Laparoscopic orchidopexy: a review of a large clinical series

OBJECTIVE: To report the overall success rate of a laparoscopic orchidopexy (LO) series over 5 years including over 100 procedures. PATIENTS AND METHODS: The records were reviewed of children who underwent laparoscopic procedures for an impalpable testis at our institutions. The laparoscopic procedures included the standard LO and one-stage and staged Fowler-Stephens (F-S) LOs. The success of orchidopexy was defined as a testis in the scrotum with no atrophy after surgery. RESULTS: From 1994, 80 children (101 impalpable testes) were treated using LO. Of these patients, 20 (25%) had impalpable testes on the right, 39 (50%) were on the left and 21 (25%) were bilateral. The testicular location was identified during laparoscopy as: intra-abdominal in 46, iliac in 14, in the internal ring in 22, 'peeping' in 12, behind the bladder in three and intracanulicular in four. Standard LO was used in 72 testes, a one-stage F-S in 20 and a two-stage F-S in nine (first stage two, second stage seven). The median (range) age of the patients was 18 months (0.5-12 years); the mean (range) follow-up was 5 (1-36) months. After orchidopexy the testis was scrotal in 90 (low 78, mid four and high eight), at the pubis in one and not stated in seven (no follow-up available). Four patients (4%) had testicular atrophy from failed F-S orchidopexies, two of whom had undergone previous testicular surgery and one caused by additional dissection around the vas. The overall success rate, including only those with follow-up, was 96% (90 of 94). Of the 20 one-stage F-S orchidopexies, 17 testes were successfully placed in the scrotum with no atrophy. The overall success rate for all F-S procedures was 85% (23 of 27). However, excluding patients who had previous testicular surgery or who required extensive dissection near the vas, 96% (23 of 24) of the testes were successfully placed into the scrotum with no atrophy. CONCLUSION: The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than reported in other series to date. LO is an effective method for managing intra-abdominal testes in children. Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.     

Magnetic resonance imaging of implanted deep brain stimulators: experience in a large series

Magnetic resonance imaging (MRI) is a commonly used and important imaging modality to evaluate lead location and rule out complications after deep brain stimulation (DBS) surgery. Recent safety concerns have prompted new safety recommendations for the use of MRI in these patients, including a new recommendation to limit the specific absorption rate (SAR) of the MRI sequences used to less than 0.1 W/kg. Following SAR recommendations in real-world situations is problematic for a variety of reasons. We review our experience scanning patients with implanted DBS systems over a 7-year period using a variety of scanning techniques and four scanning platforms. 405 patients with 746 implanted DBS systems were imaged using 1.5-tesla MRI with an SAR of up to 3 W/kg. Many of the DBS systems were imaged multiple times, for a total of 1,071 MRI events in this group of patients with no adverse events. This series strongly suggests that the 0.1 W/kg recommendation for SAR may be unnecessarily low for the prevention of MRI-related adverse events.     

Mucinous breast carcinoma: a large contemporary series

BACKGROUND: Mucinous breast cancer is typically associated with a favorable prognosis. This study aimed to assess recent trends and prognostic features in the treatment of mucinous breast carcinoma. METHODS: A retrospective review of our database of patients who presented with mucinous breast cancer was performed. We evaluated patient and tumor characteristics and examined the relationships between these factors and risk for locoregional recurrence. RESULTS: One hundred eleven patients with mucinous breast cancer were identified. Seventy-one (64%) underwent lumpectomy with radiotherapy. Fourteen (13%) had lymph node metastasis, and node positivity was associated with larger tumor size; node-positive patients had a mean tumor size of 2.7 cm compared with 1.5 cm for node-negative patients (P = .0003). No patients with tumor size <1 cm had lymph node metastasis. Five patients (5%) had local and/or distant recurrence. CONCLUSIONS: Mucinous breast cancer is associated with a low recurrence rate as well as a low incidence of lymph node metastasis. In patients with small (<1 cm) tumors, consideration for deferring nodal evaluation may be made.     

Colorectal cancer: a large unselected Australian series

An unselected prospective consecutive series of 575 patients with a single adenocarcinoma of the colon and of 331 patients with a single adenocarcinoma of the rectum registered between 1971 and 1984 at the Princess Alexandra Hospital is reported. The tumours were staged according to the Australian Clinicopathological Staging (ACPS) System. Approximately one-quarter of the patients were incurable when they presented. For curative operations for carcinoma of the colon, the operative mortality was 3%. For curative operations for carcinoma of the rectum, the operative mortality was 1% for abdominoperineal resection and 4.5% for anterior resection. The relative 5 year survival for all patients was 54.5%. The findings are compared with other large Australian series as well as with series from the United Kingdom and the United States.     

