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PubMed1980

[Extensive lymphadenectomy in operations for stomach cancer].

Serial histological assays of lymph nodes removed during extensive lymphadenectomy not infrequently reveal metastases, in case of gastric cancer, in paraaortic lymph nodes and the nodes located along the celiac trunk, splenic and hepatic vessels. Among 35 patients 19 showed metastases in these nodes. Metastases were detected also in cases when lymphnodes of these collectors seem to be intact (in8 of 23 patients). Routine lyphadenectomy is unlikely to be considered radical. A total of 112 operations with extensive lymphadenectomy have been performed: gastrectomy (84), distal resection (12), proximal resection (13), extirpation of the gastric stump (3). Of special value is transabdominal approach associated with instrumental correction by dilators attached to an operating table (the technic suggested by M. Z. Sigal). The technic of this operation is described. A total mortality rate was 14.3%. There were no lethal complications due to lymphadenectomy. It seems rational to revise the currently used estimates of the degree of radicality of lymphadenectomy in gastric cancer.

Adult↗
PubMed1995

[Transesophageal and epicardial echocardiography in the evaluation of conservative surgery of the mitral valve. Complementary methods?].

BACKGROUND: Over the last two decades several new surgical methods for repairing a regurgitant mitral valve have been proposed. Unfortunately, early applications of such techniques were not always encouraging because the evaluation in the operating room led to false optimism due to a marked difference between static and functional anatomy of the repaired valve. By means of intraoperative echocardiography, be it transesophageal or epicardial, it is now possible to assess the functional result immediately after valvuloplasty and to decide about further surgery, right at the operating table. MATERIALS AND METHODS: Thirty-six patients (mean age 61.8 years) who underwent mitral valve repair were studied; all underwent preoperative transthoracic echocardiography in the week preceding surgery, and intraoperative transesophageal echo before cardiopulmonary bypass. The surgical results were evaluated by epicardial and/or transesophageal echocardiography in the operating room, and by transthoracic and/or transesophageal approach during follow-up. RESULTS: In 5 patients with intraoperative echocardiography done before valve repair, leaflets pathology and subvalvular apparatus were better evaluated. Besides, in 3 patients the more evident calcification of the leaflets led the surgeon to decide on direct replacement rather the reconstruction of the valve. The postoperative assessment has shown an unsatisfactory correction in 8 patients (24%). In 4 of these patients an important mitral regurgitation was reported and in 2 there was a moderate regurgitation. In the last 2, a iatrogenic stenosis had resulted. Of these 8 patients, 6 underwent valve replacement using an artificial valve. The other 2 patients (one with moderate stenosis and the other with moderate regurgitation) did not undergo a second operation because of the excessive operating time taken for valvuloplasty and the advanced age of the patients. During follow-up, from 6 to 54 months, a remarkable mitral regurgitation was present in 4 patients, one being severe and the other moderate. A persistence of ventricular dilatation was present only in these patients, while in the remainder the left ventricular diameters were normal. Finally, the mitral valve area after six months was between 1.5 an d4 cm2. CONCLUSIONS: Intraoperative echocardiography, both transesophageal and epicardial, can help the surgeon by giving him useful diagnostic information, if carried out before reconstructing the mitral valve with regurgitation. Its application is even more useful if applied straight after the surgical intervention. Unsatisfactory results may be evidenced at once and the operating team will decide right at the table for further repair or replacement, thus avoiding a second operation and the relevant risks.

Aged↗
PubMed2004

Robot-assisted laparoscopic cholecystectomy: initial Mayo Clinic Scottsdale experience.

