Petr Stadler, M.D., Ph.D., Head Department of Vascular Surgery, Na Homolce Hospital in Prague, Czech Republic. He was certified as a console surgeon for the da Vinci surgical system in August, 2005 at the University of California, Irvine. Dr. Stadler is a member of the Czech Association of Cardiovascular Surgery, the ESVS, the ISMICS, the SRS and a founding member of the International Endovascular and Laparoscopic Society. He has also received a few prestigious honors from the Czech Association of Cardiovascular Surgery for the best publications in 2004 and 2006, the Letter of Appreciation from Korean Society of Endoscopic and Laparoscopic Surgeons in May 2008, the price of the Czech Society of Angiology for the publication in the year 2007 and the best audiovisual presentation in 2009 in USA (ISMICS), in 2013 in USA (SCVS) and in 2020 (P.A.Wetter Award, SLS MIS Virtual Meeting). He performed also the robot-assisted vascular operations in South Korea, Russia, Poland and India.
Objective: The aim of this retrospective study was to describe and evaluate our single center experience with robotic aortic and non-aortic vascular surgery to treat mostly occlusive disease and aneurysms. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon.
Methods: From November 2005 to June 2020, 500 robot assisted vascular operations were performed. 326 patients were prospectively evaluated for occlusive disease, 127 patients for abdominal aortic aneurysm (AAA), 5 for a common iliac artery aneurysm, 10 for a splenic artery aneurysm, 1 for a internal mammary artery aneurysm, 16 patients for median arcuate ligament release, 10 for endoleak II treatment post endovascular aneurysm repair (EVAR), 2 for renal artery reconstruction and 3 cases were inoperable. 5 hybrid procedures in study were performed.
Results: 477 cases (95,4%) were successfully completed robotically, 3 patient's surgery (0,6%) was discontinued due to heavy aortic calcification and severe peri-aortitis respectively. In 20 patients (4%) conversion was necessary. The thirty-day mortality rate was 0,4% (2 patients), and early non-lethal postoperative complications were observed in 8 patients (1,7%).
Conclusions: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures. The robotic system provides a real opportunity for minimally invasive surgery in the field of vascular surgery and offers true mini-invasive surgical vascular interventions with all its advantages. Robotic AAA treatment and aorto-femoral represent the standard operations in vascular surgery, and they are not only possible but also safe and successful.
Dr. Nadia Youssef studied Medical sciences at University of South Wales and graduated with first class honours in 2016. She then studied Medicine and graduated from Cardiff University in 2020. Like many final year medical students, Nadia graduated early to help tackle the COVID crisis in Aneurin Bevan University Health Board. As a keen new doctor with a strong passion in colorectal surgery, she was able to complete two audits and a systematic review and she presented her findings in local and national conferences.
Aim: To study available data on the advantages of peritoneal lavage with distilled water following CRC resection, and compare that to Betadine® and saline peritoneal lavages in improving overall patient outcomes.
Methods: PubMed, Google Scholar, and Cochrane database were searched until October 2020. References from relevant articles were reviewed to widen the search.
Results: Overall, 3 experimental studies were identified. Water was found to be superior to other peritoneal lavage solutions in inducing tumorigenic cell lysis in vitro. Mice who underwent peritoneal lavage with water survived longer and had a significantly reduced peritoneal tumour burden compared to mice who did not undergo lavage, or those treated with saline lavage solution. Peritoneal secretions were found to contaminate water lavage and reduce its cell-lytic effect. Nonetheless, complete cell lysis was achieved in vivo by prolonging the time of cell exposure to contaminated lavage solution by 20 min.
Conclusion: This systematic review appreciates that water would not eliminate the risk of disease recurrence, but it could potentially reduce it. As peritoneal lavage is a simple, inexpensive and well-practiced technique in cancer surgery, despite any overwhelming evidence, we suggest adjusting the procedure and utilising distilled water, as murine model studies suggest it may improve prognosis in patients with disseminated disease. Further evidence is required to regard sequential peritoneal lavages with water as beneficial and safe in humans.
Dr Manoj Anandan studied at Monash University, Malaysia and graduated as MBBS(Hons) in 2017. He then worked as an intern in Burnie, Tasmania especially in the General Surgery Department. He then did some research with Mr James Robert-Thomson in 2019 before moving to University Hospital Geelong, Melbourne to work as a Surgical Registrar. He has published articles in ANZ Journal of Surgery and is currently working on an Australian audit of retromuscular ventral hernia repairs.
