RESUMEN
OBJECTIVE: To review the first robotic hernia repairs performed at the Ilyinsky Hospital, evolution of this technology, learning curve and early outcomes. MATERIAL AND METHODS: There were 17 procedures at the Ilyinskaya Hospital between 2021 and 2023 (13 men and 4 women). Mean age was 60 years, body mass index 28 kg/m2. ASA grade 1 was observed in 1 patient, grade 2 - 14 ones, grade 3 - 2 patients. Ventral, inguinal and umbilical hernias were diagnosed in 7, 8 and 2 cases, respectively. Ventral hernias required IPOM+ procedure in 3 cases, eTEP-RS procedure in 2 cases and eTEP-RS-TAR procedure in 2 cases. Patients with inguinal hernia underwent transabdominal preperitoneal hernia repair. In case of umbilical hernia, TARUP procedure was performed in 1 case and vTAPP procedure in 1 case. RESULTS: Mean surgery time was 2 hours 38 min (min 1 hour 35 min, max 10 hours 11 min). There was one intraoperative complication (bleeding from epigastric artery). The follow-up period ranged from 3 months to 3 years. There were no recurrent hernias. Postoperative complications were noted in 2 cases. One patient was diagnosed with epididymitis after TAPP, 1 patient - with seroma after eTEP-RS procedure. All complications were relieved by conservative treatment. Bleeding from a. epigastrica inferior was diagnosed after removal of the trocar at the end of surgery. This event required suturing. CONCLUSION: Robotic hernia repair appears to be technically feasible and safe. This approach provides favorable results regarding quality of life and recurrence rate.
Asunto(s)
Hernia Inguinal , Hernia Ventral , Hernia Incisional , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hernia Inguinal/cirugía , Hernia Ventral/cirugía , Herniorrafia/métodos , Hernia Incisional/cirugía , Laparoscopía/métodos , Calidad de Vida , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
OBJECTIVE: To demonstrate safe introduction of a new technology (Da Vinci robotic system) into laparoscopic bariatric practice. MATERIAL AND METHODS: We analyzed treatment outcomes in patients with morbid obesity who underwent robot-assisted sleeve gastrectomy between 2020 and 2023. The same team of surgeons performed all operations. Evolution of technique and preparation of the operating theatre were recorded. Demographic data of patients, surgery time (docking and total surgery time), simultaneity of intervention, intraoperative and postoperative complications, as well as weight loss after 6 months were retrospectively analyzed. RESULTS: There were 15 robot-assisted sleeve gastrectomies between 2020 and 2023. Of these, 14 patients underwent surgery without complications. One patient was diagnosed with portal vein thrombosis that required anticoagulation. Median surgery time 194 [173.5; 241] min, period between incision and docking - 35 [30; 36] min. The length of hospital-stay was 3 days. The median weight loss after 6 months was 37.5% [29.5; 51.2]. CONCLUSION: This study demonstrates safe introduction of a new technology to prepare the bariatric team for more complex surgical interventions in the future.
