Minerva Surgery最新文献

Background: Centellicum^®, a standardized Centella Asiatica extract, has been used orally for fibrosis and scar prevention. The main aim of this 2-month registry pilot study was the reduction of visible, significant scars and keloids after suturing traumatic wounds with irregular edges (lacerations), using Centellicum^®.

Methods: The effects of oral Centellicum^® (450 mg/day; 2 capsules) and a standard management (SM) on wound healing were compared with the effects of a control group that used only the standard management.

Results: Forty-eight otherwise healthy male subjects with lacerations requiring suturing were included in the study. 25 took Centellicum^® in addition to the standard management and 24 followed the standard management only. No side effects were observed with the supplement. Centellicum^® supplementation showed very good tolerability and compliance with 98% of the capsules correctly used. The two groups of otherwise healthy male subjects with lacerations were considered comparable at inclusion and there were no dropouts. No infections were observed. At 60 days, the scar dimensions were significantly smaller in the supplemented group (P<0.05). The elevation of the scar above the surrounding, non-affected skin, was also significantly reduced in the Centellicum^® group compared to controls (P<0.05). Local pain levels were significantly lower (P<0.05) in the supplement group at 60 days. Additionally, the scar redness score was significantly lower in the supplement group compared to controls (P<0.05) by the end of the study. The incidence of initial keloid formation was significantly lower in the supplemented subjects at 60 days, as determined by finger-point pressure palpation and high-resolution ultrasound (P<0.05). Skin flux, as measured by laser Doppler flowmetry (indicating hypervascularization due to local inflammation) was lower (P<0.05) with Centellicum^® at the end of the study. Inflammation, assessed via thermography (hot spots on the healing skin) was less visible and reduced in most areas in the supplement group (P<0.05) in comparison with the control group. Plasma oxidative stress was significantly lower in the Centellicum^® group at the end of the study (P<0.05).

Conclusions: Oral Centellicum^® intake over 2 months improved healing of lacerations and reduced scarring, fibrosis and keloids at the level of the lesions. A larger study setup with more patients and with a prolonged study duration is needed to confirm these initial results.

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.

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.

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.