Chirurgia最新文献

Background: The advancements in the field of robotic surgery have led to its use in breast surgery. We report the first robotic-assisted nipple-sparing mastectomy (RNSM) using the da Vinci Xi surgical system, in Romania, for a patient with contralateral breast cancer. Immediate breast reconstruction was performed using a silicone implant. There were no major immediate complications. On this occasion, a systematic review was performed to examine the data on safety, feasibility, oncological and cosmetic outcomes for this procedure.Methods: We reviewed the literature from September 2015 to August 2024 in PubMed, Scopus, and EMBASE. Original studies reporting on patients diagnosed with or at high-risk of breast cancer undergoing RNSM were included.Results: Postoperative complications of RNMS were minimal and comparable to those observed with conventional nipple-sparing mastectomy. Furthermore, two studies found that RNSM resulted in significantly lower rates of skin and nipple-areola complex necrosis compared to open surgery (0% vs. 12.5% and 2.4% vs. 15.2%, respectively). Additionally, robotic-assisted mastectomy was linked to greater overall cosmetic satisfaction. On the other hand, the total costs and operating times for robotic procedures were higher than those for open surgery.Conclusion: RNSM is a feasible technique for prophylactic purposes, with both advantages and disadvantages. Although emerging data support the oncological safety and potential benefits, future studies are needed to validate its efficacy in cancer treatment.

Background: Ovarian surface epithelial cancer (OSEC) are an entity in which, according to genomics and pathology data accumulated in the last couple of decades, several different nosological entities with distinct etiologies are aggregated. In ovarian cancer, surgery is the pivot of treatment, to which medical oncological treatment is added by recommendation in most cases. Materials and Methods: This is a single centre sample of 263 cases with OSEC operated from January 2014 until December 2021 with a 28-month period of follow-up, until 30th April 2024. OSEC surgical procedures in stages IIB to III and IV of the disease are complex interventions in order to have the R0/optimal cytoreduction achieved, so we summarised and coded them as follows: 1 = biopsy (of the tumour/peritoneum); 2 = bilateral/unilateral adnexectomy (BA/UA) +- total hysterectomy (TH) +- omentectomy +- peritoneal biopsies; 3 = (2) with total hysterectomy with bilateral adnexectomy (THBA) +- by extraperitoneal/subperitoneal route+peritonectomies (exclusively diaphragmatic) and electrocauterization of peritoneal carcinomatous lesions; 4 = (3) with visceral (multiple) resections +- stoma; 5 = (4) with diaphragmatic peritonectomies/stripping/partial resection of the diaphragm; 6 = palliative surgery. Results: Debulking surgery (DS) was carried out for n = 182 patients with no residual tissue = R0 being registered in n = 41. Results for patients with residual tissue (n = 141) after DS recorded the following findings: 1 cm (49% cases), 1.1-2 cm (29%) and 2 cm (22%). Recorded results for endometrial ovarian carcinoma (EC) n = 27 shown a tumour free survival probability estimate (%) at 60 months of 66% as both surgery and platinum based chemotherapy are efficient. For clear cell ovarian carcinoma (CCC) n = 7 recorded results shown a tumour free estimate (%) at 60 months of 14%, being known the controversy as to whether or not paclitaxel is an active drug for CCC. Major complications were recorded in 25 patients with a fatality ratio of 5/25. Conclusion: Considering OSEC is a relatively rare disease and the importance of collecting substantial numbers of samples by histotypes to further knowledge about ovarian cancer it comes crucial to establish collaborative endeavour of tertiary centers with standardised and quality control strategies.

Objective: To compare the accuracy of arthroscopy with MRI in diagnosing ramp lesions associated with anterior cruciate ligament (ACL) injuries.

Design: Prospective observational study. Material and Methods: We included 100 patients with complete ACL tear.

