فهرست مطالب

Minimally Invasive Surgical Sciences - Volume:5 Issue: 4, 2016
  • Volume:5 Issue: 4, 2016
  • تاریخ انتشار: 1395/09/18
  • تعداد عناوین: 8
|
  • Moneeb Nasir, Sofoklis Panteleimonitis, Jamil Ahmed, Hassan Abbas, Amjad Parvaiz * Page 2
    Background
    Laparoscopic rectal cancer surgery offers several advantages over open surgery, including quicker recovery, shorter hospital stay and improved cosmesis. However, laparoscopic rectal surgery is technically difficult and is associated with a long learning curve. The last decade has seen the emergence of robotic rectal cancer surgery. In contrast to laparoscopy, robotic surgery offers stable 3D views with advanced dexterity and ergonomics in narrow spaces such as the pelvis. Whether this translates into a shorter learning curve is still debated. The aim of this literature search is to ascertain the learning curve of robotic rectal cancer surgery.
    Methods
    This review analyses the literature investigating the learning curve of robotic rectal cancer surgery. Using the Medline database a literature search of articles investigating the learning curve of robotic rectal surgery was performed. All relevant articles were included.
    Results
    Twelve original studies fulfilled the inclusion criteria. The current literature suggests that the learning curve of robotic rectal surgery varies between 15 and 44 cases and is probably shorter to that of laparoscopic rectal surgery.
    Conclusions
    There are only a few studies assessing the learning curve of robotic rectal surgery and they possess several differences in methodology and outcome reporting. Nevertheless, current evidence suggests that robotic rectal surgery might be easier to learn than laparoscopy. Further well designed studies applying CUSSUM analysis are required to validate this motion.
    Keywords: Learning Curve, Robotic, Rectal Surgery, Rectal Cancer
  • Shahram Yazdani, Maryam Akbarilakeh* Page 3
    Context: Most of the studies proved that effective self-care of patients depends on continuing systematic support of patients to improve their knowledge, skills, and confidence of self-care. With regard to the importance of self-care support system, the design of a pattern for it in Iran was placed on the agenda through the ministry of health and medical education (MOHME) project. The aim of this article is to develop a pattern through two steps; the first is critically analyzing the literature on the structure and functions of self-care support system, and the second is to summarize potential factors which can be used as self-care support system components in health system to synthesize the pattern.
    Evidence Acquisition: Systematic literature searches of papers published between 2002 - 2014 were carried out using the electronic databases. Critical interpretive synthesis (CIS) was then undertaken to provide a comprehensive overview of the topic for developing the national pattern. Finally, scrutinizing the pattern was done through focus group discussion of experts in MOHME.
    Results
    We found the steps of designing a system for self-care support. Then, we set the goals and strategies of self-care support program and factors affecting the choice of self-care support pattern. Then, series of interventions were selected as self-care program pattern by a team of health care providers from all levels of the health system. Components of self-care support system in the country based on their interactions with patients and place of the program in the health care system were categorized in a matrix.
    Conclusions
    To empower the staff of self-care support system, an appropriate training design is needed beside a good self-care support program. Self-care team members must teach specific information or skills to patients and their families. These members must possess special knowledge and skills. Also, the evaluation of self-care support program is one of the main components of the national system of self-care.
    Keywords: Self-Care, Self-Management, Patients Support
  • Naghmeh Mokhber, Hossein Shaghayegh, Mahdi Talebi, Alireza Tavassoli* Page 4
    Introduction
    Eating disorders and morbid obesity have become common over the recent years. Laparoscopic gastric bypass surgery is known as one of the most effective methods for weight loss. Due to the rarity of studies regarding the association of depression and surgery, we aimed to compare the levels of depression in patients with excessive obesity before and after gastric bypass surgery.
    Materials And Methods
    This Quasi-experimental study performed on 40 obese patients who underwent gastric bypass surgery with BMI higher than 40 or between 35 to 40 (with FBS > 100 mg/dL) in Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran during September 2011 to September 2012.The Beck depression inventory (BDI) was performed one week before, and three and six months after operation and changes in BMI and BDI were evaluated using ANOVA with repeated measures.
    Results
    40 obese patients with the mean age of 34.20 ± 11.32 years old and mean BMI of 45.31 ± 2.56 kg/m2 were studied. Also, male to female ratio was 7:1. Average of BDI, before and three months after the operation was 27 ± 11.31 and 18.50 ± 9.718, respectively (P
    Conclusions
    It can be concluded that depression level of the patients was decreased after the surgery and the recovery progressed gradually.
    Keywords: Depression, Gastric Bypass Surgery, Obesity
  • Amir Hossein Faghihi, Somayyeh Mokhber, Arezou Hashemzadeh, Pejman Mansouri, Abdolreza Pazouki* Page 5
    Background
    Obesity, a major risk factor for fatty liver disease, is increasing worldwide. Morbid obese patients have a higher prevalence of fatty liver disease in addition to more severe complications, and high prevalence of abnormal liver function tests (LFTs). The aim of this study is to determine the pattern of LFT and liver ultrasonography of morbid obese Iranian patients undergoing bariatric surgery.
    Methods
    The study population included 308 morbid obese patients who were candidates for Laparoscopic Roux-en-Y Gastric Bypass surgery. Body mass index (BMI), age, gender, weight, height, blood tests including alanine transaminase (ALT), aspartate transaminase (AST), direct bilirubin (Bil D), total bilirubin (Bil T), and liver ultrasound reports were recorded for all of the patients. Patients with alcohol intake or hepatitis or human immunodeficiency virus (HIV) were excluded from the study. The data were entered and analyzed using SPSS-16. The chi-square, ANOVA and Independent-sample t- test used in the study analysis.
