Ethanol monitoring of irrigating fluid absorption in transcervical resection of the endometrium

Background . We evaluated the precision in using ethanol to indicate and quantify absorption of irrigating fluid during transcervical resection of the endometrium.
Methods . The ethanol concentration in the expired breath, the serum sodium level, the blood loss and the volumetric fluid balance were measured over 10-min periods during 62 operations. A solution containing glycine 1.5% and ethanol 1% was used to irrigate the uterus.
Results . Most principles previously outlined for ethanol monitoring in transurethral prostatic surgery could also be applied in endometrial resection.
In the 21 patients who showed the intravascular pattern of ethanol changes, the breath alcohol measurement corrected for absorption time predicted the volume of irrigant absorbed {up to 2,531 ml) with a standard error of 230 ml at the end of any 10-min period of absorption. Repeated measurement of serum sodium indicated intravascular fluid absorption with practically the same precision as the breath test.
Extravascular absorption was found in 14 patients. In these operations, the volume of irrigant absorbed (up to 1,767 ml) could be predicted with a standard error of 92 ml from the ethanol concentration at the plateau level attained after absorption had occurred.
Conclusion . Ethanol monitoring is precise enough to allow monitoring of irrigating fluid absorption in endometrial resection.     

宫腔镜手术在治疗子宫纵隔畸形的不孕不育患者中的价值

目的研究宫腔镜手术在治疗子宫纵隔畸形不孕不育患者中的临床疗效。方法选取我院在2010年2月至2012年2月间收治的72例子宫纵隔畸形不孕不育患者的临床资料,根据随机数字表,将患者分为两组,每组各36例。观察组经宫腔镜行子宫纵隔切除术,对照组经腹行子宫纵隔切除术,比较两组患者的手术时间、术中出血量、住院时间,并随访其流产率及分娩率。结果 1比较两组患者的住院时间、手术时间、术中出血量,观察组均低于对照组,差异具有统计学意义(P0.05)。在两组患者中,均无周围脏器损伤、感染、宫腔粘连、大出血等并发症。2手术前后组间比较流产率与分娩率对比差异不大,无统计学意义(P0.05)。组内手术治疗前后比较,两组治疗后的流产率均明显低于治疗前,治疗后的分娩率均明显高于治疗前,差异显著(P0.05)。结论通过采用宫腔镜手术对子宫纵隔畸形不孕症患者进行治疗,可提高临床疗效,缩短手术时间与住院时间,减少术中出血量,值得临床推广应用。     

优化手术配合流程在快通道外科诺舒子宫内膜切除手术中的应用

目的:探讨优化手术配合流程在快通道外科诺舒子宫内膜切除手术中的应用.方法:优化诺舒阻抗控制子宫内膜切除术治疗功能失调性子宫出血手术配合,实施标准规范的配合流程.采用自行设计的《诺舒手术患者情况跟踪表》分别进行术后一个月、三个月的随访.结果:50例,患者手术效果满意,术后随访对手术室提供的服务满意率为96％.结论:通过优化诺舒手术配合的流程,为女性患者提高舒适护理,预防术中不良事件,让更多女性患者受益.     

宫腔镜联合腹腔镜子宫纵隔切除术对妊娠结局的影响

目的探讨宫腔镜联合腹腔镜子宫纵隔切除术(transcervical resection of septum,TCRS)后对妊娠结局的影响。方法 2007年12月~2011年12月在我院因纵隔子宫致不孕不育患者47例,均行TCRS术。随访2年,对比同期1 348例正常子宫结构育龄妇女的妊娠结局。结果研究组TCRS术前累积妊娠127例次,术后累积妊娠34例次,自然流产率由术前82.68%(105/127)下降至5.88%(2/34),足月妊娠率、活婴率分别由术前4.72%(6/127)和3.15%(4/127)上升至82.35%(28/34)和85.29%(29/34)。上述各指标手术前后比较,差异均具有统计学意义(P0.05)。手术前后早产率比较差异无统计学意义(P0.05)。TCRS后妊娠者孕期并发症与对照组比较,差异均无统计学意义(P0.05)。但TCRS后妊娠者剖宫产率高于对照组,差异具有统计学意义(P0.05)。结论 TCRS可明显改善纵隔子宫患者的妊娠结局,不增加孕期并发症,但TCRS后剖宫产率显著增加。     

Transcervical thymic biopsy in children with immunodeficiency

To more fully characterize immunodeficiency states, thymic biopsies add useful information. The transcervical technique is simple and does not require a sternal-splitting procedure. The thymus was much larger than anticipated in 12 of 12 cases so far biopsied, including six cases of severe combined immunodeficiency. A sample of 2-3 gm was readily removed. A slight wound infection was encountered in only one instance; no generalized septic episode resulted.     

Ectopic Cervical Thymoma Excised through a Transcervical Approach Combined with Video-assisted Thoracoscopic Surgery: A Case Report

Ectopic cervical thymoma (ECT) is a rare tumor. We present a case of 56-year-old woman with an ECT in the anterior neck that was correctly diagnosed preoperatively. The patient had no symptoms of myasthenia gravis or other immune disorders, and the tumor was not invading any adjacent structures. We performed tumor resection and thymectomy through a transcervical approach using video-assisted thoracoscopic surgery with a multi-access single port. To our knowledge, this is a novel combined technique for the resection of an ECT.     

