Minerva Surgery最新文献

Background: Primary hyperparathyroidism is characterized by elevated plasma calcium levels due to inappropriate secretion of parathyroid hormone (PTH) in most cases by an adenomatous or hyperplastic parathyroid. We present a retrospective analysis of a large cohort of patients operated on of parathyroidectomy in our center analyzing their diagnostic characteristics, intraoperative match and surgical outcomes.

Methods: We included patients with benign parathyroid disease who underwent parathyroidectomy associated or not with hemi- or total thyroidectomy at the Sant'Anna University Hospital of Ferrara between September 2003 and September 2022.

Results: In our study 371 patients fulfilled the inclusion criteria. The most widely used preoperative imaging method was ultrasound, followed by 99mTc-sestamibi scintigraphy. In most cases, preoperative imaging correctly localized the affected parathyroid. Considering the intraoperative site of the pathologically affected parathyroid, the majority of pathological parathyroids were located in the lower districts of the neck and a smaller percentage in the upper, intermediate, and ectopic sites. Postoperative complications were infrequent.

Conclusions: The main challenge in parathyroid surgery lies in the difficulty in localizing the pathological parathyroid at the surgical site, which can lengthen the surgical time by increasing comorbidities. Currently, the results on pathological parathyroid localization are good. Technology needs to be developed toward greater diagnostic accuracy and minimally invasive surgical approaches.

Background: Surgical approach for splenic flexure cancer is demanding due to the complex regional anatomy and the variety of vascular and lymphatic reticula. Minimally invasive approach is recommended to reduce morbidity and postoperative stay, however, laparoscopic SFC resection may results challenging due to vascular and lymphatic dissection. Robotic assistance may help in performing such a procedure thanks to its enhanced dexterity, increased range of motion, enhanced precision and visualization.

Methods: From a database of 287 colorectal procedures, data of twelve consecutive patients who underwent elective splenic flexure resection for SFC with curative intent from 2018 to 2024 at our institution were included in this retrospective cohort study. Parameters considered for statistical analysis were operative time, time to bowel canalization, length of postoperative stay, and 30-day postoperative complications. Kaplan-Meier method was used for univariate survival analysis.

Results: All patients underwent robotic left splenic flexure resections for cancer using the da Vinci Si surgical system in the first 9 and the Vinci Xi surgical system in the last 3 procedures. Median operative time was 267 minutes. Median operative time in the three procedures carried out by Xi system was 200 minutes. All procedures were R0. One postoperative complication occurred. Three conversions were needed, one for pulmonary failure and two for technical difficulties in severe locally advanced tumor.

Conclusions: Robotic splenic flexure resection for SFC seems to be safe and feasible, Xi system is promising in reducing time and ameliorate a fast postoperative recovery. Further studies are needed to confirm the role of robotic in splenic flexure resection for SFC.

Minimally invasive approaches like endoscopic, laparoscopic, and robotic surgery have revolutionized bariatric and metabolic surgery (MBS). Despite the safety of MBS in specialized centers, acute complications requiring emergency treatment may occur and present challenges for general surgeons, especially in community hospitals. This is further complicated by the rising popularity of bariatric surgery tourism and the increasing diversity of bariatric surgical techniques. This paper provides an updated review of the management of acute abdominal complications after minimally invasive MBS, intending to guide general surgeons in managing these patients, especially in emergency settings where specialized bariatric care may not be readily available.

Thyroidectomy is a common procedure in endocrine surgery, frequently performed to treat benign and malignant thyroid conditions. Recurrent laryngeal nerve (RLN) injury, a major complication, underscores the necessity for meticulous nerve dissection during surgery. Intraoperative neuromonitoring (IONM) has emerged as a valuable adjunct to visual identification in RLN preservation. This review synthesizes current literature on IONM in thyroid surgery, emphasizing its role in enhancing RLN integrity assessment and reducing surgical complications such as vocal cord paralysis. IONM techniques include intermittent and continuous monitoring, each offering distinct benefits in nerve function evaluation. While debate persists regarding IONM's efficacy in mitigating unilateral RLN injuries, protocols integrating IONM data have significantly reduced the incidence of bilateral RLN injury, exemplifying advancements in surgical safety. Challenges remain, including variability in study outcomes and the optimal timing of IONM application.

Background: Vegetarianism is constantly increasing worldwide. However, the role of metabolic and bariatric surgery (MBS) in vegetarians/vegans is unclear as there is very limited data on this topic. The aim of this study was to evaluate MBS outcomes in vegetarians or vegans.

Methods: Retrospective analysis of a prospectively maintained database of a single-bariatric surgeon was carried out. All patients with a vegetarian or vegan lifestyle undergoing MBS were included.

Results: Eleven patients were included; none were lost to follow-up. Ten patients were women, the mean age and Body Mass Index (BMI) were 40.8±14 years and 43.5±4.9 kg/m², respectively. Five patients (45%) were lacto-ovo-vegetarians, one (9%) was ovo-vegetarian, two (18%) were lacto-ovo-pesco-vegetarians, and three (27%) were vegans. Eight patients consumed vitamin supplements preoperatively, the mean albumin level was 4.1±0.2, 3/11 patients had vitamin D deficiency, 2/11 patients had vitamin-B12 deficiency, and 2/11 patients had iron deficiency. Eight patients (73%) underwent one anastomosis gastric bypass (OAGB), 2/11 patients (18%) underwent single anastomosis duodeno-ileal bypass with sleeve gastrectomy, and one patient (9%) underwent sleeve gastrectomy, the mean biliopancreatic limb length in OAGB was 225 cm. The median follow-up time was 17 months, the mean BMI and percentage of total weight loss during follow-up were 28.2±5 kg/m² and 35.3±10.7%, respectively. The mean albumin level was 3.82±0.27, 3/11 patients had vitamin D deficiency, and 3/11 patients had iron deficiency.

Conclusions: This study reports preliminary data on MBS outcomes in vegetarian/vegan patients. It was shown to be safe, effective, and an acceptable rate of nutritional deficiencies during follow-up. Further large cohort studies are required to clarify this data.

Introduction: Rouvière's sulcus, an anatomical landmark, has been proposed as a potential aid in enhancing surgical safety. This study aims to assess the prevalence of RS and its anatomical variations both in the existing literature and within our clinical practice.

Evidence acquisition: A systematic literature search was conducted, and relevant studies were identified.

Evidence synthesis: Fourteen studies were obtained from literature search and we added data extracted during our clinical practice, considering them as the fifteenth study (1802 patients enrolled). In the 15 studies analyzed, the overall pooled prevalence estimate of the Rouvière's sulcus was 82.6%. The study heterogeneity was high, I²=87.8%. The subgroup analysis showed negligible difference between studies with cadaveric dissection (PPE=82.6%) and laparoscopic dissection (PPE=82.6%). The analysis of variations according to Singh and Prasad criteria shows that the Type 1A was the most common variation (60.1%). The prevalence of other types was lower:14.2% in Type 1B, 17.3% in Type 2 and 8.5% in Type 3.

Conclusions: Rouvière's sulcus is identified in the majority of patients undergoing LC, and starting the dissection after its recognition can represent a method to reduce IBDI. Considerable heterogeneity exists in the anatomical variations and further research is ongoing to evaluate an association between the variations and technical complexity associate at risk of iatrogenic bile duct injuries.