Introduction: Laparoscopic liver resections (LLRs) constitute an area of surgery that has been ke... more Introduction: Laparoscopic liver resections (LLRs) constitute an area of surgery that has been kept away from residents in their hands-on training. The aim of our study is to assess the feasibility and the value of a didactic “step-by-step” program for LLR performed by residents using the swine training model. Methods: From May 2018 to November 2019, three hands-on workshops were held. The protocol involved the performance of cholecystectomy, liver mobilization, minor and major hepatectomies. The participants’ performance results in terms of operative time, blood loss, conversion, trainers’ intervention, and intraoperative mortality, were recorded. The first workshop was comprised of 30 residents who previously participated in laparoscopic surgery workshops. In the second workshop, after six residents dropped out due to residency completion, the findings for the remaining 24 residents were compared to those for 24 junior-attending surgeons who did not follow the protocol and had not...
BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. F... more BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. Following specific mutations, microsatellites can vary in the number of repeats thus making the DNA unstable. Microsatellite instability (MSI) is responsible for approximately 20% of rectal cancers, while the remaining 80% are caused by chromosomal instability. One of the following genes, MLH1, MLH2, MLH 6, and PMS2, is inactivated, leading to MSI colorectal cancers. AIM This study aimed to analyze the expression of some MMR system genes presenting mutations in mucinous rectal cancer and their correlations with clinical data. METHODS A retrospective study was performed on patients with rectal mucinous adenocarcinoma who underwent surgery between January 2000 and January 2017. We collected a total of 42 patients and analyzed the demographic data, histopathological results and MMR system genes mentioned above. RESULTS Almost 93% of the cases analyzed had MSI-H and only 7% were MSI-L. For ML...
AIM Endorectal ultrasonography (ERUS) and high-resolution Magnetic Resonance Imaging (HR-MRI) are... more AIM Endorectal ultrasonography (ERUS) and high-resolution Magnetic Resonance Imaging (HR-MRI) are two frequently used techniques for the preoperative staging of rectal cancer to offer proper neoadjuvant or surgical treatment. Because tumor restaging after neoadjuvant therapy using ERUS and HR-MRI remains challenging the aim of this study is to determine which of the two imaging methods used in restaging rectal cancer has the highest accuracy. MATERIAL AND METHODS We included patients with rectal cancer who underwent ERUS and HR-MRI scans before and after neoadjuvant chemo-radiotherapy (n-CRT). The n-CRT was followed by imagistic restaging at 6 weeks after the last therapy session and by surgical resection. The pathology stage from the surgical sample was compared with the HR-MRI and ERUS restaging. RESULTS Fifty-four patients underwent n-CRT and 47 were restaged by both ERUS and HR-MRI. ERUS was accurate in tumor restaging after n-CRT in 29 cases (61.7%) and HR-MRI in 32 cases (68%)...
The treatment of hydatid cyst includes various forms: from open surgery to laparoscopic and endos... more The treatment of hydatid cyst includes various forms: from open surgery to laparoscopic and endoscopic therapies, all enhanced by specific antiparasitic drugs. In this chapter are summarized the main techniques of laparoscopic treatment of hydatid cyst and its major postoperative complications. Surgical techniques described vary depending on the topographic location, expression on the surface of the liver, presence of complications, type of bilio-cystic fistula and experience of the surgical team. Also a series of specific devices meant to treat this disease are noted. PAIR method was not detailed in this chapter because is a percutaneous method. Laparoscopic approach of hepatic hydatid cyst is used increasingly in the treatment of this condition and for experienced teams this can become the most effective method of treatment, in combination with antiparasitic medication.
