Advantages and disadvantages of celioscopic surgery in gynecology

In the last decade, operative laparoscopy has been a break through in the practice of gynecology. Recent progress has been made with the development of cold light, appropriate atraumatic instrumentation, video-camera and CO2 laser. Laparoscopy provides access to the pelvis, allowing for diagnosis and treatment of a variety of pathologies. The most frequent indication is the treatment of ectopic pregnancy. Salpingotomy with tubal preservation, the procedure of choice for young women wanting to become pregnant, has been used in 88 cases. However, tubal preservation is not always possible (rupture of the ovarian tube, hemosalpinx), and sometimes not even advisable (inflammatory lesions, homolateral recurrence) and salpingectomy was necessary in 294 cases. Another indication for salpingectomy is painful chronic salpingitis, resulting from an undetected or ill-treated Chlamydia trachomatis infection: 84 cases. Infertility surgery is the second most important indication for laparoscopic procedure. The authors have performed salpingoovariolysis in 49 cases, neosalpingostomy in 34 cases and fimbrioplasty in 31 cases. Reproductive outcome at 18 months post-operatively was comparable to results following microsurgical techniques, with a rate of ongoing pregnancies of 53% for adhesiolysis and 27.7% for distal tuboplasties. Immediate opening of hydrosalpinges at the time of diagnostic laparoscopy allows for precise evaluation of the tubal mucosa, thereby establishing prognosis. Laparoscopy also allows for management or ovarian cyst, first explored to determine the absence of any sign of malignancy. In most cases, the cyst's contents and wall may be entirely removed by laparoscopy: 115 cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Advantages and disadvantages of nonfusion technology in spine surgery

Nonfusion technology in spine surgery may improve outcomes by reducing surgical morbidity and the incidence of adjacent level degeneration; however, new technologies also introduce new short- and long-term complications. There is currently no evidence that nonfusion implants are superior to fusion in mid- to long-term follow-up. Understanding the potential risks and benefits of nonfusion technology is essential for spine surgeons and their patients. This article reviews the current evidence relating to the potential risks and benefits of nonfusion technology in spine surgery.     

Advantages and disadvantages of one-stage and two-stage surgery for arrhythmias and Ebstein's anomaly.

OBJECTIVE: To evaluate efficacy of one-step and two-step surgery approach in patients with arrhythmias combined with Ebstein's anomaly. METHODS: Fifty-three patients with Ebstein's anomaly combined with tachyarrhythmias (58.5% men, 41.5% women, mean age 21.6+/-10.7 years) were operated on. In group A (32 patients), one-step surgical correction (simultaneous intraoperative elimination of arrhythmias and congenital heart defect repair) was performed, whereas in group B (21 patients), two-step surgery was performed with initial elimination of arrhythmogenic substrate by transcatheter radiofrequency ablation (first step) and following surgical repair of congenital heart defect (second step). RESULTS: In group A, total hospital mortality was 3.1% (1 patient) due to initial severe condition of this patient. One-step surgery was effective in 93.5% of cases. Mortality was not observed in group B. Efficacy of transcatheter radiofrequency ablation was 76.2%. CONCLUSIONS: One-stage and two-stage surgery of arrhythmias and Ebstein's anomaly are highly effective. First step of surgery of combined pathology reduces cardiopulmonary bypass time, complications and mortality while performing the second step of congenital heart defect surgery. However, simultaneous approach (one-step surgery) is better in terms of arrhythmia elimination.     

Advantages and disadvantages of mechanical vs. manual anastomosis in colorectal surgery. A prospective study

The merits of mechanical versus manual anastomosis were evaluated in a prospective study of 48 patients undergoing resection of colonic or rectal cancer. The analyzed factors included the time required for construction of the anastomosis, the length of hospital stay, the cost/benefit ratio and complications. The anastomosis was manually performed with monolayer polyglactin 910 sutures in 24 cases and mechanically with an E.E.A. stapler in 24. The anastomosis time averaged 14 min in the suture group and 14.3 min in the stapling group, and the respective hospitalization times were 16 and 17 days. The mean cost was 48,000 lire in the manual, and 200,000 lire in the mechanical group. Four complications occurred in each group. Apart from the cost, no intergroup difference was statistically significant.     

Advantages and disadvantages of pinless external fixation

The AO pinless external fixator (PEF) uses trocar tipped clamps to grip the outer tibial cortex rather than pins to transfix it. Its main advantage is to avoid further contamination of the medullary canal in open tibial fractures where a nail may subsequently be used. We tested the anatomical safety of this device and its effect on plastic surgical procedures compared with a standard unilateral external fixator (UEF).

