World journal of surgery
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World journal of surgery · Jul 2010
Assessing operative performance in advanced laparoscopic colorectal surgery.
Competent technical skills performance in complex operations is vital for satisfactory patient outcome. Assessing these skills is therefore of paramount importance. In this study we aim to develop and validate a new tool that can assess both generic and specific technical skills in advanced complex laparoscopic colorectal surgery in the operating room. ⋯ This new assessment tool of generic and specific technical skills in advanced laparoscopic colorectal surgery is reliable and has face, content, concurrent, and construct validities. The tool has the possibility of being used as a surgical training and appraisal tool.
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World journal of surgery · Jul 2010
18F-FDG PET for the identification of adrenocortical carcinomas among indeterminate adrenal tumors at computed tomography scanning.
18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) has been proposed for the evaluation of adrenal tumors. However, only scarce data are available to evaluate its usefulness for the identification of primary adrenal carcinomas in patients with no previous history of cancer and equivocal tumors on computed tomography (CT) scan. The objective of the present study was to evaluate the diagnostic performance of 18F-FDG-PET to predict malignancy in such patients. ⋯ Because of its excellent negative predictive value, 18F-FDG-PET may be of help in avoiding unnecessary surgery in patients with non-secreting equivocal tumors at CT scanning and low 18F-FGD uptake.
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World journal of surgery · Jul 2010
Flexible thoracoscopy may facilitate video-assisted thoracoscopic lobectomy.
Video-assisted thoracoscopic lobectomy was introduced in the early 1990s but has not yet gained widespread acceptance. The VATS approach is still controversial although several studies suggest less postoperative morbidity compared with open thoracotomy. Nevertheless, some patients report long-lasting chest wall pain following VATS procedures, and, in theory, such pain may be related to intercostal nerve injury. The present study presents our experience with a commercially available flexible thoracoscope. ⋯ Video-assisted thoracoscopic lobectomy by flexible thoracoscopy is feasible and in our opinion easier and safer compared with rigid thoracoscopy. In our experience all parts of the operation are better visualized and many surgical pitfalls may be avoided. Even during early phases of setting up the VATS lobectomy program, the duration of the operation is comparable with open surgery, and postoperative pain is low, possibly because porthole angulation is minimized.
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World journal of surgery · Jul 2010
A modified Nuss procedure for late adolescent and adult pectus excavatum.
Although the Nuss procedure has been widely adopted as a standard procedure in children with pectus excavatum, reports focusing on its use in adults are rare. We retrospectively reviewed postoperative results to evaluate the safety and efficacy of the Nuss procedure in late adolescents and adults with pectus excavatum. ⋯ Using the thoracoscope, the compound bar technique, the 3-point wire fixation, the crane technique, and sometimes double bar insertion showed that the Nuss procedure could be performed safety and effectively in late adolescent and adult patients with pectus excavatum.
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Massive bleeding during hepatectomy is a risk for mortality and morbidity. We examined the risk factors for massive bleeding and their correlations with outcomes. ⋯ RMH for large PLCs, tumor compression of the IVC, and an anterior approach without the LHM are risks for massive bleeding during hepatectomy. Preparation of rapid infusion devices in these cases is necessary to avoid prolonged hypotension.