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Biomedical subjects

A M Paganini

Publications and source records attributed to A M Paganini.

34 records · Page 2Linked to original sources
PubMed1998

Ultrasound-guided laparoscopic cryoablation of hepatic tumors: preliminary report.

The purpose of this ongoing prospective study is to evaluate the feasibility, safety, and efficacy of a total laparoscopic approach for ultrasound-guided cryoablation of primary and secondary hepatic tumors. Of 56 patients who underwent ultrasound-guided cryoablation, a total laparoscopic approach was employed in 18 (5 men, 13 women; mean age 48.6 years, range 35-77 years). Fifteen patients were included for secondary hepatic tumors and three for primary hepatic tumors. Selection criteria were the presence of three or fewer nodules, less than 40% liver volume replaced by tumor, and absence of extrahepatic disease. Altogether 28 lesions were confirmed by intraoperative laparoscopic ultrasonography and were treated; 25 by ultrasound-guided laparoscopic cryoablation and 3 by laparoscopic wedge resection. After cryoablation, surface parenchymal splits with bleeding from the frozen tissue were observed in six patients and required conversion to open surgery in two patients whose lesions were located in segment 8. No major complication and no mortality were observed. One or more minor complications occurred in nine patients; they included pleural effusion (n = 8, 44.4%), subdiaphragmatic fluid collection ( n = 3, 16.6%), worsening hepatic insufficiency in a cirrhotic patient (n = 1, 5.5%), and wound infection in a patient converted to open surgery (n = 1, 5.5%). The mean hospital stay was 6.4 days (range 3-14 days). At a mean follow-up of 10.8 months (range 5-16 months) all patients are alive and 14 are disease-free, as demonstrated by normalization of tumor markers and negative magnetic resonance imaging. In carefully selected patients total laparoscopic ultrasound-guided cryoablation is feasible and safe. A longer period of follow-up is required to evaluate the efficacy of the procedure and its impact on survival.

Adult↗
PubMed1998

Follow-up of 161 unselected consecutive patients treated laparoscopically for common bile duct stones.

BACKGROUND: Aim was to study the incidence of recurrent ductal stones and of biliary strictures at follow-up after laparoscopic treatment of gallstones and common bile duct stones and to update the short-term results. METHODS: Ductal stones were proven in 161 patients of 1,975 (8.1%) undergoing laparoscopic cholecystectomy. Laparoscopic transcystic CBD exploration was the method of choice. If this was unsuccessful, laparoscopic choledochotomy was performed. After treatment, all patients were enrolled in a continued, ongoing follow-up study. RESULTS: Laparoscopic CBD exploration was completed in 157 cases (transcystic 107, choledochotomy 50). Retained stones occurred in eight patients (5%) and major complications (cystic duct leakage, hemoperitoneum) in six (3.8%); mortality occurred in one high-risk patient (0.6%). Follow-up available in 154 patients (two unrelated deaths) for a period of up to 62 months showed the occurrence of recurrent ductal stones in five cases (3.2%) and no signs of bile stasis, suggestive of ductal stricture, on the basis of clinical and laboratory findings. CONCLUSIONS: This prospective, ongoing follow-up study demonstrates that laparoscopic treatment of gallstones and common bile duct stones in unselected patients is feasible and safe.

Adolescent↗
PubMed1998

A randomized, controlled, clinical study of laparoscopic vs open tension-free inguinal hernia repair.

BACKGROUND: The aim of this prospective, randomized, controlled clinical study was to compare laparoscopic transabdominal preperitoneal (TAPP) hernia repair with a standard tension-free open mesh repair (open). METHODS: A total of 108 low-risk patients with unilateral (primary or recurrent) or bilateral hernias were randomized to TAPP (group 1 = 52 cases) or open (group 2 = 56 cases). The outcome measures included operating time, complications, postoperative pain, return to normal activity, operating theater costs, and recurrences. RESULTS: The mean operative time was longer for the TAPP than for the open group only in unilateral primary hernias. At rest, the median Visual Analog Scale (VAS) score was higher for group 1 than group 2 at 48 h postoperatively. Mild to discomforting pain in the inguinal region after 7 days, night pain after 30 days, and inguinal hardening after 3 months were more frequent in group 2 than group 1. No significant differences were observed in return to normal activities between the groups. One hernia recurrence was observed after 1 month in group 1. TAPP was significantly more expensive than open. CONCLUSIONS: TAPP was associated with less postoperative pain than open. The increase in operating theater costs, however, was dramatic and was not compensated by shorter time away from work. TAPP should not be adopted routinely unless its costs can be drastically reduced.

