Minimalinvasive Pankreastumorchirurgie

Introduction and purpose

Despite being technically challenging, minimally-invasive pancreatic surgery is increasingly being used to treat pancreatic diseases. Therefore, the evaluation of its oncological safety and its advantages arebecoming increasingly more important. This review focuses on these questions based on the currently available literature.

Material and methods

The technically less demanding laparoscopic distal pancreatectomy has been evaluated in numerous meta-analyses. Minimally invasive pancreaticoduodenectomy has only been reported from a few centers worldwide.

Results and conclusion

Minimally invasive pancreatic surgery, in particular laparoscopic distal pancreatectomy, is increasingly being used to treat pancreatic tumors. The advantages of laparoscopy, such as less intraoperative blood loss, reduced postoperative pain and a shorter length of stay have all been demonstrated in large trials. However, a sufficient oncological treatment was only assessed via indirect surrogate parameters, such as the number of lymph nodes obtained and R0 resection rates; therefore, larger prospective trials are needed to prove adequate oncological treatment. To date, minimally invasive techniques should only be employed in trials on treatment of pancreatic malignancies.     

Minimalinvasive Beckenchirurgie

The pelvis is the mechanical connection between the lower extremities and the spinal column. The aim of surgical treatment for pelvic and acetabular injuries is to compensate the strong mechanical forces needed here, without compromising wound healing and restricting muscle function due to additional soft tissue damage. In recent years, minimally invasive stabilizing techniques, which reduce surgical risks and recovery time as well as improving outcomes, have become increasingly established. The increased use of improved imaging modalities also plays a significant role here. Surgical errors can be avoided in the osteosynthesis of acetabular fractures by means of intraoperative visualization using 3D image converters. Navigated percutaneous pelvic sacroiliac screw fixation is the main procedure to be used for pelvic and acetabular navigation. New software enables a 2D representation of the hip area and a 3D calculation of instrument and implant positions, thereby reducing X-ray exposure and increasing intraoperative safety.     

Minimalinvasive Osteosyntheseverfahren

Trauma und Berufskrankheit - Minimalinvasive Osteosyntheseverfahren finden auch in der Unfallchirurgie immer mehr Verbreitung. Allerdings existieren minimalinvasive Methoden schon seit vielen...     

Minimalinvasive therapie der cholezystolithiasis

Ohne Zusammenfassung     

Update Unfallchirurgie

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Evidenzbasierte Unfallchirurgie

Wenn man bereit ist, ?rztliche Entscheidungen kritisch zu sehen, wird man zur Entscheidungsfindung - neben Expertenmeinung oder pathophysiologischer Begründung - auch aus der klinischen Forschung empirisch gewonnenes Wissen (“evidence”) heranziehen. Was “evidence” ist, wie sie wirkt, wie h?ufig sie in der Unfallchirurgie eingesetzt wird sowie Probleme mit und Grenzen von evidenzbasierter Medizin (EbM) sind Gegenstand dieses Artikels.     

Minimalinvasive Verfahren bei der Dupuytren-Kontraktur

Dupuytren’s contracture represents a degenerative disorder with fibromatosis of the palmar and digital collagenous fibers. A genetic disposition has been observed and a higher prevalence in male patients. Frequently, the disease starts with nodule formation in the palm and progresses distally to the fingers. The severity of flexion contracture can be described with Tubiana’s staging system, which gives the total impairment of movement in gradually increasing 45° steps. The following cords can contribute to the flexion contraction but are not always found simultaneously: pretendinous cord, central cord, spiral cord, lateral cord, retrovascular cord, thumb pretendinous cord and the abductor digiti quinti cord. The most frequently used operative therapy is partial aponeurectomy (synonymous with fasciectomy). Local cutaneous flaps are planned from the beginning in the operative process so that the skin can be closed without tension after resection of all affected cords and is frequently performed with VY flaps, homodigital or bilobed flaps. Especially in the region of the palmar proximal phalanx, skin closure can be difficult in highly advanced stages of contracture. Further operative procedures include complete fasciectomy, segmental fasciectomy and open faciotomy, which are employed less frequently. In addition so-called minimally invasive forms of treatment exist, such as percutaneous needle fasciotomy, which was rediscovered by French rheumatologists and in Europe was slowly transferred to the hand surgeons from 2001 onwards. Injectable collagenase (Xiapex®/Xiaflex®) was approved in 2010 in the USA and in 2011 in Europe and adopted for the treatment of Dupuytren’s contracture. In Germany the distribution of Xiapex® was terminated but in the USA and other countries, collagenase is still used. This poses the question whether this compound, which is difficult to obtain in Germany has nevertheless changed the therapy of the Dupuytren’s contraction.     

Update Unfallchirurgie

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Update Unfallchirurgie