Long-level intramedullary spinal cord astrocytoma complicated with spine scoliosis: Report of two cases

Introduction and importanceLong-level intramedullary astrocytomas complicated with spine scoliosis are rare. Surgical treatment of such tumors becomes more complicated and challenging when spinal scoliosis is present. However, studies describing the treatment of long segmental intramedullary spinal cord astrocytomas complicated with severe spine scoliosis have been rarely reported.Case presentationTwo cases of long-level intramedullary astrocytomas complicated with severe spine scoliosis were surgically treated with one-stage operation of tumor resection and scoliosis correction in this report. Case 1: A 16-year-old boy presented to our hospital with a five-month progressive paresthesia, weakness of the left lower limb, and a long-time abnormal body appearance. MRI showed a T4-T12 intramedullary tumor combined with spinal scoliosis. Case 2: A 14-year-old boy presented at our service with a 6-year history of visible spine scoliosis and a 1-year progressive motor disability of bilateral lower limbs. Spine MRI indicated a long-level abnormal syringomyelia signal from C4 to L1 and there was irregular enhancement after intravenous contrast medium administration at C7-T2 and T9-T12 level.DiscussionWe performed a laminectomy over the whole length of the tumor and corrected the scoliosis with trans-pedicle screws. The patients exhibited a long-time tumor free with largely neurological function preservation. One-stage operation did not generate severe short- or long-term complications. The correction of the scoliosis prevented the progression of the spinal deformity and facilitated the recovery of normal life.ConclusionThis case report demonstrates that the one-stage resection of long-level intramedullary astrocytoma and correction of the complicated scoliosis might be a feasible option.     

Complication of Hirschsprung’s disease immediately after pregnancy: A rare case report

Introduction and importanceHirschprung's disease (HD) is a rare congenital colonic disorder that may develop in adult age, often determining a poor life quality with complications needing an emergency surgical setting. The disease rarely presents as an acute intestinal obstruction like SV, which represents an abdominal emergency issue.Case presentationA few days after discharge from gynecology unit because of her first childbirth, a young woman with HD developed colonic obstruction due to sigmoid volvulus, which was treated with Hartmann's procedure.Clinical discussionSome months later, the patient underwent a two-stage Duhamel's procedure to restore the digestive tract's continuity. Both hospital periods were free of critical events.ConclusionThe woman regained a good quality of life: Duhamel’s procedure revealed as a safe technique to use in HD adult.     

Reduced port laparoscopic surgery using umbilical zigzag incision for Meckel’s diverticulitis

IntroductionReduced port laparoscopic surgery using an umbilical zigzag incision is comparable to conventional multiport laparoscopic surgery. This method is associated with improved cosmesis and decreased wound pain.Presentation of caseA 67-year-old man visited our hospital. He presented emergency room with a chief complaint of right lower abdominal pain by walking. The patient was diagnosed Meckel’s diverticulitis by computed tomography (CT). At first, antibiotics therapy and fasting were performed. Three months later, the patient underwent resection of Meckel’ diverticulum with zigzag transumbilical laparoscopic surgery. The patient’s postoperative course was good, and he rarely felt wound pain. The patient started oral intake three days after surgery, and was discharged 10 days after surgery.DiscussionZigzag transumbilical laparoscopic surgery is very useful for resection of the small intestine. This method is associated with improved cosmesis and decreased wound pain. In the case of Meckel’s diverticulitis, we suggest that interval resection of Meckel’s diverticulum was very useful as it was an operation that could be performed easily.ConclusionReduced port laparoscopic surgery using an umbilical zigzag incision is considered to be an excellent technique in terms of operability and aesthetic outcomes.     

Early experience with a new integrated microwave surgical device,Acrosurg Revo®, for laparoscopic surgery: A case series of two patients

IntroductionAbdominal surgery uses various energy devices for vessel sealing, tissue dissection, and detachment. Currently, Acrosurg Revo® (Nikkiso Co., Ltd., Tokyo, Japan), a novel energy device using microwaves, has been developed for use in laparoscopic surgery. This report describes the early clinical experience of using this device in two cases of laparoscopic surgery.Presentation of caseCase 1 was of a 64-year-old woman who underwent laparoscopic abdominal incisional hernia repair. Case 2 was of a 56-year-old man with a diagnosis of ascending and sigmoid colon cancer who underwent laparoscopic right hemicolectomy and sigmoid colectomy with D3 dissection. Each surgery was completed using Acrosurg Revo® and an endoscopic electrosurgical unit. The postoperative course was uneventful, and both patients were discharged from the hospital without any complications.DiscussionWith this new and novel device, vessel sealing, hemostasis, coagulation, tissue dissection, and detachment were all possible. Notably, there was no spark or mist that hindered the surgical field of view. Furthermore, because microwave coagulation did not result in tissue carbonization, there was a considerable decrease in device tip contamination.ConclusionThe Acrosurg Revo® may be a useful energy device for laparoscopic surgery.     

