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Laparoscopic liver resection: Toward a truly minimally invasive approach

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World Journal of Gastrointestinal Endoscopy 2015年第3期7卷 159-161页

作者： Satoshi Ogiso Etsuro Hatano Takeo Nomi Shinji Uemoto Division of Hepato-Biliary-Pancreatic Surgery and Transplantation Department of Surgery Graduate School of Medicine Kyoto University Department of Surgery Nara Medical University

In the surgical treatment of hepatocellular carcinoma and colorectal liver metastasis, it is important to preserve sufficient liver volume after resection in order to avoid post-hepatectomy liver sufficiency and to increase the feasibility of repeated hepatectomyin case of intrahepatic recurrence. Parenchymasparing approach, which minimizes the extent of resection while obtaining sufficient surgical margins, has been developed in open hepatectomy. Although this approach can possibly have positive impacts on morbidity and mortality, it is not popular in laparoscopic approach because parenchyma-sparing resection is technically demanding especially by laparoscopy due to its intricate curved transection planes. "Small incision, big resection" is the words to caution laparoscopic surgeons against an easygoing trend to seek for a superficial minimal-invasiveness rather than substantial patient-benefits. Minimal parenchyma excision is often more important than minimal incision. Recently, several reports have shown that technical evolution and accumulation of experience allow surgeons to overcome the hurdle in laparoscopic parenchymasparing resection of difficult-to-access liver lesions in posterosuperior segments, paracaval portion, and central liver. Laparoscopic surgeons should now seek for the possibility of laparoscopic parenchyma-sparing hepatectomy as open approach can, which we believe is beneficial for patients rather than just a small incision and lead laparoscopic hepatectomy toward a truly minimally-invasive approach.

关键词： Laparoscopy Liver resection Hepatectomy minimally-invasive Parenchyma-sparing Laparoscopicsurgery Hepatocellular carcinoma Liver metastasis Liver lesion Colorectal carcinoma

Endoscopic Management of Pediatric Cholesteatoma

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Journal of Otology 2020年第1期15卷 17-26页

作者： Peter J.Ryan Nirmal P.Patel Department of Otolaryngology and Head and Neck Surgery Royal North Shore HospitalSt LeonardsNSWAustralia Kolling Deafness Research Centre Macquarie University and University of SydneyNSWAustralia

Pediatric cholesteatoma occurs in one of two forms:congenital cholesteatoma,developing from embryonic epidermal cell rests or acquired cholesteatoma,associated with a focal defect in the tympanic membrane.This disease has been traditionally managed with the operating microscope,often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities.Recently,advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive,transcanal endoscopic approach.This review discusses the current literature relating to the etiopathogenesis,assessment and endoscopic management of pediatric cholesteatoma.Early outcomes of endoscopic treatment,emerging trends and technologies are also reviewed.

关键词： Cholesteatoma Pediatric Endoscopic minimally-invasive Middle ear Mastoid

Intravenous leiomyomatosis with different surgical approaches:Three case reports

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World Journal of Clinical Cases 2019年第3期7卷 347-356页

作者： Jie He Zheng-Bo Chen San-Ming Wang Mu-Biao Liu Zhi-Gang Li Hai-Yan Li Gang Zhao Department of Cardiovascular Surgery Guangdong Cardiovascular InstituteGuangdong General Hospital Guangdong Academy of Medical Sciences Department of Vascular Surgery Guangdong Cardiovascular Institute Guangdong General Hospital Guangdong Academy of Medical Sciences Department of Gynecology and Obstetrics Guangdong General Hospital Guangdong Academy of Medical Sciences

BACKGROUND Intravenous leiomyomatosis(IVL) is a rare and complicated disease, which requires surgery by a multidisciplinary team. However, the optimal surgical approach has not been determined.CASE SUMMARY Here we report three cases of IVL treated with different surgical approaches. All patients presented with circulation symptoms. Two patients had lower extremity edema and the other had cardiopalmus. The diagnosis of IVL was confirmed based on the imagining examinations and pathological findings. All patients underwent surgical treatment and were discharged without any complications.CONCLUSION Preoperative examination is crucial for surgical planning and surgical approach is dependent on the patient's condition and tumor involvement.

关键词： Intravenous leiomyomatosis Surgery Cardiac tumors Case report minimally-invasive

Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi:A case report

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World Journal of Clinical Cases 2019年第12期7卷 1461-1466页

作者： Luca Morelli Niccolò Furbetta Desirée Gianardi Matteo Palmeri Gregorio Di Franco Matteo Bianchini Gianni Stefanini Simone Guadagni Giulio Di Candio General Surgery Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa 56124 Italy EndoCAS (Center for Computer Assisted Surgery) University of Pisa Pisa 56124 Italy

BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.

