Body Resection Research Articles

Carotid Body Tumor-Its Features and Resection Surgery

Carotid Body Tumor-Its Features and Resection Surgery

Commentary on: Outcome After Breast Reduction Considering Body Mass Index and Resection Amount.

Commentary on: Outcome After Breast Reduction Considering Body Mass Index and Resection Amount.

Experience in selecting patients to undergo robotic pancreatic surgery

Objective To review our initial experience in selecting patients to undergo robotic pancreatic surgery. Methods This is a retrospective study on 100 patients who underwent robotic pancreatic operations at the Chinese PLA General Hospital from September 2009 to March 2015. Results 89 patients underwent robotic pancreatic body and tail resection, 5 patients superficial enucleation of pancreatic lesions, 3 patients middle pancreatic resection, 1 patient pancreaticoduodenectomy, 1 patient pancreatico-gastric ana-stomosis, and 1 patient pancreatico-jejunal anastomosis. Conclusions Robotic pancreatic surgery was safe and feasible. Lesions located in pancreatic body and tail could be treated with resection of pancreatic body and tail, and this appeared to be the best indication for robotic pancreatic surgery. Focal lesions on the surface of pancreas could be enucleated using the Da Vinci robotic surgical system. Extreme care should be exercised in selecting patients for robotic pancreaticoduodenectomy, because the surgical risk is high. Key words: Da Vinci robotic surgical system; Pancreatic operation; Indication

A Case Report of Congenital Hyperinsulinism Associated With a Pancreatic Head Lesion Successfully Treated by Duodenum-Preserving Pancreatic Head and Body Resection

A Case Report of Congenital Hyperinsulinism Associated With a Pancreatic Head Lesion Successfully Treated by Duodenum-Preserving Pancreatic Head and Body Resection

Metacarpophalangeal joint arthroscopy

Pain reduction in the affected metacarpophalangeal joint (MP joint) by synovectomy, loose body extraction and resection of intraarticular scars. Synovitis in rheumatoid arthritis (RA) not responding to antirheumatic treatment, primary and secondary degenerative arthritis, osteochondral lesions, loose bodies, foreign bodies, capsular contracture, septic arthritis, posttraumatic arthralgia (old collateral ligament injury), intraarticular fractures. Established biomechanical changes in RA such as ulnar deviation and palmar subluxation with extensor tendon luxation of the MP joint. Advanced radiologic changes in degenerative arthritis. Joint instability in posttraumatic conditions. Fresh skin lesion near portals. Longitudinal traction of the affected finger in a Chinese finger trap. The joint is filled with Ringer solution. Placement of a radial and ulnar dorsal portal at joint space level, through the extensor hood, at the dorsal border of the collateral ligaments. Diagnostic arthroscopy. In case of insufficient visibility (i.e., bulky synovitis in RA) "blind" shaving in the dorsal recess at first. Completion of synovectomy under sight. If necessary additional ablation of synovial tissue by a radiofrequency (RF) electrosurgical system. Use of arthroscope (1.9 mm) with a 30° angle of vision and shaver (aggressive cutter; 2.0 mm). Low-suction drain, soft padded dressing. Immediate postoperative mobilization for the full range of finger movement. In 106 MP joint arthroscopies from 2009-2011, very high patient satisfaction was achieved. Best results were obtained in RA, even in advanced radiologic changes (Larsen stages 1-3). Only in Larsen stage 4 results were rated lower. In early stages of degenerative arthritis (Kellgren-Lawrence 0-2), patient satisfaction was also very high, however decreased rapidly with increasing degree of radiologic changes. The results in posttraumatic cases are promising.