The PEF and UEF were placed on two amputated limbs which were then dissected. Structures at risk were traced on ten cadaver limbs.

We found that important anatomical structures were endangered by the PEF and that safe zones could not always be defined. The UEF avoided these structures. Plastic surgical approaches were made more difficult by the PEF which imposed limitations on local flap design and endangered the arterial perforators which supply them.

We conclude that safety is compromised by the PEF because margins for error are small. It poses additional problems in soft tissue reconstruction and highlights the need for co-operation between plastic surgical and orthopaedic teams in choice of fixation device.     

机器人肝切除技术的优势和弊端

目的与传统腹腔镜肝切除术配对比较探讨机器人肝切除技术的优势和弊端。方法回顾性分析本中心2009年4月至今连续46例达芬奇机器人手术系统行肝脏部分切除术的病例,统计其术中技术、手术时间、术中出血量及术后恢复情况等临床资料,与本中心同期开展的110传统腹腔镜肝切除术的临床病例资料行对照研究。描述性分析另外10例机器人肝门部胆管癌根治术病例资料。结果除1例机器人肝切除术中转开腹手术,2组病例均为完全腹腔镜下完成手术。传统腹腔镜下采用双主刀技术进行操作。2组病例的平均手术时间差异有统计学意义(P=0.0032),平均失血量无统计学差异(P=0.3470)。2组病例的术后并发症、住院时间等情况对比无统计学差异。机器人肝门部胆管癌技术可行,但手术时间明显较长、出血量大,术后并发症发病率高、住院时间长。结论达芬奇机器人手术系统行精准肝切除术安全可行,由于其稳定性和3D视野尤其利于精准的肝门解剖和腹腔镜下缝合,可以拓展腹腔镜肝切除的适应证。但达芬奇机器人手术系统戳孔布局、器械配合、机械臂对腹腔内外空间的占用严重阻碍助手的操作等原因造成手术难度较大、手术时间延长。另外,机器人手术的费效比较高也阻碍了这一技术的广泛开展。     

Advantages and disadvantages of endoscopically assisted front-lift

Reduced surgical risk, a diminution of visible scars, rapid recovery, long-termed results and reduced costs are at present the most important demands on development in aesthetic plastic surgery. Endoscopically assisted front-lift meets perfectly the need of reduced invasiveness. It is technically simple and associated with a minimum of complications. It brings minimal scars beyond the hairline with a favourable effect after eliminating the drop of the brows, and wrinkles on the forehead. The duration of the effect in the aging face depends, however, similarly as other methods, on the characteristics of the skin, changes in other parts and the individual disposition. A marked disadvantage is the high initial, cost of special equipment. Their recovery ensues from the reduced time of surgery, reduced consumption of material, lower number of complications and more rapid return to normal life.     

Advantages and disadvantages of adrenaline in regional anaesthesia

Adrenaline has been added to local anaesthetic solutions for more than a century. The aim has been to delay the absorption of the local anaesthetic drug and to prolong and enhance its anaesthetic effect, both in peripheral and central neuraxial blockades. The intention in this chapter has been to give up-to-date knowledge about adrenaline as an adjuvant to local anaesthetics and/or opioids in clinical peripheral and central blockades. My own research has focused on optimizing postoperative epidural analgesia by adding adrenaline and/or fentanyl to an epidural mixture with dilute bupivacaine or ropivacaine. The main part of this chapter will therefore focus on the advantages and disadvantages of adrenaline in epidural analgesia. However, recent knowledge about adrenaline in peripheral blockade will also be covered, together with some pharmaceutical comments on the shelf-life of local anaesthetic mixtures containing adrenaline.     

胰头癌扩大切除利弊的探讨

胰头癌根治术于 1935年由Ｗｈｉｐｐｌｅ首创 ,后人为纪念其贡献 ,把胰十二指肠切除术称为Ｗｈｉｐｐｌｅ手术 ,且沿用至今。胰头癌扩大切除含扩大胰十二指肠切除术及全胰切除术 ,分别讨论如下一、扩大胰十二指肠切除术又称区域性胰腺切除术 (ｒｅｇｉｏｎａｌｐａｎｃｒｅａｔｅｃｔｏ ｍｙ) ,由于临床上诊断的胰头癌多为进展期癌 ,部分病例癌肿又侵及周围血管 ,如门静脉、肝动脉等 ,因而切除率低。 195 1年Ｍｏｏｒｅ等报告合并门静脉切除的胰十二指肠切除 ,但一直未能广泛开展。 1973年Ｆｏｒｔｎｅｒ〔1〕提出区域性胰腺切除术以后 ,合…