关键词： Case report da Vinci Xi EndoWrist stapler Walled-off pancreatic necrosis TilePro minimally-invasive surgery

Laparoscopic Liver Resection: A Tool to Improve Outcomes in Obese Patients Requiring Liver Resection

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Open Journal of Gastroenterology 2022年第12期12卷 347-360页

作者： Asmita Chopra Michael Devries Rachel Mullins Roberta Redfern Kerri Ann Simo Department of Surgery University of Toledo School of Medicine Toledo Ohio Promedica Health System Toledo Hospital Toledo Ohio

Introduction: Obesity is associated with an increased risk of fatty liver disease, predisposing to liver fibrosis and cirrhosis, as well as increased occurrence of hepatocellular carcinoma. Obesity is intuitively considered a risk factor for increased post-hepatectomy morbidity and mortality. Nevertheless, peer-reviewed literature reveals significant heterogeneity between different cohorts contributing to varying conclusions. Outcomes in this cohort for Laparoscopic Liver Resection (LLR), especially in non-academic settings remain under-evaluated. The current study evaluated outcomes of LLR in obese patients, in a community health system. Methods: A retrospective analysis of all patients undergoing LLR at the flagship hospital in the community health system, between 2013 and 2020, was performed. Classified into two groups based on Body Mass Index (BMI): obese (BMI > 30 kg/m2) vs non-obese (BMI Results: 90 patients underwent LLR during the 7-year period;obese = 38 and non-obese = 52. No statistically significant differences were noted between obese and non-obese cohorts, in baseline characteristics including age (53.1 ± 15.1 vs 56.8 ± 11.6 years), female gender (60.5% vs 53.8%), and ASA grade (3.13 ± 0.53 vs 3.02 ± 0.54) (all p > 0.05). Univariate analysis showed no statistically significant differences between obese and non-obese groups, comparing estimated blood loss [300 (100 - 500) vs. 200 (100 - 462.5) cc], operative time [177 (125 - 215) vs. 150.9 (111 - 207) minutes], bile leak (2.6% vs. 4.1%), post-operative bleeding (2.6% vs. 4.1%), infection (0% vs. 4.1%), cardiorespiratory complication (10.5% vs 12.2%), conversion rate (5.3% vs 5.8%), length of stay [4 (3 - 5) vs. 4 (2 - 5) days], 90-day reoperation (0% vs. 2%) and 90-day readmission (2.6% vs. 4.1%) (p > 0.05). Multivariate analysis showed no association between obesity and composite complication rate (p = 0.97), after adjusting for alcohol abuse, neoadjuvant therapy, and prior liver surgery. Conclusion: LLR is a key technique that can be rep

关键词： Liver Resection Laparoscopic Obesity Surgical Outcomes minimally-invasive

Endoscopic excision of a tympanic paraganglioma: Training the next generation of ear surgeons

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2017年第3期3卷 160-162页

作者： Natasha Pollak Resha S.Soni Department of Otolaryngology-Head(&)Neck Surgery Lewis Katz School of Medicine Temple University Philadelphia PA USA

Tympanic paragangliomas are uncommon vascular tumors of neural crest origin.Classically these lesions have been surgically managed via a transcanal or transmastoid approach using binocular microscopy.We describe a case in which a tympanic paraganglioma was removed via a transcanal approach,using the endoscope exclusively.Endoscopic ear surgery enhances visualization,helping to ensure complete tumor removal,while reducing unnecessary dissection and its associated morbidity.For small middle ear neoplasms,a purely endoscopic approach is feasible,with excellent results.Resident education in ear surgery has also been enhanced by the use of endoscopes.The wide field of view provided by the endoscope helps trainees understand the intricate three-dimensional anatomy of the middle ear cleft.

关键词： Paraganglioma Glomus tympanicum Endoscopic ear surgery minimally-invasive ear surgery Otolaryngology education Surgery education

Narrow band imaging evaluation of duodenal villi in patients with and without celiac disease:A prospective study

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World Journal of Gastrointestinal Endoscopy 2019年第2期11卷 145-154页

作者： James H Tabibian Jean F Perrault Joseph A Murray Konstantinos A Papadakis Felicity T Enders Christopher J Gostout Division of Gastroenterology and Hepatology Mayo Clinic Division of Gastroenterology Olive View-UCLA Medical Center Division of Biomedical Statistics and Informatics Mayo Clinic