OBJECTIVE: To review a single institution's experience with robot-assisted laparoscopic cholecystectomy. PATIENTS AND METHODS: We reviewed retrospectively all cholecystectomies performed with the assistance of a surgical robot at the Mayo Clinic in Scottsdale, Ariz, from October 2002 to July 2003. Cholanglograms were obtained intraoperatively for patients with elevated results on liver function tests. The gallbladder was removed by the surgeon with the use of the robot. A surgical assistant at the operating table exchanged instruments in the robot arms and applied clips when needed. Total operating time, assembly time of the robot, complications, and postoperative course were evaluated. RESULTS: Nineteen patients underwent robot-assisted laparoscopic cholecystectomy; 16 had symptomatic cholelithiasis, 2 had gallbladder polyps, and 1 had acute cholecystitis. Of the 19 surgeries, 16 were completed successfully with robotic assistance. In 3 consecutive patients, a mechanical problem occurred with the robot; however, all procedures were completed laparoscopically. The mean set-up time, including patient positioning and preparation and robotic installation, was 28.1 minutes. The mean +/- SD operating time was 82.3+/-17.9 minutes without a cholanglogram and 102+/-20.9 minutes with a cholanglogram. There were no complications and no conversions to an open procedure. CONCLUSION: Robotic surgery offers many potential advantages, including surgeon comfort, elimination of surgeon tremor, improved imaging, and increased degrees of freedom of the operative Instruments, compared with conventional laparoscopic surgery. However, patient outcomes and operative costs need to be evaluated further.

Adult↗
PubMed1999

A case of thoracoscopic bilateral lung volume reduction surgery in a supine position.

We present a case of thoracoscopic bilateral lung volume reduction surgery performed with the patient in a supine position. By rotating the operative table, bilateral apical resection could be performed without difficulty. The duration of the operation was 160 minutes and the patient's forced expiratory volume in 1 second improved from 0.81 l to 2.49 l.

Endoscopy↗
PubMed1991

Meralgia paresthetica after coronary bypass surgery.

Meralgia paresthetica is a neurologic disorder characterized by localized paresthesia and numbness on the anterolateral aspect of the thigh and involving the lateral femoral cutaneous nerve. It involves no motor deficits. Meralgia paresthetica, which may result from a variety of causes, has been observed as a rare complication in heart operations. Its cause when associated with such operations is uncertain but may be prolonged relaxed positioning on the operating table and recovery room stretcher. Another possible cause of meralgia paresthetica after heart operations is the "frog-leg" position of the legs during vein harvesting. Patients with this condition should be advised of its untreatable, but benign and self-limiting, nature.

Aged↗
PubMed1989

[Repositioner of external fragment of mandibular ramus (ramus repositioner) in sagittal split ramus osteotomy of mandible].

In sagittal ramus split osteotomy of the mandible, rigid internal fixation of the fragments with screws has become one of the main fixation techniques. This screw-fixation has the advantages to reduce the period of intermaxillary fixation which is unpleasant for patients. On the other hand, it is necessary that the condyles are exactly positioned to the glenoid fossa after surgical correction. Incorrect repositioning of the mandibular ramus will induce serious problems, e.g. relapse caused by mandibular movement, pain of temporomandibular joint, occlusal dysfunction, etc. Some surgeons make efforts to avoid the problems by various methods. Postoperative radiographs are one of the procedures, which taken while the patient is on the operating table. Various appliances are also used for the purpose of repositioning ramus at operation. We have devised a simple appliance that allows the surgeon to be sure that the position of the external fragments of the mandibular ramus will be precisely established. We named this appliance "ramus repositioner". It consists of 1.2 mm orthodontic wire in diameter, cold-cure acrylic resin and titanium mini-plates. It is fabricated and tried to fit prior to the operation. At operation, both ends of its orthodontic wire are inserted into the tubes on the buccal surfaces of the maxillary first molars. The positions of the mandibular ramus involved condyles are recorded by mini-plates on this appliance with its exclusive self-tapping screws preoperatively. Then the appliance is removed and mandible is splitted. After splitting, the appliance is replaced with the screw hole landmarks that tapped before.(ABSTRACT TRUNCATED AT 250 WORDS)

Fracture Fixation, Internal↗
PubMed1991

[Injury of the left hepatic vein by a large hepatic echinococcal cyst].