We present a medical case of a 61 year-old male patient who reported to the outpatient clinic wit... more We present a medical case of a 61 year-old male patient who reported to the outpatient clinic with a parastomal hernia of 10 cm in diameter and a postincisional midline hernia of 15 cm in diameter. We emphasized that the patient had undergone surgery 4 years before for a rectal adenocarcinoma, in which we performed an abdominal perineal resection of the rectum with end colostomy. At the time of admission, there were no imagistic signs of local or distant relapse. The surgical technique used aimed to repair both of the abdominal defects by placing a large polypropylene mesh (30x30 cm) spanning into the retro-rectus space in a sublay position. On the colostomy side, the mesh is extended up to the median axillary line by performing TAR (transversus abdominis release), according to the technique described by Pauli, thus the colostomy side is not modified. The post-operatory evolution was favourable, with the return of intestinal transit for faeces and gas on the second post-operatory da...
A serious problem for patients with unresectable pancreatic cancer and chronic pancreatitis is pa... more A serious problem for patients with unresectable pancreatic cancer and chronic pancreatitis is pain. For many of these patients medical therapy is unable to assure a good control of it. Celiac plexus nerve block and surgical denervation of the pancreas have proven their superiority over medical therapy. Thoracoscopic splanchnicectomy is a palliative procedure that consists in identification and division of all the roots of the splanchnic nerves from T5 to T10. It can be performed either on a single part or bilaterally.
Endometriosis is a disease represented by the presence of extra uterine endometrial tissue. It is... more Endometriosis is a disease represented by the presence of extra uterine endometrial tissue. It is a rare condition, and malignant transformation is seldom. We report a case with clear cell adenocarcinoma oncogenesis on abdominal wall scar that appeared after years of a caesarian section. After diagnosis, surgical treatment was performed twice, due to the fact that the margins were infiltrated with tumor cells, with replacement of the defect with a polypropylene mesh. The patient was cured and discharged with a favorable prognostic. To the best of our knowledge, there are few reported cases of clear cell adenocarcinoma arising from abdominal wall endometriosis. It is a rare condition that appears mostly after abdominal surgical interventions that clinicians must be aware. Abdominal wall, Endometriosis, Cesarean section, Clear cell adenocarcinoma, Malignant transformation.
Introduction: Laparoscopic liver resections (LLRs) constitute an area of surgery that has been ke... more Introduction: Laparoscopic liver resections (LLRs) constitute an area of surgery that has been kept away from residents in their hands-on training. The aim of our study is to assess the feasibility and the value of a didactic “step-by-step” program for LLR performed by residents using the swine training model. Methods: From May 2018 to November 2019, three hands-on workshops were held. The protocol involved the performance of cholecystectomy, liver mobilization, minor and major hepatectomies. The participants’ performance results in terms of operative time, blood loss, conversion, trainers’ intervention, and intraoperative mortality, were recorded. The first workshop was comprised of 30 residents who previously participated in laparoscopic surgery workshops. In the second workshop, after six residents dropped out due to residency completion, the findings for the remaining 24 residents were compared to those for 24 junior-attending surgeons who did not follow the protocol and had not...
BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. F... more BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. Following specific mutations, microsatellites can vary in the number of repeats thus making the DNA unstable. Microsatellite instability (MSI) is responsible for approximately 20% of rectal cancers, while the remaining 80% are caused by chromosomal instability. One of the following genes, MLH1, MLH2, MLH 6, and PMS2, is inactivated, leading to MSI colorectal cancers. AIM This study aimed to analyze the expression of some MMR system genes presenting mutations in mucinous rectal cancer and their correlations with clinical data. METHODS A retrospective study was performed on patients with rectal mucinous adenocarcinoma who underwent surgery between January 2000 and January 2017. We collected a total of 42 patients and analyzed the demographic data, histopathological results and MMR system genes mentioned above. RESULTS Almost 93% of the cases analyzed had MSI-H and only 7% were MSI-L. For ML...