BACKGROUND Duodenal biopsies are commonly obtained during esophagogastroduodenoscopy(EGD) but are very often histopathologically normal. Therefore, a more strategic method for evaluating the duodenal mucosa and avoiding unnecessary biopsies is needed.AIM To examine the clinical utility of narrow band imaging(NBI) for evaluating duodenal villous morphology.METHODS We performed a prospective cohort study of adult patients at Mayo Clinic Rochester from 2013-2014 who were referred for EGD with duodenal biopsies. A staff endoscopist scored, in real-time, the NBI-based appearance of duodenal villi into one of three categories(normal, partial villous atrophy, or complete villous atrophy), captured ≥ 2 representative duodenal NBI images, and obtained mucosal biopsies therein. Images were then scored by an advanced endoscopist and gastroenterology fellow, and biopsies(gold standard) by a pathologist, in a masked fashion using the same three-category classification. Performing endoscopist, advanced endoscopist, and fellow NBI scores were compared to histopathology to calculate performance characteristics [sensitivity, specificity,positive and negative, negative predictive value(NPV), and accuracy]. Inter-rater agreement was assessed with Cohen's kappa.RESULTS112 patients were included. The most common referring indications were dyspepsia(47%), nausea(23%), and suspected celiac disease(14%). Duodenal histopathology scores were: 84% normal, 11% partial atrophy, and 5% complete atrophy. Performing endoscopist NBI scores were 79% normal, 14% partial atrophy, and 6% complete atrophy compared to 91%, 5%, and 4% and 70%, 24%,and 6% for advanced endoscopist and fellow, respectively. NBI performed favorably for all raters, with a notably high(92%-100%) NPV. NBI score agreement was best between performing endoscopist and fellow(κ = 0.65).CONCLUSION NBI facilitates accurate, non-invasive evaluation of duodenal villi. Its high NPV renders it especially useful for foregoing biopsies of histopathologically normal duodenal mucosa.

关键词： Endoscopy Digestive tract Mucosa Celiac disease minimally-invasive imaging Esophagogastroduodenoscopy

Emerging technology in acute resuscitation monitoring

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Open Journal of Nursing 2012年第3期2卷 332-335页

作者： Matthew Tichauer Jonathan McCoy Department of Emergency Medicine Robert Wood Johnson Medical School New Brunswick USA

Fluid optimization in the resuscitation of shock became the mainstay of treatment following the advent of Early Goal-Directed Therapy (EGDT) by Rivers et al. in 2001 [1]. Patients presenting in shock require prompt optimization of volume status and cardiac out- put to ensure adequate perfusion. Poor optimization may be associated with prolonged hospital and intensive care unit stays. The prior gold standard, pulmonary artery catheterization, is rarely available in the emergency department setting and its invasive nature has led to recent re-evaluation of its clinical utility. However, there are new monitoring technologies that are being studied in the intensive care unit setting that may soon be available in emergency departments to aid in nursing and physician decision making to improve acute resuscitation.

关键词： Critical Care Monitoring minimally-invasive Resuscitation

Laparoscopic liver resection for hepatocellular adenoma

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World Journal of Gastrointestinal Surgery 2011年第7期3卷 101-105页

作者： Mohammed Abu Hilal Francesco Di Fabio Robert David Wiltshire Mohammed Hamdan David M Layfield Neil William Pearce Hepatobiliary and Pancreatic Surgical Unit Southampton University Hospitals NHS TrustTremona RoadSouthampton SO16 6YDUnited Kingdom

AIM:To investigate the role of laparoscopy in the surgical management of hepatocellular adenoma(HA). METHODS:We reviewed a prospectively collected database of consecutive patients undergoing laparoscopic liver resection for HA. RESULTS:Thirteen patients underwent fifteen pure laparoscopic liver resections for HA(male/female:3/10; median age 42 years,range 22-72 years).Two patients with liver adenomatosis required two different laparoscopic operations for ruptured adenomas.Indications for surgery were:symptoms in 12 cases,need to rule out malignancy in 2 cases and preoperative diagnosis of large HA in one case.Symptoms were related to bleeding in 10 cases,sepsis due to liver abscess following embolization of HA in one case and mass effect in one case(shoulder tip pain).Five cases with ruptured bleeding adenoma required emergency admis-sion and treatment with selective arterial embolization. Laparoscopic liver resection was then semi-electively performed.Eight patients(62%)required major hepatectomy[right hepatectomy(n=5),left hepatectomy (n=3)].No conversion to open surgery occurred.The median operative time for pure laparoscopic procedures was 270 min(range 135-360 min).The median size of the excised lesions was 85 mm(range 25-180 mm). One patient with adenomatosis developed postoperative bleeding requiring embolization.Mortality was nil. The median hospital stay was 4 d(range 1-18 d)with a median high dependency unit stay of 1 d(range 0-7 d). CONCLUSION:The laparoscopic approach represents a safe option for the management of HA in a semi-elective setting and when major hepatectomy is required.

关键词： Laparoscopy minimally-invasive surgery Hepatocellular adenoma Major hepatectomy Outcome