan, collecting indicators of efficacy and safety. SUMMARY OF THE EVIDENCE We included 5 case series and one clinical trial. The patients' mean age ranged from 65-74.3 years, and the mean prostate volume was 41-55cm3. The mean number of Urolif® implants was 3.7-5.5. The maximum follow-up in months was 24, 12 (3 studies) and one (2 studies). Improvements were found in lower urinary tract symptoms, as measured with the International Prostate Symptom Score, Benign Prostatic Hyperplasia Impact Index (BPHII), maximum urinary flow (Qmax) and postvoid residual (PVR) volume. Improvements were in found sexual dysfunction symptoms, as measured with the Sexual Health Inventory for Men (SHIM) and the Male Sexual Health Questionnaire or Ejaculatory Dysfunction (MHSQ-EjD), and in quality of life (QoL). In the clinical trial, the differences were significant for International Prostate Symptom Score, BPHII, Qmax and QoL (p<.05). The adverse effects were mild. CONCLUSIONS Although the quality of evidence is low, Urolift® constitutes a good therapeutic alternative for patients with benign prostate hyperplasia. The short to medium-term results show that the technique contributes to improving lower urinary tract symptoms, with no relevant side effects, does not affect sexual function and improves quality of life. Further research is required, especially on long-term results.
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López F, Llorente JL, Álvarez-Marcos C, Morato M, Suárez C, Rodrigo JP. [Outcomes following transoral resection of oropharyngeal squamous cell carcinoma]. Acta Otorrinolaringol Esp 2014; 66:74-82. [PMID: 24958186 DOI: 10.1016/j.otorri.2014.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/22/2014] [Accepted: 02/01/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral surgery (TOS) as the primary treatment for oropharyngeal carcinoma. METHODS We reviewed 43 previously untreated patients with oropharyngeal carcinoma, who were treated with TOS. Distribution of the primary tumor site was: tonsil (52%), soft palate (23%), base of the tongue (21%) and posterior wall (4%). Eight patients had a stage I disease, 9 had a stage II disease, 7 had a stage III disease, 16 had a stage IVA, and 3 had stage IVB disease. Eighteen patients underwent postoperative radiotherapy. Records of these patients were reviewed to obtain measures such as local and regional control, overall and disease-specific survival, and speech and swallowing function. RESULTS The overall recurrence rate was 44%, and the local recurrence rate was 18%. The 5-year overall survival and disease-specific survival rates were 55% and 66%, respectively. Five-year disease-specific survival rates by site were as follows: 100%, 85%, 44%, and 30% for posterior wall, tonsil, soft palate and base of the tongue, respectively. Five-year estimates for local control were 100%, 90%, and 0% for palate, tonsil and for base of the tongue tumors, respectively. All of the patients preserved the larynx and live without tracheotomy and oral alimentation was successfully without feeding tube. CONCLUSIONS TOS as the primary treatment approach offers a surgical alternative for treatment of the primary oropharyngeal tumor, in the era of chemoradiation therapy. This approach confers a good local control and functional outcomes.
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Affiliation(s)
- Fernando López
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - José L Llorente
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - César Álvarez-Marcos
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Marta Morato
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Carlos Suárez
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Juan P Rodrigo
- Servicio de Otorrinolaringología, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Villalobos Mori R, Escoll Rufino J, Herrerías González F, Mias Carballal MC, Escartin Arias A, Olsina Kissler JJ. Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy. Cir Esp 2014; 92:472-7. [PMID: 24581876 DOI: 10.1016/j.ciresp.2013.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/03/2013] [Accepted: 12/06/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). MATERIAL AND METHODS From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 to 65 years were selected, with onset of symptoms less than 48h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology and costs. RESULTS The median age, BMI, sex and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P=.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. CONCLUSION SILS appendectomy is safe, effective and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique.
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Affiliation(s)
| | - Jordi Escoll Rufino
- Servicio de Cirugía, Hospital Universitari Arnau de Vilanova, Lérida, España
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Martínez-Rodríguez I, Martínez-Amador N, de Arcocha-Torres M, Quirce R, Ortega-Nava F, Ibáñez-Bravo S, Lavado-Pérez C, Bravo-Ferrer Z, Carril JM. Comparison of 99mTc-sestamibi and 11C-methionine PET/CT in the localization of parathyroid adenomas in primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol 2013; 33:93-8. [PMID: 24125595 DOI: 10.1016/j.remn.2013.08.002] [Citation(s) in RCA: 6] [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] [Received: 06/21/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the usefulness of (11)C-methionine PET/CT (MET) in the localization of the parathyroid adenomas and to compare the results with those obtained with the conventional technique in double-phase (99m)Tc-sestamibi scintigraphy (MIBI). We evaluated the optimal timing to acquire MET images. MATERIAL AND METHODS A prospective study that included 14 patients (mean age: 65.5 ± 9.7 years) with primary hyperparathyroidism (PH) who underwent surgery was performed. Mean serum iPTH was 215.8 ± 108 pg/mL and serum calcium 10.8 ± 0.9 mg/dL. MIBI (planar and SPECT) was obtained 10 min and 2-3h after injection of 740 MBq (20 mCi) of (99m)Tc-sestamibi. MET was obtained 10 min and 40 min after injection of 740 MBq (20 mCi) of (11)C-methionine. MIBI and MET images were visually evaluated and compared. A score for 10 min and 40 min MET images from 0 (no abnormal uptake) to 3 (intense uptake) was assigned. RESULTS MIBI and MET were positive and concordant in 11/14 patients and in 10 of them the parathyroid adenoma was correctly localized. In 3/14 MIBI was positive and MET negative (MIBI correctly localized the parathyroid adenoma in 2 of them). According to the timing of MET imaging acquisition, the 10 min and 40 min acquisition showed the same score in 10 patients, it was higher at 10 min acquisition in 3 and in 1 the parathyroid adenoma was only detected at 40 min acquisition. CONCLUSION MIBI remains the technique of choice for the localization of parathyroid adenomas in patients with PH. MET may play a complementary role in selected patients. Delayed acquisition should be included in the MET protocol when the early acquisition is negative.
