F Varcus, M Papurică, A Coman, C Duţă, C Tarta
Clinica II Chirurgie


Full document: Laparoscopic reoperation of the biliary tract after open surgery 

March 30th, 2018

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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 paperDoes previous open surgical experience have any influence on robotic surgery simulation exercises? 

March 29th, 2018

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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

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.


Full paperCorrelation between leptin and ghrelin expression in adipose visceral tissue and clinical-biological features in malignant obesity 

March 29th, 2018

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C. Foppa • P. I. Denoya • C. Tarta •
R. Bergamaschi


Assessing the blood supply of the bowel is a difficult task even for experienced surgeons. Laser-assisted indocyanine green (ICG) fluorescent dye angiography provides intraoperative visual assessment of blood flow to the bowel wall and surrounding tissues, allowing for modification to the surgical plan, which can reduce the risk of postoperative complications. ICG angiography was
prospectively performed in a single center during a 1-year period for small bowel ischemia and left colorectal resections.
ICG angiography played a major role in the intraoperative decision making in 4 of 160 patients, whose clinical and operative details are here reported. In case of acute small intestine ischemia, resection is not warranted unless absolute perfusion units are below 19 (relative 21 %). When evaluating blood supply to the left colon prior to anastomosing, resection is recommended with
absolute units lower than 18 (relative 31 %) even if the bowel appears macroscopically perfused.

Keywords: Laser-assisted ICG angiography  SPY  Small bowel ischemia  Left colorectal resection  Blood supply


Full paper: Indocyanine green fluorescent dye during bowel surgery: Are the blood supply ‘‘guessing days’’ over?

March 28th, 2018

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1)Department of Anatomy, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldiş” Western University, Arad, Romania
2)Department of Radiology, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldiş” Western University, Arad, Romania
3)Department of Surgery, “Victor Babeş” University of Medicine and Pharmacy, Timisoara, Romania
4)Department of Surgery, Faculty of Medicine, Pharmacy and Dental Medicine, “Vasile Goldiş” Western University, Arad, Romania

Endothelial cells are highlighted using a variety of endothelial markers. One of the best known markers is CD34, a surface antigen. The most used immunohistochemical marker for identification of activated endothelial cells is CD105. We chose to compare these two markers in order to evaluate angiogenesis of the rectal cancers by determining the microvessel density (MVD). Our study included 31 patients with rectal cancer between 2010–2014, who underwent rectal resection at Arad and Timisoara Counties Hospitals, Romania. We used MVD quantification by highlighting the tumor blood vessels with two different endothelial markers using the immunohistochemical protocols. The CD34 evaluation of MVD was 37 vessels/field/×200 peritumoral (PT), compared with normal rectal mucosa with 17 vessels/field/×200. Intratumoral (IT) MVD for CD34 positive vessels was between 7 and 120 vessels/field/×200. Average IT MVD CD105+ was 13.7 vessels/field/×200, the PT MVD CD105+ was 10 vessels/field/×200. Usually, IT MVD CD105 is smaller than PT MVD CD105, a pattern that was not respected in our study. There was a statistical significant correlation between IT MVD CD34 and PT MVD CD34 with p=0.008, also IT MVD CD34 and IT MVD CD105 with p=0.009, PT MVD CD34 with PT MVD CD105, p=0.001. PT MVD CD34 had a statistical significant correlation with T, p=0.004. IT MVD CD105 associated with T, p=0.004, and with N, p=0.004. The evaluation of both CD34–CD105 showed the role of angiogenesis in the cancer proliferation and local spread, the angiogenesis level being maintained high even in the advanced stages of the disease. There was observed a difference between the intratumoral and peritumoral MVD, the study of this difference possibly leading to a better assessment of prognosis and adjusted therapies in the future.

Keywords: CD34, CD105, rectal cancer, endoglin, angiogenesis.


Full paper: Comparative analysis of microvessel density quantifiedthrough the immunohistochemistry expression of CD34 and CD105 in rectal cancer

March 28th, 2018

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Laparoscopic Repair of Inguinal Hernia TEP versus TAPP

Flore Vãrcus1, Ciprian Duta1, Amadeus Dobrescu1, Fuger Lazar1, Marius Papurica2, Cristi Tarta1

1Surgical Clinic 2, Victor Babes University of Medicine and Pharmacy, Timişoara, Romania
2Intensive Care and Anesthesia Unit, Victor Babes University of Medicine and Pharmacy, Timişoara, Romania

articol hernie_varcus

February 8th, 2018

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Laparoscopic totally extraperitoneal inguinal hernia repair under epidural anesthesia

F Varcus, C Tarta, C Duta, M Papurica, Adina Coman, F Lazar

University of Medicine and Pharmacy Victor Babes Timisoara

Second Surgical Clinic of Timisoara County Hospital


Introduction:Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has proved efficacy, causes less postoperative pain, better cosmetic results and earlier return to work. One important obstacle to the widespread acceptance of TEP is the requirement for general anesthesia (GA). In our study we assessed the practice of the TEP under epidural anesthesia.

Results:In all 26 cases operation started with epidural anesthesia, but 5 (19,2%) of them were converted to GA; the other 21 (80,8%) were realized only under epidural anesthesia. All cases were successfully completed laparoscopically and there were no conversions to classical procedures. The  conversions to GA was done because of the accidentaly pneumoperitoneum (with subsequent shoulder-tip pain), wich require the mechanical ventilation for the management of hypercapneea. There were no intraoperative others incidents. Concerning the operative time, there was no significant difference between the cases conducted under epidural anesthesia (69.6 ± 29 min), and those converted to GA (64.3 ± 17.3 min). No straining was noticed. One patient needed further local peri-umbilical anesthesia. One patient with congenital hernia developed seroma of the scrotum treated successfully by only one ponction.

Material and Methods:Twenty six patients with unilateral inguinal hernia underwent laparocopic operation under spinal anesthesia. Hernia’s size was small, without complications. ASA risk class of the patients was I and II. The patient’s age was between 32-62 years, median  age being 49 years. One 10mm trocar was placed near the omphalos, 2 others 5 mm trocars between omphalos  and pubis. The operatory space was realised with the finger and the camera, without baloon.

Discussion/ Conclusion:

TEP under spinal anesthesia is fesable and save. In our experience pneumoperitoneum, with hypercapneea was the only factor who interplay leads to conversion to. A good surgical anesthesiology collaboration is necessary to obtain the good results. The option of the patient for this technique is mandatory.


February 8th, 2018

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Full text here: Laparoscopic Repair for Perforated Peptic Ulcer: A Retrospective Study

January 26th, 2018

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December 13th, 2017

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