Harmonic long shears further reduce operation time in transanal endoscopic microsurgery

Background: Previous research indicates that application of 5-mm harmonic shears rather than diathermia significantly reduces operation time in transanal endoscopic microsurgery (TEM). Frequently, however, additional instruments were required to complete resection. We investigated whether the new 5-mm harmonic long shears (H-LS) are better equipped for TEM compared with regular harmonic shears (HS). Methods: Between 2001 and 2006, 162 tumors (117 adenomas, 42 carcinomas, and 3 other tumors; mean distance 6.6 cm, mean area 40 cm2) were excised in 161 patients (82 men, 79 women; mean age 66 years). Results: Eighty-eight resections were performed with HS and 74 with H-LS. Tumor and patient characteristics were similar except for specimen area. Tumors resected by H-LS were on average smaller than those resected by HS (34.4 versus 44.1 cm2; Mann-Whitney U-test: p = 0.027). Mean operation time was 48 min and proportional to area in both groups (univariate analysis of variance p<0.001). Mean operation time was 54 min using HS and 41 min using H-LS (t-test: p<0.001). After correction for area, operation time for H-LS was reduced by 14% compared with HS (t-test: p<0.001). H-LS is singly capable of completing resection in 88% compared with 26% for HS (Mann- Whitney U-test: p<0.001). Mean blood loss was 16 cc for HS and 3 cc for H-LS (p<0.001). Morbidity (11%) and mortality (0.6%) were not different between the two groups (Fisher's exact test). Conclusion: Performing transanal endoscopic microsurgery with 5-mm harmonic long shears reduces operation time compared with regular shears, and completing resection seldom requires other instruments

Problematiche di chirurgia generale nel paziente cardiochirurgico

Editore Luigi Pozzi Rom

Laparoscopic ultrasonography: limits and potential of present technologies.

During recent years, laparoscopic contact sonography has been introduced into clinical practice to remedy the limitations of minimal invasive surgery. The technology of laparoscopic ultrasound probes is described in this paper as well as the technique of US contact scanning via the laparoscopic approach. This method is a tool which allows the examination of tissues and non-palpable parenchymal organs in endoscopic surgery, thus permitting correct assessment of both anatomy and the spreading of neoplasms, with consequent impact upon surgical decision making

Trans-vaginal repair of recurrent rectovaginal fistula with interposition of BIO-A Tissue Reinforcement

Rectovaginal fistulas (RVFs) represent the majority of all symptomatic leakages after anterior and low anterior resection in women. Conservative management is useful in paucisymptomatic patients with small fistulas but is usually unsuccessful in all other cases. The surgical strategies are various and heavily dependent on the type and extent of anatomic involvement. We present a case of a 51-year-old female with a multi-recurrent rectovaginal fistula that occurred since a laparoscopic sigmoidectomy was performed for a complicated diverticular disease in May 2015. An attempt to close the fistula was undertaken three times. In July 2019, a transvaginal repair was performed with interposition in the rectovaginal septum of GORE® BIO-A® Tissue Reinforcement. The postoperative course was uneventful. There was no recurrence and functional outcome was good at 24-months follow-up. Rectovaginal fistula can be successfully treated using the interposition of a GORE® BIO-A® Tissue Reinforcement with significant economic savings and good functional outcomes even through a transvaginal approach. It represents a therapeutic option for an otherwise difficult-to-treat complex fistula

Manuale di terapia enterostomale

Corretta esecuzione stomie intestinali e prevenzione delle complicanz

Insufficienza multisistemica (Multi Organ Failure)

Editrice L’Antologia Napol