Ciprian Duta, MD, PhD, Stelian Pantea, MD, PhD, Caius Lazar, MD, Abdullah Salim, MD, Daniela Barjica, MD
ABSTRACT
Background and Objectives: Open surgery has been the mainstay treatment for liver hydatidosis in the past.
Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.
Methods: In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.
Results: Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver
abscess and the other had a biliary fistula.
Conclusions: In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.
Key Words: Laparoscopic approach, Liver hydatidosis, Percutaneous echo-guided puncture.
Full paper: Minimally Invasive Treatment of Liver Hydatidosis
Duta Ciprian May 7th, 2018
Posted In: Doctor
CIPRIAN DUŢĂ1), SORINA TĂBAN2), DIANA AL-JOBORY1), ADELINA-ROXANA GHEJU2), ROMULUS-BOGDAN TIMAR3), SORIN DEMA4), POMPILIU HORAŢIU PETRESCU5)
Worldwide, colorectal cancer is one of the most prevalent malignancies. Due to oncological safety concerns, data regarding the laparoscopic surgical treatment of rectal cancer is scarce. Our study’s main aim was investigate the oncological adequacy of laparoscopic surgery in the treatment of rectal cancer by comparing its oncological reliability with the oncological results obtained after open surgery for rectal cancer.
In this retrospective study, 80 patients who underwent surgery for rectal cancer, admitted in our Clinic between January 1, 2014–November 31, 2015 were enrolled. The studied group was stratified according to the way of approach chosen: classic surgery (59 cases) and laparoscopic surgery (21 cases), respectively. Based on the histopathological examination, we analyzed the histological grading of rectal neoplasms, TNM staging, resection margins, lymphovascular and perineural invasion and the number of regional lymph nodes identified in the perirectal
adipose tissue. The average number of isolated lymph nodes demonstrated non-significant differences between the two types of approaches: 20 lymph nodes in the classical approach versus 18 lymph nodes in the laparoscopic approach (p=0.109). Lymph nodes affected by metastases were associated in the majority of cases with stage IIIB and stage IIIC rectal cancers (100% and 83.3%, respectively). The laparoscopic approach proved to be efficient in terms of reaching oncological resection limits. On the resection specimens extracted by laparoscopic surgery, the residual tumor (R1) was encountered in 5% of the cases versus in 6.7% of the cases after classic surgery. The laparoscopic approach is oncologically feasible in the rectal cancer surgical treatment.
Keywords: rectal cancer, laparoscopy, classic approach, lymph nodes, resection limits, tumor grade.
Duta Ciprian May 7th, 2018
Posted In: Doctor
Alin Adrian Cumpanas1, Razvan Bardan1, Ovidiu Catalin Ferician1, Silviu Constantin Latcu1, Ciprian Duta2, Fulger Octavian Lazar2
1Department of Urology, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
2Department of Surgery, Victor Babeș University of Medicine and Pharmacy, Timisoara, Romania
A b s t r a c t
Introduction: Within the last years, there has been a trend in many hospitals to switch their surgical activity from open/laparoscopic procedures to robotic surgery. Some open surgeons have been shifting their activity to robotic surgery. It is still unclear whether there is a transfer of open surgical skills to robotic ones.
Aim: To evaluate whether such transfer of skills occurs and to identify which specific skills are more significantly transferred from the operative table to the console.
Material and methods: Twenty-five volunteers were included in the study, divided into 2 groups: group A (15 participants) – medical students (without any surgical experience in open, laparoscopic or robotic surgery); and group B (10 participants) – surgeons with exclusively open surgical experience, without any previous laparoscopic or robotic experience. Participants were asked to complete 3 robotic simulator console exercises structured from the easiest one (Peg Board) to the toughest one (Sponge Suture). Overall scores for each exercise as well as specific metrics were compared between the two groups.
Results: There were no significant differences between overall scores of the two groups for the easiest task. Overall scores were better for group B as the exercises got more complex. For the intermediate and high-difficulty level exercises, most of the specific metrics were better for group B, with the exception of the working master space item.
Conclusions: Our results suggest that the open surgical skills transfer to robotic skills, at least for the very beginning of the training process.
Key words: robotic surgery, open surgery, training simulator
Full paper: Does previous open surgical experience have any influence on robotic surgery simulation exercises?
Duta Ciprian March 29th, 2018
Posted In: Doctor
GABRIEL VERDEŞ1), CIPRIAN CONSTANTIN DUŢĂ1), ROXANA POPESCU2), MIHAI MITULEŢU2), SORIN URSONIU3), OCTAVIAN FULGER LAZĂR1)
1)Department of Surgery, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
2)Department of Cell and Molecular Biology, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
3)Department of Public Health, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
Abstract
Morbid obesity is a metabolic disease characterized by an excessive accumulation of adipose tissue (≥40%). This disorder is commonly associated with cardiovascular disease, arteriosclerosis, type 2 diabetes, hypothyroidism and some types of cancer. The most common metabolic signals associated with the disease are leptin, ghrelin, with antagonic effects. Our study aimed at highlighting leptin and ghrelin expression levels, as well as establishing correlations between them and clinical-biological parameters in obese patients. The biological material was taken intraoperatively from the visceral adipose tissue. Expression of genes of interest was performed after total RNA extraction and reverse transcription–polymerase chain reaction (RT-PCR) and amplification with TaqMan specific primers. The results of the study showed significant differences in the expression of leptin mRNA between obese patients and the control group as well as the gender of the
subjects. Ghrelin levels correlated positively with obesity, but not with gender. There were no significant correlations between the expression of the genes of interest and the parameters studied (age, body mass index – BMI, cholesterol, triglycerides, glycemia, diabetes, hypothyroidism and hypertension). The results of the study suggest that the evaluation of leptin levels can be used clinically in assessing the metabolic status of the patient with malignant obesity.
Keywords: malignant obesity, leptin, ghrelin, RT-PCR.
Duta Ciprian March 29th, 2018
Posted In: Doctor
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