Exclusion criteria: 1) Partial ACL tear, 2) ACL revision surgery or previous knee surgery, 3) Multi-ligamentous knee injury, 4) Extensive medial meniscus tear. Results: Nine patients were diagnosed with ACL-associated ramp lesions. All nine had magnetic resonance imaging (MRI) signs, but these were not statistically significant ( 2=1.884, FEp=0.348). Mean medial meniscal slope for patients with ramp lesions was 2.88 +- 0.46, without was 2.47 +- 0.55 (T=2.146, P=0.034), implying statistical significance as visualized by arthroscopy. Arthroscopy is superior in diagnosing ramp lesions.

Conclusion: Arthroscopy is superior in diagnosing ramp lesions due to cost-effectiveness, direct visualization, and immediate treatment capability. The absence of specific MRI signs for ramp lesions further supports this conclusion.

Background: The evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies.

Objective: To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and Methods: Sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. Results: No Statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy).

Conclusion: Axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC.

Key message: With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC for patient who have shown down-staging of their axillary status after NACT. Radiotherapy can show better results in the long term with regards lymphedema.

Introduction: The primary aim of this meta-analysis was to compare the operative outcomes of single-port laparoscopic versus single-port robotic platforms in colorectal surgery. Materials and Methods: A comprehensive literature search was conducted for studies comparing operative outcomes and short-term follow-up data of single-port laparoscopic versus single-port robotic colectomy. Data from eligible studies were extracted, qualitatively assessed, and included in a meta-analysis. Odds ratios (ORs) and mean differences with 95 per cent confidence intervals were calculated. Results: Three studies with a total of 346 patients (Robotic: 112 cases versus Laparoscopic: 234 cases) were included. There was no statistical difference noted with regard to overall morbidity, length of hospital stay and intra- and postoperative complications between the two groups. However, the robotic approach resulted in higher lymph nodes yield in oncologic cases (SMD -0.25, 95% CI -0.50 to -0.01, p = 0.04, I2 = 0%). Conclusion: Both single-port laparoscopic and robotic techniques appear to be safe and feasible options in colorectal surgery displaying comparable perioperative outcomes. Larger randomized controlled trials are needed to justify their application, particularly with regard to procedurerelated costs.

Introduction: Colorectal cancer (CRC) has exhibited an increasing incidence worldwide in recent years, underscoring the importance of early diagnosis methods. This study aimed to assess the influence of CD44 gene polymorphism rs187115 on CRC susceptibility. Material and Methods: The study encompassed 470 CRC patients and 165 healthy controls. Genotyping of all biological blood samples was conducted using the TaqMan assay on the ABI 7500 Real Time PCR System (Applied Biosystems, USA). Results: The genotyping revealed that carriers of the variant G allele, including the genotypes AG and GG, exhibited a heightened risk of CRC occurrence, with an odds ratio (OR) of 1.89 (95% confidence interval [CI] = 1.57-1.97; p = 0.047) compared to those carrying the AA genotype. Conclusions: The findings underscore the potential utility of CD44 rs187115 polymorphisms as a novel predictive biomarker for CRC prognosis.

Introduction: The study investigated the therapeutic approach and clinical management of pediatric burn patients admitted to the Pediatric Surgery and Orthopedics Clinic of the County Emergency Hospital Craiova over a two-year period (2017-2018). The primary objective was to evaluate the effectiveness of the treatments applied, including grafting procedures and their impact on long-term prognosis. Material and Methods: The cases of 80 children with burns of varying severity were retrospectively analyzed. Patients were classified according to the severity and the mechanism of burn injury. The collected data were processed using Microsoft Excel 2021. Patients were classified into three categories based on the affected body surface area (BSA): Category 1 patients, with a BSA = 10%, showed very good results and required less intensive care. Category 2 patients, with a BSA between 10% and 50%, had good outcomes but needed more prolonged care. Category 3 patients, with a BSA = 50%, had satisfactory results but faced more challenges in recovery, highlighting the need for enhanced prevention measures and better treatment protocols. Results: The majority of patients came from rural areas, and thermal burns were the most common. The effectiveness and safety of the treatments applied were highlighted, with a generally favorable impact on long-term prognosis. Treatment included both surgical and non-surgical approaches, with generally favourable clinical outcomes. Conclusion: The study highlights significant differences between rural and urban environments, suggesting the need for prevention and education campaigns regarding pediatric burns and improved access to medical services. It also emphasizes the need for integrated management to reduce the severity and complications associated with burns. The results provide a solid foundation for future strategies aimed at improving the care of paediatric burn patients.

