Zentralblatt für Chirurgie
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Case Reports Webcasts
[Robot-assisted minimally invasive lobectomy with systematic lymphadenectomy for lung cancer].
Lobectomy for lung cancer is the standard therapy for lung cancer in limited stages. The adoption of minimally invasive lobectomy (video-assisted thoracic surgery or VATS lobectomy) has increased worldwide since its first description more than 15 years ago. However, the VATS technique has a long learning curve and sometimes limitations in terms of precise preparation and presentability of the central structures of the lung hilus due to the limited mobility of the standard thoracoscopic instruments. By using a four-arm robotic platform (DaVinci®), not only the preparation of the hilus structures but also the central lymphadenectomy can be performed in a comfortable and safe way under a clear and precise view. ⋯ Robot-assisted minimal invasive lobectomy is feasible with special regard to oncological and technical aspects. Especially the intrathoracic precise dissection of the tissue under a perfect view allow a comfortable and safe operation technique.
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The prevalence of bronchiectasis not due to cystic fibrosis (NCFB) increases with older age. Because of multifaceted etiology of bronchiectasis an extensive diagnostic approach is essential. This includes in-depth anamnesis and a high resolution CT scan of the chest (HRCT). ⋯ In case of localized bronchiectasis and failure of conventional therapy surgery of bronchiectasis is an effective treatment option. In some cases surgery is necessary due to haemoptysis, aspergilloma, lung abscess and pleuraempyema. To improve the treatment options of bronchiectasis results of epidemiological, basically and clinical research trials are expected and needed.
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Due to the variety of differential diagnoses causing acute scrotum and their possible consequences, this finding is a challenge for diagnostic and therapeutic management in the daily clinical practice of paediatric medicine. ⋯ In approximately one fifth of registered patients, a testicular torsion is present causing the acute scrotum, and leading to an obligatory surgical intervention. Various causative differential diagnoses can be clarified by precise medical history and exact physical examination. Imaging procedures can be helpful in decision-finding. Finally, the clinical finding is crucial and decisive. If a testicular torsion cannot reliably be excluded by clinical investigation or imaging, an immediate surgical exploration of the testis has to be performed.
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Observational Study
[Teamwork in the operating theatre: the German Observational Teamwork Assessment for Surgery (OTAS-D) and its first application in Germany].
The quality of surgical teamwork contributes to performance of the operating theatre team, service quality and patient safety in surgery. Observational tools are a feasible and reliable way to capture and evaluate teamwork in the operating theatre (OT). We introduce the German version of the Observational Teamwork Assessment for Surgery (OTAS-D) and present the first observational results from German OTs. ⋯ The German version of OTAS-D is a psychometrically robust method to capture the quality of teamwork in operating theatres. It enables the analyses of teamwork between the surgical, nursing and anaesthesia professions in acute surgical care. Limitations of the first application results are considered. Finally, potential applications for surgical teaching, research and quality management are discussed.
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Splenic rupture is the most common injury in blunt abdominal trauma at any age. The grade of rupture, haemodynamic stability and, in the case of operative treatment, the experience of the surgeon all play an important role in preserving the spleen. Due to its important immunological function preservation of the spleen should be the goal. ⋯ The majority of primarily partially spleen-preserving operations result from OIS grade IV ruptures of the spleen. Use of a partially spleen-saving surgical approach was successful in ¾ of these patients. Low morbidity and documented perfusion of the remnant spleen at long-term follow-up indicate that a spleen-preserving technique is warranted if an operative approach is required.