Anaesthesia for carotid body tumour resection in a patient with the Eisenmenger syndrome

A patient with the Eisenmenger syndrome presented for removal of a carotid body tumour under general anaesthesia. The presentation and management of the case are described and some of the anaesthetic problems associated with these two uncommon conditions are discussed. The case is reported because of its rarity and because some of the complications of carotid body surgery may be particularly hazardous in the presence of the Eisenmenger syndrome. The importance of monitoring, of maintaining a stable heart rate and blood volume, and the danger of paradoxical systemic air embolism are stressed.     

Central pontine myelinolysis: sequele of hyponatremia during transcervical resection of endometrium

Transcervical resection of endometrium is an alternative to hysterectomy for women with menorrhagia. The procedure involves the use of cutting loop diathermy to resect the endometrium while the uterine cavity is irrigated with 1.5% glycine which can absorb consequent fluid and electrolyte shifts. Severe hyponatremia leading to central pontine myelinolysis is an extremely rare complication of this procedure. We report a case of a young female undergoing transcervical resection of endometrium for menorrhagia, who developed central pontine myelinolysis but made a complete recovery after three months.     

Transcervical superior mediastinal lymphadenectomy in the management of papillary thyroid carcinoma

AIM: Surgery is the treatment of choice for lymph node metastases in papillary thyroid carcinoma. When adequately treated by surgical extirpation, the presence of lymph node involvement does not seem to have a negative impact on cure rates or survival. Surgical lymphadenectomy for metastatic papillary thyroid carcinoma has been well described for both the central and the lateral compartments of the neck. Superior mediastinal lymphadenectomy, however, has only sporadically been mentioned. We describe our experience with transcervical superior mediastinal lymphadenectomy (TSML) that avoids the morbidity of the traditional sternal split. MATERIALS AND METHODS: This retrospective analysis included 30 patients (24 women and 6 men; age range, 17-72 years) who underwent TSML by the senior author (JLF) for papillary carcinoma metastatic to the superior mediastinum between 1985 and 1999. Histopathologic examination confirmed positive nodes in all the mediastinal dissections. All patients received postoperative I(131). RESULTS: All the patients are alive after a median follow-up of 5 years (range, 1-14 years). Twenty-nine of 30 patients remain free of disease, whereas one patient is alive with lung and bone metastases. No patient has had local or regional relapse. The only significant complication was a high incidence of temporary (70%) and later permanent (50%) hypoparathyroidism. CONCLUSIONS: TSML is a safe and effective treatment for superior mediastinal metastases in papillary thyroid carcinoma.     

Visual evoked potentials and visual acuity after transurethral resection of the prostate

Changes in visual evoked potentials, visual acuity, blood ammonia levels and serum electrolytes (Na+ and K+) after transurethral resection of the prostate using glycine as an irrigating fluid performed under subarachnoid block were studied in 12 patients, in the pre-operative and immediate postoperative periods. Visual evoked potentials (p100 latency), recorded by shift of a checkerboard pattern, increased significantly from a pre-operative value of mean (SEM) 101.18 (1.63) msec in the right eye, and 102.5 (1.47) msec in the left eye to 108.91 (1.8) msec (p less than 0.01) and 108.08 (2.53) msec (p less than 0.01) respectively in the postoperative phase. There were no changes in visual acuity as assessed by a Snellen's chart, blood ammonia levels and serum electrolyte concentrations. The amount of glycine used intra-operatively for irrigation ranged from 3 to 31 litres.     

Duodenum-preserving resection of the head of the pancreas

Summary. Duodenum-preserving resection of the head of the pancreas was developed 25 years ago by Beger. This procedure is indicated in patients suffering from chronic pain in combination with inflammation of the head of the pancreas, common bile duct obstruction, pancreatic duct obstruction and/or obstruction of the retropancreatic vessels. At the Inselspital in Berne, 74 patients underwent this operation between 1993 and 1996. The median length of the operation was 380 min, with the need for transfusion in a median of 0 units (0–6). There was no postoperative mortality. Total postoperative morbidity was 13 %. One patient needed relaparotomy on day 17 for small bowel obstruction. Median length of hospital stay was 11 days. Postoperatively, two patients developed diabetes. Duodenum-preserving resection of the head of the pancreas represents an organ-preserving principle of surgery. This procedure treats the complications of chronic pancreatitis and provides long-term pain relief in more than 80 % of patients.      

Glycine and transurethral resection

Fifty patients undergoing transurethral resection of the prostate were studied for evidence of glycine absorption and haemodilution. Plasma glycine levels increased substantially in nine patients and, in five, calculated irrigant fluid absorption ranged from 619-1582 ml; another patient had absorbed 1360 ml fluid with only a small rise in plasma glycine. Two illustrative case histories are presented. The role of glycine as an inhibitory neurotransmitter is discussed and the possibility of toxic mechanisms other than dilutional hyponatraemia is mentioned. Intravenous diuretics, hypertonic saline, and perhaps calcium salts, are recommended for the overt transurethral resection syndrome.     

