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Evaluation of the Harmonic Scalpel Use in the Surgical Treatment of Thyroid Diseases

100%
Gniłka W., Dąbrowiecki S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 2
53-58
EN
There are different methods to reach hemostasis in the operative field. Recently the harmonic scalpel in surgery has been analyzed.The aim of the study was to compare the advantages in terms of operative time of thyroidectomies performed using the harmonic scalpel versus conventional suture ligation technique. Another aim of the study was to evaluate complications in both groups.Material and methods. From January 1, 2005, to December 31, 2006, 43 patients underwent subtotal thyroid resection using the harmonic scalpel for hemostasis (group 1). They were compared with a group of 46 patients who underwent conventional thyroidectomy with hemostasis achieved by following electrocoagulation and ligation (group 2). The study analyzed the duration of the procedure, considering the volume of the operated thyroid gland and extent of the thyroidectomy in both groups.Results. The duration of the thyroidectomies ranged between 30 and 160 minutes. The comparison in the mentioned groups showed that the harmonic scalpel shortened the duration of the procedure. An iterative procedure was applied with the step of 1 ml of the goiter volume, to check if this effect was present in whole volume range of the operated thyroid.Analysis in subgroups demonstrated that only in case of goiter size <50 ml the use of the harmonic scalpel clinically significant shortened the time of operation.Conclusions. The use of the harmonic scalpel shortened the time of thyroidectomy, as only in patients with the smaller goiter volume.
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Foreign Body Impaction Within the Pseudopylorus after Mason's Vertical Bariatric Gastroplasty - A Case Report

81%
Szczęsny W., Dąbrowiecki S., Szmytkowski J., Reśliński A.
Polish Journal of Surgery
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2010
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vol. 82
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issue 11
631-633
EN
A rare case of solid foreign body impaction within the pseudopylorus created during Mason's bariatric vertical banded gastroplasty is discussed in the report. The patient was referred to the authors' center with symptoms of high gastrointestinal obstruction, which had appeared 48 hours prior to admission. The situation was resolved by endoscopic removal of the impacting foreign body with the use of Dormia basket. Anastomoses and strictures resulting from bariatric procedures are a frequent location of food bolus obstructions and bezoars. It is therefore important to perform a diagnostic gastroscopy prior to performing a bariatric procedure in order to check for preexisting conditions, including malignant tumors.
3
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Intragastric Balloon (BIB System) in the Treatment of Obesity and Preparation of Patients for Surgery - Own Experience and Literature Review

81%
Dąbrowiecki S., Szczęsny W., Popławski C., Sosnowski D.
Polish Journal of Surgery
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2011
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vol. 83
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issue 4
181-187
EN
Despite the recognition of bariatric surgery as the only effective method of weight reduction, we remain in search of minimally invasive methods, both for the treatment of obesity and preparation of patients for surgical procedures.The aim of the study was to determine intragastric balloon (Allergan) implantation results as the only method of treating obesity, and patient preparation for further stages of abdominal hernia operations, as well as other surgical procedures.Material and methods. The study presented own results considering the use of Bioenteric Intragastric Balloons (BIB system) in the treatment of pathological obesity, and preparation of patients for bariatric surgery and abdominal hernia operations. The study group comprised 18 female and 7 male patients. Average patient age amounted to 50.6 and 54 years, respectively. Indications for intragastric balloon insertion were as follows: preparation for hernia (10 cases) and bariatric (5 patients) operations, and weight reduction management (8 patients). In two cases the implantation of the intragastric balloon served the preparation for gynecological and orthopedic (vertebral column) operations. One female patient was prepared for both bariatric and hernial surgery. The procedure was performed under general anesthesia. Statistical analysis considered 22 patients (one female patient was excluded from analysis, due to death, two other were excluded because of lack of sufficient data).Results. In case of two patients the intragastric balloon system was removed before 6 months had elapsed because of intolerance. One female patient died during the observation period for reasons not related to the procedure. The obtained BMI reduction ranged between 2 and 6 kg/m2, which amounted to a maximum weight loss of 24 kg. In one patient a weight gain of 2 kg was observed. Considering patients prepared for abdominal hernia operations weight reduction was greater and better maintained after the removal of the BIB system.Conclusions. According to the authors of the presented study the intragastric balloon serves its role as a bridge to bariatric procedures and weight reduction, before planned extensive postoperative hernia operations. The use of the intragastric balloon only to reduce weight has no medical and economic justification.
4
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Intraoperative Parathormone Assay and Radioguided Parathyroidectomy in Patients with Primary Hiperparathyroidism

71%
Pypkowski J., Dąbrowiecki S., Wierzchowski P., Szmytkowski J., Pilecki S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 1
16-23
EN
The outcome of surgical treatment of primary hyperparathyreoidism (PHP) is largely dependent on the radicality of the operation. This is sometimes difficult due to abnormal location of the glands. The use of intraoperative parathormone assay (IOPTH) and a handheld gamma-ray detector (HGRD) might influence the outcome of treatment.The aim of the study was to assess the feasibility of intraoperative parathormone assay and handheld gamma ray detector in surgical treatment of primary hyperparathyroidism.Material and methods. Prospective analysis of the treatment outcomes of patients with PHP undergoing surgery at the Dept. of General and Endocrine Surgery was accomplished. The patients were divided into two groups: G1 - patients in whom HGRD was used to intraoperatively locate the parathyroid glands; G2 - patients in whom both the HGRD and IOPTH were utilized. In all of the patients preoperative serum calcium and PTH measurements were taken. Thirty minutes before the scheduled start of the operation, patients from both groups received an 800 MBq dose of the Tc-MIBI radiomarker. Gamma radiation measurements were performed with the use of a Gamma Finder handheld device. In patients from the G2 group, serum PTH was assessed 10 minutes after the removal of the last gland. In the G1 group, bilateral neck exploration was performed. In the G2 group, the operation was brought to a close after the Miami criterion was met; in most cases, the surgery was limited to unilateral neck exploration.Results. Between 2007 and 2009 25 patients underwent surgery for PHP (group G1 - 12, group G2 - 13). There was one case of persistent hyperparathyroidism in group G1. All of the parathyroidectomies in group G2 were successful. No difference in the length of hospital stay were noted between the groups. The duration of surgery was longer in group G2.Conclusions. Surgical treatment of PHP with the combined use of a handheld gamma radiation detector and an intraoperative parathormone assay yields satisfactory results despite limited tissue preparation.
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