Parastomal hernias are a common complication of stomas. However, gastric outlet obstruction secondary to a parastomal hernia is a rarity, with only 14 reported cases in literature and predominantly found among elderly women above 75 years -old with colostomies. It has been hypothesized that gastric ligament laxity and acquired fascial defects increase the risk of parastomal gastric herniation. We report a retrospective case of a 60-year-old lady who presented with the above mentioned picture on a background of a previous abdominoperineal resection with an end colostomy for a colorectal carcinoma 9 years ago as well as 3 previous incisional hernias with mesh reinforcements. The patient presented with gastric outlet obstruction from a pre-existing parastomal hernia that manifested in localized upper abdominal pain and profuse vomiting. She had two previous admissions for partial gastric outlet obstruction from her parastomal hernia which were managed symptomatically. On this presentation, she was febrile, tachycardic with an irreducible tender parastomal hernia and elevated inflammatory marker. Computed tomography (CT) abdomen revealed more pronounced proximal gastric dilatation compared to previous scans with the body of stomach situated within the parastomal hernia. The patient was resuscitated and had nasogastric decompression pre-operatively and was noted to have dense intra-abdominal adhesions with a substantial stomach volume incarcerated within a large parastomal hernia intra-operatively. She had adhesiolysis performed laparoscopically using two robotic ports situated between two 12mm ports, an old mesh that was adherent to the stomach and small bowel was reduced with hernia reduced . The Sugarbaker technique was applied to repair the hernia with a Biodesign mesh and subsequently the end colostomy was mobilized, pulled through the hernial sac and the stoma refashioned. The patient had an uneventful recovery period post-operatively and was discharged on day five. The significance of this case in literature would be that it is the first where roboticassociated laparoscopic surgery was applied.
Helen Gharaei has completed her MD in the Mashhad University of Medical Science (1992) and postdoctoral studies in anesthesiology in Uremia University School of Medicine and has got her pain fellow degree from Tehran University of Medical Science from Iran (2012), and FIPP degree (Fellowship of Interventional Pain Practice) from Texas Tech University, USA (2013). She has specialized training in minimally invasive chronic pain procedures for medically challenging patients and practice in a private multidisciplinary clinic in Tehran, Iran. She has published many books and papers focusing on the safety of pain injection and has been serving as an editorial board in the reputed journal. She invited as a speaker in many international conferences from the beginning of her professional carries. She is an international trainer & researcher and known as a pioneer on ultrasound-guided spine injection, especially she is the inventor of the IRAN technique in spine injection. She has been teaching at multiple interventional pain management courses including cadaver workshops of ultrasound & fluoroscopy-guided pain injection locally and abroad. She is an education committee in interventional pain and spine center (IPSC) and founder of Son- Guide Pain Injection School of Iran. She constantly contributes to the growth of pain education worldwide.
The object of this study is to introduce a novel USG approach for lumbar periradicular injections by investigating radicular artery nearby (IRAN) technique and to assess the feasibility and preliminary means by fluoroscopy.
The USG periradicular injection is performed under real time imaging. An axial scanning view is obtained through identifying the spinous processes, lamina, zygapophyseal joints and transverse processes.
The curve probe put transversally and the needle site check in axial and sagittal view.
The IRAN technique was defined by sliding probe a little lower under the facet joint in sagittal plane to view the pulse of nearby radicular artery by Doppler or Pulse Echo. Then spinal needles are advanced with in-plane technique toward the artery until touch the nearby bone.
Fluoroscopy examination confirms that the needle tip is correctly placed under the pedicle along the nerve root and lateral to the pars interarticularis with no intravascular injection.
Although searching for small vessels is difficult in cadaver studies, the IRAN technique would be confirmed in the future on Cadaver section.
The IRAN technique introduce pulse of artery (spinal ramus branch of the lumbar segmental artery (SA) or SA itself, not radicular artery) as a new sonoanatomic landmark for safe periradicular placement of the needle for extraforaminal injection.
I am 53 year old; 29 years old as a doctor, specialist in general and cardiovascular surgery. I founded a cardiovascular surgery service in a public hospital. Currently head of the Cardiovascular Surgeons Team in Argentina, SCIRE CARDIOVASCULAR, 60/70 surgeries per month.
Most important results:
100% surgery survival in cardiac surgery; 94% after-year survival, l in 5 years cardiac surgery, 95 % permeability in lower limbs by pass
More than 5000 surgeries for hemodialysis 98% effective
Endovascular surgery wide experience, vascular trauma surgery wide experience, visiting professor, university of mississippi, design and manufacture of surgical instrumental, collaborating book in tc and mr cardiovascular.
In many young patients, blood pressure with a tendency to be low associated with fine vessels causes many arteriovenous fistulas for hemodialysis (AVF) in upper limbs with prostheses to fail.
These patients remain for months or for life with indwelling catheters, with the risk of infection that means and a decrease in their quality of life. In some, another AVF is made with prostheses in femoral vessels, but the problems associated with the prostheses continue.
For this reason we think of a technique that is with a vein, which these patients would benefit.
In this way we avoid the risk of occlusion due to hypotension and infections typical of AVF with prostheses.
Avoid indwelling catheters and AVFs with femoral prostheses in young patients with exhaustion of vascular accesses.
Material and method
Between July and October 2020, 5 patients were operated on with transposition of the femoral vein.
It was used in 4 patients under 30 years of age and in a 57-year-old patient.
In all 5, access to upper limbs was exhausted. The 57-year-old also had a left femoral AVF with prosthesis.
Varicose veins and lower limb arteriopathy were ruled out in the 5 patients.
In all the patients they began to puncture at approximately 30 days; with flows greater than 300 ml / min and venous resistance less than 200 mmHg.
The punctures were started with needle No. 17, currently No. 15. The pump flow is between 300 and 400 ml / min, the venous resistance is less than 200 mmHg. The KTV around 1.5.