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Laparoscopic Appendectomy as an Alternative to Conventional Procedure – Results in our own Material

100%
Merenda M., Litarski A., Kabziński P., Janczak D.
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vol. 85
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issue 6
323-328
EN
Appendectomies are the most common surgical procedures performed in the emergency surgery setting. Since more than one decade laparoscopic appendectomy appeared as an alternative procedure to commonly used conventional appendectomy as a recognized method of treatment of acute appendicitis. Despite multiple papers and studies comparing these techniques, still no clear indications and eligibility criteria exist for either of them. The aim of the study was to evaluate results of treatment of acute appendicitis using the laparoscopic method versus the conventional appendectomy, basing on parameters affecting treatment results and costs, such as duration of hospitalization, complications, use of medications. Material and methods. The analysis included patients who underwent surgical treatment for acute appendicitis at the Department of Surgery of 4th Military Clinical Hospital in Wrocław between 2006 and 2012. Since 2006, 128 laparoscopic appendectomies (group 1) were performed, while 189 patients underwent conventional procedure during this time (including 11 who underwent a diagnostic laparoscopy - group 2). The study was based on retrospective analysis of medical records of patients. Treatment results were evaluated basing on the following parameters: duration of hospitalization, amount of used analgesics, duration and type of antibiotic therapy, peri- and postoperative complications. Results and conclusions. Results obtained at our Clinic, similar to results obtained at other sites, warrant use of laparoscopic appendectomy. Use of minimally invasive techniques provides better treatment results, mainly with regard to shorter duration of hospitalization, lower use of antibiotics and analgesics, which also contributes to lower overall treatment costs.
2
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Over 10 Years of Experience in the Laparoscopic Treatment of Adrenal Lesions via Lateral Transperitoneal Approach

80%
Otto M., Dzwonkowski J., Ciąćka T., Jędrasik M.
Polish Journal of Surgery
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2008
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vol. 80
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issue 9
478-486
EN
The aim of the study was to present own experience in the treatment of adrenal pathology using laparoscopic adrenalectomy (LA) via lateral transperitoneal approach.Material and methods. From 29.10.1997 to 30.04.2008 in the Department of General, Vascular and Transplant Surgery of Warsaw Medical University 417 LA have been performed in 405 patients. The indications were 195 (48%) non-functioning incidentaloma type tumors and 210 (52%) functioning tumors. Among them hypercortisolism in 66 (31.5%) patients (Cushing's disease - 3, Cushing's syndrome -28, subclinical Cushing's syndrome - 35), pheochromocytoma in 82 (39%), Conn's syndrome in 61 (29%) and adrenogenital syndrome in 1 (0.5%). There where 288 (71%) women and 117 (29%) men with the mean age of 51.8 years. The mean size of adrenal tumor was 41.1 mm. In 62 (15%) bilateral lesions were noted. All patients were operated laparoscopically via lateral transabdominal approach.Results. LA was successful in 393 patients (97%). We performed 393 (97%) unilateral LA, 10 (2.5%) bilateral simultaneous LA, 2 (0.5%) bilateral two-staged LA and also 2 (0.5%) sparing LA. 12 (3%) patients underwent simultaneous LA with laparoscopic cholecystectomy due to symptomatic cholecystolithiasis and 2 (0,5%) with laparoscopic umbilical hernioplasty. 12 (3%) conversions were necessary. 15 (3.7%) complications occurred, 3 (0.7%) intraoperative and 12 (3%) postoperative. There was 1 remote death on the 56th postoperative day.Conclusions. 1. LA should be recognize as the referential method in the treatment of adrenal pathology. 2. Results, as well as avoiding unnecessary complications and intraoperative difficulties is possible thanks to: close cooperation with the endocrinologist, experience gained from performing other laparoscopic operations, experience got at making open adrenalectomies.
3
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Minimally Invasive Surgery in Newborns and Infants - Own Experience

70%
Patkowski D., Rysiakiewicz K., Rysiakiewicz J., Koziełł A., Apoznański W., Czernik J.
Polish Journal of Surgery
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2009
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vol. 81
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issue 2
81-86
EN
The aim of the study was to present own experience in utilisation of minimally invasive techniques in newborn and infant.Material and methods. It is retrospective analysis of minimally invasive procedures conducted in Department of Pediatric Surgery and Urology with focus on patients group up to age of one year.Results. In total 1791 minimally invasive procedures were conducted of which 234 (13.1%) operations were performed on 227 (7 patients underwent procedure twice) children in age group of up to one year in period from 01.04.1995 till 30.06.2008. There were 28 (11.97%) thoracoscopic and 206 (88.03%) laparoscopic procedures. No complications related to creation of pneumoperitoneum or surgical pneumothorax were observed. The commonest indications to surgery were inguinal hernia (116 children) oesophageal atresia with tracheoesophageal fistula (23 cases) and prolonged neonatal jaundice (18 patients).In total in 29 cases it was necessary to convert to open surgery, 2 cases due to intraoperative complications (bleeding, duodenal wall perforation) and in 14 cases due to poor visualisation of operating field.Conclusions. There is broad spectrum of indications to minimally invasive surgery in newborn and infant patients. Results indicate good tolerability of the procedure even in patients with low weight, safety and efficacy in typical conditions. Limited number of procedures performed in various conditions does not allow to draw uniform conclusions and requires further study.
4
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Cystic Adrenal Lesions - Analysis of Indications and Results of Treatment