Adolescent↗
PubMed1998

Transanal endoscopic microsurgical excision of irradiated and nonirradiated rectal cancer. A 5-year experience.

Transanal endoscopic microsurgery (TEM) allows minimally invasive full-thickness local excision of rectal tumors with perirectal fat dissection. Thirty-seven patients with extraperitoneal rectal carcinoma underwent full thickness TEM resection for T1 (10 patients), T2 (20 patients), and T3 (6 patients) lesions, with associated radiotherapy in the second and third group. One patient, staged as T2, underwent full-dose radiotherapy and TEM and the pathologist did not find cancer cells on the specimen (pT0). Morbidity included would dehiscence and stool incontinence in three and two patients, respectively, that resolved with medical therapy and rectovaginal fistula in one patient that required reoperation. No perioperative mortality was observed. Mean follow-up was 35 months (range 17-60 months), with two local recurrences (5.4%) that were successfully retreated. Cancer-related mortality due to systemic metastases was 8.1%. This is the first clinical study reporting on the application of TEM combined with radiotherapy for the treatment of T2 and T3 rectal cancer in selected patients. This approach is feasible, safe, and appears to be effective at the present duration of follow-up, with preservation of normal and sphincter function.

Adenocarcinoma↗
PubMed1997

A new technique to facilitate laparoscopic resection of low rectal tumors.

To make laparoscopic low rectal resection feasible and technically correct, an articulating stapler made for open surgery was employed during laparoscopic low rectal resection in two patients with rectal tumors whose distal margins were located at 7 and 8 cm, respectively, from the dentate line. The problem with laparoscopic linear staplers is that they do not allow transverse resection of low rectal tumors with a double-stapling technique, placing the suture line in an exactly perpendicular position to the rectum below the tumor. The use of this stapler made for open surgery allows extension of the laparoscopic approach to low-lying rectal lesions following established surgical and oncological principles.

Adenocarcinoma↗
PubMed1996

A new T-tube applier in laparoscopic surgery.

In the majority of patients undergoing laparoscopic choledochotomy, it is advisable to insert a T-tube into the duct after ductal exploration, as bile sludge or fibrin deposits may obstruct the papilla and cause postoperative cholangitis. Based on our experience in open surgery, a limited transverse choledochotomy is preferred, which reduces the possibility of damaging the common bile duct blood supply. Such a technique can complicate laparoscopic T-tube positioning, however. After experimenting with the method described by Kitano et al. [Surg Endosc 7:104-105 (1993)], which was abandoned because it was difficult to carry out with the type of soft silicone rubber tubes that we normally use, two subsequent techniques were developed and are described. They were employed in 3 and 10 patients, respectively, out of 21 who underwent laparoscopic transverse choledochotomy. The most satisfying results were obtained using a system employing two sets of telescopic cannulae of different diameters. Laparoscopic T-tube introduction through a transverse choledochotomy using two telescopic cannulae was rapid and safe and allowed to precisely guide T-tube positioning inside the common duct.

Cholecystectomy, Laparoscopic↗
PubMed1996

Laparoscopic treatment of gallbladder and common bile duct stones: a prospective study.

The aim of this study was to investigate prospectively the feasibility, success rate, safety, and short-term results of single-stage laparoscopic treatment of gallstones and ductal stones in 100 consecutive, unselected patients. Common bile duct (CBD) stones were diagnoses at routine intraoperative cholangiography and choledochoscopy in 100 of 950 patients with gallstones undergoing laparoscopic cholecystectomy (LC). Unsuspected CBD stones were present in 39 patients (4.1% of 950; 39% of 100); 26 patients were referred for surgery after failed endoscopic sphinctertomy (ES) performed elsewhere. Transcystic duct CBD exploration (TC-CBDE) was the procedure of choice. When it was not feasible, choledochotomy and direct CBD exploration (D-CBDE) was performed. Use of biliary drainage was liberal. A completion cholangiogram was obtained for all patients. Laparoscopic treatment of CBD stones was successful in 96 patients: after TC-CBDE in 63 and after D-CBDE in 33. Four operations were converted to open surgery (4%). Retained stones, observed in five patients, were treated by ES in two cases and by percutaneous endoscopic/fluoroscopic lithotripsy in three. Minor morbidity included biloma (n = 2), port site infection (n = 2), and subumbilical hematoma (n = 1). Major morbidity was bile leakage from the cystic duct stump in two cases due to clips or transcystic duct drainage displacement, respectively. One elderly, high risk patient died after being referred for several failed attempts of endoscopic clearance; she died from cardiogenic shock 3 days after successful laparoscopic treatment. Laparoscopic CBD exploration is feasible and safe in most patients, with short-term results that compare favorably with the results of sequential ES/LC reported in the literature.