A clinical series of 80 patients with adenosquamous carcinoma of pancreas

To raise the awareness of adenosquamous carcinoma of pancreas and discuss the treatment of it. Clinical data of 80 cases of pancreas adenosquamous carcinoma patients in the Department of Pancreas Surgery of Changhai Hospital of Second Military Medical University from December 2003 to October 2011 were analyzed. The diagnose and treatment methods were discussed. There were 61 male cases and 19 female cases who aged from 28 to 81 years, with an average age of 60 years. The primary symptoms included 46 cases (57.5%) of abdominal malaise, 6 cases (7.5%) of low back pain, 4 cases (5.0%) of abdominal swelling pain with low back pain, 15 cases (18.8%) of abdominal swelling pain with jaundice, 5 cases (6.3%) of painless jaundice, 3 cases (3.8%) of significantly decreased body-weight and 1 case (1.3%) of no symptom. All the patients had been identified as pancreas tumor suffers by ultrasound, enhanced CT scan or MRI. Totally there were 43 cases of head/unciform process tumors, 15 cases of pancreas body tumors and 22 pancreas tail cases.Health situation of all cases were follow-up observed in the outpatient department or telephoned every 3 months till 24 months after the surgery. Among the 80 patients, 19 patients underwent pancreaticoduodenectomy (PD) , 19 patients received pylorus-preserving PD, with 4 cases of palliative resection and 1 case of total pancreatectomy. The volume of bleeding during the surgery varied from 50 to 3 500 ml with a blood transfusion volume varied from 0 to 4 000 ml. Consumed time for PD procedures was 90 to 260 min with 60 to 150 min for body and (or) tail resection with or without lienectomy. The mean diameter of tumor was (4.9 ± 2.2) cm. Pathological tests showed 35 cases of positive lymph nodes, adjacent organ invasion happened in 35 patients, however, nerve invasion were found in 68 cases.Eighteen cases occurred postoperative complications, including bleeding, pancreatic fistula, gastric emptying, incision fat liquefaction and infection, pleural effusion, ascites and nervous diarrhea. There were only 48 effective follow-up patients, with a loss ratio of follow-up by 40.0%, reasons for the loss includes change of contact information, refuse or unable to provide useful information by the relatives of the patients.Sixteen patients received chemotherapy, and 8 patients received radiotherapy after operation. All patients were dead in the effective follow-ups. The postoperative median survival time was 6 months (0.1 to 23.0 months). Adenosquamous carcinoma of pancreas is a rare kind of malignant tumor, nerve invasion can be found in almost all the cases. Patients with adenosquamous carcinoma of pancreas have an unfavorable prognosis. The principle treatments are surgery, radiotherapy and chemotherapy.

Surgical treatment for the pancreatic benign tumor following organ preserve principle

Objective To summery the value of treatment for pancreatic benign tumor following the organ preserve principle.Methods The clinical data of 77 patients with pancreatic benign tumor at the General Hospital of Tianjin Medical University from Jan 2002 to Jan 2012 was analyzed.All patients were divided into traditional pancreatic surgical treatment group (n=24) which include pancreaticduodenectomy(PD) and pancreatic body and tail resection plus spleenectomy(DP) and treatment following organ preserve principle (n =53).Results There are tumor evacuation,segmentectomy,pancreatic head resection with duodenum preserving and pancreatic body and tail resection with spleen preserving in the group of treatment following organ preserve principle.Pathology diagnosis showed insulinoma 30 cases,mucinous cystadenoma 16,serous cystadenoma 10,intraductal papillary mucinous tumor 17,solid pseudopseudopapillary tumor 3 and 1 case of pancreatic intraductal hyperplasia.The rate of pancreatic leakage were 26.3％ (5/19) in traditional surgical treatment group and 24.3％ (9/37) in group of treatment following organ preserving respectively.There was no significant difference between these two groups(P＞0.05).The rate of new development diabetis and aggrasive of the preexist diabetis post the pancreatic surgery were 20.8 ％ (5/24),20 ％ (1/5),13.2(7/53),30 ％ (3/10)respectively.There was no significant difference between these two groups(P=0.485,P=1.000).Conclusions The surgical treatment following the organ preserving is a safe and effective procedure for the patients with pancreatic benign tumor.This new method can preserve the pancreatic parenchymal maximally,avoid the extra-and endo-secrete function loss and preserving the function of spleen. Key words: Pancreatic neoplasms; Pancreatectomy