AIM Endorectal ultrasonography (ERUS) and high-resolution Magnetic Resonance Imaging (HR-MRI) are... more AIM Endorectal ultrasonography (ERUS) and high-resolution Magnetic Resonance Imaging (HR-MRI) are two frequently used techniques for the preoperative staging of rectal cancer to offer proper neoadjuvant or surgical treatment. Because tumor restaging after neoadjuvant therapy using ERUS and HR-MRI remains challenging the aim of this study is to determine which of the two imaging methods used in restaging rectal cancer has the highest accuracy. MATERIAL AND METHODS We included patients with rectal cancer who underwent ERUS and HR-MRI scans before and after neoadjuvant chemo-radiotherapy (n-CRT). The n-CRT was followed by imagistic restaging at 6 weeks after the last therapy session and by surgical resection. The pathology stage from the surgical sample was compared with the HR-MRI and ERUS restaging. RESULTS Fifty-four patients underwent n-CRT and 47 were restaged by both ERUS and HR-MRI. ERUS was accurate in tumor restaging after n-CRT in 29 cases (61.7%) and HR-MRI in 32 cases (68%)...
The treatment of hydatid cyst includes various forms: from open surgery to laparoscopic and endos... more The treatment of hydatid cyst includes various forms: from open surgery to laparoscopic and endoscopic therapies, all enhanced by specific antiparasitic drugs. In this chapter are summarized the main techniques of laparoscopic treatment of hydatid cyst and its major postoperative complications. Surgical techniques described vary depending on the topographic location, expression on the surface of the liver, presence of complications, type of bilio-cystic fistula and experience of the surgical team. Also a series of specific devices meant to treat this disease are noted. PAIR method was not detailed in this chapter because is a percutaneous method. Laparoscopic approach of hepatic hydatid cyst is used increasingly in the treatment of this condition and for experienced teams this can become the most effective method of treatment, in combination with antiparasitic medication.
We present a medical case of a 61 year-old male patient who reported to the outpatient clinic wit... more We present a medical case of a 61 year-old male patient who reported to the outpatient clinic with a parastomal hernia of 10 cm in diameter and a postincisional midline hernia of 15 cm in diameter. We emphasized that the patient had undergone surgery 4 years before for a rectal adenocarcinoma, in which we performed an abdominal perineal resection of the rectum with end colostomy. At the time of admission, there were no imagistic signs of local or distant relapse. The surgical technique used aimed to repair both of the abdominal defects by placing a large polypropylene mesh (30x30 cm) spanning into the retro-rectus space in a sublay position. On the colostomy side, the mesh is extended up to the median axillary line by performing TAR (transversus abdominis release), according to the technique described by Pauli, thus the colostomy side is not modified. The post-operatory evolution was favourable, with the return of intestinal transit for faeces and gas on the second post-operatory da...
A serious problem for patients with unresectable pancreatic cancer and chronic pancreatitis is pa... more A serious problem for patients with unresectable pancreatic cancer and chronic pancreatitis is pain. For many of these patients medical therapy is unable to assure a good control of it. Celiac plexus nerve block and surgical denervation of the pancreas have proven their superiority over medical therapy. Thoracoscopic splanchnicectomy is a palliative procedure that consists in identification and division of all the roots of the splanchnic nerves from T5 to T10. It can be performed either on a single part or bilaterally.
Endometriosis is a disease represented by the presence of extra uterine endometrial tissue. It is... more Endometriosis is a disease represented by the presence of extra uterine endometrial tissue. It is a rare condition, and malignant transformation is seldom. We report a case with clear cell adenocarcinoma oncogenesis on abdominal wall scar that appeared after years of a caesarian section. After diagnosis, surgical treatment was performed twice, due to the fact that the margins were infiltrated with tumor cells, with replacement of the defect with a polypropylene mesh. The patient was cured and discharged with a favorable prognostic. To the best of our knowledge, there are few reported cases of clear cell adenocarcinoma arising from abdominal wall endometriosis. It is a rare condition that appears mostly after abdominal surgical interventions that clinicians must be aware. Abdominal wall, Endometriosis, Cesarean section, Clear cell adenocarcinoma, Malignant transformation.
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