Excellent Cosmetic Effect Research Articles

Perforated peptic ulcer closure: laparoscopic or open?

To compare laparoscopic and open closure of perforated peptic ulcer (PPU). The study included 153 patients who underwent PPU suturing. 78 patients underwent laparoscopic closure (laparoscopic group) and open suturing via upper midline laparotomy was performed in 75 cases (open group). Surgery time, postoperative pain severity, time of analgesics intake, postoperative complications, hospital-stay and and cosmetic effect were compared. Laparoscopic PPU closure may be effective and accessible in experienced endoscopic surgeon. It significantly reduces postoperative pain severity, need for analgesics, incidence of postoperative complications and provides excellent cosmetic effect. However, there is greater time of surgery compared with open intervention. There were no significant differences in hspital-stay between groups. Laparoscopic PPU suturing can be considered a good alternative to open surgery. Further researches are needed for standardization, assessment of safety, real advantages and disadvantages of laparoscopic technique.

Appliation of oncoplastic breast-conserving reconstruction for patients with early-stage breast cancer

Objective To analyze the cosmetic effects and postoperative complications of patients with early breast cancer who underwent oncoplastic breast-conserving reconstruction and traditional breast-conserving surgery. Methods From January 2012 to October 2015, we collected a total of 67 patients with early-stage breast cancer who underwent breast-conserving surgery in Affiliated Mindong Hospital of Fujian Medical University. Thirty patients who underwent oncoplastic breast-conserving reconstruction were in observation group, and 37 patients who underwent traditional breast-conserving surgery were in the control group. The postoperative complications, cosmetic effects and survival situations in the two groups were compared. Results In the aesthetic effects evaluation, 22 patients (73.33%) and 16 patients (43.24%) had good or excellent cosmetic effects, 6 patients (20.00%) and 14 patients (37.84%) had general cosmetic effects, 2 patients (6.67%) and 7 patients (18.92%) had poor cosmetic effects in the observation group and control group, with a significant difference (Z=-2.513, P=0.012). Four patients (13.33%) in the observation group had postoperative complications, including that 1 patients had incisional dehiscence followed by incisional wound infection and skin necrosis, and 3 patients had subcutaneous exudates. However, 2 patients (5.41%) in the control group had postoperative complications, including 1 patients with incisional dehiscence, and 1 patients with incisional wound infection. There were no significant difference in the occurrence rates of postoperative complications in the two groups (χ2=0.490, P=0.484). The mean follow-up period was 28 months. We found 1 patients of local recurrence, and 2 patients of metastases in the control group. However, all patients were free of recurrence and metastases in the observation group, with no significant difference (P=0.140). Conclusion Oncoplastic surgical technique in the breast-conserving surgery for patients with early-stage breast cancer is a safe and effective procedure, with highly satisfactory cosmetic effects for the majority of patients, which is worth to recommend. Key words: Breast neoplasms; Mammaplasty; Reconstructive surgical procedures

Transareolar pulmonary bullectomy for primary spontaneous pneumothorax

BackgroundConventional 3-port video-assisted thoracoscopic surgery is the classic approach for the diagnosis and treatment of primary spontaneous pneumothorax. Transareolar pulmonary bullectomy rarely has been attempted. This study aimed to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary spontaneous pneumothorax. MethodsFrom January 2013 to December 2014, a total of 112 male patients with primary spontaneous pneumothorax underwent transareolar pulmonary bullectomy by use of a 5-mm thoracoscope. ResultsAll procedures were performed successfully, with a mean operating time of 26.5 minutes. The mean length of transareolar incision for the main operation was 2.0 ± 0.2 cm, the mean length of incision for the camera port was 0.6 ± 0.1 cm, and the mean postoperative cosmetic score was 3.0 ± 0.8. All patients regained consciousness rapidly after surgery. One hundred seven patients (95.5%) were discharged on postoperative day 2 or 3, with the remainder discharged on postoperative day 4 or 5. Postoperative complications were minor. At 6 months postoperatively, there was no obvious surgical scar on the chest wall, and no patient complained of postoperative pain. No recurrent symptoms were observed. One-year follow-up revealed an excellent cosmetic result and degree of satisfaction. ConclusionsTransareolar pulmonary bullectomy is a safe and effective therapeutic procedure for primary spontaneous pneumothorax caused by pulmonary bullae. The incision is hidden in the areola with excellent cosmetic effects. This novel procedure shows promise as a treatment of primary spontaneous pneumothorax.

Laser treatment of congenital melanocytic nevi: a review of the literature.

