Hepatic Vein and Inferior Vena Cava Reconstruction during Hepatic Surgery Resection for Cancer

Invasion of tumor in the liver requires surgical interventions that may reduce the effects or may eliminate the tumor-affected cells. The renewal of the hepatic vein and inferior vena cava has enabled most specialized oncologists and medical specialists to use advanced diagnostic methods in the treatment of the liver tumors. Liver resection has prolonged the lives of many patients and the invention of live donor organ transplants has effectively enabled the use of liver resection in most cancer centers across the world. By reviewing data from 10 articles, 21 surgical analyses were investigated and analyzed for the risks involved in the applications of reconstructions of hepatic vein and inferior vena cava in the surgical liver resection. The postoperative complications and the indications of reconstructions were mentioned. The results indicated that with these surgical procedures, complications are still involved but may be successful for particular patients

Giant Incisional Hernia: Which Treatment? Case Report and Review of Literature

BACKGROUND: Incisional hernias are one of the most common complications developing in 3.8–11.5% after abdominal surgery. The management of giant incisional hernia (GIH) with loss of abdominal domain remains a surgical challenge with a high recurrence rate of 30%, elevated comorbidity and a mortality rate between 0% and 5%. CASE REPORT: A 70-year-old woman presented at our emergency room with a 24 h history of abdominal bloating. She had severe comorbidities and GIH with loss of domain (LOD). Abdominal _TC scan demonstrated a GIH about 10 × 11 cm, associated with colon and ileus with “LOD.” CONCLUSION: Different risk factors are important for developing an incisional hernia as old age, vascular disease, diabetes, obesity, renal failure, hepatic disease, protein deficiency, immunosuppression, and smoking. Surgical treatment should be centralized to discuss every case with a multidisciplinary team (general surgeon, plastic surgeon, and radiologist)

IndoCyanine Green fluorescence guided resections in hepatobiliary surgery

Background: Fluorescence-guided surgery (FGS) has recently gained popularity as a promising technique for treating visceral, hepatobiliary, and pancreatic neoplasms. It involves using laser sources to illuminate injected substances that emit a fluorescence signal, guiding surgical procedures, and providing real-time visualization of otherwise undetectable structures. This review explores the advancements in hepatobiliary surgery using IndoCyanine Green (ICG) fluorescence guided resections. Methods: The review examined the use of FGS in identifying subcapsular liver tumors, millimetric hepatocellular carcinoma, intrahepatic cholangiocarcinoma, liver metastases, and various benign liver neoplasms. In addition, fluorescence cholangiography using ICG injection was explored to improve liver surgery\u27s accuracy and safety. Results: The review found that ICG fluorescence-guided resections can potentially improve surgical outcomes by enhancing the accuracy and safety of procedures. The use of fluorescence cholangiography allows for the efficient identification of the bile ducts and helps surgeons avoid damaging critical structures during liver surgery. Conclusion: ICG fluorescence-guided resections represent a promising method for improving surgical outcomes and patient safety for visceral and hepatobiliary Surgery. It is a quick, easy, inexpensive, and safe device that can be used for various surgical applications. As imaging systems continue to improve, fluorescence imaging can become a widely used intraoperative navigation tool for open, laparoscopic, and robotic surgery

