Добірка наукової літератури з теми "Mininvasive surgery"

Urinary stress incontinence is often related to cystocele, hence treatment cannot exclude correction of the latter. The authors have treated 2nd-3rd grade cystocele secondary to central impairment using a mininvasive technique consisting of a vaginal flap suspended anteriorly to the pubic tubercles, according to the traditional “Vesica kit” procedure, and posteriorly to the iliopubic branches in line with the Cooper ligaments using “Vesica kit” screws inserted through the abdominal wall under videolaparoscopy after creating a pneumo-Retzius space. Whenever a pneumo-Retzius cannot be created due to previous pelvic surgery, the same operation may be performed either through a small sovrapubic incision or by inserting 4 screws in line with the pubis. After 1 year the 20 operated patients show satisfying results with good prospects, but a longer follow-up is necessary to confirm these results. The aim of this study is to describe a mininvasive surgical technique for treating 2nd-3rd grade cystocele, associated or not with urinary stress incontinence.

Background and objectives: The Gold-Standard treatment for Advanced Epithelial Ovarian Cancer remains cytoreductive surgery followed by systemic chemotherapy. Surgery can be performed either by an open or minimally invasive approach (MIS), although the former remains the most widely used approach. Recently, Van Driel et al. proved that adding 100 mg/m2 of Cisplatin in Hyperthermic Intraperitoneal Chemotherapy (HIPEC) at Interval Debulking Surgery (IDS) gives a disease-free survival (DFS) advantage. Similarly, Gueli-Alletti et al. demonstrated how the MIS approach is feasible and safe in IDS. Moreover, Petrillo et al. reported pharmacokinetic profiles with a higher chemotherapy concentration in patients undergoing HIPEC after MIS compared with the open approach. Therefore, the following review investigates the oncological and clinical safety consequences of the association between MIS and HIPEC. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed and Scopus databases in April 2022. Studies containing data about oncological and safety outcomes were included. We registered the Review to the PROSPERO site for meta-analysis with protocol number CRD42022329503. Results: Five studies fulfilled inclusion criteria. 42 patients were included in the review from three different Gynecological Oncological referral centers. The systematic review highlighted a Recurrence Rate ranging between 0 and 100%, with a 3-year Platinum-Free Survival between 10 and 70%. The most common HIPEC drug was Cisplatin, used at concentrations between 75 and 100 mg/m2 and at an average temperature of 42 °C, for 60 to 90 min. Only 1 Acute Kidney Insufficiency has been reported. Conclusions: The scarcity of clinical trials focusing on a direct comparison between MIS and the open approach followed by HIPEC in EOC treatment does not make it possible to identify an oncological advantage between these two techniques. However, the safety profiles shown are highly reassuring.

Pancreatic traumatic injuries should be managed by multidisciplinary approach. Standard redo surgery can be avoided or supported by innovative mininvasive approaches both endoscopically and/or radiologically. Pancreatic endotherapy has an increasing role in the management of pancreatic injuries. Understanding the pathophysiology of pancreatic leak is crucial to guide the treatment. Endoscopic treatment must be tailored on the type and site of pancreatic fistula to achieve the optimal clinical outcome: there is not a one-way standard treatment but the best treatment for different types of pancreatic injuries considering both retrograde and endoscopic ultrasound (EUS)-guided approaches.

In the last years a wide range of new technique offers the possibility to have R0 resection in colorectal cancer. We report our experience about Single Port Laparoscopic Surgery (SPL) for not advanced right colon cancer and about pelvectomy with cilindric Abdominal Perineal Resection (APR) for advanced rectal cancer. SPL offer mainly cosmetic advantages but also quicker recovery. No touch technique with adequate surgical margin and lymphectomy were respected. Operative time of SPL was 85- 115 minutes, the incision was 5 cm long. There were no complications. Length of hospital stay was 4-6 days. With advanced pelvic cancer, pelvic exenteration with en-bloc resection is indicated. Then we propose a case of a 55 years old woman with a pelvic recurrence from a metastatic rectal cancer involving the right obturator fossa, the vaginal stump, the right ureter. Modern surgical technique give us the chance to offer the most appropriate oncologic surgical treatment.

