Surgical laparoscopy, endoscopy & percutaneous techniques
-
Surg Laparosc Endosc Percutan Tech · Dec 2011
Case ReportsEndoscopic removal of impacted magnetic foreign bodies in the gastroesophageal junction.
Ingestion of foreign bodies is common in gastroenterology practice. Most of them are spontaneously passed through gastrointestinal tract. However, ingestion of multiple magnets can cause serious complications, because magnets attract each other and they hold the gastrointestinal wall. ⋯ In general, impacted magnetic foreign bodies should be removed by surgical intervention because of a high perforation risk. But, in this case, we used an insulated-tip knife for endoscopic submucosal dissection technique to make an incision to expose the impacted magnetic foreign bodies, and removed them successfully without surgery. With this report, we hope to encourage gastroenterologists to consider this new technique as one of procedures for difficult cases, including impacted foreign bodies.
-
Surg Laparosc Endosc Percutan Tech · Dec 2011
Case ReportsLaparoscopic adrenalectomy for a rare 14-cm adrenal schwannoma.
Laparoscopic surgery for adrenal tumors is the gold standard for benign tumors; however, its role for adrenal cancer, metastases, and large suspicious lesions remains controversial. This aspect becomes clinically more important as larger incidentaloma are being detected with increasing frequency. Here, we discuss a rare case of a giant 14-cm adrenal schwannoma, which presented as an incidentaloma and was excised laparoscopically. ⋯ Adrenal schwannoma is an extremely rare entity and can grow considerably in size. So far, this is the largest adrenal schwannoma reported in literature. In agreement with a growing number of publications, laparoscopic adrenalectomy can also be used for potentially malignant tumors larger than 10 cm in diameter provided the tumor does not infiltrate into other organs, conversion to open surgery is carefully considered, and resection occurs within the anatomic planes, thus ensuring the intactness of the tumor capsule.
-
Surg Laparosc Endosc Percutan Tech · Oct 2011
Randomized Controlled Trial Comparative StudyEffects of epidural-and-general anesthesia combined versus general anesthesia during laparoscopic adrenalectomy.
Laparoscopic approach is increasingly performed for functional adrenal tumor resections. The aim of this study was to compare general anesthesia and general anesthesia combined with epidural anesthesia for laparoscopic adrenalectomy. In our study, we planned to examine hemodynamic changes (heart rate, systolic, diastolic, and mean pressures) and quantity of adrenocorticotropic hormone, adrenaline, noradrenaline, cortisol, and aldosterone in laparoscopic adrenalectomies under general anesthesia with or without epidural anesthesia. ⋯ There was no significant difference in hemodynamic parameters, ACTH, cortisol, adrenaline, and noradrenaline levels between the 2 groups. Aldosterone levels were higher in general+epidural anesthesia group. The results of our study suggest that epidural anesthesia in addition to general anesthesia in patients with functional adrenal tumors undergoing laparoscopic adrenalectomy might be an effective and safe method to prevent the fluctuations in hormone levels.
-
Surg Laparosc Endosc Percutan Tech · Aug 2011
Case ReportsLaparoscopic-assisted spleen-preserving and pylorus-preserving total pancreatectomy for main duct type intraductal papillary mucinous tumors of the pancreas: a case report.
Minimally invasive and function-preserving pancreatectomy would be the ideal approach for benign and borderline malignant tumors of the pancreas. Total pancreatectomy can be indicated for the main duct type of intraductal papillary mucin-producing tumor (IPMT) to achieve radical resection. Recently, several studies advocating total pancreatectomy in IPMT have been published, but they are all believed to be done by conventional laparotomy. ⋯ She was discharged 20 days after surgery. She was followed for more than 2 years without evidence of tumor recurrence. Her blood sugar level was well controlled by insulin pump therapy and image study showed well-preserved spleen function.
-
Surg Laparosc Endosc Percutan Tech · Aug 2011
Comparative StudyProspects of robotic thyroidectomy using a gasless, transaxillary approach for the management of thyroid carcinoma.
Robotic surgical systems are among the most innovative surgical developments and have radically promoted the use of minimally invasive techniques. Robotic technologies using different approaches have also been applied to thyroid surgery. Recently, the authors described a novel robotic surgical method for thyroid surgery based on a gasless, transaxillary approach (TAA), and have since serially reported on its technical feasibility and safety. Here, the authors report their experience of a consecutive series of 1000 cases treated using robotic thyroidectomy, and demonstrate its use for the surgical management of thyroid cancer. ⋯ The authors conclude that robotic thyroidectomy using a gasless TAA is a feasible, safe, and promising surgical alternative for selected patients with low-risk thyroid cancer, and recommend that the inclusion criteria of this technique be gradually extended to advanced thyroid cancer given suitable operator experience and future developments in robotic systems and instrumentation.