Robotic Duodenopancreatectomy

INTRODUCTION: Advanced methods of treating pancreatic cancer are being explored to minimize some of the adversities associated with traditional laparoscopy. One of the most promising procedures is robotic duodenopancreatectomy, which appears to reduce morbidity, mortality, conversion rate, hospital stay, and improve oncological results among patients. As such, the procedure is gaining popularity in several medical facilities. AIM: The article describes robotic duodenopancreatectomy, improved surgical treatment of pancreatic cancer that involves the use of augmented reality. MATERIALS AND METHODS: The study involves a systematic review of existing literature on robotic duodenopancreatectomy. A total of 16 scholarly articles, published within the past 5 years, are used to synthesize information designed to provide a conclusive summary of evidence related to robotic duodenopancreatectomy. All the materials are retrieved from two medical databases, MEDLINE and ProQuest. RESULTS/OUTCOME: Morbidity: The rate of morbidity associated with the procedure is relatively high, up to 40%, but slightly lower compared to open laparoscopy, which exhibits morbidity rates of approximately 75%. Mortality: There is evidence of incidences of mortality in robotic duodenopancreatectomy, ranging between 1 and 12.5%. The main cause of death associated with the procedure is post-pancreatic hemorrhage. Conversion rate: The conversion rate in robotic surgery is relatively lower compared to open laparoscopy, ranging between 0 and 37.5%. However, it can decrease to 33.3% after subsequent surgeries. Hospital stay: The procedure is associated with a shorter hospital stays (13.7–24 days) compared to open laparoscopy (25.8 days). Oncological outcomes: Robotic duodenopancreatectomy lacks clear oncological results. However, few studies have established a median overall survival of 15 months. CONCLUSION: Given that robotic duodenopancreatectomy reduces the rates of mortality, morbidity, conversion rate, and length of hospital stays, it appears to be an ideal treatment of pancreatic cancer

Von Hippel-Lindau Syndrome: Medical Syndrome or Surgical Syndrome? A Surgical Perspective

Von Hippel-Lindau syndrome (VHL) is an autosomal dominant disease caused by a genetic aberration of the tumor suppressor gene VHL and characterized by multi-organ tumors. The most common neoplasm is retinal or cerebral hemangioblastoma, although spinal hemangioblastomas, Renal Clear Cell Carcinoma (RCCC), pheochromocytomas (Pheo), paragangliomas, Pancreatic Neuroendocrine Tumors (PNETs), cystadenomas of the epididymis, and tumors of the lymphatic sac can also be found. Neurological complications from retinal or CNS hemangioblastoma and metastases of RCCC are the most common causes of death. There is a strong association between pheochromocytoma and VHL syndrome, and pheochromocytoma is often a classic manifestation of the syndrome. RCCCs are often incidental and identified during other tests. Between 35 and 70% of patients with VHL have pancreatic cysts. These can manifest as simple cysts, serous cysto-adenomas, or PNETs with a risk of malignant degeneration or metastasis of no more than 8%. The objective of this retrospective study is to analyze abdominal manifestations of VHL from a surgical point of view

Analysis of Treatment Option for Synchronous Liver Metastases and Colon Rectal Cancer

Colorectal or bowel cancer is one of the major causes of cancer worldwide. Research has shown that 15 to 20% colorectal cancer patients are also diagnosed with synchronous liver metastases (LM) at presentation and about one third eventually develop liver lesions (Leporrier, Maurel, Chiche, Bara, Segol, and Launoy, 2006; Manfredi, Lepage, Hatem, Coatmeur, Faivre, and Bouvier, 2006).   Management of cases with colorectal cancer comorbid with liver metastases is more complex (Schmoll, Van Cutsem, Stein, Valentini, Glimelius, Haustermans et al., 2012; Bismuth, Castaing, and Traynor, 1988). This highlights the need for suggesting the need for effective treatment while optimizing timing during surgical and medical treatment of primary plus metastatic disease. According to Fong, Fortner, Sun, Brennan, and Blumgart, 1999), such patients cases are likely to present with severe cancer biology and thereby less likely to be long-term survivors

Laparoscopic Cholecystectomy (LC): Toward Zero Error [Retracted]

In 1990, laparoscopic cholecystectomy (LC) was considered the new beginning of an exciting period in the management of pathologies associated with gallbladder. Two decades later, biliary morbidity alongside LC is nearly thrice higher compared to conventional open surgery. In the 1990s, Strasberg et al. explained the manner, in which a critical view of safety can be attained and the manner in which vascular injuries and accidental biliary caused by unclear anatomy, incautious control of bleeding, or rare variations could be prevented. The aforementioned principles have been overlooked until recently, only gaining recognition in the past 15 years. This review seeks to explore the aspect of safety in LC based on various techniques

Assessment of the Completeness of Lymph Node Dissection Using Indocyanine Green in Laparoscopic and Robotic Gastrectomy for Gastric Cancer – A Review