Asunto(s)
Laparoscopía , Obesidad Mórbida , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Estudios Retrospectivos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Resultado del Tratamiento , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/cirugía , Gastrectomía/efectos adversos , Gastrectomía/métodos , Pérdida de PesoRESUMEN
BACKGROUND: Transabdominal preperitoneal (TAPP) inguinal hernia repair requires the surgeon to have good manual skills in laparoscopic surgery, as well as an understanding of the laparoscopic features of the groin anatomy. This is why TAPP is considered a more difficult surgical procedure compared to open techniques. Realistic training model for TAPP inguinal hernia repair would enhance surgeons' skills before they enter in the operation room. Our aim was to create a realistic, inexpensive, and easily reproducible model for laparoscopic TAPP inguinal hernia repair and to assess its effectiveness. METHODS: The applied TAPP inguinal hernia repair training simulator consists of a laparoscopic box and an inguinal region model placed in it. The model of the groin area is made of the porcine stomach and assembling materials. Uniaxial tensile and T-peel tests were performed to compare the mechanical properties of the porcine stomach and the human cadaver peritoneum. Thirty eight surgeons performed TAPP inguinal hernia repair using this model. Their opinions were scored on a five-point Likert scale. RESULTS: Close elastic modules of the porcine and human tissues (13.5 ± 4.2 kPa vs. 15.8 ± 6.7 kPa, p = 0.531) gave to trainees a realistic tissue feel and instrument usage. All participants strongly agreed that model was highly useful for TAPP inguinal hernia repair training. They also put the following points: the model as a whole 5 (3-5), simulation of anatomy 5 (3-5), simulation of dissection and mobilization 5 (3-5), and simulation of intracorporeal suture 5 (4-5). CONCLUSIONS: We successfully created a model for TAPP inguinal hernia repair training. The model is made of inexpensive synthetic and biological materials similar to the human tissue. The model is easy to reproduce and can be used in the training programs of surgical residents.
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Hernia Inguinal/cirugía , Herniorrafia/educación , Laparoscopía/educación , Modelos Anatómicos , Entrenamiento Simulado , Adulto , Anciano , Animales , Cadáver , Femenino , Ingle/cirugía , Humanos , Masculino , Persona de Mediana Edad , Peritoneo/cirugía , Mallas Quirúrgicas , Suturas , Porcinos , Adulto JovenRESUMEN
Spontaneous chylous peritonitis during pregnancy is a rare disease. Only a few publications are currently devoted to this problem. The authors reported successful treatment of a patient with spontaneous chylous peritonitis in the first trimester of pregnancy. Moreover, etiology, epidemiology, pathophysiology, diagnosis and treatment of patients with spontaneous chylous peritonitis and chiloperitoneum are analyzed. The authors consider laparoscopy as a safe and efficient method of treatment of patients with spontaneous chylous peritonitis including pregnant women.
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Ascitis Quilosa/cirugía , Peritonitis/cirugía , Complicaciones del Embarazo/cirugía , Ascitis Quilosa/diagnóstico , Ascitis Quilosa/etiología , Ascitis Quilosa/fisiopatología , Femenino , Humanos , Laparoscopía , Peritonitis/diagnóstico , Peritonitis/etiología , Peritonitis/fisiopatología , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/fisiopatología , Primer Trimestre del EmbarazoRESUMEN
AIM: To analyze an efficacy of FT-protocol in patients with acute cholecystitis. MATERIAL AND METHODS: Prospective randomized study included 102 patients (45 of main group (FT) and 57 of control groups). Patients did not differ by TG13 severity index. The protocol included information, antibiotic prophylaxis, restriction of drainage, intraperitoneal anesthesia with long-term anesthetics, low pressure pneumoperitoneum, antiemetics in the presence of risk factors, early activation and feeding of the patient. Pain was assessed by VAS immediately after surgery, and 2, 6 and 12-24 hours postoperatively. RESULTS: Surgery time was similar in both groups. Need for anesthesia and pain severity were significantly lower in the FT group. A total absence of pain (VAS 0-1) on the 1st postoperative day was noted in 8 (17.7%) of the FT group and 2 (3.5%) patients of the control group (p=0.038). Shoulder pain developed in 4 (8.9%) cases of the main and 22 (38.6%) cases of the control group (p=0.001). Postoperative nausea developed in 13% of the FT group vs 40.5% in the control group (p=0.05). Hospital-stay was 1.29±0.7 days and 2.7±1.6 (p<0.0001), respectively. The time of the first stool was similar. Twenty-four (53.5%) patients of the FT group and 8,9% of the control group were discharged on 1st postoperative day. There were 2 (IIIA) complications in the main group and 3 - in the control group (IIIA, IIIB and IV). There were no mortality and readmissions. CONCLUSION: FT protocol in AC reduce postoperative pain, dyspepsia, shoulder pain and in-hospital stay with equal number of postoperative complications.