Pancreaticogastrostomy: A Salvage Procedure for Pancreatic Body and Neck Resection

The purpose of this analysis was to evaluate the technological viability, basic safety and consequence of central pancreatectomy (CP) with pancreaticogastrostomy in properly chosen sufferers with noncancerous central pancreatic pathology. This research is centered on the infirmary charts of West China hospital. We recruited 20 individuals from 2007 to 2009 diagnosed with benign cancerous growth of pancreatic body and neck. They underwent pancreatic body and neck resection adhering to pancreaticogastrostomy. We carried out central pancreatectomy following pancreaticogastrostomy in 20 patients: 8 with serous cyst adenomas, 11 with mucinous cystadenomas, and 1 with neuroendocrine tumor. The position of all tumors was restricted to body and neck of the pancreas, measuring a mean ± standard deviation of 2.6±1.3cm. The mean post-operative hospital stay was 7 days (ranging from 6 to 16 days).There was no intraoperative additional complications. From a technical perspective, CP is a safe and sound, pancreas-preserving pancreatectomy for non-enucleable non-cancerous pancreatic pathology restricted to the pancreatic body.

Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience

The aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material. MATERIAL AND METHODS. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinationswere performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas - 14, body of the pancreas - 4, tail of the pancreas - 5, body and tail of the pancreas - 1, retroperitoneal space - 4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy - 11, distal pancreatic resection with splenectomy - 6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure - 1, pancreatic resection by Beger procedure - 1, pancreatic head and body resection with splenectomy - 1, tumour enucleation or local excision - 4, exploratory laparotomy with specimen collection - 3. The mean hospitalisation period was 25 days (4-78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess - 2, wound suppuration - 2, pancreatic fistula - 1, acute pancreatitis - 1, pancreaticojejunal anastomosis leak - 1, peritoneal cavity haemorrhage - 1, acute cholangitis - 1, adhesion obstruction - 1, subobstruction - 1, portal vein thrombosis - 1, sepsis - 1, fluid in pleural cavity - 1, acute heart failure - 1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.

The Practice of Pancreatic Resection after Roux-en-Y Gastric Bypass

The morbid obesity epidemic in the United States has resulted in increasing numbers of patients who have undergone Roux-en-Y gastric bypass who require surgical management of nonbariatric disorders. When pancreatic resection is indicated in bariatric patients, consideration of the altered foregut anatomy can be applied to the principles of pancreatic resection to foster effective techniques that minimize operative complications. A retrospective review and analysis of bariatric patients who underwent pancreatic resection at the Medical University of South Carolina Digestive Center over a 2-year period (2006 to 2007) was conducted to assess indications for operation, operative techniques, and postoperative outcome in patients with previous Roux-en-Y gastric bypass. There were five patients (four female, one male) identified with a mean age of 35 years (range, 32-50 years). The mean time interval from gastric bypass to pancreatic resection was 42.6 months (range, 10-72 months). Indications for pancreatic operations were islet hyperplasia in two patients, chronic pancreatitis in two, and serous cystadenoma in one. Two patients underwent duodenal-preserving pancreatic head resection (Beger procedure) and three underwent distal pancreatectomy and splenectomy. Mean length of hospital stay was 11.4 days (range, 5-22 days). Two patients had extended hospital stay as a result of gastrointestinal ileus. There was no other operative morbidity or mortality. Mean length of patient follow up was 9.8 months (range, 1-17 months). Specific operative techniques used in pancreatic head resection were duodenal preservation, pancreatic drainage with an omega loop constructed from a mid-Roux limb, and excluded stomach gastrostomy. Techniques used in pancreatic tail and body resection were splenectomy discontinuous from pancreatectomy, division of the splenic vein and artery at the pancreatic neck early in surgery, retrograde dissection of the pancreas body and tail, and dissection of the body and tail posterior to the Roux limb leaving the Roux limb intact. Pancreatic resection after Roux-en-Y gastric bypass is safe and effective when using prescribed operative principles that minimize disruption of the foregut reconstruction and adds protection to the gastric remnant with a gastrostomy for decompression and access for enteral alimentation when necessary.