    Results
    Data analyses showed that alkaline phosphatase (ALKP) is the most elevated serum enzyme in morbid obese patients 26 (87.6%). ALT, AST, bilirubin total and bilirubin direct were more than upper normal range in 70 (24.1%), 80 (26%), 2 (1.5%) and 15 (11.4%) in all patients, respectively. Ultrasonography of the liver showed that fatty liver disease occurred in approximately 280 (91%) of our patients. In our study, the only liver enzyme that had significant difference with fatty liver and normal groups was AST (P: 0.027). The patients were divided into three groups on the basis of the BMI: BMI of 35 - 40 kg/m2, 40 - 50 kg/m2, and above 50 kg/m2. There is not any significant difference between the mean of ALKP, ALT, AST, bilirubin (direct and total) serum level and fatty liver in these three groups.
    Conclusions
    The prevalence of abnormal LFTs in Iranian morbid obese patients is in high status especially the level of ALKP. Liver ultrasonography has high sensitivity for the fatty liver in morbid obese patients but LFTs rise only in few patients with fatty liver.
    Keywords: Bariatric Surgery, Liver Function Tests, Morbid Obesity, Ultrasonography
  • Francisco Javier PÉrez Lara*, Arminda Ferrer Berges, Herman Oehling, Arturo Del Rey Moreno, Horacio Oliva Munoz Page 6
    Background
    The number of laparoscopic procedures done each year continues to rise substantially. Clinically significant hemorrhage from secondary port sites at laparoscopy is an uncommon but serious complication and can become unrecognized intraoperatively. Abdominal wall hemorrhage and bruising may complicate laparoscopic operative procedures.
    Methods
    We propose an easy technical gesture to stop the bleeding at the port site in laparoscopic surgery. A simple technique is described to treat this complication.
    Conclusions
    Our proposal is a simple gesture, easy to reproduce and, with no surgical time waste which we can obtain very good results in major bleeding difficult to control with traditional methods by that.
    Keywords: Haemostatic Patch, Trocar, Laparoscopic Surgery, Bleeding
  • Sohail Bakkar*, Gabriele Materazzi Page 7
    Background
    Since the early 1990s, endoscopic adrenalectomy has become the gold standard surgical approach for the adrenal gland. Also, lateral transperitoneal adrenalectomy (LTA) which is the most widely used approach accompanies that. Posterior retroperitonoscopic adrenalectomy (PRA) is another safe and effective approach for the adrenal gland. However, it has not gained global popularity. This is largely attributed to the unfamiliarity of surgeons with the ergonomics and executional steps of the procedure, and the relevant retroperitoneal anatomy. Misconceptions held by both surgeons and anesthesiologists regarding the consequences of the high-pressure retroperitoneal insufflation required may also be a contributing factor. The aim of this article is to provide a detailed description of PRA in a manner which allows the proper acquisition of the knowledge required to perform the procedure safely and effectively.
    Methods
    To achieve the objective of this article, it has been broadly divided into three sections including background, operative technique, and comments. The background provides an introduction to the procedure and its advantages. The section about operative technique provides a detailed description of the preoperative preparatory phase, the proper access, and the executional steps of the procedures supplemented with illustrative figures. It also provides insight into potential hazards related to the anatomy of the adrenal veins, and the means of dealing with variant anatomy. The comments’ section deals with the procedure’s learning curve, and the factors affecting it. It also describes the ideal case for the commencement of the learning curve. A clarification of the misconceptions surrounding PRA is also provided in this section.
    Conclusion
    With thorough technical knowledge and an adequate learning curve, PRA could serve as the surgeon’s preferred surgical approach to the adrenal gland within the confines of its selection criteria.
    Keywords: Retroperitoneoscopic Adrenalectomy, Posterior Retroperitoneoscopic Adrenalectomy, Retroperitoneal Adrenalectomy, Minimally Invasive Adrenalectomy
  • Mansoure Vahdat, Samaneh Rokhgireh*, Ashraf Sadat Mousavi, Kobra Tahermanmanesh, Sepideh Khodaverdi, Leila Nazari, Shahrzad Tehrani Page 8
    Introduction
    There are different causes of abnormal uterus bleeding. Foreign body is a less common etiology due to the increasing rate of cesarean delivery. We are confronting some uncommon complications of cesarean section. Uterine incision closure is a substantial step in cesarean section. Since suture material hydrolysis is affected by patient different features, impaired suture material degradation in uterus scar may cause some complications like abnormal uterine bleeding.
    Case Presentation
    We reported a 49-year-old woman who had abnormal uterine bleeding with prior history of multiple cesarean section. During hysteroscopy, abnormal mass was seen in anterior surface of uterine cavity compatible with the level of internal os. Polypectomy and removal of foreign body followed by endometrial curettage were performed. After hormonal assay and sonography evaluation, the patient underwent hysteroscopy and foreign body was observed in anterior surface of uterus. She was followed and visited 6 month after operation and she had no abnormal bleeding. Perhaps this foreign body led to abnormal uterine bleeding.
    Conclusions
    Patient characteristics has important role in suture material degradation. Impaired suture hydrolysis in uterus incision may cause abnormal uterine bleeding. It is interesting to demonstrate whethersuture degradation in previous cesarean section has a role in formation of placenta accrete or not .This issue needs more investigation. Because there is no similar case in literature, we cannot compare our article with others.
    Keywords: Sutures, Hysteroscopy, Case Report