While different sorts of affection of the biliary tree by the hydatide cysts of the liver are frequent (20-30%), vascular complications are rare. That is why serious peroperative bleedings are usually caused by surgical mistakes. Bleeding caused by hydatide cyst itself is very rare, sudden, abundant, dramatic and usually lethal on the operative table. We present a 76-years-old man in whom during the operation of a huge hydatide liver cyst, sudden and abundant bleeding from the defect (2 x 0.5 cm) of the left hepatic vein caused by the cyst itself, appeared. The bleeding was successfully solved by direct suture of the defect. Three months later hepatitis B viral infection manifested apparently after numerous blood and plasma transfusions during surgery, and patient died in hepato-renal syndrome.

Aged↗
PubMed1991

Surgical face masks in modern operating rooms--a costly and unnecessary ritual?

Following the commissioning of a new suite of operating rooms air movement studies showed a flow of air away from the operating table towards the periphery of the room. Oral microbial flora dispersed by unmasked male and female volunteers standing one metre from the table failed to contaminate exposed settle plates placed on the table. The wearing of face masks by non-scrubbed staff working in an operating room with forced ventilation seems to be unnecessary.

Air Microbiology↗
PubMed1999

Training in abdominal aortic aneurysm (AAA) repair: 1987-1997.

OBJECTIVES: in the U.K. a decrease in working hours has led to shortening of surgical training. Operative experience must, therefore, be gained more quickly. The aim of this study was to examine the effect of these changes in relation to outcome following abdominal aortic aneurysm (AAA) repair; a vascular "indicator" operation as defined by the U.K. Royal Colleges. DESIGN, MATERIALS AND METHODS: analysis of a prospectively gathered database of 1136 consecutive elective and emergency AAA repairs. Two time periods, 1987-1991 and 1992-1997, are compared. RESULTS: since 1991 consultants have performed fewer asymptomatic (95/130 vs. 135/244,p =0.0012, chi-square test), elective symptomatic (51/72 vs. 32/62, p =0.035), emergency symptomatic (33/49 vs. 38/82, p =0.031) and ruptured (173/229 vs. 160/268, p =0.0003) AAA repairs. This has been associated with a significant increase in the proportion of procedures where a trainee is assisted by a consultant or operates "solo". Operative mortality did not change significantly between the two time periods, and was not affected by the absence of a consultant from the operating table. CONCLUSIONS: supervised trainees can perform an increasing proportion of AAA surgery without increasing operative mortality and can safely operate "solo" in selected cases. Auditing training in relation to clinical outcome is mandatory if the needs of patients and training surgeons are both to be met.

Aortic Aneurysm, Abdominal↗
PubMed1997

[Factors for postoperative persistent hypertension in patients with aldosterone-producing adenoma].

We determined the factors for postoperative persistent hypertension in the patients with aldosterone-producing adrenal adenoma (APA) in 53 patients with APA who were followed up for average 3.1 years. All had normal serum potassium concentration postoperatively. Blood pressure was normal in 37 patients (69.8%) but 18.7/12.7 kPa or more in 16 patients (30.2%) with persistent hypertension. Also compared were sex, age, history of hypertension, effect of reducing blood pressure to antisterone, preoperative blood pressure, time of persistent hypertension, serum potassium concentration, aldosterone concentration in 24 hour urine, amount of PRA, and the type of operation. The results showed that an APA patient aged 50 years or more appears to have a great chance of persistent hypertension than an APA patient under age of 40 years, and the odds ratio is 3:1. There was a significant difference between the mean age for persistent hypertension and for normal blood pressure, and varioas response of reducing blood pressure to antisterone (P < 0.05). It is suggested that for an older APA patient and the patient without of reducing blood pressure to antisterone, there are other factors for hypertension such as renal veinlet change or renal interstitial lesions except for hyperaldosteronism. We recommend renal biopsy (using kidney puncture) at the operating table for those patients in order to understand pathological change and guide treatment after operation.

