Open Surgical Excision Research Articles

Trocar site recurrence after robotic partial nephrectomy to treat of renal cell carcinoma.

Introduction:Wound seeding during surgical excision of malignant tumor is known problem in the oncologic surgery. Trocar site recurrence (TSR) is well described in laparoscopic oncologic surgery. Little has been reported about TSR after robotic partial nephrectomy (RPN) performed for renal cell carcinoma (RCC). Here, we report on the incidence of TSR and demonstrate the presentation of this type of RCC recurrence.Patients and Methods:We reviewed prospectively collected data about patient who underwent RPN at our institute from September 2009 to March 2018. We reviewed the medical record of the patients who had the diagnosis of RCC on the final pathology. We identified the patient with TSR and demonstrated their presentation and treatment along with the outcome.Results:A total of 335 patients underwent RPN during the study period for renal mass. Two hundred and sixty-nine (80.3%) patients were found to have RCC on the final pathologic evaluation of their mass. We identified two patients (0.7% of all the RCC in the study) who developed TSR during an average follow-up period of 31 months (ranging from 18 to 72 months). The first recurrence appeared 18 months after the surgery. The second recurrence presented 72 months after RPN. Both cases underwent open surgical excision of the trocar site, in which the recurrence appeared.Conclusion:TSR is potential type of RCC recurrence after RPN, though it is rare and underreported. Special attention should be given to examine the trocar site during the surveillance follow-up of RCC treated with RPN. It can develop up to 72 months after the surgery.

Surgery for patellar tendinopathy (jumper's knee).

Surgery for patellar tendinopathy (jumper's knee).

Pre-operative management of Pleomorphic and florid lobular carcinoma in situ of the breast: Report of a large multi-institutional series and review of the literature

BackgroundPleomorphic and Florid Lobular carcinoma in situ (P/F LCIS) are rare variants of LCIS, the exact nature of which is still debated. AimTo collect a large series of P/F LCIS diagnosed on preoperative biopsies and evaluate their association with invasive carcinoma and high grade duct carcinoma in situ (DCIS). Data obtained were compared with those reported in the literature. MethodsA multi-institutional series of P/F LCIS was retrieved. All cases were diagnosed on pre-operative biopsies, which was followed by an open surgical excision. Data on post-operative histopathology were available. A literature review was performed. ResultsA total of 117 cases were collected; invasive carcinoma and/or DCIS was present in 78/117 cases (66.7%). Seventy cases of P/F LCIS were pure on biopsy and 31 of these showed pathological upgrade in post-surgical specimens. Pre-operative biopsy accuracy was 47/78 (60.3%); pre-operative biopsy underestimation of cancer was 31/78 (39,7.%). In the literature review papers, invasive carcinoma or DCIS was associated with 274 of 418 (65.5%) cases of P/F LCIS. Pre-operative biopsy accuracy was 66% (181/274) whereas pre-operative biopsy underestimation of cancer was 33.9% (93/274). ConclusionsThe data presented here indicate that P/F LCIS is frequently associated with invasive carcinoma or high grade DCIS and that pre-operative biopsy is associated with an underestimation of malignancy. Open surgery is indicated when P/F LCIS is diagnosed pre-operatively.

Possible Approaches to Endoscopic Treatment of Popliteal Cysts: From the Basics to Troublesome Cases

Popliteal cysts can be an oppressive symptom in patients with concomitant intra-articular knee pathologies. Because isolated treatment of intra-articular lesions is usually not sufficient to resolve the problems associated with a large symptomatic popliteal cyst, a popliteal cyst should be concurrently addressed with other knee pathologies to maximize patient outcomes. Conservative treatment and open surgical excision are associated with high rates of recurrence, so arthroscopic techniques are the preferred treatment options for recalcitrant cases. Arthroscopic communication-enlargement surgery with cyst wall removal seems to be the most effective. We present a simple and effective basic technique for arthroscopic popliteal cyst treatment and some approaches that allow management of the more demanding cases.

Comparing Vacuum-Assisted Percutaneous Excision to Open Surgical Excision for Borderline or High-Risk Breast Lesions

Comparing Vacuum-Assisted Percutaneous Excision to Open Surgical Excision for Borderline or High-Risk Breast Lesions

Liposuction: a veritable option in management of gynecomastia case report

Introduction: Gynaecomastia is the commonest aesthetic problem in men. Treatment in our environment is mainly by open surgical excision. The practice of liposuction is still developing in our region. We present our experience in the use of liposuction in the management of bilateral gynaecomastia in Alex Ekwueme Federal University Teaching Hospital Abakaliki with a satisfactory outcome. Method: We report a case of 33-year old male with idiopathic bilateral gynaecomastia (Simon grade IIb) and resultant aesthetic concern. Treatment was by suction-assisted liposuction with satisfactory outcome. Results: The lipoaspirate from the left breast was 900 mls and 600 mls from the right breast. Male chest contour was regained several weeks post-surgery with good patient satisfaction. Conclusion: Liposuction alone offered a satisfactory outcome in the management in this case.

