Surgery Open Digestive Advance最新文献

Introduction

Use of minimally invasive surgery for distal pancreatectomy has been demonstrated with improvement in the length of hospitalisation, blood loss and splenic preservation rate. Current literature concerning operating time with robotic assistance is divergent. The aim of our study is to analyse the learning curve and the evolution of operating time in robotic assisted distal pancreatectomies.

Patients and methods

From 2014 to 2021, in a single center performing 60 to 80 pancreatectomies per year, all patients who underwent robotic assisted distal pancreatectomy were included. A descriptive analysis of peri-operative data has been made as well as an analysis of the learning curve concerning operating time, intraoperative blood loss, splenic preservation rate, length of hospitalization, rate of pancreatic fistula, and grade III and IV Clavien-Dindo's complications.

Results

35 patients were included. The number of spleno-pancreatectomies and distal pancreatectomies with splenic preservation were, respectively 28 and 7. Mean operating time was 178 min. Rate of Grade III and IV Clavien Dindo's complications was 5.7%. There was no death within the 90 post operating days. During the inclusion period, the same surgeon performed 318 other robotic assisted digestive surgeries. The operating time was the criteria that improved the most. It decreased from a mean of 236 min for the first 8 procedures, to 165 min from the 9th intervention onwards. 5 out of 7 of splenic preservations were performed from the 26th procedure. Rate of blood loss, length of stay and post-operative complications did not improve during the study period.

Conclusion

Our analysis suggests a notable decrease in operating time from the 9^th robotic assisted distal pancreatectomy and leans on the importance of global robotic expertise of the surgeon.

Primary hyperhidrosis is a common disease that affects about 5% of the population in which plantar damage exists in 40% of cases responsible for significant social, professional and psychological repercussions. The most effective and sustainable treatment is surgery by thoracic or lumbar sympathectomy depending on the location. Lumbar sympathectomy has long been practiced for the treatment of non-revascularizable obliterating arteriopathy of the lower limbs, and retains a bad reputation, in particular due to sexual dysfunction. However, it is extremely effective for the treatment of plantar hyperhidrosis with 98 to 100% efficiency and thanks to laparoscopy, the operative risks are low and the sexual dysfunction almost nil. Initially described in 1995, since 2002 many teams have improved the technique around the world. The purpose of this article is to describe the technique of retroperitoneoscopic lumbar sympathectomy in 2021 and to discuss its results.

Background

Gangrenous acute calculous cholecystitis (GACC) is acute calculous cholecystitis (ACC) with gallbladder wall necrosis. This study compared specific postoperative course between grade II non-gangrenous acute calculous cholecystitis (NGACC) and GACC.

Methods

All patients with grade II ACC according to the Tokyo guidelines who underwent cholecystectomy from 2007 to 2019 in the first 5 days after onset of symptoms were included in this single-center retrospective study with propensity score weighting. The primary endpoint was overall postoperative complications according to the CCI (comprehensive complication index) compared between patients with GACC and grade II NGACC. Secondary endpoints were intraoperative complications, major complications according to the Clavien-Dindo classification, surgical site infection, medical complications, cholecystectomy-specific complications, reintervention, mortality, length of hospital stay, and readmission.

Results

390 patients underwent cholecystectomy, including 174 GACC. After propensity score weighting, overall postoperative complications according to the CCI (p < 0.001), major complication rate (14.5% vs. 8%, OR = 1.95, CI95% [1.02;3.76], p = 0.04), cholecystectomy-specific complication rate (8.4% vs. 3.3%, OR = 2.67, CI95% [1.06;6.76], p = 0.03), and mean length of hospital stay (5 days vs. 4 days, p = 0.009) were higher in the GACC than in the NGACC group. By contrast, there was no significant difference in reintervention (OR = 1.39, CI95% [0.68;2.85], p = 0.37), mortality (OR = 2.47, CI95% [0.43;14.07], p = 0.31) or readmission (OR = 1.09, IC95% [0.37;3.15], p = 0.87).

Conclusion

GACC is a specific form of grade II ACC with higher morbidity that needs specific peri-operative management.

Angiomyxoma is a rare subtype of myxoid tumor, usually arising from soft tissue of the pelvis and perineum and responsible for infiltrative growth and local recurrence. Other localization of this neoplasm is rare. Clinical and imaging presentations are non-specific and can mimick the most frequent primary cystic liver tumours namely biliary cystadenocarcinoma and intra-ductal papillary neoplasm of the bile duct. We describe here one case encountered in the liver. A 90 x 45 mm liver cystic lesion with tissular component showing enhancement was discovered in a 35-year-old woman suffering from abdominal pain. Considering the atypical and suspicious radiologic characteristics of the mass, a surgical resection was performed. An angiomyxoma was diagnosed on pathological examination. No sign of relapse was found during the follow-up. Our literature search identified six additional cases. This description supports the possibility of angiomyxoma as a differential diagnosis of atypical cystic liver tumours.