Introduction Laparoscopic colorectal surgery (LCRS) offers similar oncologic outcomes to the open approach along with early postoperative recovery but is not without complications, with bleeding being uncommon but with variable impact and technical resource demand. Methods A descriptive and retrospective study of bleeding in patients undergoing elective LCRS in our center between 01/012018 and 31/12/2021. The data analysis was performed using the SPSS statistical software. Results Out of 945 LCRS, 45 patients (4.8%) presented some hemorrhagic event. The main diagnosis was colorectal cancer (35), followed by diverticular disease (6). The procedures most frequently associated with bleeding were sigmoidectomy (13), TATME (7) and right hemicolectomy (7). Five patients presented moderate (4) or severe (1) intraoperative bleeding, controlled during surgery. The most commonly used hemostatic devices were biopolar energy (29.5%) and combined (34.1%). The diagnosis of postoperative bleeding was clinical in 20 cases (45.5%), 17 by CT angiography (38.6%) and 7 by endoscopy (15.9%). In 36.4% the origin of hemorrhage was in the anastomosis, demonstrated by endoscopy or radiological study. Eleven patients (25%) required reintervention: seven by open approach and four by laparoscopy (two conversions). Therapeutic endoscopy was performed in 7 patients (15.9%), in 1 patient interventional radiology-surgery was combined, and in another patient endoscopy-surgery. There was no mortality due to this cause. The mean length of stay after surgery was 19.52 days. Conclusions Hemorrhage in LCRS is a rare but potentially serious complication that requires early diagnosis and staged multidisciplinary approaches, including advanced therapeutic endoscopy and interventional radiology procedures.
Introduction Soft tissue leiomyosarcomas represents 0.7% of all malignant tumors. The most common location is the retroperitoneum, and the appearance of local or distant recurrences after resection is not uncommon. Pathological study is important to establish the confirmatory diagnosis and the prognosis of this type of lesion. Clinical case We present the clinical case of a patient with retroperitoneal leiomyosarcoma that was resected associated with ipsilateral nephrectomy. An 11-month follow-up revealed a hepatic lesion in segment 5, suggestive of metastasis. We decided on surgical resection of this lesion. Liver segmentectomy was performed by laparoscopic approach. The pathological study of the liver lesion showed a tumor of about 5 centimeters, compatible with leiomyosarcoma metastasis, presenting abundant mitoses (8/10), 15% necrosis in the central area and a Ki67 of 20%. Discussion Leiomyosarcoma is a very aggressive tumor. Its treatment is fundamentally based on the surgical resection of the primary and its possible metastases. The pathological study of the piece, with special emphasis on the number of mitoses, as well as the Ki- 67%, are indicators of the aggressiveness of the tumor and the prognosis. Given the low incidence of these tumors, it is recommended that the approach of these tumors be done in multidisciplinary teams and in specialized centers.
INTRODUCTION Simulation training has become a widely accepted educational tool for the development of technical skills in endoscopic surgery. The objective of this work was to evaluate bachelors who hold a Degree in Medicine in the execution of exercises carried out in both physical and virtual simulations. MATERIAL AND METHODS The descriptive study was carried out among 400 students (266 women and 134 men) in their third year of medicine studies between 2016 and 2019. The practises consisted of 11 hours of teaching, made of theory introduction, and exercise work in groups of 15-20 students on 4 workstations: LapSim, Pelvitrainer, Transanal Endoscopic Surgery (singleport) and Flexible Endoscopy. The execution time per individual exercise and in pairs is collected. RESULTS Individual exercises: the average execution time was: 277.0±117.8 sg, LapSim: 158.8± 66.44 sg and Pelvitrainer: 123.6±82.7sg. Couple exercises: the average execution time in Transanal Endoscopic Surgery was: 79.4±51.9 sg and Flexible Endoscopy: 53.56±34.4 sg. The analysis by gender showed that men performed better in LapSim with an average of 141.4 sg ± 52.2 in respect to women, 167.8 sg ± 71.1 (p < 0.05). In the rest of the exercises, no significant differences were shown. CONCLUSIONS Conducting simulated practises or studies for further development in the Degree is feasible, with objective evaluations of the skills acquired. The possibility of interacting in a controlled environment and with immediate feedback has made it possible to identify baseline differences by gender only in virtual simulation.
Aim Laparoscopic inguinal repair originated in the early 80's, but despite the time elapsed its use is not generalized, although more groups are adopting it as the technique of choice. With this wordk we seek to analyze our results after generalizing the laparoscopic approach. Material & Methods Descriptive and retrospective study of patients electively operated by Totally Extraperitoneal (TEP) or Transabdominal Preperitoneal (TAPP) repair, between January 2020 and December 2022, for primary or recurrent inguinal hernia. Results A total of 138 patients underwent surgery, 92.8% male, mean age 60.7 (SD 11.9) years. Of these, 113 had unilateral hernia and 25 bilateral. In 115 (83.3%) the hernia was primary. The mean operative duration was 61.3 (SD 24.3) minutes, and 2 complications (1 right inferior epigastric artery injury on postoperative day 10 and 1 intraoperative ligament bleeding). There were 3 TEP to TAPP conversions and 3 recurrrences (1 no surgery due to patient refusal, 1 repair by anterior approach and another reoperated by TAPP). At one month possoperatively, 87.7% reported no or mild pain, 113 patients being discharged. The average follow-up wa 83.1 (SD 129.2) days. When analyzing the specific approach, TEP was predominant: 110 (79.7%) with similar postoperative results of pain vs TAPP although with significantly shorter operative duration: 53.1 vs 68.9 minutes (p <0.001). Conclusions Inguinal laparoscopy in our setting is safe and effective in the short term for primary repair. Our results support laparoscopic repair with TEP as the first choice and TAPP as an alternative.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.