Tenoscopic‐assisted treatment of a solitary caudodistal tibial osteochondroma

SummarySolitary osteochondromas are a relatively infrequent cause of lameness in the horse, most commonly occurring in the caudal distal radial metaphysis, with sparse reports in other locations. Their presence adjacent to a synovial sheath frequently results in intra‐thecal tendinous laceration and resultant synovial effusion. Surgical excision in combination with arthroscopic debridement of the tendinous pathology offers the best prognosis for soundness. This report details the successful treatment of a caudodistal tibial osteochondroma using a combination of open surgical excision and tarsal sheath tenoscopy.

Isolated Congenital Tracheobiliary Fistula

Congenital tracheobiliary fistula is a rare developmental anomaly with a persistent communication between the biliary system and the trachea. A 7-day-old baby with severe respiratory distress and aspiration pneumonia. Tracheobilliary fistula identified on bronchoscopy. Open surgical excision of fistula was followed by improvement. This condition should be considered in the differential diagnosis of intractable aspiration pneumonia.

Scapular Osteochondroma: An Infrequent Case

Osteochondroma of the scapula is a rare benign tumor in view of its location, which produces pain and mechanical dysfunction of the joint when it is on the ventral surface of the scapula, mainly affecting men during bone growth periods, between the ages of 10 and 30, accounting for 14.4 % of all scapula tumors and 49 % of benign tumors of the scapula. They arise in the metaphyseal regions of the long bones (femur, humerus, tibia), causing mechanical irritation leading to functional impotence, bursitis, and fracture of the scapula. Few cases in flat bones have been described. Diagnosis is made with physical, clinical and complementary examinations, and must be confirmed by prior histopathology biopsy. The surgical indication includes mechanical dysfunction of a joint or tendon in relation to the size of the lesion, sarcomatous change being the procedure of choice in open surgical excision. The case of an 11-year-old girl who was diagnosed with a subscapular osteochondroma after previous excisional biopsy, is described below.

Giant fronto-ethmoidal osteoma with orbital and intracranial extension: a case report

<p class="abstract">Osteomas of the paranasal sinuses are often small, asymptomatic and incidentally diagnosed on radiological imaging. Giant osteomas, although rare, are clinically significant due to their propensity to cause orbital and intracranial complications. Complete surgical resection is usually possible with good outcome and low recurrence rate. We report a case of 62 years female who presented with proptosis and blurring of vision. Radiological work up revealed giant fronto-ethmoidal osteoma measuring 7.9×5.1×4.8 cm extending into the orbit and along the anterior skull base. Open surgical excision of the osteoma was done via left fronto-orbital approach. This is one of the largest fronto-ethmoidal osteomas reported in the literature till date.</p>

Mesenteric cysts revisited: An ever-intriguing issue

Background: Mesenteric cysts continue to intrigue the surgeons and radiologist alike. Patients and Methods: Our records were reviewed to identify mesenteric cysts, diagnosed in the period from February 2014 to September 2016. Results: We identified one male and four females, with a median age of 44 years. Abdominal pain was the presenting feature in all patients. ultrasound was done in four cases, where the cyst was missed in one case, and no clue to its nature was given in the remaining three, while computed tomography suspected the diagnosis in four patients and failed in one. Laparoscopic excision was attempted in only one patient, but eventually, all patients underwent open surgical excision. In four patients, the cyst was removed intact, while in the fifth, a minor wall break occurred, resulting in limited spillage of cyst contents. Histopathological examination showed simple mesothelial cyst in three cases, a pseudocyst in the fourth case and a cystic lymphangioma in the fifth. All patients tolerated surgery well, and up to the time of writing this paper, no recurrence was reported. Conclusion: Mesenteric cysts, with its numerous types, continue to intrigue the concerned physicians. Regardless of the approach, excision of the intact cyst should be the aim, most conveniently by open surgery. Although laparoscopy could be employed, this should be entertained with caution, to avoid cyst rupture or leaving part of the wall behind, thus predisposing to recurrence.