More recently, few scientists have attempted to figure out how to improve the careful recognizable proof of the lymphatic waste courses and lymph node stations during radical gastrectomy in this way beginning another examination outskirt in this field called "navigation surgery". Among the distinctive detailed arrangements, the presentation of the indocyanine green has drawn consideration for its attributes, a fluorescence colour that can be identified in the near-infrared spectral band. A fluorescence imaging innovation has been coordinated with frameworks of lymph node dissection in laparoscopic and robotic gastrectomy surgery for gastric cancer. Current confirmations uncover that ongoing vessel navigation by using indocyanine green fluorescence during laparoscopic gastrectomy was demonstrated doable with negligible complications. Its utilization may empower the presentation of fruitful robotic or laparoscopic pylorus-preserving gastrectomy with a decrease in unintended intraoperative wounds, for example, second rate polar dead tissue of the spleen during laparoscopic gastrectomy. The clinical ramifications of utilization of indocyanine green in laparoscopic and robotic gastrectomy for gastric cancer was, in any event, for surgeons with a significant level of involvement with laparoscopic D2 dissection, the near-infrared imaging framework can fill in as a complimentary apparatus to affirm total lymphatic node dissection in patients with atypical life structures. With some restrictions the incorporated innovation of indocyanine green fluorescence with near-infrared imaging systems was practical and a promising strategy for lymphatic mapping in laparoscopic and robotic gastrectomy for gastric cancer

A Review on Clinical Outcomes of Pancreaticoduodenectomy in Octogenarian Patients

Management of malignant diseases in elderly patients has been a global clinical issue because of increased life expectancy worldwide. Currently, pancreatic adenocarcinoma mainly occurs after 60 years of age, and its prognosis remains poor despite modest improvements in recent decades. Surgical resection is the only potentially curative treatment for pancreatic cancer. Resection of the pancreas, either by pancreaticoduodenectomy (PD) or laparoscopic pancreaticoduodenectomy (LPD) is a complex surgical procedure with a high rate of morbidity and mortality. However, mortality rates after pancreatic surgery have dropped to less than 2-5% at experienced centers. Whereas, complication rates are high, reaching at least 30% in many centers. Mortality also increases proportionally with age viz. 6.7% of patients aged 65-69 years, 9.3% of patients aged 70-79 years, and 15.5% of patients aged 80 years or older. The present review article delineates clinical outcomes along with safety, morbidity and mortality after PD or LPD in elderly, especially in octogenarian patients

Robotic Radical Nephrectomy with Vena Cava Thrombus Extraction (RRN-VCTE) for Renal Cell Carcinoma: A Meta-Analysis of Surgical Technique and Outcomes

Renal cell carcinoma (RCC) with vena cava tumor thrombus is a challenging condition, which requires complex surgical management. Robotic radical nephrectomy with vena cava thrombus extraction (RRN-VCTE) has emerged as a promising and minimally invasive technique. This meta-analysis aims to review the surgical technique and outcomes of RRN-VCTE in patients with RCC and vena cava tumor thrombus. A comprehensive literature search was conducted using databases, including PubMed, Embase, and Cochrane Library. Studies published in English till October 2021 were included. Keywords used for the search included “robotic radical nephrectomy,” “vena cava tumor thrombus,” “surgical technique,” and “outcomes.” Studies that reported on patient outcomes and surgical techniques of RRN-VCTE were included. Statistical analysis was performed to assess the pooled outcomes. The meta-analysis included 16 studies comprising 298 patients who underwent RRN-VCTE. The majority of patients were males (62.4%) with a median age of 58.9 years. The median tumor size was 7.2 cm, and 93.9% of patients had level 3 or 4 vena cava thrombus. The mean operating time was 328 min, with a range of 248–423 min. Blood loss ranged from 100 to 1500 mL. The overall complication rate was 26.5%, with no reported deaths. The average hospital stay was 9.5 days. The 2-year and 5-year survival rates were 77.5 and 53.1%, respectively. RRN-VCTE is a promising and minimally invasive surgical technique for RCC with vena cava tumor thrombus, whch is associated with low complication rates and acceptable oncological outcomes. Further research is needed to confirm the long-term survival rates and compare RRN-VCTE outcomes with conventional surgical techniques. Nonetheless, RRN-VCTE appears to be a valuable option for patients with RCC and vena cava tumor thrombus