Adolescent↗
PubMed1996

Clinical application of three-dimensional (3-D) vision systems and virtual reality helmets in video-assisted surgery.

Thoraco-Iaparoscopic surgery presents a series of technical difficulties linked mainly to the necessity of acquiring proper motor coordination and spatial reconstruction of an operative field that is seen from a distance on a two-dimensional video monitor, in the absence of any direct tactile feedback. In an effort to improve the motor coordination of the operating surgeon and of the surgical team, many apparatuses have recently become available on the market that allow the reproduction of a 3-Dimage on a video monitor. Such apparatuses have technical characteristics that are substantially diverse in technology and provide signifi- cantly different end results.

Journal Article↗
PubMed1996

Laparoscopic adjustable silicone gastric banding (LASGB) for the treatment of morbid obesitiy.

Morbid obesity is a serious disease that is responsible for several co-morbid conditions. Increased risks of hypertension, adult onset diabetes mellitus, dyslipidemia, pulmonary disease (Pickwickian syn- drome), musculo-skeletal disorders, gallbladder disease, deep vein thrombosis, venous stasis ulcers, and increased prevalence of certain types of cancers (uterine, breast, colon carcinoma) have been reported, ( together with severe psychological and social disability.' Nonsurgical treatment options including various combinations oflow-calorie or very-low-calorie diets, behavior modification, exercise, and drug therapy may achieve acceptable transient weight reduction but fail to maintain reduced body weight in most patients.'

Journal Article↗
PubMed1996

Technique of transanal endoscopic microsurgery (TEM).

Early stages of rectal cancer, well and ~oderately differentiated, have a l~w r~te of regional spread a~d therefore may be treated by conservative therapy. 1-3 Transanal Bnrloscopic MIcrosurgery (TEM)was In- troduced into clinical practice' by G. Buess in 1983.This technique allows for the local treatment of be- nign lesions and the early stages of rectal cancer through a modified rectoscope, yielding good exposure of the operative field with-three-dimensional vision; mucosectomy and full thickness excision procedures can be performed. TEM benefits are the same as other minimally invasive techniques: less pain, reduced morbid- ity, faster recovery time, and an absence of skin scars. In the present paper, the authors report the technique and the results of the experience of 89TEM procedures for the treatment of rectal tumors.

Journal Article↗
PubMed1996

Conservative ultrasound-guided laparoscopic treatment of posttraumatic splenic cysts: report of two cases.

Recently, laparoscopic splenectomy has been reported by various authors. Further advancement of this minimally invasive surgery is the conservative treatment of nonneoplastic lesions of the spleen. The authors report two clinical cases in which the laparoscopic approach has been employed to treat a large posttraumatic cyst of the spleen. Using a specifically developed ultrasound probe for laparoscopic surgery, the authors identified the thinnest area of the wall in two large intraparenchymal posttraumatic splenic cysts (diameters: 11 and 8 cm). After an explorative puncture, the orifice was enlarged using electrocautery scissors. The opening of the cyst was further enlarged and a 35-mm ELC stapler with vascular cartridges was applied in order to resect as possible the cyst wall and to obtain an adequate hemostasis of the splenic parenchima. Both postoperative courses were uneventful, and the patients were discharged on day 5 after a negative ultrasound examination of the abdomen. This is the first report of successful conservative treatment of a large posttraumatic cyst by laparoscopic surgery.

Cysts↗
PubMed1995

Single-stage laparoscopic treatment of gallstones and common bile duct stones in 120 unselected, consecutive patients.

Feasibility, success rate, safety, and short-term results of single-stage, laparoscopic, transcystic--whenever possible--or choledochotomic treatment of gallstones and common bile duct (CBD) stones were evaluated in 120 unselected patients. Of 1095 patients who underwent laparoscopic cholecystectomy, 120 had ductal stones; among those patients, stones were suspected or proven in 72, 27 of whom were referred after failed endoscopic sphincterotomy (ES) performed elsewhere; unsuspected CBD stones were discovered in 48. The procedure was successful in 116 patients. Four patients required conversion to open surgery. The transcystic access was feasible in 77 patients; a choledochotomy was required in 39. Incidence of retained CBD stones was 4.3%. Minor complications, major complications, and mortality were observed in 6.8%, 1.7%, and 0.8% of patients, respectively. Single-stage laparoscopic treatment of gallstones and CBD stones in unselected patients is safe and feasible in the majority of cases, with success rates and short-term results that are not inferior to reported results of ERCP/ES and cholecystectomy.

