Spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results

Cianci, Pasquale; Fersini, Alberto; Tartaglia, Nicola; Altamura, Amedeo; Lizzi, Vincenzo; Stoppino, Luca Pio; Macarini, Luca; Ambrosi, Antonio; Neri, Vincenzo

doi:10.1007/s00464-015-4363-y

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…The usefulness of protocols for massive hemotransfusion and the need for bedside clotting analyzers have also been demonstrated. The European guidelines currently recommend to directly transfer patients to an appropriate trauma center for treatment and to follow a restricted volume replacement strategy during initial resuscitation [ 1 , 2 , 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 101 , 121 , 122 , 151 , 154 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 ]. Blood product optimal use procedures continue to evolve, and their development should be goal directed.…”

Section: Management Of Patients With Severe Trauma In the Edmentioning

confidence: 99%

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

et al. 2021

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Coagulopathy induced by major trauma is common, affecting approximately one-third of patients after trauma. It develops independently of iatrogenic, hypothermic, and dilutive causes (such as iatrogenic cause in case of fluid administration), which instead have a pejorative aspect on coagulopathy. Notwithstanding the continuous research conducted over the past decade on Trauma-Induced Coagulopathy (TIC), it remains a life-threatening condition with a significant impact on trauma mortality. We reviewed the current evidence regarding TIC diagnosis and pathophysiological mechanisms and summarized the different iterations of optimal TIC management strategies among which product resuscitation, potential drug administrations, and hemostatis-focused approaches. We have identified areas of ongoing investigation and controversy in TIC management.

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Section: Management Of Patients With Severe Trauma In the Edmentioning

confidence: 99%

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

et al. 2021

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“…They are also one of the main causes of disability, resulting in high direct and indirect costs [3]. Therefore, correct and quick identification of the cause of bleeding, as well as neglected coagulopathies, is of great importance for the correct management of several surgical pathologies [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Trauma Coagulopathy and Its Outcomes

et al. 2020

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Background and Objectives: Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. Material and Methods: We conducted a prospective, monocentric, observational study of all patients (n = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Results: Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was >10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE <−6. Conclusions: Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion (p = 0.016) requirements and need hospitalization (p = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) (p = 0.000) and a greater number of anatomical districts involved (p = 0.000). Head trauma (p = 0.000) and abdominal trauma (p = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy (p = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.

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“…Robotic surgery overcomes these pitfalls by providing steady-state three-dimensional visualization, augmented dexterity with endo-wrist movements, and superior ergonomics for the surgeon. Laparoscopic repair is technically difficult in this subset of patients because of the presence of great anatomical distortion, which requires meticulous dissection of the hernia sac that must be accomplished with limited motion of rigid instruments and poor ergonomics [20][21][22]. Furthermore, various reports published in the literature (Table 1) suggest that there is a higher recurrence rate after the laparoscopic approach for giant hiatal hernia (GHH) repair than after conventional surgery [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Robotic voluminous paraesophageal hernia repair: a case report and review of the literature

Tartaglia¹,

Pavone²,

Lascia³

et al. 2020

J Med Case Reports

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Background: The treatment for sliding esophageal hernia with mild gastroesophageal reflux is usually conservative, but surgical treatment is recommended for refractory sliding esophageal hernia, paraesophageal hernia liable to prolapse, or paraesophageal hernia with ulceration and/or stenosis. Robotic surgery overcomes laparoscopic pitfalls by providing steady-state three-dimensional visualization, augmented dexterity with endo-wrist movements, and superior ergonomics for the surgeon. Case presentation: To investigate robotic paraesophageal hernia repair, a literature search was conducted using PubMed with the following key words: mini invasive surgery, robotic surgery, hiatal hernia, and Nissen fundoplication. We present the case of a 44-year-old Italian woman with a 20-year history of gastroesophageal reflux disease refractory to medical treatment, who underwent robotic Nissen fundoplication. In our center, we use the da Vinci® Xi™ Surgical System, which is an advanced tool for minimally invasive surgery. Conclusions: Various reports published in the literature suggested that the robot-assisted approach was effective and was associated with very low postoperative morbidity and was accompanied by satisfactory symptomatic and anatomical radiological outcomes during a follow-up period. The robotic approach to paraesophageal repair is safe and effective with low complication rates. With increased experience, the operative time, length of stay, and complications decrease without compromising surgical principles.

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Spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results

Cited by 4 publications

References 28 publications

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes

Trauma Coagulopathy and Its Outcomes

Robotic voluminous paraesophageal hernia repair: a case report and review of the literature

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