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Dimas Javier GARCILAZO ARISMENDI

Reina Sofia University Hospital
Cordoba, Испания
MD
830 лайков
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Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique
Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery.
The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.

Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure.

In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty.

From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62).

This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.
Хирургические операции
1 год назад
3821 просмотр
428 лайков
0 комментариев
07:37
Advanced bariatric surgery: reduced port simplified gastric bypass, a reproducible 3-port technique
Minimally invasive surgery is a field of continuous evolution and the advantages of this approach is no longer a matter of debate. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has shown to be the cornerstone in the treatment of morbid obesity and so far all the efforts in this technique have been conducted to demonstrate safety and efficacy. Nowadays, reduced port surgery is regaining momentum as the evolution of minimally invasive surgery.
The purpose is to describe our technique of LRYGB, which mimics all the fundamental aspects of the “simplified gastric bypass” described by A. Cardoso Ramos et al. in a conventional laparoscopic surgical approach (5 ports) while incorporating some innovative technical features to reduce the quantity of ports. Despite the use of only three trocars, there is no problem with exposure or ergonomics, which represent major drawbacks when performing reduced port surgery.

Our technique can be a useful and feasible tool in selected patients in order to minimize parietal trauma and its possible complications, to improve cosmetic results, and to indirectly avoid the need for a second assistant, thereby improving the logistics, team dynamics, and economic aspects of the procedure.

In our experience, this technique is indicated as primary surgery in patients without previous surgery and with a BMI ranging from 35 to 50. Major contraindications are liver steatosis, superobese patients, and potentially revisional surgery. Although based on the experience of the team, we had also to perform revisional surgery mostly from ring vertical gastroplasty.

From January 2015 to June 2017, we analyzed 72 consecutive cases in our institution with a mean initial BMI of 43.12 (range: 30.1-58.7) using this approach, and the mean operative time was 64.77 minutes (range: 30-155, n=72) and excluding revisional cases or cases associated with cholecystectomy (58.72 min, range: 30-104, n=62).

This approach should be performed by highly skilled surgeons experienced with conventional Roux-en-Y gastric bypass and with one of the patients feeling particularly comfortable. We strongly suggest using additional trocars if patient safety is jeopardized.
Complete cytoreductive surgery (CRS) and HIPEC using a minimally invasive approach with NOTES extraction for peritoneal carcinomatosis from primary ovarian cancer
This is the case of a 60-year old woman who sought medical advice for constipation and increased abdominal perimeter in October 2016. The abdominal CT-scan suggested a peritoneal carcinomatosis of ovarian origin along with an ascites.
The PET-scan did not show any other lesions. CA125 levels were high (1265 U/mL). The biopsy was positive and immunohistochemistry (IHC) showed a high-grade ovarian peritoneal serous carcinoma (CK7: (+), CK20: (-), WTI: (+), P53: (+), PAX8: (+), CA125: (+), RE: (+)). The diagnosis of a FIGO stage IIIc peritoneal carcinomatosis of ovarian origin was established. The patient was treated with neoadjuvant chemotherapy (Carboplatin-Paclitaxel- Bevacizumab, 4 cycles).
The patient showed a favorable clinical response with ascites disappearance. The radiological imaging also showed the disappearance of peritoneal implants. Only a 3cm right parauterine mass persisted and a biochemical response was noted with CA125 decrease (32 U/mL). A radical cytoreductive surgery is decided upon using a minimally invasive intraperitoneal hyperthermia chemotherapy. A complete cytoreduction (CC0) was performed after tumor load determination with a Peritoneal Cancer Index (PCI) of 4. It showed a greater pelvic affectation and a minimal involvement of the greater omentum. We performed a hysterectomy, a double adnexectomy, and a bilateral pelvic and parietal peritonectomy. Complete omentectomy with a gastro-omental arcade preservation, round ligament resection, bilateral iliac lymphadenectomy, and appendectomy were performed. The surgical specimens were extracted through the vagina. The patient underwent an intraoperative hyperthermic intraperitoneal chemotherapy (42ºC) with Paclitaxel (60mg/m2). Postoperative outcomes were uneventful.
Хирургические операции
2 года назад
6487 просмотров
402 лайка
0 комментариев
32:37
Complete cytoreductive surgery (CRS) and HIPEC using a minimally invasive approach with NOTES extraction for peritoneal carcinomatosis from primary ovarian cancer
This is the case of a 60-year old woman who sought medical advice for constipation and increased abdominal perimeter in October 2016. The abdominal CT-scan suggested a peritoneal carcinomatosis of ovarian origin along with an ascites.
The PET-scan did not show any other lesions. CA125 levels were high (1265 U/mL). The biopsy was positive and immunohistochemistry (IHC) showed a high-grade ovarian peritoneal serous carcinoma (CK7: (+), CK20: (-), WTI: (+), P53: (+), PAX8: (+), CA125: (+), RE: (+)). The diagnosis of a FIGO stage IIIc peritoneal carcinomatosis of ovarian origin was established. The patient was treated with neoadjuvant chemotherapy (Carboplatin-Paclitaxel- Bevacizumab, 4 cycles).
The patient showed a favorable clinical response with ascites disappearance. The radiological imaging also showed the disappearance of peritoneal implants. Only a 3cm right parauterine mass persisted and a biochemical response was noted with CA125 decrease (32 U/mL). A radical cytoreductive surgery is decided upon using a minimally invasive intraperitoneal hyperthermia chemotherapy. A complete cytoreduction (CC0) was performed after tumor load determination with a Peritoneal Cancer Index (PCI) of 4. It showed a greater pelvic affectation and a minimal involvement of the greater omentum. We performed a hysterectomy, a double adnexectomy, and a bilateral pelvic and parietal peritonectomy. Complete omentectomy with a gastro-omental arcade preservation, round ligament resection, bilateral iliac lymphadenectomy, and appendectomy were performed. The surgical specimens were extracted through the vagina. The patient underwent an intraoperative hyperthermic intraperitoneal chemotherapy (42ºC) with Paclitaxel (60mg/m2). Postoperative outcomes were uneventful.