Adenoma↗
PubMed2001

A comparison of 1.5% glycine and 2.7% sorbitol-0.5% mannitol irrigants during transurethral prostate resection.

PURPOSE: We performed a prospective randomized trial comparing glycine 1.5% with 2.7% sorbitol-0.5% mannitol irrigating solution. We evaluated blood loss, fluid absorption, temperature change, cardiac effects and postoperative symptoms. MATERIALS AND METHODS: Between April 1998 and July 1999, 205 treated patients were included in the statistical analysis. Intraoperative irrigating fluid absorption was measured with the patient on the operating table. Serum cardiac troponin I was used as a marker of perioperative myocardial damage. Operative details were recorded, including the type of anesthesia, resection time and the weight of resected tissue. Postoperative symptoms were documented prospectively. RESULTS: Mean patient age was not significantly different in the glycine and sorbitol-mannitol groups. (72.1 versus 73.7 years). American Society of Anesthesiologists grade was also comparable. Median resection time was 27 minutes and resected tissue weighed a mean of 21 gm. The median resection rate was 0.8 gm. per minute. Blood loss and temperature changes during resection were similar in the 2 groups. Overall median blood loss was 216 ml. and irrigant absorption was 140 ml. In the sorbitol-mannitol group significantly less fluid was apparently absorbed during resection (median 88.2 versus 184.4 ml.). Analysis of the incidence of symptoms of the transurethral prostate resection syndrome did not show any differences in the irrigant groups. Cardiac damage measured using troponin I also showed no significant difference in the 2 groups, although there was a high overall incidence of 7.5%. CONCLUSIONS: We noted no significant differences in 1.5% glycine and 2.7% sorbitol-0.5% mannitol as an irrigating solution for transurethral prostate resection.

Aged↗
PubMed1997

Role of laparoscopic surgery in pediatric urology.

OBJECTIVES: In our clinic, laparoscopy was introduced in 1987 for the exploration of non-palpable testes and since 1991 it has also been applied with therapeutic aims. We present our experience with this minimally invasive technique in pediatric patients. PATIENTS AND METHODS: Between May 1987 and September 1996, 219 laparoscopic procedures were performed in children. All children received general anesthesia. Positioning of the patient on a rotatable and tiltable operating table is very important. RESULTS: All laparoscopic interventions were well tolerated in children. The operative time for exploration of a nonpalpable testis ranged from 10 to 30 min, and for varix ligation from 15 to 30 min. In nephrectomy and nephroureterectomy cases 80-150 min were required. The excision of the urachal remnant and the drainage of lymphocele took between 30 and 70 min. No immediate postoperative complications were observed. Mobilization and oral intake were routinely carried out on the day of surgery. The children required little or no postoperative pain medication. CONCLUSION: Laparoscopy has been found to be the most reliable diagnostic tool in evaluating nonpalpable testes within the pediatric population. This approach enables subsequent therapy of laparoscopic orchiectomy, primary laparoendoscopic orchidopexy, or laparoscopically assisted two-stage Fowler-Stephens maneuver. Laparoscopic varix ligation is a simple and highly effective treatment modality for the pubescent male with a symptomatic varicocele. To date, the recurrence rate is 1.8% based on 80 patients followed for over 1 year. Fenestration of lymphoceles following renal transplantation has been found to be as efficaciously treated with laparoscopy as with open surgery. Laparoscopic nephrectomy and/or nephroureterectomy are technically demanding procedures and should only be performed by an experienced laparoscopic surgical team to minimize the complication rate. At the present time, the intraoperative costs of laparoscopic surgery are greater than with open surgery due to the use of disposable instrumentation and longer operating room times. However, minimally invasive surgery continues to gain a greater and more important role in the field of pediatric urology.