Adult↗
PubMedDate not supplied

Laparoscopic colonic resections versus open surgery: a prospective non-randomized study on 310 unselected cases.

BACKGROUND/AIMS: Laparoscopic colorectal surgery, particularly for malignancy, is still debated. The aim of this study was to prospectively evaluate the postoperative outcome as well as the short- and medium-term results of laparoscopic surgery compared with those after open conventional surgery. METHODOLOGY: A series of 310 consecutive patients, operated on by the same surgical team, have been included in this study; 150 patients (75% with malignant lesions) underwent laparoscopic surgery, whereas 160 patients (73% with malignant lesions) were treated by open surgery. The treatment modality was selected by the patients after reading the informed consent form. RESULTS: Laparoscopic surgery was technically feasible in 91.4% of cases. Mean operative time for laparoscopic surgery was longer than for open surgery (251 vs. 175 min) (P < 0.001). Mean postoperative hospital stay after laparoscopic surgery was 10.5 days, as compared to 13.3 days after open surgery (P < 0.05). In the laparoscopic surgery group minor complications' rate was 3.6% and compared favorably to the 7.5% observed after open surgery (P = 0.261). No statistically significant difference was observed in the major complications rate (9.4% after laparoscopic surgery and 6.8% after open surgery) and in operative mortality (1.4% for laparoscopic surgery and 0.6% for open surgery). The local recurrence rate was lower after laparoscopic surgery as compared to open surgery: 3% versus 9.2% (P = 0.152), respectively. Mean follow-up was 34.2 months during which time we observed 2 cases of port site recurrence. After implementing adequate prophylactic measures, no parietal implants were observed in the last 80 patients who underwent laparoscopic surgery for malignancy. Distant site metastases occurred in 11% in both groups. At 36 months cumulative survival probability in laparoscopic surgery completed malignant cases was 0.74% as compared to 0.66% after open surgery. CONCLUSIONS: Morbidity and mortality were similar in the 2 groups. Laparoscopic patients experienced less pain. A slightly higher incidence of local recurrence was observed in the open surgery group, whereas the percentage of distant site metastases and the cumulative survival probability in the 2 groups were similar. Port site recurrences are a cause of concern but they can be prevented with adequate prophylactic measures. The short- and medium-term results of laparoscopic surgery compared favorably with those of open surgery in this prospective non-randomized study. Long-term oncological result are not known yet. In patients with malignancy prospective randomized trials on larger patient numbers are required.

Colectomy↗
PubMedDate not supplied

[Single-stage laparoscopic surgery of cholelithiasis and choledocholithiasis in 268 unselected consecutive patients].

AIMS: The introduction of laparoscopic cholecystectomy (LC) has modified the treatment of gallstones and common bile duct (CBD) stones. Aim of this prospective study was to evaluate the results of single stage laparoscopic management of gallstones and CBD stones. PATIENT AND METHODS: From January 1991 to October 1999, CBD stones were present at intraoperative cholangiography in 268 patients (pts) (169 females, 99 males, mean age 55.6 years, range 12-94 years) out of 2693 undergoing LC (10%) for gallstones. CBD stones were unsuspected in 123 (45.9%) and suspected in 145 (54.1%). RESULTS: CBD exploration was successful in 264 cases (98.5%) (transcystic 164, choledochotomy 100). Four pts were converted to open surgery (1.5%). Retained stones in 15 patients (5.7%), were treated by ERCP/ES (6 pts) and by percutaneous endoscopic/fluoroscopic stone removal (6 pts). Spontaneous stones passage occurred in 2 pts, one patient is waiting for treatment. Major morbidities were hemoperitoneum (4 cases) and cystic duct bile leakage (3 cases). One high risk patient died postoperatively. Recurrent stones were observed in 5 pts (1.9%), at 1, 4, 8, 18, 26 months respectively after T-tube removal, and were treated by ERCP/ES in 4 cases. Spontaneous stone passage occurred in 1 case. CONCLUSIONS: LC and CBD exploration has shown to be safe and feasible with low morbidity and mortality. The rationale of this approach is to solve two problems during the same procedure, limiting the role of endoscopic sphincterotomy to the treatment of residual ductal stones.

Adolescent↗