No abstract

Background: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. Aim: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. Methods: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. Results: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. Conclusion: “Percutaneous radiofrequency assisted liver partition with portal vein embolization” (PRALLPS) is a feasible procedure.

Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option. To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules. A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital. The average age was 50.1 ± 11.7 (21–83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1–8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm 2 ± 3.63 (0.09–23.45 cm 2 ). The average ablation time was 11 minutes ± 5.36 (3–20 minutes). The hospitalization period was 24 hours ± 10.16 (7–48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively ( P < .05). The thyroid function tests, pre and postablation showed no significant changes ( P > .05). Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.

No abstract

No abstract

No abstract

Background:The aeronautical industry is one of the disciplines that most use control systems. Its purpose is to avoid accidents and return safer flights. The flight of an airplane, from its takeoff to its landing is a process divided into stages under strict control. A surgical procedure has the same characteristics. We try to identify and develop the stages of the surgical process using the experience of the aviation industry in order to optimize the results and reduce surgical complications. Aim:To identify and develop the stages of the surgical process so that they could be applied to surgery departments. Methods:A search, review and bibliographic analysis of the application of aeronautical control and safety to medical practice in general and to surgery, in particular, were carried out. Results:Surgical process comprises the perioperative period. It is composed of Preoperative Stage (it is divided into 2 “sub-steps”: hospital admission and control of preoperative studies) Operative Stage (it is divided into 3 “sub-steps”: anesthetic induction, surgery, and anesthetic recovery) and Postoperative Stage (it is divided into 2 “sub-steps”: control during hospitalization and ambulatory control). Two checkpoints must be developed. Checkpoint #1 would be located between the preoperative and operative stages, and checkpoint #2 would be located between the operative and postoperative stages. Surgical factors are surgeons, instrumental and technology, anesthesiology and operating room environment. Conclusion:It is possible and necessary to develop a systematic surgical procedure. Its application in the department of surgery could optimize the results and reduce the complications and errors related to daily practice.

No abstract