Giant Lower Back Lipoma in Pediatric : A Case Report

Backgrounds : Lipoma is the most common soft-tissue mesenchymal neoplasm in adults. Lipoma that sized over 10 cm and weighed over 1000 grams is considered giant lipoma. Giant lipoma, especially in children are rare, so it represent a real diagnostic and therapeutic challenge. In this case report, we report a further case.Case : A three-year-old girl with a history of progressive growing mass on the lower back since born resulting in pain. CT scan with contrast shows soft tissue mass with fat content sized 6,1 x 12,1 x 12,7 cm without contrast enhancement. Surgical excision was performed to completely remove the tumor. Histopathology examination confirmed the diagnosis of lipoma.Conclusion : Pediatric giant lipomas are rare, when they occur an appropriate work up must be done. This should be followed by adequate open surgical excision and repeat examination over time to monitor for recurrence.

The Outcome of Treatment of Flexor Sheath (seed) Ganglia by a Percutaneous Partial Pulley Release.

The aims of this study were to assess the safety and efficacy of a technique of partial percutaneous pulley release. A retrospective cohort study was undertaken treating adults with seed ganglia with a percutaneous pulley release. The patients were reviewed independently after a mean of 6 (range 6-36) months. We treated 24 patients over a 3 year period. There were 14 women and ten men. The mean age was 39 (range 17-65) years. We were able to assess 21 patients with long term follow up. There was complete resolution in 14 (2/3) and partial resolution in four. The remaining three patients had persisting symptoms and requested open surgical excision. Apart from local tenderness and failure of resolution there were no complications of percutaneous pulley release. Bursting or aspiration of flexor sheath ganglia appears to be the best primary treatment. If the ganglion recurs, this study suggests a percutaneous release is safe and will resolve the symptoms in most patients.

Endoscopic Versus Open Excision of Os Trigonum for the Treatment of Posterior Ankle Impingement Syndrome in an Athletic Population: A Randomized Controlled Study With 5-Year Follow-up

Background: Open surgical excision of the os trigonum has been the traditional treatment for posterior ankle impingement syndrome (PAIS). However, the endoscopic excision has recently become quite popular. Purpose/Hypothesis: The purpose of our study was to compare the results of endoscopic versus open excision of a symptomatic os trigonum for the treatment of PAIS in an athletic population. It was hypothesized that the endoscopic technique would be superior to the open technique regarding functional outcomes, pain, and time to return to training and the previous sports level. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From 2008 to 2011, 52 athletes underwent a symptomatic os trigonum excision; 26 athletes had an open procedure (group A) and 26 had an endoscopic procedure (group B). The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Visual Analog Score–Foot and Ankle (VAS-FA) were obtained, and the time to return to training and to previous sports level was recorded. Results: Patients in group B appeared to have significant improvement of AOFAS hindfoot score compared with those in group A (P < .05), whereas no statistical significance was found for the postoperative VAS-FA scores between the 2 groups. The mean ± SD time to return to training was 9.58 ± 3.98 weeks for group A and 4.58 ± 1.47 weeks for group B (P < .001). The time to return to previous sports level was 11.54 ± 3.89 weeks for group A and 7.12 ± 2.25 weeks for group B (P < .001). The overall complication rate was 23% for group A (6 cases) and 3.8% for group B (1 case). Conclusion: Both the open procedure and the endoscopic approach yielded acceptable outcomes in terms of function and pain. However, complication rates were remarkably lower with endoscopic treatment, and the time to return to full activities was much shorter. Endoscopic excision of the os trigonum is a safe and effective treatment option for athletes who require early return to their previous sports level.

Tenosynovial Giant-Cell Tumors of the Foot and Ankle: A Critical Analysis Review.

➢ Tenosynovial giant-cell tumor (TGCT) is the common term used to describe a group of soft-tissue tumors that share a common etiological link. Historically, the multiplicity of terms used to describe these tumors, in addition to contention regarding etiology, has led to confusion regarding their diagnosis and treatment.➢ An overexpression of colony-stimulating factor-1 (CSF-1) caused by a specific chromosomal translocation t(1;2) has been identified in both localized and diffuse tumors and has led to an interest in pharmacological therapies targeting the CSF-1/CSF-1R (CSF-1 receptor) axis.➢ Operative treatment remains the mainstay of treatment for TGCT of the foot and ankle; however, given the rarity of these tumors, treatment recommendations have not been verified on the basis of large cohort studies or high-level evidence.➢ A multidisciplinary approach is important in TGCT treatment. Open surgical excision or synovectomy is considered to be the first-line treatment. While the roles of arthroscopic excision, radiation therapy, and targeted pharmacological therapies have not been validated, these therapies may be of use for selected patients, particularly those with recurrent or unresectable lesions.➢ A clear definition of tumor recurrence based on radiographic evidence of progression and/or return of symptoms is required to quantify the outcomes of treatment, to reduce heterogeneity between studies, and to avoid morbidity associated with repeated surgical excisions.