Transcervical resection of tracheal diverticulum

Tracheal diverticulum is a clinical entity rarely reported in the literature. It can be congenital or acquired in origin, and most cases are asymptomatic, usually being discovered incidentally at CT scan. Therefore, treatment has not been widely reported. We present the case of a 30‐year‐old man with a 6‐month history of repeatedly coughing and tracheobronchitis. CT scanning revealed the lesion. The patient underwent surgical resection of the tracheal diverticulum via a transcervical approach. Symptoms resolved after surgical treatment. Reexamination of the neck, chest, trachea, and lungs of the patient was performed with CT scan postoperative. © 2016 Wiley Periodicals, Inc. Head Neck 39: 187–190, 2017     

Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome

Aim The study aimed to compare robotic rectal resection with laparoscopic rectal resection for cancer. Robotic surgery has been used successfully in many branches of surgery but there is little evidence in the literature on its use in rectal cancer. Methods We performed a systematic review of the available literature in order to evaluate the feasibility, safety and effectiveness of robotic versus laparoscopic surgery for rectal cancer. We compared robotic and laparoscopic surgery with respect to twelve end‐points including operative and recovery outcomes, early postoperative mortality and morbidity, and oncological parameters. A subgroup analysis of patients undergoing full‐robotic or robot‐assisted rectal resection and robotic total mesorectal excision was carried out. All aspects of Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) statement were followed to conduct this systematic review. Comprehensive electronic search strategies were developed using the following electronic databases: PubMed, EMBASE, OVID, Medline, Cochrane Database of Systematic Reviews, EBM reviews and CINAHL. Randomized and nonrandomized clinical trials comparing robotic and laparoscopic resection for rectal cancer were included. No language or publication status restrictions were imposed. A data‐extraction sheet was developed based on the data extraction template of the Cochrane Group. The statistical analysis was performed using the odd ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables. Results Eight non randomized studies were identified that included 854 patients in total, 344 (40.2%) in the robotic group and 510 (59.7%) in the laparoscopic group. Meta‐analysis suggested that the conversion rate to open surgery in the robotic group was significantly lower than that with laparoscopic surgery (OR = 0.26, 95% CI: 0.12–0.57, P = 0.0007). There were no significant differences in operation time, length of hospital stay, time to resume regular diet, postoperative morbidity and mortality, and the oncological accuracy of resection. Conclusion Robotic surgery for rectal cancer has a lower conversion rate and a similar operative time compared with laparoscopic surgery, with no difference in recovery, oncological and postoperative outcomes.     

经尿道前列腺电切术后出血原因分析及处理

目的探讨经尿道前列腺电切术(TURP)后出血的原因及处理方法。方法对行TURP术的316例患者的临床资料进行回顾性分析。结果316例患者中,28例术后出血,其中术后早期出血23例,迟发性出血5例;26例经保守治疗治愈,2例经电切镜止血。结论术中确切止血及术后引流通畅是预防TURP术后出血的关键;术后及时发现出血并正确处理可避免再次手术,对膀胱内充满血块不能吸出者电切镜下止血是一种安全有效的方法。     

Simultaneous resection for rectal cancer with synchronous liver metastasis is a safe procedure

Background

One quarter of colorectal cancer patients will present with liver metastasis at the time of diagnosis. Recent studies have shown that simultaneous resections are safe and feasible for stage IV colon cancer. Limited data are available for simultaneous surgery in stage IV rectal cancer patients.

Methods

One hundred ninety-eight patients underwent surgical treatment for stage IV rectal cancer. In 145 (73%) patients, a simultaneous procedure was performed. Fifty-three (27%) patients underwent staged liver resection. A subpopulation of 69 (35%) patients underwent major liver resection (3 segments or more) and 30 (44%) patients with simultaneous surgery.

Results

The demographics of the 2 groups were similar. Complication rates were comparable for simultaneous or staged resections, even in the group subjected to major liver resection. Total hospital stay was significantly shorter for the simultaneously resected patients (P < .01).

Conclusions

Simultaneous resection of rectal primaries and liver metastases is a safe procedure in carefully selected patients at high-volume institutions, even if major liver resections are required.     

Intravesical pressure and the TUR syndrome

Intravesical pressure was measured continuously during 35 transurethral prostate resections using a fine suprapubic catheter. Absorption of irrigating fluid was detected by tagging it with ethanol and sampling the expired breath using an alcohol meter. Higher mean (SD) intravesical pressure was demonstrated in those patients who absorbed irrigating fluid (19.1 (7.7) mmHg) than in those who did not (12.4 (6.5) mmHg; p = 0.00004). Higher peak pressures were also demonstrated among absorbing patients. Traditional risk factors for fluid absorption, such as operator experience and resectate mass, were found to correlate with pressure exposure over time. Exposure to supranormal bladder pressure over time is the final common path for all causes of absorption. Vesical pressure monitoring may be a valuable feedback tool during difficult resections or operator training.