Congenital melanocytic nevi (CMN) are nevi that are present from birth and occur in approximately 1% of newborns. CMN may be cosmetically disfiguring and are at risk for malignant transformation. For these two reasons, CMN are frequently treated. A variety of treatment modalities have been utilized with variable efficacy, including excision, dermabrasion, curettage, chemical peels, radiation therapy, cryotherapy, electrosurgery, and lasers. The current treatment of choice for CMN is surgical excision. However, some CMN occur in cosmetically sensitive areas, where a surgical scar is less acceptable, or in inoperable locations. For these reasons, there has been increasing interest in the potential for laser treatment of CMN. The lasers that have been studied to date for the treatment of CMN include pigment-specific lasers, including ruby (694nm), alexandrite (755nm), and Nd:yttrium aluminum garnet (YAG) (1064nm), as well as ablative laser treatment with CO2 laser (10,600nm) and Er:YAG (2940nm). To date, ruby lasers have been studied most extensively in the treatment of CMN. Ruby laser has been shown to improve the cosmetic appearance of some CMN and may be cautiously considered for lesions located in cosmetically sensitive areas that are less amenable to surgical excision. For very large CMN, ruby laser has been tried as an alternative to extensive surgical and grafting procedures. Dual treatment with Q-switched ruby laser and normal mode ruby laser may provide the best outcomes; however, multiple treatment sessions should be anticipated. The practicality and expense of multiple treatments should be discussed with the patient prior to initiating treatment. Importantly, because of the persistence of dermal nevus cells, lifelong follow-up is required for all laser-treated CMN, even those with excellent cosmetic effect.

Minilaparoscopic cholecystectomy - the new non-visible scars technique. Preliminary report of first series.

IntroductionSurgery without scars is the dream of many patients and surgeons as well. It includes many new laparoscopic techniques (LESS, SILS, hybrid NOTES), but data concerning common bile duct (CBD) lesions are unavailable.AimTo establish the new technique of minilaparoscopic cholecystectomy (MCh): non-visible scar intervention without increasing the risk of CBD lesions.Material and methodsForty consecutive patients with symptomatic gallbladder lithiasis were qualified for elective laparoscopic cholecystectomy (LCh) using one 10/11 mm umbilical port, one 5 mm right suprapubic port and two minilaparoscopic, disposable, no-port graspers. There were 26 women and 14 men, with the mean age 56 (17–72) years and with the average body mass index 28 (18–33) kg/m2. CO2 Veress 15 mm Hg pneumoperitoneum was performed after transumbilical incision, and the first 10/11 mm port was inserted at the beginning for the 5 mm laparoscope and finally for typical instruments. Next under camera control, a 5 mm trocar was inserted in the right ‘bikini line’. To this port the laparoscope was relocated from the umbilicus, and under its control two minilaparoscopic, disposable, non-port graspers were introduced after small, 2 mm skin incisions in the right anterior axillary line and in the right mesogastrium to catch the gallbladder. Next through the umbilical port, using typical instruments, the cystic duct and artery were dissected, clipped and cut. The gallbladder was removed through the umbilical port whole.ResultsThere was no conversion to open cholecystectomy. In 5 cases drainage of the gallbladder lodge was necessary through a 5 mm port in the right bikini line. The time of the intervention ranged from 90 min during the introduction of the new method to 50 min for the last procedures. No postoperative complications were observed, and all patients were discharged at the same time as after conventional LCh.ConclusionsTwo-port laparoscopic cholecystectomy performed with two minilaparoscopic no-port graspers does not increase the risk of CBD lesions. It provides an excellent cosmetic effect and is very convenient for the surgeon like typical LCh.

Development of a new formulation of interferons (HEBERPAG) for BCC treatment

Purpose: This work is aimed to show briefly, the clinical development of a new pharmaceutical formulation of interferons for the treatment of basal cell carcinoma. Methods: A rationale design of the combination of IFN-a2b and -γ based in their anti-proliferative synergism on several tumors cell lines identified adequate proportions to be combined to obtain the best clinical results. The potential mechanism of antitumoral effect was studied by qPCR mRNA quantification. HEBERPAG (anti-proliferative synergistic combination of co-formulated recombinant interferons-a2b and –γ) was used in clinical trials in adult patients with non-melanoma skin cancer. Trials were conducted after approval by the ethics review boards of the institutions participating in trials; and the patients gave their written informed consent to be enrolled in the studies and receive HEBERPAG. Results: HEBERPAG inhibits the proliferation of several tumor cell lines in vitro and in vivo. The combination has improved pharmacodinamic properties. Several clinical trials have demonstrated the efficacy of HEBERPAG in BCC, with excellent cosmetic effect and well tolerable, mild side effects. HEBERPAG was approved by State Control Center for Drug, Medical Equipment and Devises in Cuba, for the treatment of basal cell carcinoma of any subtype, size and localization, and adjuvant to other treatments, surgical or not. After 3-year follow-up, a recurrence rate of 0.03% was detected in treated patients. Conclusions: HEBERPAG is a novel formulation of IFNs, more potent than separated IFNs for the treatment of basal cell carcinoma, with more rapid and prolonged clinical effect and excellent cosmetic effect and safety profile.

