Biomedical subjects

D Cuccurullo

Publications and source records attributed to D Cuccurullo.

11 recordsLinked to original sources

PubMed2006

Distal pancreas surgery: outcome for 19 cases managed with a laparoscopic approach.

BACKGROUND: In the past decade, laparoscopy has shown its efficacy also for advanced surgery. In this report, the authors retrospectively review their experience with the distal pancreas. METHODS: From April 1999 to October 2004, 19 patients underwent a laparoscopic procedure for pathologies of the distal pancreas. The authors performed one distal pancreatectomy (DP) with conservation of the spleen and section of the splenic vessels, four distal splenopancreatectomies (DSP), one DSP plus a left adrenalectomy, two enucleations, seven DPs with conservation of the spleen and the splenic vessels, and four cystojejunostomies. RESULTS: One procedure was converted to open surgery because of a hemorrhagic complication. No other significant intraoperative complications occurred. The postoperative course was characterized by one bleed managed conservatively, two pancreatic fistulas (one requiring a second operation), one abscess drained under echographic view, and one reactive pancreatitis. The mean postoperative stay was 8.5 days. The histologic report showed 16 benign diseases and 3 malignant tumors. The mean follow-up period was of 42 months. The patient who had DP spleen preservation with section of the splenic vessels reported mild pain in the left hypochondrium, probably attributable to chronic splenic ischemia, during the first 3 postoperative months. One incisional hernia occurred in the patient who underwent conversion to an open procedure, and one patient affected by adenocarcinoma died 10 months after the operation. CONCLUSIONS: The authors can affirm that laparoscopy for the distal pancreas is a successful procedure in terms of results and surgical feasibility. Prospective studies are necessary to confirm their positive impression.

Adrenalectomy↗

PubMed2005

Treatment of primary inguinal hernias by "held in mesh repair": our experience related to 3,520 cases.

In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called "held in mesh repair". From 1990 to 2003 we treated 3,520 cases of primary hernia with the "held in mesh repair". 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the "held in mesh repair" and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.

Anesthesia, Local↗

PubMed2005

Laparoscopic adrenalectomy for malignant neoplasm: our experience in 15 cases.

BACKGROUND: We report our experience with laparoscopic adrenalectomy (LA) for malignant pathologies that in some cases required a multiorgan resection. METHODS: In this study, we retrospectively reviewed a group of 15 patients (10 men, and five women) who underwent an operation for primitive or metastatic adrenal malignant tumors. RESULTS: The sizes of the lesions ranged from 3.5 to 8.5 cm (average 3.6). We performed 11 adrenalectomies (four right and seven left), two left adrenalectomies with distal spleno-pancreatectomy, one right adrenalectomy with nephrectomy, and one laparoscopic exploration that showed a peritoneal spreading. Six patients, with a follow-up ranging from 3 to 24 months (mean 13.6 months), are disease free; the others developed metastatic repetitions or local recurrences. CONCLUSIONS: LA could be performed always respecting the oncological principles of radical excisions. This approach in our patients has been associated with low morbidity, low intraoperative blood loss, short hospital stay, and fast functional recovery.

Adrenal Gland Neoplasms↗

PubMed2004

Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience.

BACKGROUND: In the last few years, robotics has been applied in clinical practice for a variety of laparoscopic procedures. This study reports our preliminary experience using robotics in the field of general surgery to evaluate the advantages and limitations of robot-assisted laparoscopy. METHODS: Thirty-two consecutive patients were scheduled to undergo robot-assisted laparoscopic surgery in our units from March 2002 to July 2003. The indications were cholecystectomy, 20 patients; right adrenalectomy, two points; bilateral varicocelectomy, two points; Heller's cardiomyotomy, two points; Nissen's fundoplication, two points; total splenectomy, one point; right colectomy, one point; left colectomy, 1 point; and bilateral inguinal hernia repair, one point. In all cases, we used the da Vinci surgical system, with the surgeon at the robotic work station and an assistant by the operating table. RESULTS: Twenty-nine of 32 procedures (90.6%) were completed robotically, whereas three were converted to laparoscopic surgery. Conversion to laparoscopy was due in two patients to minor bleeding that could not be managed robotically and to robot malfunction in the third patient. There were no deaths. Median hospital stay was 2.2 days (range, 2-8). CONCLUSIONS: The main advantages of robot-assisted laparoscopic surgery are the availability of three-dimensional vision and easier instrument manipulation than can be obtain with standard laparoscopy. The learning curve to master the robot was >or= 10 robotic procedures. The main limitations are the large diameter of the instruments (8 mm) and the limited number of robotic arms (maximum, three). We consider these technical shortcomings to be the cause for our conversions, because it is difficult to manage bleeding episodes with only two operating instruments. The benefit to the patient must be evaluated carefully and proven before this technology can become widely accepted in general surgery.