Scarless Cholecystectomy: Laparoscopic Cholecystectomy with Abdominoplasty

Three patients presented to our hospital with abdominal wall laxity and symptomatic cholelithiasis. All of them wanted to undergo a cosmetic procedure (abdominoplasty) to reduce the abdominal wall laxity. They were also diagnosed to have cholelithiasis and had intermittent episodes of pain in the right upper quadrant of the abdomen. The ports for laparoscopic cholecystectomy were made in such a way that all the ports sites were removed in the skin flap that was excised during abdominoplasty, and there was no scar in the upper abdomen. The procedure was completed without leaving any telltale signs of laparoscopic cholecystectomy, and this led to a better cosmetic result from the patients’ point of view.     

Preliminary experience with a large scale vascular registry

The preliminary study carried out on a voluntary basis, has illustrated the feasibility of a large scale vascular registry serving as a benchmark against which a standard of practice of vascular surgery can be assessed.An initial experience with 165 surgeons active in the clinical practice of surgery (contributing 8,800 major vascular reconstructive cases in a 9 month period) suggests access to an enormous data base of vascular surgery practice against which community standards may be measured.     

Versatility of the free anterolateral thigh flap: clinical experience in a series of 20 patients

The main nutrient vessel of the anterolateral thigh flap is the perforator originating from the descending branch of the lateral circumflex femoral artery (LCFA). It supplies a large area of skin on the anterolateral aspect of the thigh. We present the experience of 20 consecutive anterolateral thigh flaps used for a variety of soft tissue defects. Fourteen flaps were used for lower leg reconstruction, four in the head and neck, and the remaining two in the hand. The largest flap was 30᎗ cm. All flaps survived except two which had partial skin necrosis, but the underlying adipose tissue survived and was grafted. Reexploration was needed for one patient in whom a thrombus blocking the vein was removed, and the flap survived completely. The anterolateral thigh flap has the advantage of a long vascular pedicle, large-caliber vessels, availability of a large skin flap area, and suitability as a flow-through flap.     

Sacral chordoma: clinical experience of a series of 11 patients over 18 years

European Journal of Orthopaedic Surgery & Traumatology - Sacral chordoma are rare low-to-intermediate grade malignant tumours that occur most commonly within the sacrum. Sacrectomy with wide...     

Single-Incision Laparoscopic Cholecystectomy: our experience and review of literature

Aim

After the revolution in the surgery of gallbladder stones represented by the laparoscopic cholecystectomy, we tried a new technique that further maximize the aesthetic results and that at the same time is of easy learning for young surgeons.

Patients and methods

From January 2011 to December 2012 we performed at our department 320 cholecystectomy: 27 in laparotomy and 293 in laparoscopy. Of these, 88 underwent to Single Incision Laparoscopic Surgery (SILS), namely the Single Incision Laparoscopic Cholecystectomy (SILC), in recruited patients aged between 19–65 years; 56 patients were females and 32 were males.

Results

The laparoscopic cholecystectomy with the SILS methodology is a safe technique. Respect to multi-port Laparoscopic Cholecystectomy (LC), we have cosmetic advances. The pain is less in extra-umbilical sites, and the major umbilical pain can be prevented by local anaesthesia.The times are slightly longer, especially at the beginning of training, but after a few of operations it is reduced to about one hour.We didn’t found any other difference in vantage and advantage between the two technics, only a case of postoperative umbilical hernia in SILS.

Conclusion

We found the SILS a safe and effective technique for the cholecystectomy.     

Risks of a large group practice: a personal experience

Formation of a large orthopaedic group practice and practicing within this group carries many risks that are not present in a small group practice. The current authors will discuss the complexity of merging groups, forming corporate policy, hiring executive administrative staff, contracting issues with insurance companies, expanding services and developing ancillary income sources, and the complex interpersonal relationships of a large group practice.     