The respiratory response to carbon dioxide in humans with unilateral and bilateral resections of the carotid bodies.

The acute hypercapnic ventilatory response (AHCVR) arises from both peripheral and central chemoreflexes. In humans, one technique for identifying the separate contributions of these chemoreflexes to AHCVR has been to associate the rapid component of AHCVR with the peripheral chemoreflex and the slow component with the central chemoreflex. Our first aim was to validate this technique further by determining whether a single slow component was sufficient to describe AHCVR in patients with bilateral carotid body resections (BR) for glomus cell tumours. Our second aim was to determine whether the slow component of AHCVR was diminished following carotid body resection as has been suggested by studies in experimental animals. Seven BR subjects were studied together with seven subjects with unilateral resections (UR) and seven healthy controls. A multifrequency binary sequence in end-tidal PCO2 was employed to stimulate ventilation dynamically under conditions of both euoxia and mild hypoxia. Both two- and one-compartment models of AHCVR were fitted to the data. For BR subjects, the two-compartment model fitted significantly better on 1 out of 13 occasions compared with 22 out of 28 occasions for the other subjects. Average values for the chemoreflex sensitivity of the slow component of AHCVR differed significantly (P < 0.05) between the groups and were 0.95, 1.38 and 1.50 l min-1 Torr-1 for BR, UR and control subjects, respectively. We conclude that, without the peripheral chemoreflex, AHCVR is adequately described by a single slow component and that BR subjects have sensitivities for the slow component that are lower than those of control subjects.

Bilateral carotid body resection in man enhances hypoxic tachycardia.

In three groups of subjects we studied heart rate (HR) and ventilatory responses to progressive eucapnic hypoxia, steady-state hypercapnia with and without hypoxia, and hyperoxic and hypoxic breathholding (BH). Groups were six subjects about 25 years after bilateral carotid body resection (BR), eight subjects of an equally long period after unilateral resection (UR), and three control subjects similar to the study groups in age and pulmonary function (C). During progressive hypoxia, HR increased more in BR than in UR and C subjects. Ventilatory response was lowest in BR subjects (as expected). Steady-state hypoxic hypercapnia (end-tidal PO2, 60 Torr) depressed HR significantly more in C than in BR and UR subjects. Again, ventilatory response was lower in BR than in C subjects. HR progressively increased during BH initiated in hyperoxia (end-tidal PO2, 200 Torr) and hypoxia (end-tidal PO2, 70 Torr). In the BR group, the HR increment during hypoxia was significantly larger than that during hyperoxia. No such difference was apparent in UR and C groups. Thus, hypoxia with or without hypercapnia tends to accelerate HR in BR subjects whereas either less tachycardia or slowing is seen in UR and C subjects.

Decreased exercise hyperpnea in patients with bilateral carotid chemoreceptor resection.

Exercise hyperpnea was compared in 5 asthmatics 25 yr after bilateral carotid body resection (BR), 4 others 19 yr after unilateral resection (UR), and 12 controls (C) matched for age and pulmonary flow limitation. In the BR group, ventilation rose less with exercise, mostly because BR experienced less tachypnea. End-tidal PCO2 rose 5.8 +/- 3.2 (P less than 0.05) to 46 Torr at 50 W. In UR and C the same load did not increase PETCO2 significantly (+2.1 and +1.4 Torr, respectively). Arterial-end-tidal PCO2 differences before and 15--45 s postexercise were insignificant in all three groups. Heart rate and blood pressure rose equally in the three groups, suggesting that the ventilatory effects were not secondary to blood flow differences and disclosing no evidence of baroreceptor denervation during glomectomy.