Objective: We describe an original minimally invasive penile plication technique with scrotal or infrapubic access, not requiring circumcision, for penile curvature of different severity and types. This technique can be used to correct both congenital and acquired curvatures, mono or bidirectional deformities. Materials and methods: Between 2012 and 2018 we treated 134 patients suffering from congenital curvature (33) and acquired curvature from Peyronie's disease (101). The average curvature was 62.2° (± 30.4°). Preoperative evaluation included prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of IIEF- 15, vasoactive penile Doppler ultrasound, analysis of thermal and vibratory sensitivity with Genito-Sensory-Analyzer (GSA) and assessment of nocturnal penile stiffness with Rigiscan, performed twice, for a detailed evaluation of patient’s erectile function. Scrotal access was performed in patients with dorsal and/or lateral penile curvature; the infrapubic access was performed in patients with ventral curvature. After preparation and incision of Colles’ fascia, penis was partially degloved and an original plication technique called "binary corporoplasty" was performed at the site or sites established at preoperative assessment, with non-resorbable synthetic multifilament (Premicron®) suture. Results: Complete correction of penile curvature was achieved in 96.8 % of patients. No major complications were reported, and no patients suffered worsening in erectile function or in penile sensitivity. The average shortening of convex side was 1.65 cm (± 0.7 cm) and all patients report easy intercourse after correction. The average time of surgery was 46 minutes (± 11 min) and all procedures were performed as a day-hospital or ambulatory settings, with local anesthesia and light sedation. Overall satisfaction rate is 96%. Conclusions: This is a simple and rapid technique that perfectly corrects even the most severe and complex penile curvatures. In comparison to traditional techniques, such as Nesbit procedure, this technique is associated with low morbidity, a very low recurrence rate and a great aesthetic results. Aesthetic and functional patients’ satisfaction was excellent.

Background: Open partial laryngeal surgery (OPLS) represents a wide array of procedures that can be fitted to treat different types of laryngeal cancer (LC). We would like to present our 30-years’ institutional experience, to analyze survival outcomes and to critically discuss prognostic factors. Methods: We reviewed all cases of OPLS performed at our Institution from 1982 to 2016 for LC. Survival analysis by Kaplan–Meier estimate was performed and prognostic variables by multivariate analysis were identified. Results: Mean follow-up time was 68.3 months, 30-day mortality 0.2%, subsequent functional total laryngectomy (TL) was 1.01%. Over 80% of cases were stage I to II. We had 25 local, 62 regional and eight distant recurrences. Local control was 94.9%, overall survival (OS) was 83.4% and disease-specific survival (DSS) was 87.7%. The two major risk factors significantly associated with the risk of death were cT and cN stage. CONCLUSIONS: We have confirmed that OPLS represents an oncologically sound option in the treatment of LC despite the emergence of non-surgical strategies and new transoral mininvasive techniques. Our results highlight that accurate staging, correct selection of the patient and a strong surgical expertise are of paramount importance in this type of surgery.

Introduction. The method of mininvasive percutaneous cryoablation is applied in the tumor lesions of bones for the purpose of local control and pain syndrome relief. In the case of chest bone destruction, such procedures are accompanied by a risk of damage to the thoracic and abdominal organs, as well as large vessels. This article discusses the peculiarities of percutaneous puncture cryoablation in patients with rib metastatic lesions.Aim. To analyze the methodological aspects of percutaneous cryoablation in patients with rib metastatic lesions and to clarify puncture stereotactic accesses.Materials and methods. The procedure was performed in 11 patients with oligometastatic bone lesions. The size of rib lesions varied from 7 to 55 mm. Surgery was performed in a CT operating room under endotracheal anesthesia. A nitric cryosystem with reusable probes of a diameter varying from 1.5 to 3.0 mm was used. The cryoablation included two cycles of cooling down to the target temperature of –190 °C with 10- and 6-min exposure, respectively.Results and discussion. As a result, optimum puncture accesses for the installation of cryoprobes in tumoral rib destruction, including tangential and perpendicular ones, were proposed. At the tangential access, the cryoprobe can be placed both directly into the tumor lesion (intraosseous variant) and into soft tissues along the bone at the lesion level (paraosseous variant). The follow-up period after the procedure varied from 3 to 27 months (11.4 ± 5.6 months). In 3 cases, the formation of a pathological fracture at the level of the ablated lesion was recorded. The local control of the tumoral process was achieved in 10 patients, a relapse in the ablation zone was noted in one case 3 months after the procedure.Conclusion. Due to the use of the described accesses, as well as the implementation of measures aimed at preventing cold cutaneous lesions, the surgery goals were successfully achieved and complications were avoided in all cases.