Transumbilical Single-Incision Laparoscopic Fundoplication: A New Technique for Liver Retraction Using Cyanoacrylate

Single-incision laparoscopic fundoplication is not widespread because of its technical difficulty. An additional stay suture or retractor is often needed for liver retraction during the procedure. Here, we share our 7 cases to demonstrate the feasibility of transumbilical single-incision laparoscopic fundoplication with a new technique for liver retraction without any stay suture or retractor. From March 2010 to October 2011, 3 patients with achalasia underwent a transumbilical single-incision laparoscopic Heller-Dor operation, and 4 patients with hiatus hernia underwent transumbilical single-incision laparoscopic hernioplasty and Nissen fundoplication. The procedures were attempted transumbilically by using three rigid trocars (one was 10 mm, and two were 5 mm) inserted through the 2-cm umbilicus incision. Conventional laparoscopic instruments were used. Adequate retraction of the liver was achieved by binding the lateral left lobe of the liver to the diaphragm with cyanoacrylate. The pneumoperitoneal time was 115-170 minutes, and blood loss was 15-50 mL. There were no intra- or postoperative complications. The hospital stay was under 6 days for all patients. The umbilical incision healed well with satisfactory cosmetic effect. The transumbilical single-incision laparoscopic technique in the treatment of achalaisa and hiatus hernia is feasible for an experienced laparoscope surgeon with excellent cosmetic effect. Cyanoacrylate, when used as described, offers a safe and simple solution to the problem of liver retraction, thus obviating the need for a stay suture or liver retractor.

Application of the Single Access Technique in Laparoscopic Surgery

Laparoscopic single access technique is a next step in development of minimally invasive surgery. The aim of the study was to present results of different laparoscopic single incision procedures and evaluate application of this technique. 102 patients (15 males and 87 females) who underwent laparoscopic single incision procedure from 15th October 2009 to 31st December 2012 were included in the study. In the analyzed period we performed 72 cholecystectomies (70.6%), 8 left adrenalectomies (7.8%), 3 right adrenalectomies (2.9%), 7 splenectomies (6.9%), 5 spleen cysts unroofings (4.9%), 2 appendectomies (2%), 1 Nissen fundoplication procedure (1%), 1 removal of the adrenal cyst (1%) and 3 concomitant splenectomies and cholecystectomies (2.9%). There were 3 technical conversions to multiport laparoscopy, but no conversion to open technique. Complications were observed in 5 patients (4.9%). Average operation time was 79 min (SD=40), average hospitalization time 2.4 day (SD=1.4). Laparoscopic single incision technique is a safe method and can be used as a reasonable alternative to multiport laparoscopy in different minimally invasive procedures especially in young patients to whom an excellent cosmetic effect is particularly important.

Laparoscopic surgery of the spleen through single umbilical incision.

IntroductionSingle incision transumbilical laparoscopic procedures are the next step in development of minimally invasive surgery. Recent studies prove that the new technique can be a safe alternative to multiport laparoscopy; therefore it is becoming more and more popular.AimWe present our preliminary experience with single incision laparoscopy of the spleen.Material and methodsWe analyse a group of 9 patients (7 women and 2 men) in whom we attempted single incision laparoscopic surgery of the spleen.ResultsSingle incision laparoscopy was successful in all patients – in 7 of them we performed splenectomy and in 2 unroofing of the splenic cyst. Additionally, in 3 patients we performed concomitant cholecystectomy. The operative technique was identical to multiport procedures. One patient required reoperation due to intra-abdominal bleeding from the wound on the first postoperative day. In one patient due to superficial injury of the stomach wall continuous suture was used to prevent perforation. In our opinion these complications are not the result of the new technique.ConclusionsThe described technique can become a safe alternative to multiport laparoscopy. It is a reasonable alternative in young patients to whom an excellent cosmetic effect is particularly important because until now it is the only documented advantage of this surgical technique.

