In recent years several endoscopic and video-assisted techniques for parathyroidectomy have been described. The role of these
techniques, with respect to time-honored conventional surgery, has been largely debated. This paper was designed to review
the evidence, and make the recommendations, for the video-assisted/endoscopic approach to parathyroidectomy. 相似文献
Sacrocolpopexy remains the “gold standard” procedure for management of posthysterectomy vaginal vault prolapse with improved anatomic outcomes compared to native tissue vaginal repair. Despite absence of clinical data, sacrocolpopexy is increasingly being offered to women as a primary treatment intervention for uterine prolapse. While reoperation rates remain low, recurrent prolapse and vaginal mesh exposure appear to increase over time. The potential morbidity associated with sacrocolpopexy is higher than for native tissue vaginal repair with complications including sacral hemorrhage, discitis, small bowel obstruction, port site herniation, and mesh erosion. Complications are more common during the learning curve of minimally invasive sacrocolpopexy. Appropriate case selection is paramount to balancing the potential for prolapse recurrence with the risk of surgical complications. Use of ultra-lightweight polypropylene mesh and vaginal mesh attachment with delayed absorbable suture may reduce the risks of vaginal mesh exposure. 相似文献
Laparoscopic liver resection for hepatocellular carcinoma (HCC) is still a matter of debate because of the uncertainty of
the long-term results and the fear of compromising the oncological resection. Published findings on survival and outcome after
laparoscopic liver resection for HCC are scarce still. The aim of the present study was to report the perioperative and long-term
outcome of minimally invasive surgical treatment of HCC. 相似文献
Surgery is the only curative treatment for primary hyperparathyroidism. Initial parathyroidectomy procedures fail due to ectopic gland location and unappreciated multigland disease. 相似文献
One-hundred twenty-five patients underwent isolated endoscopic aortic valve replacement. The surgical access was a 3–4 cm minithoracotomy in the second right intercostal space; 3 additional 5 mm miniports for the introduction of a 30-degree thoracoscope, the Chitwood clamp, and the vent line are required. Stended bioprostheses, Rapid Deployment, and Sutureless valves were implanted in 56, 23, and 46 cases, respectively. Mean cross-clamping and cardiopulmonary bypass times were 87.5 ± 22.1 and 126.1 ± 28.4 minutes, respectively. Thirty-day mortality was 0.8%. One patient (0.8%) needed a re-exploration for bleeding and 3 patients (2.4%) required a new permanent pacemaker implantation. No major neurologic events were observed.
Long-term oncologic outcomes after minimally invasive surgery (MIS) for rectal adenocarcinoma compared to open surgery continue to be debated. We aimed to review our high-volume single-institution outcomes in MIS rectal cancer surgery.
Methods
A retrospective review of a prospectively collected database was completed of all consecutive adult patients with rectal adenocarcinoma treated from January 2005 through December 2011. Stage IV or recurrent disease was excluded. Demographics and operative and pathologic details were reviewed and reported. Primary endpoints include survival and recurrence.
Results
A total of 324 patients were included and median follow-up was 54 months (IQR?=?37.0, 78.8). The mean age was 58.2?±?14.1 years. Tumors were in the upper rectum in 111 patients, mid-rectum in 113 patients, and lower rectum in 100 patients. Stage III disease was most common (49.4%). Overall conversion to open procedure rate was 13.9%. The circumferential radial margin was positive in only 1 patient (0.3%) and the mean lymph node yield was 24.7?±?17.2. Cancer recurred in 42 patients (13%), 10 (2.5%) patients developed local recurrence, 32 (9.8%) developed distant metastasis, and 2 (0.6%) patients had both. The 5-year overall survival for stage 0, 1, 2, and 3 disease is 96, 91, 80, and 77%, respectively (p?=?0.015).
Conclusion
In carefully selected rectal cancer patients treated with MIS, long-term outcomes of survival and recurrence appear to compare favorably to previously published series.
The affect of the surgical approach for primary hyperparathyroidism (1HPT) on long-term symptom relief has not been studied. This study compares the long-term relief of symptoms assessed by the Parathyroidectomy Assessment of Symptoms (PAS) score in patients undergoing bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). 相似文献
Minimally invasive parathyroidectomy (MIP) has become a well-accepted treatment for selected patients with primary hyperparathyroidism
(PHPT). However, few studies have evaluated long-term outcomes for this operative approach. We therefore chose to examine
both the long-term symptom resolution and biochemical cure following MIP for PHPT. 相似文献
Latero-lateral duodenojejunostomy is the treatment of choice for superior mesenteric artery syndrome (SMAS). The present study analyzes the long-term outcomes in 13 patients undergoing laparoscopic surgery for SMAS.
Materials and methods
A retrospective study of 10 females and three males undergoing surgery between 2001 and 2013 was performed. Demographic, clinical and radiologic data and long-term surgical outcomes were recorded. In 12 patients latero-lateral duodenojejunostomy and in one patient distal laparoscopic gastrectomy with Roux-en-Y reconstruction were performed. The median age was 24 years (20–28), and the median duration of symptoms was 24 months (5–24). The most frequent symptoms were abdominal pain (n = 11; 92.3%), nausea and vomiting (n = 10; 77%) and weight loss (n = 9; 69.2%). The median operating time was 98 min (86–138) and hospital stay was 3 days (1–14).
Results
No reconversions occurred, and one patient experienced gastric emptying delay in the immediate postoperative period with spontaneous resolution. In four patients, SMAS was associated with severe stenosis of the celiac trunk which was treated in the same operation, and four patients presented stenosis of the left renal vein (the “nutcracker” phenomenon). With a median follow-up of 94 months (SD 65.3), eight patients (61.5%) had excellent results. One patient had a relapse of symptoms 4 years after surgery requiring distal gastrectomy, two patients presented delay in gastric emptying following temporary improvement and one patient experienced no improvement.
Conclusions
Latero-lateral duodenojejunostomy yields good results in SMAS although it requires other gastric motility disorders to be ruled out for appropriate treatment to be established.
Minimally invasive esophagectomy has gained popularity over the past two decades. The procedural goal is to decrease the high overall morbidity of a traditional open esophageal resection. The entire spectrum of open esophagectomy techniques has been successfully replicated in a minimally invasive fashion.
Discussion
Esophagectomy remains one of the most technically challenging operations, and developing the skills necessary for minimal invasive esophagectomy is associated with a steep learning curve. Minimally invasive approaches show most promise for benign disease and select early esophageal cancers, but their role in more advanced cancer remains controversial due to lack of long-term results.
Conclusion
As minimally invasive esophagectomy matures, its true value in both benign and malignant disorders will become better defined.