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Colecistitis Aguda/rehabilitación , Colecistitis Aguda/cirugía , Protocolos Clínicos , Atención Perioperativa , Humanos , Atención Perioperativa/rehabilitación , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: To define optimal terms of surgery for acute adhesive non-strangulatory small bowel obstruction. MATERIAL AND METHODS: The analysis included 703 publications from e-LIBRARI.RU (342 works) and NCBI (361 works) databases for acute adhesive intestinal obstruction. The vast majority of articles presented retrospective analysis of single-center experience. RESULTS: It has been established that short course of medication is predominantly used for acute adhesive intestinal obstruction in the Russian Federation. International studies point 2-5 days for conservative treatment. The advantages and disadvantages of short and long courses of medication were analyzed. Therefore, multicenter, prospective, randomized trial 'Comparison of early operative treatment (12-hour medication) and long-term conservative treatment (48 hours) for acute adhesive small bowel obstruction' (COTACSO) was planned and registered (Unique Protocol ID: 14121729). The study protocol involves clinical, laboratory and instrumental exclusion of strangulation, randomization and conservative treatment of 2 groups of patients for 12 and 48 hours. Patients will undergo surgical interventions if obstruction will be present by that date. The main endpoint is mortality rate in both groups. The end of the study is December 2020.
Asunto(s)
Tratamiento Conservador/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Obstrucción Intestinal/cirugía , Intestino Delgado , Tiempo de Tratamiento/normas , Adherencias Tisulares/cirugía , Adulto , Femenino , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Intestino Delgado/patología , Intestino Delgado/cirugía , Tiempo de Internación , Masculino , Selección de Paciente , Proyectos de Investigación , Adherencias Tisulares/complicaciones , Adherencias Tisulares/diagnósticoRESUMEN
Results of 335 combined operations were analyzed. Men were 89 (27%), women - 246 (73%), the majority of patients were of middle age. 285 (85%) operations included cholecystectomy. 195 (58%) patients had hernioplasty. The third place belonged to vascular operations - 76 (23%). Certain predisposing factors, correlating with the risk of the complicated postoperative course, were marked out. Indications and contraindications to the combined operation were assigned, based on the number of predisposing factors in a patient. Considering the increased risk of intraoperative complications during the combined operation (increased duration, blood loss), participation of highly experienced surgeons and use of modern high-tech equipment seem to be reasonable. The general results of the analysis prove that combined operations are effective, safe and economically beneficial.
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Colecistectomía/efectos adversos , Colelitiasis/cirugía , Hernia Abdominal/cirugía , Herniorrafia/efectos adversos , Complicaciones Posoperatorias/epidemiología , Medición de Riesgo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Colelitiasis/complicaciones , Femenino , Estudios de Seguimiento , Hernia Abdominal/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , Adulto JovenAsunto(s)
Complicaciones Posoperatorias/prevención & control , Práctica Profesional , Procedimientos Quirúrgicos Operativos , Ahorro de Costo , Humanos , Cuidados Intraoperatorios/métodos , Selección de Paciente , Práctica Profesional/clasificación , Práctica Profesional/economía , Pronóstico , Ajuste de Riesgo , Procedimientos Quirúrgicos Operativos/clasificación , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/métodos , Terminología como Asunto , Factores de Tiempo , Cicatrización de HeridasRESUMEN
Treatment results of 5 patients with unformed intestinal fistulae are represented. High unformed intestinal fistulae are acknowledged to be completely unsuitable for conservative treatment and should be operated on. Complex treatment should include complete parenteral feeding, adequate fecal diversion with the use of aspirational drainage. Surgical treatment must be y the increase of fistula discharge or absence of fistula formation. Low intestinal fistulae should better be surgically dissected after their organization, otherwise urgent surgery is to be performed by complications development, such as purulent leakage into the abdominal cavity or severe wound infection.