61%
Major P., Pędziwiatr M., Matłok M., Ostachowski M., Winiarski M., Rembiasz K., Budzyński A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 4
184-189
EN
Cysts are a rare pathology of adrenal glands. As the development of new diagnostic techniques takes place, the occurrence of adrenal cystic lesions has been rapidly increasing. The majority of them are solid adrenal lesions, but localized fluid collections are also more frequently diagnosed. In case of solid adrenal lesions, there are straight indications for surgery, but on the other hand there are no clear guidelines and recommendations in case of adrenal cysts.The aim of the study was to analyze surgical methods and evaluate treatment effects in patients who were qualified for laparoscopic adrenalectomy due to adrenal cystic lesions.Metarial and methods. Identical criteria were used to qualify patients with solid and cystic lesions of the adrenal gland for surgery. Out of the whole number of 345 patients who underwent laparoscopic surgery for adrenal tumors, 28 had adrenal cysts. 16 of them (57%) were women and 12 (43%) men. The average age of the studied group was 46.4 years (25-62 years). The average cyst diameter in CT was 5.32 cm (1.1-10 cm). Most of the lesions were hormonally inactive (22 patients), but in 6 cases increased level of adrenal hormones was observed.Results. Pathological analysis revealed 4 (14%) pheochromocytomas and 2 (7%) dermoid cysts. In case of 22 (79%) patients, the postoperative material was profiled by pathologists as insignificant according to potential neoplasmatic transformation risk: 5 (17.5%) - endothelial vascular cysts, 3 (11%) endothelial lymphatic cysts, 7 (25.5%) pseudocysts, 3 (11%) simple cysts, 2 (7%) bronchogenic cysts, 1 (3.5%) - cortical adenoma and 1 (3.5%) cyst was of myelolipoma type.Conclusions. Based on the performed research and previous experience in treating patients with adrenal lesions we can conclude that application of the same evaluating algorithm for both cystic and solid lesions is valid.
5
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Migracja implantów podskokowych w korekcji płaskostopia u dzieci: badanie pilotażowe w modelach kości syntetycznych

51%
Kwiatkowski M., Guszczyn T., Sobolewski A., Sar M., Hermanowicz A.
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vol. 24(2)
121-132
EN
Background. Subtalar implant migration as a complication following subtalar arthroeresis has been described in the scientific literature. However, clinical studies do not allow for unequivocally determining the underlying causes. The aim of the study is to determine the risk of migration of two geometric types of subtalar implants. Biomechanical tests were carried out on a synthetic bone model with a soft tissue substitute, which allowed for reduction of variability of results caused by biological differences. Material and methods. A foot model mirroring natural anatomy was made from synthetic bone and a silicone soft tissue substitute with the same hardness as that of the soft tissues of the foot. Two types of 11 mm Ti6Al4V titanium alloy implants were studied, namely, a rectangular subtalar screw and a cylindrical subtalar screw, a type commonly used in flatfoot reconstruction surgery in children. The screws were placed in the sinus tarsi and subjected to cyclic loading (up to 1,000,000 cycles at a frequency of 5 Hz, with a maximum load of 500 N). Comparative pull-out force tests were performed immediately following implantation and after the dynamic loading test. Wyniki. Following the dynamic loading test, all 12 samples were qualified for the pull-out force test. Cylindrical screws demonstrated higher pull-out force values both for the samples tested immediately following implantation and for those that underwent dynamic loading. Implants of the same shape did not show statistically significant differences in the Mann-Whitney U test (p >0.05). Wniosek. The synthetic research model produces reproducible results in the assessment of risk of implant migration. Long-term loading does not significantly affect the risk of implant migration.
PL
Wstęp. Powikłanie po zabiegu artroerezy podskokowej, jakim jest migracja implantu podskokowego jest opisywana w literaturze naukowej, jednakże badania kliniczne nie pozwalają jednoznacznie określić przyczyn tego zjawiska. Celem pracy jest określenie ryzyka migracji dwóch typów geometrycznych implantów podskokowych. Badania biomechaniczne przeprowadzono w modelu kości syntetycznej z substytutem tkanek miękkich, co umożliwiło zmniejszenie zmienności wyników, spowodowanej różnicami biologicznymi. Materiał i Metody. Model stopy odwzorowujący naturalną anatomię stworzono z syntetycznych kości oraz silikonowego substytutu tkanek miękkich o twardości odpowiadającej tkankom miękkim stopy. Badano 2 rodzaje implantów ze stopu tytanu Ti6Al4V, o rozmiarze 11 mm – wkręt podskokowy o geometrii prostopadłościennej oraz model wkrętu podskokowego o geometrii walcowej, który reprezentuje typ implantu powszechnie stosowany w zabiegach korekcji płaskostopia u dzieci. Wkręty umieszczono w zatoce stępu i poddano cyklicznemu obciążaniu (do 1’000’000 cykli z częstotliwością 5 Hz, przy maksymalnym obciążeniu 500 N). Badania porównawcze siły wyrywania wykonano bezpośrednio po implantacji oraz po badaniu dynamicznym. Wyniki. Każda z 12 próbek po badaniu dynamicznym została zakwalifikowana do badania siły wyrywania. Wkręty o geometrii walcowej wykazały wyższe wartości siły wyrywania w odniesieniu do próbek badanych bezpośrednio po implantacji oraz do próbek, które przeszły badanie dynamiczne. Implanty o tej samej geometrii nie wykazały istotnych statystycznie różnic w teście U Manna-Whitneya (p>0,05). Wniosek. Zaprezentowany syntetyczny model badawczy pozwala na uzyskanie powtarzalnych wyników w ocenie ryzyka migracji implantu. Długotrwałe obciążenie nie wpływa istotnie na ryzyko migracji implantu.
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