Rozhledy v Chirurgii最新文献

Introduction: Dislocation fractures of the distal lower leg require surgical treatment. If the quality of the soft tissues and skin does not allow primary suture of the wound, it presents a serious challenge for the surgeon. In our case, after reposition and fixation of the fractures, we were able to perform a fascia suture with a residual large skin and subcutaneous defect. We decided to use a combination of Amnioderm application and negative pressure therapy.

Methods: The authors describe the procedure for the treatment of an acute wound in a young, morbidly obese patient with an ankle injury following a traffic accident.

Discussion: Closure of the surgical wound in the field of swelling and hematoma is a frequent problem encountered in patients after ankle osteosynthesis. There are several possible approaches, one of which is the use of negative pressure therapy. Its effect can be enhanced by the application of Amnioderm.

Conclusion: Although this is the first use of the presented technique, based on our other general experience with Amnioderm and the frequent use of negative pressure wound therapy from other indications, we dare to say that it is a safe method that offers an effective solution to a complex, critical situation.

Since the beginning of carotid surgery, there has been an effort to find the safest technique for carotid endarterectomy and ensure sufficient brain perfusion during the procedure. Similarly, endovascular procedures have been modernized from simple balloon angioplasty to stent placement, and protective systems have been developed to prevent periprocedural embolization. The second half of the last century became an important stage in examining and comparing the results of carotid endarterectomy and carotid stenting, -searching for and establishing indication criteria in the context of highly effective antiplatelet -therapy. At the turn of the century, with the advent of modern techniques of regional anesthesia and intravenous analgosedation, most vascular departments gradually moved away from carotid surgery under general anesthesia and there was a renaissance of eversion endarterectomy techniques. From a vascular perspective, carotid surgery underwent a long, closely monitored development and defended its place as the first choice in the treatment of carotid stenoses.

Introduction: Principles of complete mesocolic excision with central vascular ligation were first published by Hohenberger with promising oncological results of right-sided colon carcinoma. Nowadays preserving of mesocolon is a gold standard; however, -there is a lack of definitive answer about the extent of lymphadenectomy. Our modified D3 lymphadenectomy can reach higher count of lymph nodes retrieval, and therefore can lead to upstaging in the patient. Nevertheless, more complex procedure can lead to various perioperative complications.

Methods: A total of 28 patients were operated by robotic assisted approach with modified D3 lymphadenectomy in the period 1/2023-12/2024 for carcinoma of the cecum and ascending colon. As a control group, 59 patients were enrolled from the period 1/2020-12/2022 operated by an open approach with standard D2 lymphadenectomy. In each input parameter, both groups were comparable.

Results: An operating time was significantly longer in robotic assisted group (P < 0.001). Blood losses were comparable for both groups. Postoperative hospital stay was lower in robotic assisted group and reached a significant threshold (P = 0.011). The re-trieved lymph node count was significantly higher in the group of modified D3 lymphadenectomy (P = 0.002). There were no surgical site infections in the miniivasive group, while in the open group they reached 17%. The occurrence of paralytic ileus was lower in the robotic assisted group (10 vs. 27.1%; P = 0.146).

Conclusion: The results of this pilot study indicate that complete robotic assisted mesocolic excision with modified D3 lymphadenectomy at right-sided colorectal carcinoma is a safe method, and does not increase the risk of peroperative vascular injuries and postoperative complications, such as paralytic ileus or surgical site infection, which leads to a shorter hospital stay.

Introduction: Takotsubo syndrome presents with the sudden onset of symptoms resembling with acute coronary syndrome with typical transient myocardial kinetic disorder. In the secondary form of the disease, the initial symptoms of the patient are extracardiac.

Case report: A 67-year-old female patient with a history of ischemic heart disease underwent urgent Hartmann's resection for sigmoid perforation due to Clostridium colitis. Two days after the primary surgery, during a planned surgical revision for another pathology, the patient developed cardiorespiratory failure. Due to the electrocardiographic finding of newly developed left bundle branch block and the echocardiographic image of extensive local kinetic disorder with severe systolic dysfunction of the left ventricle, the patient was indicated for selective coronary angiography with suspicion of acute coronary syndrome. The examination did not demonstrate coronary artery involvement. After the diagnosis of Takotsubo syndrome was established, the patient was successfully treated with gradual resolution of symptoms and normalization of left ventricular function.

Conclusion: Takotsubo syndrome is a diagnosis that can be potentially fatal and -should be a part of the differential diagnostic assessment in surgical patients when acute coronary syndrome is suspected. With properly adjusted therapy, the symptoms of this disease disappear without functional and morphological consequences.

Mediastinal lymphadenectomy plays a crucial role in the surgical treatment of -non-small cell lung cancer (NSCLC), as accurate staging significantly influences subsequent therapy. Robot-assisted thoracoscopic surgery (RATS) has emerged over the past decade as an advanced minimally invasive approach with the potential to achieve high oncological radicality. This review explores the outcomes of mediastinal lymphadenectomy performed using the RATS technique and compares them with those of video-assisted thoracoscopic surgery (VATS). In most studies, a higher, at least comparable, total number of lymph nodes was retrieved with RATS compared to VATS. The number of dissected nodal stations was comparable between RATS and VATS in most studies. Authors frequently highlight the advantages of robotic technology, including enhanced visualization, precise dissection, and the potential to detect occult nodal metastases. The technique is also associated with low morbidity and a feasible learning curve. Although robust long-term survival data are still lacking, current findings suggest that RATS may represent a safe and effective option for mediastinal lymphadenectomy in NSCLC, particularly in centres with established robotic programs.