Background: Ovarian surface epithelial cancer (OSEC) are an entity in which, according to genomics and pathology data accumulated in the last couple of decades, several different nosological entities with distinct etiologies are aggregated. In ovarian cancer, surgery is the pivot of treatment, to which medical oncological treatment is added by recommendation in most cases. Material and Methods: This is a single centre sample of 263 cases with OSEC operated from January 2014 until December 2021 with a 28-month period of follow-up, until 30th April 2024. OSEC surgical procedures in stages IIB to III and IV of the disease are complex interventions in order to have the R0/optimal cytoreduction achieved, so we summarised and coded them as follows: 1 = biopsy (of the tumour/peritoneum); 2 = bilateral/unilateral adnexectomy (BA/UA) total hysterectomy (TH) omentectomy +- peritoneal biopsies; 3 = (2) with total hysterectomy with bilateral adnexectomy (THBA) +- by extraperitoneal/subperitoneal route+peritonectomies (exclusively diaphragmatic) and electrocauterization of peritoneal carcinomatous lesions; 4 = (3) with visceral (multiple) resections +- stoma; 5 = (4) with diaphragmatic peritonectomies/stripping/partial resection of the diaphragm; 6 = palliative surgery. Results: Debulking surgery (DS) was carried out for n = 182 patients with no residual tissue = R0 being registered in n = 41. Results for patients with residual tissue (n = 141) after DS recorded the following findings: 1 cm (49% cases), 1.1-2 cm (29%) and 2 cm (22%). Recorded results for endometrial ovarian carcinoma (EC) n = 27 shown a tumour free survival probability estimate (%) at 60 months of 66% as both surgery and platinum based chemotherapy are efficient. For clear cell ovarian carcinoma (CCC) n = 7 recorded results shown a tumour free estimate (%) at 60 months of 14%, being known the controversy as to whether or not paclitaxel is an active drug for CCC. Major complications were recorded in 25 patients with a fatality ratio of 5/25. Conclusion: Considering OSEC is a relatively rare disease and the importance of collecting substantial numbers of samples by histotypes to further knowledge about ovarian cancer it comes crucial to establish collaborative endeavour of tertiary centers with standardised and quality control strategies.

This study investigates the correlation between the histopathologically confirmed or refuted diagnosis of Hirschsprung Disease (HD) and the type of surgery performed on patients. Data from 24 patients were analyzed, divided into two categories: confirmed HD (n=17) and refuted HD (n=7). The results did not identify a statistically significant association between the diagnosis of HD and the sex of the patients (p-value = 1.000000). Further studies with larger samples are needed to clarify this relationship.

Introduction: Reconstruction surgery of the proximal aorta in most cases involves the use of an aortic conduit, followed by reimplantation of the coronary ostia. Although uncommon, the origin of the coronary arteries in certain anatomical variants poses additional difficulties when performing surgery on the aortic root and requires a different treatment rationale. Case report: We hereby present the case of a 60-year-old patient with multiple cardiovascular risk factors (smoking, arterial hypertension and dyslipidemia), suffering from severe degenerative stenosis of a bicuspid aortic valve, associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. The patient presented with severe degenerative bicuspid aortic valve stenosis associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. Following the preoperative assessment, it was decided that the best course of action was to perform surgery on the aortic valve and ascending aorta. During the surgery, the origin of the right and left coronary ostia were found at the level of the left coronary cusp, both forming a common coronary button. Due to this particular anatomical variant, it was decided to reimplant them as a common button onto the main conduit by means of an interposed No.10 PTFE (Polytetrafluoroethylene) vascular prosthesis. Conclusion: A rare case of aortic root surgery associated with coronary ostia origin variant "shotgun barrel", which required a different method of reimplantation: modified Cabrol technique.