Role of multislice computed tomography in characterization of different retroperitoneal masses

Background Multislice computed tomography imaging (MSCT) plays an integral role in the characterization of primary retroperitoneal masses and in the evaluation of their extent and involvement of adjacent structures, and therefore in treatment planning. Many authors have described useful imaging features to distinguish between the different entities. Aim The aim of this study was to evaluate the role of MSCT in differentiation of primary retroperitoneal masses in correlation with pathological findings. Patients and methods This prospective study was performed on 43 patients aiming to determine the role of cross-sectional computed tomography (CT) imaging in the differential diagnosis of primary retroperitoneal masses. Each case was submitted for pathological analysis either following open surgical biopsy, surgical excision, or image-guided biopsy by CT or ultrasound. Correlation of CT findings with pathological results was obtained. Results The calculated accuracy for the diagnosis and differential diagnosis of primary retroperitoneal masses by MSCT was 69.7% in the studied cases matched with pathological findings, which represented 30 cases of our study. This was helpful in narrowing the differential diagnosis and thus in treatment planning. Conclusion Multi-slice Computed Tomography (MSCT) is considered the basic standard in morphological evaluation, and the diagnosis of primary retroperitoneal masses according to their origin is carried out first and then characterization of the mass lesion is performed depending upon the specific imaging characteristics detected on CT examination such as consistency, component, vascularity and enhancement pattern, as well as specific pattern of spread.

First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions).

The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group—a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.

Primary Omental Hydatid Cyst:- Report of Two Cases

We are reporting two cases of primary omental hydatid cyst in children of 12 yr &amp; 5yr of age respectively. Both cases were diagnosed on ultrasound &amp; managed successfully by open surgical excision of the cyst. In our patients cyst were unilocular &amp; in one of the patients it contained large numbers of daughter cysts (approx.150). We failed to find in literature a giant primary omental hydatid cyst with so many daughter scolexs of varying sizes.J. Paediatr. Surg. Bangladesh 5(2): 68-72, 2014 (July)

Considerations in performing open surgical excision of dorsal wrist ganglion cysts.

To investigate which conditions should be considered to make a successful resection of the entire ganglion complex during open excision. We reviewed 52 patients who underwent open surgical excision of dorsal wrist ganglions. The inclusion criterion was a symptomatic ganglion causing pain, weakness and limitation of range of motion. The mean follow-up was 26 (range 12-45) months. We recorded operative details including whether or not the stalk was identified, how the ganglia were resected, and where the stalk originated. Intentional rupture of cyst was performed when the stalk was not easily identified with dissection. Pain score was measured using a visual analog scale system pre-operatively and post-operatively. Recurrence was also described. A stalk was identified in eight cases using dissection and in 43 cases by rupturing the cyst. The entire ganglion complex was resected in 50 cases. The stalk originated most commonly in the radio-lunate joint. The average pain score improved from 3.9 to 1.8 after ganglion removal. The ganglion recurred in two cases where incomplete resection of the ganglion was made. In the majority of ganglions, it is difficult to identify the stalk and its capsular attachment due to a large cyst with severe adhesion to adjacent soft tissues including joint capsule. Rupturing a cyst on purpose helps to identify the stalk and minimize capsular loss. A ganglion over the radiolunate joint was most commonly found and excision of joint capsule over scapholunate joint without identification of the stalk and its capsular attachment might result in recurrence. Recurrence was definitely related to incomplete resection which was more commonly made in ganglions over uncommon sites. Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.

Solid pseudo-papillary tumor of the pancreas: Clinical features, diagnosis and treatment

Introduction: Solid pseudo-papillary neoplasm (SPNs) of the pancreas is a rare entity, representing 1% to 2% of all pancreatic neoplasms. Young women in the second and third decades are more likely to develop this pathology compared to men, with a ratio of 1:10. However, its signs and symptoms are non-specific and vague, leading to a delay in diagnosis. Methods: We performed a retrospective review of thirteen patients with SPN managed in four large tertiary care institutions from August 2001 to May 2015, with highlights to sex, age, clinical presentation, diagnosis, and treatment, site of lesion, diameter, and follow up. Results: Thirteen patients were identified, all of them were females, and the mean age of our sample was 28 years. At admission, abdominal mass was present in nine cases, one had emesis due to gastric outlet compression, one had diabetes and two others had their tumors discovered in routine sonogram. Pre-operative TC scans showed lesions with various degrees of solid and liquid material without invasion into surrounding tissues. Twelve patients underwent open surgical excision and one had a laparoscopic resection. All patients had uneventful postoperative courses. Eight of our cases were in the body-tail region and four in the head of the pancreas. Mean diameter of the tumor was 8.8 centimeters and mean follow up was 83.8 days. Conclusion: Although rare, suspicion might arise when finding solid and cystic pancreatic tumors in young female patients. Surgical resection offers excellent outcomes, however enucleation of the tumor can be conducted in selected patients.