Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Robotic liver resection can overcome some of the limitations of laparoscopic liver surgery; therefore, it is a promising tool to increase the proportion of minimally invasive liver resections. The present article gives an overview of the current literature. Furthermore, the results of a nationwide survey on robotic liver surgery among hospitals in Germany with a DaVinci system used in general visceral surgery and the perioperative results of two German robotic centers are presented.
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To improve perioperative quality and patient safety, the German S3 guideline should be consistently implemented to avoid perioperative hypothermia. Perioperative normothermia is a quality indicator and should be achieved by anesthesiologists and surgeons. To detect hypothermia early during the perioperative process, measuring body temperature should be started 1-2 h preoperatively. ⋯ A standard operating procedure (SOP) to avoid hypothermia should be introduced in every operative unit. The incidence of postoperative hypothermia should be evaluated in operative patients every 3-6 months. The goals should be to measure body temperature in >80% of patients undergoing surgery and for >70% to exhibit a core temperature >36 °C at the end of surgery.
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Despite the lack of long-term results, peroral endoscopic myotomy (POEM) has been increasingly propagated as a feasible alternative to pneumatic balloon dilatation (BD) and laparoscopic Heller myotomy (LHM) in patients with achalasia. After a long-term follow-up, a large percentage of patients reported recurrence of dysphagia. It is unclear which kind of procedure (redo POEM or LHM) should be utilized in these patients with failed POEM. ⋯ The published experiences with POEM seem to show promising short-term results in terms of dysphagia relief; however, the few available mid-term analyses demonstrated no essential advantages when compared to LHM; therefore, the LHM must still be considered the gold standard procedure for definitive treatment of achalasia. According to our case report, LHM was shown to be a safe and effective although laborious treatment option due to scarring even after failed treatment by POEM.
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The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. ⋯ Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.