Introduction: The modified Henry approach is predominantly used in the treatment of distal radius fractures. Over the years, it has undergone numerous modifications, and its original interpretation varies significantly. This summary also discusses other volar approaches to the distal radius. The original description of the approach is attributed to Arnold Kirkpatrick Henry, who, in his three publications, mentions the interval between the radial artery and the flexor carpi radialis muscle. Currently, many controversies are being debated, including extended approaches, techniques and options for transecting the pronator quadratus muscle, indications and methods for carpal tunnel release, transection of the brachioradialis muscle, and others. Variations: Anatomical structures visualized during the modified Henry approach are not highly variable. Occasionally, an accessory flexor carpi radialis brevis muscle and several variants of the pronator quadratus muscle may be present, which have only been described in case reports.

Conclusion: Among the many controversies debated regarding the modified Henry ap-proach, the most clinically significant are the proper release of the brachioradialis muscle and the early detection of carpal tunnel symptoms followed by appropriate intervention. Other volar approaches are used less frequently and typically in specific indications.

Facial loss injuries present a significant surgical challenge, often requiring not only the expertise of a plastic surgery specialist but also interdisciplinary collaboration. Special attention is given to acral structures, such as the nose, lips, and auricles. This article details each step in the reconstruction of these areas, including the use of flap plastics and microsurgical techniques. Emphasis is placed on the specifics of treating animal-induced injuries, with an overview of infection prevention and treatment strategies. The article also includes a list of replantation centers in the Czech Republic that provide care in cases of loss injuries requiring it. The aim is to offer a comprehensive overview of current trends and practical approaches for surgeons encountering these complex cases in outpatient practice.

Ocular traumas include a wide range of injuries from trivial conditions to extensive perforating injuries that can lead to visual function impairment of various ranges and even to the loss of the eye itself. In terms of first aid, not only an ophthalmologist but also a physician of any specialty can effectively intervene and minimize the consequences of these conditions. Open globe injuries represent prognostically the most severe conditions which have to be treated by an experienced ophthalmologist. Closed injuries are most commonly manifested as corneal erosions, foreign bodies on the surface of a globe or contusions of varying severity. These conditions do not always require urgent primary intervention by an ophthalmologist. The opposite is true for chemical traumas which are often caused by alkali. Urgent intervention consisting in eye lavage is crucial to minimize complications. Periocular tissue injuries can be divided into orbital skeletal fractures and soft tissue traumas of the orbit and eyelids. Acute conditions in ophthalmology also include inflammations of the eye and periocular tissue, of which endophthalmitis and retroseptal orbital cellulitis are the most prognostically serious. Acute retinal circulatory disorders include central retinal artery occlusion and acute ischemic optic neuropathy. Acute angle-closure crisis can be manifested as sudden severe pain of the globe, headache and blurred vision. The other most common causes of acute visual impairment are hemophtalmus and retinal detachment, the conditions which require specialized intervention of an ophthalmologist. Sudden conditions in ophthalmology require prompt diagnosis and early basic medical intervention which can be provided by a physician of any specialty and can significantly reduce subsequent complications. Ultimate treatment then belongs to the ophthalmologist.

Introduction: Not only in the Czech Republic, robotic surgery has passed through the rapid development and exponential increase numbers of procedures in all spheres of surgery. We focused on evaluation of our initial experience with robotic-assisted colon resection over 3 years.

Methods: This is a retrospective, monocentric study involving a total of 105 patients who underwent robotic surgery in the colon area from January 2021 till December 2023.

Results: A total of 49 women and 56 men underwent a robotic procedure. The average age was 65 years. In total, 63 right-sided hemicolectomies, 18 left-sided hemicolectomies, 22 colon sigmoid resections and 2 transverse colon resections were performed. The median console operation time was 205 min, 8 patients underwent a conversion of the procedure (7.62%). Postoperative complications were seen in a total of 21 patients (20%). The median length of stay was 6 days.

Conclusion: Robotic surgery in the colon area is an effective method of surgical treat-ment for oncological and benign diseases. The initial time demands of the procedures are balanced by the low surgical burden on the patient, with low perioperative blood loss, and with the oncological safety and radicality of the procedure in patients with cancer at the same time. And last but not least, the possibility of shortening the length of stay, with a low level of postoperative complications (Clavien-Dindo ≥ grade III below 3%) is a great advantage.

We present a case report of a 26-year-old patient with an incidental finding of intra-abdominal fibromatosis (desmoid) in the small pelvis who presented to the urology outpatient clinic for erectile dysfunction. Ultrasound examination revealed hydronephrosis of the right kidney with parenchymal reduction, and a bulky tumor was detected in the small pelvis, which was compressing the right-sided ureter. The patient was followed up with a CT scan which confirmed a solid tumour in the small pelvis of unclear origin, the nature of the tumour and the treatment were discussed by the multidisciplinary team and a decision was made to resect the tumour. Pathologist confirmed sporadic variant of desmoid. Desmoid tumors are characterized by both locally aggressive carcinomas mimicking growth and frequent recurrences after resection, which may require subsequent oncological treatment. For these reasons, patients with desmoids should be fol-lowed up by an oncologist, ideally at centers experienced in treating this rare disease.