Laparoscopic right donor nephrectomy: a large single-center experience

BACKGROUND: Laparoscopic procurement of right donor kidneys is frequently avoided or performed using hand-assist devices because of concerns regarding donor safety, adequate exposure, and vessel length. The present study describes the authors' large series of right donor nephrectomies performed laparoscopically without the use of hand ports or other manual assist devices. METHODS: The authors retrospectively analyzed all right laparoscopic donor nephrectomies performed at their center from November 1, 1999, to February 20, 2004. Study variables included operative times, blood loss, hospital stay, graft function, and donor and recipient complications. Left donor nephrectomies performed during the same period served as controls. RESULTS: Of 387 laparoscopic kidney procurements, 54 (14 %) were right nephrectomies. Blood loss, extraction times, length of stay, and overall complication rates were similar between right and left donor groups. The mean operative time in the right nephrectomy group was significantly shorter than in the left nephrectomy group (169 +/- 25 and 186 +/- 29 min, respectively; P = 0.003). Graft function 1 month after transplantation and the incidence of delayed graft function were similar in both groups. There was one graft loss caused by thrombosis in the left nephrectomy group; other graft-related complications in the recipients were similar in both groups. CONCLUSIONS: This large single-center experience demonstrates that laparoscopic right donor nephrectomy performed without hand-assist devices is safe and yields kidneys with excellent function. The authors conclude that selection of the appropriate kidney for donation using this approach can be based on the same criteria that have traditionally governed open donor nephrectomy.     

自制带阀门血管内支架非开胸堵闭巨大动脉导管未闭

目前：探讨自制带阀门血管内支架堵闭装置在巨大动脉导管未闭（ＰＤＡ）动物模型及临床病例的应用效果。方法：对１０只巨大ＰＤＡ实验模型动物,经股动脉插入血管内支架堵闭装置,完成堵闭ＰＤＡ。６例ＰＤＡ病人,经８￣１４Ｆ血管鞘通过股动脉或股静脉,顺利送入堵闭装置,操作一次成功。结果：所有的实验动物堵闭均一次成功,于术后１￣１８０天解剖动物,行病理检查见ＰＤＡ堵闭完全,达到永久性闭合。临床病例术毕即刻动脉造影     

The surgical patient with Brugada syndrome: a four-case clinical experience

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and ST segment elevation in precordial leads) and a high risk of cardiac arrest for malignant dysrhythmia. The genetic basis is a molecular defect of the cardiac sodium channel and the pattern of inheritance is autosomal dominant. Many factors during general anesthesia (medications, bradycardia, temperature changes) could precipitate malignant dysrhythmia in these patients. Because criteria to identify the surgical patient at high risk for developing malignant dysrhythmia are lacking, we can only speculate about the available studies on nonsurgical patients. We describe four patients during general anesthesia and propose intraoperative and postoperative monitoring (the first 36 h).     

Laser angioplasty with a pulsed NdYAG laser: early clinical experience

Since December 1986, 40 laser angioplasty procedures have been performed using the energy from a pulsed NdYAG laser, delivering near infrared light (1064 nm) in 100-microseconds pulses of approximately 300 mJ per pulse, directly through a transparent sapphire tipped device. All patients had total occlusion of the superficial femoral artery and symptoms severe enough to warrant surgery, with ulceration or gangrene in eight, rest pain in 14 and severe claudication interfering with life-style in the others. The device was introduced through an antegrade puncture of the superficial or common femoral artery and laser recanalization was followed by attempted balloon angioplasty in all cases. Occlusions were a median length of 15 cm (range 2-35 cm); ten patients had previously undergone failed attempts at conventional balloon angioplasty and four had occluded femoropopliteal grafts. Thirty-seven legs of 34 patients were treated with an average of 60 J (range 10-235 J) with successful recanalization in 27 and immediate reocclusion in seven. The 20 successful recanalizations have been followed up for up to 24 months (median 7 months) with only one late occlusion at 5 months. Failed recanalization was due to poor transmission by the delivery device in the early part of the series (five cases), repeated passage of the device down a collateral branch (four cases), dissection at the site of previous surgery (two cases) or no apparent reason (two cases). Immediate reocclusion was due to very poor run off in patients with severely ischaemic limbs (three cases) or technical difficulties with balloon dilatation (two cases). Complete symptomatic relief was obtained in all the cases of radiologically successful laser angioplasty. Early surgery was required in one case following reocclusion of the artery when an angioplasty balloon failed to deflate, and one patient suffered a skin reaction thought to be due to inadequate removal of the sterilizing solution. A different sterilizing procedure is now followed. Laser angioplasty can reduce the number of patients requiring bypass surgery and improvements in the device and access methods may reduce the number of untreatable cases.     

Laparoscopic adrenalectomy for large unilateral pheochromocytoma: experience in a large academic medical center

Background  

Laparoscopic adrenalectomy is the treatment of choice for most adrenal lesions. Concerns have persisted about its application to large pheochromocytomas due to reports of hemodynamic instability, difficult dissection, and tumor spillage.