BACKGROUND Three-dimensional (3D) imaging, a recent technical innovation in laparoscopic surgery, has been introduced to enhance depth perception and facilitate operations. The clear benefit of the 3D laparoscopy has never been tested. Some concerns emerged regarding the possible negative effects over the visual system in those surgeons who performed 3D surgery every day. 3D laparoscopy has been validated both in “in-vitro” and “in-vivo” (clinical) settings. All survey done in laparoscopic simulator comparing surgical exercise (suturing, peg transfer, cutting) performed with 2D or 3D system reported better results in the second group, regardless the surgeon experience. Less data is disposable in the clinical setting, but with same conclusions. The use of 3D technology needs passive or active polarized glasses. Optometric tests, objective exams (RMN or EEG) and subjective questionnaires have been widely used to evaluate the alterations in the visual system utilizing the 3D technology. Each test concluded that 3D technology causes alteration in the EEG waves, but how long these alterations last is still unknown. AIM The aim of this study was to evaluate the possible benefit of using the 3D technology in terms of surgical outcomes (study 1) and to evaluate the alterations over the visual system operating in 3D laparoscopy (study 2). MATERIALS AND METHODS The study was a single-center prospective observational clinical trial, divided in two sub-study with a single patients-population. Participants included patients aged 18 years old and above, eligible for colorectal resections for neoplastic or inflammatory diseases. Four experienced surgeons in colorectal and laparoscopic surgery participated in the study. Each surgeon followed the standard laparoscopic surgical rules performing the different type of colorectal resection, regardless the study subgroup. Data were collected at the pre-operative clinic, during surgery, during the hospitalizations and at the short term follow-up (30th days). For each study, there was a primary endpoint: 1. Primary endpoint for Study 1: incidence of Clavien grade 3, 4 and 5 postsurgical complications in patients undergone 3D colorectal resection; 2. Primary endpoint for Study 2: to grade the visual work load of surgeons operating with 3D screens and glasses. At the end of each procedure (2D or 3D) the first surgeon had to fill in two different subjective questionnaire (the NASA task load index questionnaire and the Simulator Sickness questionnaire) to grade the visual sickness felt during the operation. RESULTS From January 2015 to September 2017, 313 patients were enrolled in the study: 82 in the 2D group, 231 in the 3D group. STUDY 1: Colorectal cancer was the main indication for surgery (n 235, 75.1%), followed by colonic diverticulosis, benign polyposis and inflammatory bowel diseases (IBD), respectively 43 (13.8 %), 25 (7.9 %) and 10 (3.2 %). Age, sex, ASA score were comparable between the two groups. The median operative time showed no statistically significant difference between the 3D and 2D groups (p 0.611). Less drains were positioned at the end of the 3D operations comparing with 2D procedures (p 0.013). The stapled anastomosis was the most frequent performed over other techniques. The other intra-operative findings showed no significant difference between the two study groups. The median hospitalization and the reoperation rate showed no difference between the two groups. STUDY 2: The statistical analysis done over all 313 cases divided in 2D and 3D did not reveled significant difference of the visual work scored by the NASA TLX. Data emerging from the SSQ questionnaire reveled no case of moderate or severe symptoms in both groups. CONCLUSIONS 3D laparoscopic surgery had the same postoperative results of the 2D standard laparoscopy. The more frequent intra-abdominal anastomosis in the 3D group might suggest a more safeness felt by the surgeon using the new technology. The NASA TLX and the SSQ questionnaire did not reveled significant difference of the visual work between 2D and 3D vision.

