Background and Objectives:Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.Methods:In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.Results:Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula.Conclusions:In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.
Since a robotic surgical system was developed in the early 1990s and the first robotic-assisted radical prostatectomy was reported in 2001, robotic surgery has spread in many surgical specialties, changing surgical management. Currently, compared to other colorectal procedures, robotic surgery appears to offer great benefits for total mesorectal excision for rectal cancer. Abdominal cavity other procedures such as right hemicolectomy and high anterior resection are relatively uncomplicated and can be performed easily by laparoscopic surgery. First reports have focused on the clinical benefits of robotic rectal cancer surgery compared with laparoscopic surgery. The indications for robotic and laparoscopic rectal cancer surgery are not different. The recently published results of the ROLARR trial, comparing robot-assisted TME to laparoscopic TME, show no advantages of robot assistance in terms of intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction. A drawback of the study is the variability in experience of the participating surgeons in robotic surgery. After correction of this confounder, an advantage for robotic assistance was suggested in terms of risk of conversion to open surgery. For robotic rectal cancer surgery to become the preferred minimally invasive option, it must demonstrate that it does not have the technical difficulties and steep learning curve of laparoscopic surgery. Robotic surgery has several technical advantages over open and laparoscopic surgery. The system provides a stable operating platform, three-dimensional imaging, articulating instruments and a stable surgeon controlled camera which is mainly beneficial in areas where space and maneuverability is limited such as the pelvis.
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