Adolescent↗
PubMedDate not supplied

[Arterial embolisms of the lower extremities].

INTRODUCTION: Embolism is one of the most frequent causes of lower limbs acute arterial occlusion [1]. Of the total number of peripheral embolism 56% of cases involve lower limbs arteries [2]. Inadequate and late treatment of the lower limbs embolism is associated with high morbidity and mortality rate. The aim of this paper was to study the aetiology of lower limbs embolism and to detect factors influencing early and late results after the operative treatment. PATIENTS AND METHODS: The study included 204 patients with 224 lower limbs embolism, treated surgically at the Institute of Cardiovascular Diseases of the Clinical Centre of Serbia in Belgrade in the period between 1993 and 1997. There were 107 (52.2%) female and 97 (47.8%) male patients. Thirty two (14.3%) patients were younger than 50 years, 64 (28.6%) were between 51 and 65, 101 (45.1%) between 66-75, while 27 patients (12.1%), were older than 75. Twenty (8.9%) patients were admitted less than 6 hours before the operation, 79 (33.3%) between 6 and 24 hours, and 125 (55.8%) more than 24 hours before the operation (Table 1). One hundred (53.6%) patients had motor and 133 (59.4%) sensor paralysis on admission. Table 2 shows arterial localization of the lower limbs embolism. The popliteal artery was involved in most cases. During the operation transfemoral arterial approach was used in 132 (58.9%) cases, while transpopliteal in 92 (41.1%) cases. Fourteen cases required bypass surgery, 43 fasciotomy, 2 intraoperative streptokinase and 4 intraoperative angiography. All patients were controlled using physical and CW Doppler ultrasonographic examinations immediately after the operation, and then one, six and 12 months, as well as every year. RESULTS: In 173 (84.4%) patients cardiac causes of embolism were found, in 8 (3.9%) noncardiac, while in 8 (3.9%) the cause could not be established. Of all cardiac causes absolute arrhythmia was most frequent. Table 3 and Table 4 show the aetiology of the lower limb embolism. The early amputation rate was 23 (10.3%) cases, while limb salvage was recorded in 174 (77.7%) patients. Of all saved limbs complete recovery was noted in 162 (72.4%) cases and peroneal nerve paresis in 12 (5.3%) cases. The early postoperative mortality rate was 27 (12.0%). Table 5 shows early results of embolectomy. The early results (limb salvage, complete recovery, rethrombosis, early reoperations, amputations rate, morbidity and mortality rate) of embolectomy were statistically significant: worse in cases when the embolus was located in the abdominal aorta and popliteal artery; in cases with a long time interval before the operation as well as in patients with sensor-motoric paralysis on admission (Tables 6-8). Of the total number of patients in 87 (56.5%) cases a late control examination was carried out. Forty nine (31.8%) patients died before the late control, while 18 (11.7%) did not come to control examination. Late recidivation of embolism was found in 3 cases. In these patients the cause could not be found, and they were treated by anticoagulant drugs.

Aged↗
PubMed2000

A human skull cast model for training of intracranial microneurosurgical skills.

Skillful microsurgical techniques such as microvascular anastomosis and repair of nerves require dedicated and extensive laboratory training. Human microneurosurgery poses several additional technical difficulties, as the intracranial procedures are often performed through a narrow operative space at a considerable length, using knee-bend instruments. This article presents a laboratory model to simulate microneurosurgical procedures in humans. A human skull cast model made from plaster is cut such that, when placed on a operating table, it represents a standard position of a pterional approach and that the point of operation is at the same depth as the hypothetical circle of Willis. A standard pterional opening is made in de skull cast and the model is placed over the rat. Subsequently, all surgical procedures starting from tissue preparation to performing an arterial, venous, and/or nerve repair are performed with the cast over the rat using microneurosurgical knee-bent instruments and a surgical microscope. Microsurgical procedures such as end-to-end vessel anastomosis and nerve repair are technically much more challenging and difficult to execute when performed through the pterional opening of the human skull cast than without the cast model. Moreover, the cast model useful in training microsurgical techniques performed with long knee-bend instruments. It is concluded that the skull cast model represents a useful method to train intracranial microneurosurgical blood vessel anastomosis and nerve repair.