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Affiliation(s)
- I Martínez-Rodríguez
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - N Martínez-Amador
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - M de Arcocha-Torres
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - R Quirce
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - F Ortega-Nava
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - S Ibáñez-Bravo
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - C Lavado-Pérez
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - Z Bravo-Ferrer
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
| | - J M Carril
- Nuclear Medicine, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
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Mocanu SN, Balagué Ponz MC, Targarona Soler EM, Roque Figuls M, Trias Folch M. [Influence of the type of thoracic access on postesophagectomy respiratory complications]. Cir Esp 2013; 91:563-73. [PMID: 24050831 DOI: 10.1016/j.ciresp.2013.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 03/15/2013] [Accepted: 03/22/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A systematic review of the literature was performed with the aim to determine differences in the rate of respiratory complications after esophagectomy for esophageal cancer using minimally invasive access vs traditional thoracic access. METHODS A literature search was performed using Medline and Cochrane Library, identifying studies that compared the 2 types of thoracic access, regardless of the type of abdominal access (laparotomy/laparoscopy). The studies selected described respiratory complications in absolute numbers and different categories. Studies that considered minithoracotomy as a minimally invasive technique were excluded. Inclusion criteria were: studies decribing the different types of respiratory complications (9 in total), and analysing the most common complications: respiratory infection, respiratory failure and pleural effusion. RESULTS Nine studies were selected (one prospective randomized trial and 8 case control studies) including 1,190 patients, 1,167 of which were operated on for esophageal cancer: 482 patients by thoracotomy and 708 by thoracoscopy. Three studies included definitions of respiratory complications, and one stratified them. The more frequent complications that allowed a meta-analysis were: respiratory infections, pleural effusion, and respiratory failure. No significant differences were found between the 2 types of access in the global analysis. DISCUSSION The type of thoracic access (thoracotomy or thoracoscopy) does not seem to influence the development of respiratory complications after esophagectomy for cancer. However, the design of the studies analysed, the absence of clear definitions and stratification of the complications makes this conclusion questionable. A consensus on the definition of complications and further prospective randomized clinical trials are necessary.
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García-Santos EP, Martín-Fernández J, Gil-Rendo A, Menchén-Trujillo B, Martínez de Paz F, Manzanares-Campillo MC, Muñoz-Atienza V, Sánchez-García S. Rapid intraoperative determination of intact parathyroid hormone during surgery for primary hyperparathyroidism. Experience at our center. ACTA ACUST UNITED AC 2013; 61:3-8. [PMID: 23910639 DOI: 10.1016/j.endonu.2013.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/02/2013] [Revised: 03/17/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is due to a single adenoma in 85%-95% of cases, and is often cured after adenoma removal. Intraoperative rapid determination of intact parathyroid hormone (PTHio) may be a tool for monitoring the effectiveness of PHPT surgery. The main objective of our study was to evaluate PTHio determination and to establish whether its successful implementation contributed to achieve minimally invasive surgery (MIS) and major ambulatory surgery (MAS) in the treatment of PHPT. MATERIAL AND METHODS Retrospective study of a consecutive series of patients diagnosed and operated on for PHPT at the University General Hospital of Ciudad Real between January 2005 and January 2012. RESULTS In the study period, 91 patients underwent surgery. 39 (42.9%) under general anesthesia, while 52 (57.1%) were candidates for regional anesthesia by cervical block. Seventy-six of all patients (83.5%) were amenable to MIS using a unilateral approach. Classical cervicotomy was performed in all other patients. PTHio determination was done in 75 patients, showing cure in the same surgery in 68 of them. MAS was performed in 70.3% (64) of patients. CONCLUSIONS Determination of PTHio may allow for changing the surgical approach to PHPT at our department, allowing for performance of MIS on an outpatient basis in a significant proportion of patients with some cosmetic improvement, probably less pain, shorter hospital stay, and less potential complications than bilateral cervical exploration.
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Affiliation(s)
- Esther Pilar García-Santos
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
| | - Jesús Martín-Fernández
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Aurora Gil-Rendo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Bruno Menchén-Trujillo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Fernando Martínez de Paz
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - M Carmen Manzanares-Campillo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Virginia Muñoz-Atienza
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Susana Sánchez-García
- Servicio de Cirugía General y de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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