Central pancreatectomy - indications revisited

Institutul Clinic Fundeni, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Pancreatectomia alternativă la rezecțiile standard (duodenopancreatectomia cefalica și pancreatectomia distală) pentru leziuni situate la nivelul istmului și corpului de pancreas. Principalul avantaj este reprezentat de conservarea atât a funcției exocrine cât și a celei endocrine a pancreasului. Dezavantajul major este reprezentat de morbiditatea postoperatorie crescută, reprezentată în principal de fistula pancreatică. Cele mai frecvente indicații ale pancreatectomiei centrale sunt reprezentate de tumorile benigne și cu potențial redus de malignizare. Chiar dacă acest procedeu chirurgical este contraindicat în carcinomul ductal de pancreas, totuși, o serie de alte malignități speciale ale pancreasului cum ar fi metastazele pancreatice ale altor neoplazii sau pancreatoblastomul pot beneficia, în anumite situații, de acest tip de intervenție chirurgicală. Deși nu este o procedură chirurgicală foarte frecvent utilizată, pancreatectomia centrală, își găsește locul în arsenalul rezectiilor pancreatice.Central pancreatectomy has emerged as a pancreas-sparing alternative technique to standard pancreatic resections (i.e. pancreatico-duodenectomy and distal pancreatectomy) for pancreatic lesions located to the isthmus and body. The main advantage is related to a better preservation of both exocrine and endocrine pancreatic functions. Conversely, the major concern is related to the high postoperative morbidity, mainly related to the postoperative pancreatic fistula rate. The most frequent reported indications for central pancreatectomy are represented by benign and low-malignant lesions of the pancreas. Although central pancreatectomy is not indicated for ductal adenocarcinoma of the pancreas, however, for certain special malignancies of the pancreas (i.e. metastasis to the pancreas of others neoplasia, pancreatoblastoma), central pancreatectomy has been proven to be a safe operation. Although central pancreatectomy is not a frequent operation, it should be included in pancreatic surgeons’ armamentarium for certain indications

Miniinvasive approach in esophageal tumoral pathology

Institultul Clinic Fundeni - Clinica Chirurgie Generală şi Transplant Hepatic “Dan Setlacec”, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Chirurgia esofagiană este grevată de morbiditate şi mortalitate crescute legate în special de trauma chirurgicală. Abordul miniinvaziv are ca scop optimizarea acestor parametrii prin diminuarea traumei chirurgicale. Este prezentată experienţa Centrului de Chirurgie Generală şi Transplant Hepatic “Dan Setlacec” din Institutul Clinic Fundeni în abordul miniinvaziv în patologia tumorală esofagiană.Morbidity and mortality in esophageal resection remain high, due especially to surgical injury. Miniinvasive surgical approach is used in order to decrease both parameters, by lowering surgical associated trauma.The aim of this study is to analyze the outcome of patients reffered for miniinvasive esophageal resection in Center for General Surgery and Liver Transplantation “Dan Setlacec” from Fundeni Clinical Institute

Augmented versus Virtual Reality Laparoscopic Simulation: What Is the Difference?: A Comparison of the ProMIS Augmented Reality Laparoscopic Simulator versus LapSim Virtual Reality Laparoscopic Simulator

BACKGROUND: Virtual reality (VR) is an emerging new modality for laparoscopic skills training; however, most simulators lack realistic haptic feedback. Augmented reality (AR) is a new laparoscopic simulation system offering a combination of physical objects and VR simulation. Laparoscopic instruments are used within an hybrid mannequin on tissue or objects while using video tracking. This study was designed to assess the difference in realism, haptic feedback, and didactic value between AR and VR laparoscopic simulation. METHODS: The ProMIS AR and LapSim VR simulators were used in this study. The participants performed a basic skills task and a suturing task on both simulators, after which they filled out a questionnaire about their demographics and their opinion of both simulators scored on a 5-point Likert scale. The participants were allotted to 3 groups depending on their experience: experts, intermediates and novices. Significant differences were calculated with the paired t-test. RESULTS: There was general consensus in all groups that the ProMIS AR laparoscopic simulator is more realistic than the LapSim VR laparoscopic simulator in both the basic skills task (mean 4.22 resp. 2.18, P <0.000) as well as the suturing task (mean 4.15 resp. 1.85, P <0.000). The ProMIS is regarded as having better haptic feedback (mean 3.92 resp. 1.92, P <0.000) and as being more useful for training surgical residents (mean 4.51 resp. 2.94, P <0.000). CONCLUSIONS: In comparison with the VR simulator, the AR laparoscopic simulator was regarded by all participants as a better simulator for laparoscopic skills training on all tested feature

The IASLC/ITMIG thymic epithelial tumors staging project: Proposals for the T component for the forthcoming (8th) edition of the TNM classification of malignant tumors

Despite longstanding recognition of thymic epithelial neoplasms, there is no official American Joint Committee on Cancer/ Union for International Cancer Control stage classification. This article summarizes proposals for classification of the T component of stage classification for use in the 8th edition of the tumor, node, metastasis classification for malignant tumors. This represents the output of the International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group Staging and Prognostics Factor Committee, which assembled and analyzed a worldwide database of 10,808 patients with thymic malignancies from 105 sites. The committee proposes division of the T component into four categories, representing levels of invasion. T1 includes tumors localized to the thymus and anterior mediastinal fat, regardless of capsular invasion, up to and including infiltration through the mediastinal pleura. Invasion of the pericardium is designated as T2. T3 includes tumors with direct involvement of a group of mediastinal structures either singly or in combination: lung, brachiocephalic vein, superior vena cava, chest wall, and phrenic nerve. Invasion of more central structures constitutes T4: aorta and arch vessels, intrapericardial pulmonary artery, myocardium, trachea, and esophagus. Size did not emerge as a useful descriptor for stage classification. This classification of T categories, combined with a classification of N and M categories, provides a basis for a robust tumor, node, metastasis classification system for the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control stage classification

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular transmission leading to generalized or localized muscle weakness due most frequently to the presence of autoantibodies against acetylcholine receptors in the postsynaptic motor end-plate. Myasthenic crisis (MC) is a complication of MG characterized by worsening muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. It also includes postsurgical patients, in whom exacerbation of muscle weakness from MG causes a delay in extubation. MC is a very important, serious, and reversible neurological emergency that affects 20–30% of the myasthenic patients, usually within the first year of illness and maybe the debut form of the disease. Most patients have a predisposing factor that triggers the crisis, generally an infection of the respiratory tract. Immunoglobulins, plasma exchange, and steroids are the cornerstones of immunotherapy. Today with the modern neurocritical care, mortality rate of MC is less than 5%

Robot-Assisted Hybrid Laparoscopic Roux-en-Y Gastric Bypass: Surgical Technique and Early Outcomes

BACKGROUND: Roux-en-Y gastric bypass performed laparoscopically remains the gold standard in bariatric surgery. The role of robot-assisted laparoscopic Roux-en-Y gastric bypass has not been clearly defined. METHODS: We present 80 consecutive cases of robot-assisted laparoscopic Roux-en-Y gastric bypass performed at a single institution. Mechanics, early outcomes, and learning curve are evaluated. Eighty robot-assisted laparoscopic Roux-en-Y gastric bypasses were performed on 71 women and 9 men with a mean age of 39 years, mean preoperative weight of 134 kg, and mean BMI of 48. RESULTS: Total mean operative time was 209 minutes. There was no mortality, leak, stricture, or obstruction. CONCLUSION: Robot-assisted laparoscopic Roux-en-Y gastric bypass is a safe and feasible option for bariatric surgery. Its role in improving surgical outcomes needs to be defined further