Implantation at Sternocleidomastoid and Chest Wall After Endoscopic Thyroid Carcinoma Surgery

Endoscopic thyroidectomy has been widely accepted by surgeons and patients for less postoperative pain, faster postoperative recovery, and excellent cosmetic effect. However, there still existed some limitations. Here, we reported a woman who suffered local implantation metastasis at sternocleidomastoid and chest wall after endoscopic thyroid carcinoma surgery. Although the implantation after endoscopic surgery is uncommon, this case reminds us to use endoscopic surgery for thyroid diseases with caution, especially for thyroid cancer. Following strict endoscopic surgery indications, comprehensive preoperative evaluation, meticulous intraoperative surgical handling, and effective protective measures, the incidence of locoregional implantation or recurrence might be dramatically reduced.

Single-incision laparoscopic cholecystectomy: Initial experience with different multichannel ports

Single-incision laparoscopic cholecystectomy is a relatively new minimally invasive surgical technique in treatment of benign gallbladder diseases. It is considered a bridge technique between conventional laparoscopic cholecystectomy (LC) and NOTES. We are presenting our initial experiences in SILC (single-incision laparoscopic cholecystectomy). Seventeen patients underwent SILC (11 women and 6 men) with an average age of 43 years. Mean BMI score was 29,4 kg/m2. The mean operative time was 93,5 minutes. There were conversions to conventional LC in two cases (11,6%). Average pain score measured on visual-analogue scale (VAS) 8 h after the operation was 2,00. All patients expressed satisfaction with achieved cosmetic effect. We conclude that SILC is safe and feasible procedure, with excellent cosmetic effect, but further prospective studies are required before SILC can be generally accepted.

Treatment for chronic synovitis of knee: arthroscopic or open synovectomy

Chronic synovitis of knee joints that cannot be treated by conservative measure effectively can be treated successfully by the operations through resecting the inflamed synovium. The operations include open synovectomy and arthroscopic synovectomy. The purpose of this study is to compare the two operations in alleviating symptoms and cosmetic effect. There were 42 patients in this study, and they suffered from chronic synovitis of knee joints, including rheumatoid arthritis and non-specific synovitis. Twenty-two knees of 22 patients underwent arthroscopic synovectomy with two to five approaches whose lengths were about 1.0cm, and 20 knees of 20 patients underwent open synovectomy with two approaches whose lengths were more than 10.0cm. Patients were evaluated by visual analog scale for pain at the 24th hour after operation. Patients were followed up for 16-20months and were evaluated by the Ogilvie-Harris scoring system. This study showed that both arthroscopic synovectomy and open synovectomy successfully alleviated the symptoms and the short-term results are similar after operation. However, the scars in the patients of the former group were much shorter than the latter group. Pain intensity of patients underwent arthroscopic synovectomy was less than that of open synovectomy at the 24th hour after operation. Both operations could treat chronic synovitis successfully. However, the arthroscopic synovectomy is the preferred operation due to fast recovery, less postoperative pain, and excellent cosmetic effect.

Brain meningioma invading and destructing the skull bone: replacement of the missing bone in vivo

BackgroundMeningiomas are frequently encountered tumours. In those invading locally into the adjacent tissue, reconstructions may pose a problem.Case reportWe report a case of a benign convexity brain meningioma with invasion into the skull bone and subcutaneous tissue. The tumour was removed completely, together with the infiltrated tissue and the defects were successfully closed with in vivo bone reconstruction.ConclusionsThe reconstruction of the skull bone is sometimes needed after the benign meningioma excision. Artificial bone may be a suitable material, allowing fast intraoperative reconstruction with excellent brain protection and cosmetic effect during the one-stage procedure.

Efficacy of Topical Aminolevulinic Acid Photodynamic Therapy for the Treatment of Verruca Planae

To evaluate the safety and efficacy of topical aminolevulinic acid (ALA) photodynamic therapy (PDT) in the treatment of verruca planae. A total of 18 patients with facial verruca planae was treated with ALA-PDT. A 10% ALA emulsion was applied on facial lesions for a 4-h incubation period after azone infiltrating for 30 min. Skin lesions of verruca planae were irradiated with 120 J/cm(2) using a 635-nm laser for 10 min. Each patient received at least two sessions at intervals of 15 days. Those with residual lesions after the first session were treated with a third PDT. Before treatment and at each return visit, the lesions were photographed. Patient satisfaction was investigated and therapeutic effect was evaluated at 6 months after termination of the therapy. Fifteen days after the first topical ALA-PDT, 10 patients achieved complete response and 7 patients showed improvement. Complete clinical response was observed in 17 patients after two sessions. At 6 months after termination, only one case relapsed among the complete clinical response patients, and the patient satisfaction rate was 88.89%. PDT, utilizing the topical application of 10% ALA, has a good result and excellent cosmetic effects for the treatment of verruca planae.