L'obiettivo di questo lavoro è supportare la chirurgia mini-invasiva (MIS) sviluppando sensori e sistemi in grado di assistere il chirurgo durante le operazioni, rimanendo “invisibili” al personale medico. Pertanto, in questa tesi ci siamo concentrati sullo sviluppo di un sistema di localizzazione elettromagnetico (EMTS), che può essere impiegato per interventi intracorporei, in quanto non richiede una linea di vista diretta tra la sorgente del segnale e il sensore, come invece è richiesto per i sistemi ottici. Infatti, per ridurre l'invasività vengono utilizzati sensori magnetici molto piccoli che misurano il campo magnetico di geometria nota prodotto da un generatore di campo (FG); a causa delle dimensioni ridotte del sensore, la sensibilità è ridotta e, quando si utilizzano gli attuali sistemi commerciali, il chirurgo deve posizionare il generatore troppo vicino al volume operatorio (ad esempio, il tavolo del paziente), ostacolando così l’equipe medica durante l'operazione. Pertanto, in questa tesi è presentato un nuovo EMTS, sviluppato per incrementare la distanza di localizzazione degli attuali sistemi, e sono tratte diverse considerazioni che possono essere applicate allo sviluppo di altri EMTSs. Inoltre, è stata sviluppata una piattaforma virtuale che consente di analizzare le prestazioni del sistema aggiungendo componenti di rumore e simulando sorgenti di errore, in modo da studiare la robustezza e l'accuratezza del sistema e le sue debolezze. La piattaforma può essere particolarmente utile per la prototipazione di sistemi, studiando gli effetti dei parametri di sistema (geometrici ed elettrici) prima della fabbricazione del prototipo di EMTS. Inoltre, insieme alla necessità di localizzare con continuità gli strumenti chirurgici all'interno del corpo umano, vi è la necessità di informazioni in tempo reale sullo stato del paziente sottoposto all’intervento. Pertanto, questa tesi si concentra anche sullo sviluppo di un sensore miniaturizzato che consenta di ottenere misure accurate di ioni, identificando parametri di fabbricazione robusti per ottenere elevate prestazioni di misura di ioni, con particolare attenzione al rilevamento del K+: gli ISE (elettrodi ione-selettivi) a forma di ago possono quindi essere inseriti negli strumenti chirurgici, fornendo così importanti informazioni in tempo reale sulla salute cellulare, misurando la concentrazione di K+ direttamente dal sangue inevitabilmente presente durante l'intervento chirurgico.
The goal of this work is to support minimally invasive surgery (MIS) by developing sensors and systems able to assist surgeon during operations, remaining “invisible” to the medical staff. Hence, in this thesis we focused on the development of an electromagnetic tracking system (EMTS), which can be employed for intracorporeal interventions, since it does not require a direct line of sight between the source of the signal and the sensor, as instead is required for optical systems. Indeed, in order to reduce invasiveness, very small magnetic sensors are used to measure the magnetic field of known geometry produced by a field generator (FG); due to the small sensor sizes, the sensitivity is reduced, and when employing current commercial systems, the surgeon needs to place the FG too much near the operating volume (i.e., patient’s table), thus hindering the staff during the operation. Hence, in this thesis is presented a novel EMTS, developed to increase the tracking distance of current systems, and several considerations are provided, which can be applied to the development of other EMTSs. Moreover, a virtual platform is developed, which permits to analyze system performances by adding noise components and simulating error sources, hence the robustness and the accuracy of the system and its weaknesses can be studied. The platform can be particularly useful for system prototyping, by investigating the effects of system parameters (geometrical and electrical ones) before the fabrication of the real EMTS prototype. Additionally, along with the need of continuously tracking the surgical tools inside human body there is the need of information about the real-time status of the patient. Therefore, this thesis will also focus on the development of a miniaturized sensor to obtain accurate measurements of ions, by finding robust fabrication parameters to achieve high sensing performances, with particular focus on K+ sensing: needle-shaped ISEs (Ion-Selective electrodes) can hence be inserted into the surgical instruments, thus providing important real-time information about cellular health, measuring K+ concentration directly from blood inevitably present during surgery.