When laparoscopy for fertility preservation prior to gonadotoxic treatment of an anterior mediastinal mass is a dilemma: A case report

IntroductionThe management of anterior mediastinal masses is a challenge for anesthesiologists. Recommendations for their management in the context of diagnostic or curative surgery are well described. The added risk of laparoscopic surgery for fertility preservation has however never been discussed in the literature.Presentation of caseWe present the case of a 32-year-old female patient with a large malignant anterior mediastinal mass. She was referred for anesthesia evaluation before laparoscopic ovarian tissue harvesting as part of fertility preservation prior to gonadotoxic treatment. The patient presented dyspnea at rest. Chest computed tomography revealed a tracheal deviation and a partial obstruction of the left mainstem bronchus. Transthoracic echocardiography showed a pericardial effusion. Proceeding to high risk anesthesia for a non-curative surgery in a patient with a highly symptomatic mass was considered unacceptable and the procedure was postponed. The patient received a single cycle of neoadjuvant chemotherapy. Clinical and radiological improvement were shown after this single dose and laparoscopic surgery was performed under general anesthesia without complications.ConclusionIn the context of an anterior mediastinal mass and fertility preservation a thorough benefit-risk analysis must be undertaken before non-curative laparoscopic surgery. In case of severe symptoms, surgery should be postponed until the patient’s condition improves after the minimum necessary chemotherapy treatment. So far it is impossible to say whether the risk exceeds the expected benefit in this difficult situation. Further studies need to be conducted in this area.     

Recurrence of thyroid carcinoma in cervical soft tissue following surgical implantation: Case report

IntroductionThyroid cancer is the most common type of malignant endocrine cancer. Differentiated thyroid cancer, which includes papillary and follicular cancers, represents majority (90%) of all thyroid cancers and has a favorable prognosis.However, a minority of patients develops loco-regional recurrence.Case reportWe report here a rare case of a 63 years-old man who underwent total thyroidectomy in 2015 for multinodular goiter whose histopathological examination revealed a papillary thyroid carcinoma. He received 6 weeks later a 100 mCi of radioactive iodine therapy. In 2017, he was admitted for multiple cervical lymph nodes with high serum thyroglobulin level (234 ng/mL) which required a bilateral central and lateral neck dissection. He was readmitted in 2019 for multiple subcutaneous neck nodules with high serum thyroglobulin level (197 ng/mL). The histopathological examination of the excised nodules revealed a papillary thyroid carcinoma. The patient showed no sign of recurrence after 2 years follow-up.ConclusionLocal soft tissue recurrence followed surgical implantation should be suspected when nodules are determined alongside the thyroid after previous thyroid surgery. Therapy for these soft tissue implants may be difficult; a comprehensive long-term postoperative evaluation should be completed to minimize the risk of recurrence in cervical soft tissue.     

Comparative effectiveness of robotic and open radical prostatectomy

Radical prostatectomy (RP) has undergone a remarkable transformation from open to minimally-invasive surgery over the last two decades. However, it is important to recognize there is still conflicting evidence regarding key outcomes. We aimed to summarize current literature on comparative effectiveness of robotic and open RP for key outcomes including oncologic results, health-related quality of life (HRQOL) measures, safety and postoperative complications, and healthcare costs. The bulk of the paper will discuss and interpret limitations of current data. Finally, we will also highlight future directions of both surgical approaches and its potential impact on health care delivery.     

Modified full-face snorkeling mask for thoracic surgery and otolaryngology surgical use: comfort and usability assessment during the COVID-19 pandemic

Background:A worldwide personal protection equipment (PPE) shortage has emerged during COVID-19 pandemic, contributing to the high incidence of SARS-CoV-2 infection among health care providers. To address this lack of PEE, new solutions have been researched. Among those, full-face snorkeling masks demonstrated to be an interesting option. Among surgical specialties otolaryngologists and thoracic surgeons are at high risk of infection, due to the close contact with airway secretions.Objectives:We tested the comfort and usability of a modified full-face snorkeling mask (Ocean Reef Mask Aria QR+) as a protective device for otolaryngologic and thoracic surgeries.Methods:The mask was customized with a 3D-printed adaptor supporting many industrial filter types, including FFP3 and heat and moisture exchangers (HME). We evaluated surgical performances of the mask, both subjectively, with a questionnaire filled in by the surgeons, as well as objectively, monitoring transcutaneous PCO₂ and PO₂ values of surgeons during surgical procedures.Results:The modified full-face snorkeling mask was tested during 9 otolaryngologic and 15 thoracic surgery procedures. The device demonstrated very good overall vision quality with some limitations regarding lateral vision and almost no difficulties in usability. Water condensation into the mask was absent in almost every case. Both PO₂ and PCO₂ parameters remained within normal ranges during every procedure.Discussion:The modified full-face snorkeling mask can be an innovative PPE. In the current COVID-19 pandemic scenario, the worldwide shortage of protective masks and goggles may exploit this ready-to-use and low-cost solution, especially for high-risk surgical procedures.