Humans↗
PubMed1975

Tele-Autotomogram and Application of the Pneumoencephalographic Chair in Stereotactic Operations.

In order to obtain clearly demonstrated reference points in a preliminary air study for target calculations in stereotactic brain operations, a tele-autotomogram taken with the rotating pneumoencephalographic chair has been used with excellent results. By means of multiaxial rotations of the chair, tele-roentgenograms, including an autotomogram with a constant small magnification, can be obtained easily at any position of the patient with one floor X-ray tube. The same chair, modified to support the stereotactic base ring, can serve as an excellent stereotactic operating table with good maneuverability, offering wide adjustment of the patient's position suitable for various operative approaches. Simultaneously, it produces identical tele-roentgenograms with the same magnification as in the preliminary study, which economizes calculation time and avoids possible measurment error during stereotactic operations.

Humans↗
PubMed2005

Concurrent robotic hybrid revascularization using an enhanced operative suite.

Hybrid myocardial revascularization combines coronary surgery with percutaneous intervention as an alternative therapy for ischemic heart disease. The order and sequence of the hybrid approach is not yet clearly defined. We report on the benefits of an enhanced surgical suite equipped with a carbon fiber operating table and digital C-arm for robotic-assisted hybrid revascularization in a single operative sequence. To our knowledge, this is the first reported case of concurrent robotic-assisted hybrid revascularization utilizing an enhanced operative suite.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Pressure sores and intra-operative risk.

The enormous cost of pressure sore care is well documented (1, 2), but a review of the available literature shows few studies on the genesis of intra-operative pressure sores exist and the contribution of operating room exposure as an aetiological factor is largely undefined. This article provides a brief overview of the aetiology of pressure sores, details interface pressures reported on operating tables, and critically reviews the literature suggesting a link between events during the intra-operative period and post-operative pressure sore formation.

Humans↗
PubMed2003

Nephrectomy at the University of Port Harcourt Teaching Hospital: a ten-year experience.

The case records of patients who had nephrectomy from 1989 to 1998 were retrieved. Data extracted for analysis included age, sex, clinical features, indications for nephrectomy, post-operative complications and histological findings. Thirty-four unilateral nephrectomies in 21 males and 13 females were done. The patients were aged between 1.5 to 75 years. The predominant presenting features were abdominal pain (76.5%), abdominal mass (70.6%), haematuria (61.8%) and weight loss (47.1%). Diagnostic investigations were intravenous urography and renal ultrasound scan. The major indications for renal exploration included non-functioning kidney and renal mass suspected to be carcinoma. The histopathological findings included renal malignancy 23 (67.6%), hydronephrosis 6 (17.6%) and renal infections 3 (8.8%). The male/female ratio in nephrectomy for malignancy was 1:1.09. Renal trauma was the indication in only one patient. Non-functioning kidneys on intravenous urography (IVU) occurred in both malignant and infective lesions. Hypertension was found in 9 patients preoperatively. It resolved in 7 patients after operation. The histological finding in one kidney differed from what was assumed at operation. Follow-up USS showed compensatory hypertrophy in the remaining kidneys. Post-operative sepsis occurred in 4 patients. One of these was a retroperitoneal abscess. Two patients with huge tumours died on the operating table. Two died from sepsis. Four patients died from metastatic disease within two years after operation. Malignancies constituted the commonest indication for and commonest cause of mortality in nephrectomy. Antibiotics prophylaxis is advocated. All nephrectomy specimens should be subjected to histopathological examination.

Adolescent↗