Adult↗

PubMed2004

Laparoscopic splenectomy for the treatment of wandering spleen.

Wandering spleen is a very rare pathologic condition that initially presents with unremarkable clinical symptoms, then dramatically manifests severe complications. A case of wandering spleen treated with laparoscopic splenectomy is described and compared with other similar reports in the literature. Laparoscopic exploration of the abdominal cavity allowed the diagnosis to be confirmed and splenectomy to be performed. An enlarged spleen led to the choice of total splenectomy to avoid both future complications and future organ torsion resulting from the long and twisted vascular pedicle. The laparoscopic approach led to a rapid recovery, a 3-day postoperative course, and satisfactory cosmetic results.

Adult↗

PubMed2003

Laparoscopic partial splenectomy for a splenic pseudocyst.

We describe a laparoscopic hemisplenectomy that was performed to treat a 21-year-old patient with a large splenic pseudocyst located in the upper splenic pole. The diagnosis was made by computed tomography and ultrasound, and surgery was performed with ultrasound scalpel, clips, and fibrin glue. Surgery lasted 70 min and did not require blood transfusions. The patient was discharged on postoperative day 3, and at 28-month follow-up there were no sequelae or recurrences. The laparoscopic approach is a valid alternative to laparotomy because the integrated magnified view enables the surgical team to perform surgery in a much shorter time and with greater hemostatic accuracy than the traditional technique.

Abdominal Injuries↗

PubMed2003

Laparoscopic removal of an intraperitoneal translocated intrauterine contraceptive device.

The use of an intrauterine contraceptive device (IUD) is often accompanied by various complications, the perforation of the uterus constituting the most dangerous. Here we report the case of a patient who complained of abdominal pains. She had had an IUD inserted 15 months previously. Three months later, as she could no longer see the IUD strings at the external os of the cervix, she underwent pelvic ultrasonography, which did not show the IUD in the uterine cavity. A diagnosis of expulsion of the IUD was made. A few months later, the patient accidentally became pregnant, and decided to have an abortion. From that time on, she started to complain of the above-mentioned symptoms. She had an abdominal X-ray which revealed the IUD in the abdominal cavity. She then underwent a laparoscopic removal of the translocated IUD.

Adult↗

PubMed2003

[Laparoscopic sigmoid resection].

AIM: The possibility of treating lesions of the colon by laparoscopic surgery dates back to the early 90s. In spite of the remarkable spread of the techniques in the last 10 years, are there still some problems related to the laparoscopic approach of malignant lesions of the colon: does it increase the risk of metastasis spread? which are the real advantages for the patient? does it increase the costs and are the benefits comparable? The authors present their experience on the resection of the sigmoid by laparoscopic approach. METHODS: From September 1998 to August 2002, in the General Surgery Unit and Center of Laparoscopic Surgery of the Monaldi Hospital in Naples, 193 laparoscopic resections of the colon-rectum have been performed, which of 101 were resections of the sigmoid for benign and malignant pathologies. The patients were 54 males and 47 females, with an age range between 34 and 86 years. RESULTS: The average operating time has been of 130 minutes (range 80-210). The average post-operative stay in hospital has been of 10.2 days (range 6-25). Three conversions in the first 30 cases have been necessary; the transit resumed within the first 24-48 hours and feeding was possible after 3 days. CONCLUSION: The postoperative follow-up has been achieved in all the patients up to 3-6 months, in 60 patients up to 2 years and in 35 patients up to 3 years. Two ventral hernias in the site of the supra-pubic incision, 1 metastasis on Trocar site, 2 local relapses and 1 parietal metastasis have been observed. The laparoscopic resection of the colon, either for malignant or for benign disease, can be performed with acceptable morbidity and mortality.

Adult↗

PubMed2002

Laparoscopic repair of congenital diaphragmatic hernia with prosthesis: a case report.