Risk Factors of Cosmetic Outcome in Early Breast Cancer Patients After Breast Conserving Therapy

Aim: In early breast cancer treated with breast conserving therapy (BCT) the cosmetic effect is an important element of the final outcome. The aim of the study was to evaluate the cosmetic effect of 187 out of 203 consecutive patients with stage 0, I and II breast cancer treated conservatively and to identify the negative factors influencing cosmesis. Material and Methods: From the entire group of 203 consecutive breast cancer patients with stage 0, I, and II treated with BCT at one oncological institution between 1994-1999, 187 women underwent cosmetic evaluation. The time of observation was 48-103 months, (median 74 months). Cosmesis was assessed qualitatively (subjectively) by the medical panel and patients themselves and quantitatively (objectively) by the medical panel, using measurements and comparing the treated breast with untreated. The relationship between cosmesis and the factors related to the disease and its management (breast size, localization of the tumour, clinical vs preclinical status, type of surgery, radiotherapy to the lymph nodes, breast boost type, adjuvant chemotherapy) was analyzed. Statistical analysis was performed using a logistic regression model. Marginal homogeneity test and Cohen kappa was calculated in order to assess the uniformity of opinion between doctors and patients. Results: According to the medical panel the cosmetic results were assessed as excellent in 59.5% of cases, as good in 34%, as fair in 6.5% of cases with no bad cosmetic results. In the opinion of the patients 67% of cases were assessed as excellent, 23.5% as good, 7.5% as fair and 2% as bad. Statistical analysis based on marginal homogeneity test and Cohen- Kappa did not confirm any concordance between the opinions of both patients and therapists. The two factors found to limit the chance of achieving the excellent cosmetic effect were: quadrantectomy (p = 0.007) and brachytherapy boost (p = 0.004). All the other factors analyzed: the size of the breast, the localization of the tumor, a non-palpable lesion and adjuvant treatment- did not influence the cosmetic outcome (p>0.1). Conclusions: BCT performed according to the guidelines applied at the Cancer Centre in Warsaw Poland provides satisfactory (excellent or good) cosmetic effect in large majority of patients (93%). A discrepancy between the cosmetic effects as evaluated qualitatively by the patients and by the medical panel was observed. The two factors limiting the chance of achieving an excellent cosmetic effect were quadrantectomy and HDR Ir192 brachytherapy boost.

Cryosurgery for the Treatment of Varicosities: Cosmetics and Effectiveness

Varicosities occur in 1.8% of women and in 1.1% of men at age 30–39 years. They may cause serious complications such as inflammantion of superficial veins, deep vein thrombosis, or pulmonary embolism. Only surgery can give satisfactory therapeutic and cosmetic results. The use of cryosurgery in surgical treatment of lower-extremity varicosities considerably increases the surgeon's potential. The use of cryosurgical probe shortens the procedure and enables removal of varicosities through a single incision. An indisputable advantage of cryosurgery in the treatment of lower extremity varicosities is its effectiveness and excellent cosmetic effect.

46. Stereotactic Mammotome Breast Biopsy – analisis of results

The purpose of work is to assess stereotactic mammotome biopsy technology in diagnostics of nonpalpable breast lesions. In the period from April to December 2000 mammotome biopsy procedure was performed on395 female patients at the I Oncological Surgery department the Greatpoland CancerCenter in Poznan. In all patients, diagnosed lesions were non-palpable and categorisedas BI-RADS III, IV, V. Patients were aged between 16 and 78 (average 52.6 years). They divided into three groups depending on radiological characteristics of the examined lesions – separate analyses were carried out for patients with microcalcifications suspicious tumores and radial scar. Diagnostic examination was performed on an ambulatory basis. Procedurewas carried out on a Fischer mammotome table using the Mammotome Biopsy System. The Cancers were detected in 17 % cases. All patients with diagnosed cancer underwent further surgical procedure. In 83 % patients in whom begin lesions were found mammography screening was recommended at 6 month intervals. The Stereotactic Mammotome Breast Biopsy System is a sensitive, minimally invasive diagnostic technology characterised by: very high diagnostic precision, minimal traumatisation of surrounding tissues, excellent cosmetic effect, economical procedure.

Minimalist placement of external ventricular drains. A quick, safe, cheap and cosmetic procedure

We report the use of a twist drill method for placement of external ventricular drains and ventriculoperitoneal shunts. We have found this method to be efficient and safe, and provides an excellent cosmetic effect.