We report here our experience in the treatment of a large congenital diaphragmatic hernia, an uncommon pathology, approachable by laparoscopy. The patient was a 33-year-old woman with trisomy 21 syndrome, who only complained of colicky abdominal pain and a cough for 7 months before the hospitalization. Thoracic and abdominal CT scans showed a large anteromedial diaphragmatic hernia with slippage of the colon into the mediastinum and posterior displacement of the cardiovascular structures. The patient underwent laparoscopic repair of the hernia. The colon was put back in the abdomen; the defect (8x4 cm) was repaired by a Composix mesh (PTFE-polypropylene), fixed to the diaphragm by nonabsorbable stitches and staples. The patient was discharged on the third postoperative day. The postoperative course was uneventful. Follow-up at 18 months didn't show any complications or recurrence. We believe laparoscopic repair of diaphragmatic hernia to be the elective surgical choice, because of its technical feasibility and certain intra- and postoperative advantages.

Adult↗

PubMed2002

Technical standardization of laparoscopic splenectomy: experience with 105 cases.

BACKGROUND: Some reports have suggested that laparoscopic splenectomy (LS) can be successfully performed in adults. However, several aspects of this procedure remain as yet undefined; therefore, several attempts have been made to modify the standard technique to try to optimize the procedure. Herein we analyze our experience with 105 laparoscopic splenectomies. METHODS: From 1993 to 2000, 105 patients underwent LS at our hospital. Twelve of these patients also underwent a concomitant cholecystectomy. There were 66 women and 39 men whose ages ranged between 4 and 78 years (median, 27.7). All patients underwent an elective laparoscopic splenectomy. Seventy five patients had thrombocytopenia (ITP), 14 had hereditary spherocytosis, eight were affected by b-thalassemia, two had splenic cysts, two had lymphoma, (two had myeloid chronic leukemia, one patient presented with a splenic abscess and one had incurred an iatrogenic spleen lesion during adrenalectomy. The first patients in this series were positioned in dorsal decubitus; however, as the team's experience increased, the right lateral decubitus became the position of choice because it provides better exposure of the splenic hilum. This procedure requires the use of only four trocars. RESULTS: Mean operating time was 95 min (range, 35-320). Hospital stay ranged from 2 to 21 days (median, 4.5). There was only one conversion to open surgery. One patient died in the postoperative period due to the evolution of a preexisting malignant disease. We recorded nine complications-four subphrenic abscesses, two cases of pleuritis, two episodes of postoperative bleeding, and one intestinal infarction 16 days after surgery. Only two patients needed redo surgery. CONCLUSIONS: We believe that the laparoscopic approach is a valid alternative to open splenectomy, but mastery of some of the technical details of this procedure could greatly help avoid its complications. On the basis of our experience, it seems that the lateral approach should be considered the position of choice because it provides exposure and easier dissection of the splenic hilar structures. We also found that a 30 degrees scope and an ultrasonic dissector allowed for perfect vision and optimal hemostasis during the procedure. At the end of procedure, the spleen should be fragmented and then extracted using an extraction bag.

Adolescent↗

PubMed2000

Vena cava injury. A serious complication during laparoscopic right adrenalectomy.

We report our experience with a case of vena cava injury during laparoscopic right adrenalectomy. A laparoscopic right adrenalectomy was performed in a 22-year-old woman who suffered from a right surrenalian adenoma. Four trocars were used for the transperitoneal laparoscopic approach with the patient in the lateral decubitus position. After isolation of the medial margin of the gland and clipping and sectioning of the main adrenal vein, the right side of the vena cava was injured during dissection of the right upper pole, due to the use of monopolar scissors. The hemorrhage was managed immediately with the aid of fenestrated atraumatic forceps and an aspiration probe. A fifth trocar was inserted to evaluate the size of the lesion, which was then sutured laparoscopically with croised 5/0 nonresorbable stitches. No transfusion was needed. Operating time was 210 min. The post-operative course was uneventful. Hospital stay was 7 days. At 10-month follow-up, the patient had no problems related to the intraoperative complication. Our preliminary experience shows that the laparoscopic approach enables safer management of lesions involving large abdominal vessels. We believe that the transperitoneal approach is the preferential route for laparoscopic adrenalectomies. Monopolar coagulation can be dangerous and must be avoided when dissecting large vessels.

Adrenalectomy↗