[Laparoscopic surgery]
ANTAL András1, BÁTFAI László1, EZER Péter1
AUGUST 28, 1991
Lege Artis Medicinae - 1991;1(14)
ANTAL András1, BÁTFAI László1, EZER Péter1
AUGUST 28, 1991
Lege Artis Medicinae - 1991;1(14)
[In the recent years abdominal surgery has developed quickly. Laparoscopic operating procedures have spread worldwide. These techniques have reached Hungary as well, though there are only few articles in this topic. Since last December - date of the first laparoscopic cholecystectomy – more than 200 operations have been done, among them the first appendectomy. These procedures are less troublesome for the patients with better cosmetic results, and the shorter period of hospitalisation and unability for work make economical advantages. First, the technical instruments and their usage, then personal coditions and the preparation programme are described. In the second part the usage of the new technique is summarized in cholecystectomy as well as in appendectomy. ]
Lege Artis Medicinae
[This year's congress of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was held in Monterey, California. As a fellow of the Department of Gastroenterology at the University of Southern California, I was able to attend the congress with the support of Dr. Berci, Professor of Surgery at Cedars-Sinai Hospital.]
Lege Artis Medicinae
[Mankind has suffered from the agony of gallstones for thousands of years. Until the second half of the last century, there was practically no cure, the only relief being spontaneous internal and external fistulas in the midst of great pain.]
Lege Artis Medicinae
[A horseshoe kidney is diagnosed usually after the onset of its complication or the symptoms caused by an arising tumor from it. A tumour was diagnosed in the right half of the horseshoe kidney in a 68 year old female patient by excretory urography, ultrasound examination and renovasography. The tumour was removed by radical nephrectomy. The kidney was exposed through a horizontal abdominal approach. Special attention was given to the separate renal arteries supplying the right half of the horseshoe kidney and to the resection of the isthmus and also regional lymphadenectomy. In the diagnosis of a horseshoe kidney excretion urography had exclusively been used earlier but nowadays ultrasound is playing an increasingly important role. Reno vasography is usually needed only before resection or nephrectomy. The appropriate treatment of a horseshoe kidney tumour - in case of a well functioning contralateral kidney - is radical ablastic tumour nephrectomy including regional lymphadenectomy. ]
Lege Artis Medicinae
[I. General principles before surgical treatment of epilepsy; II. The surgical investigation process; III. Indications for surgery]
Lege Artis Medicinae
[The author details the main indications of external fixstion, as well as the professional and socioeconomic causes of recent trends. He also describes the management of extremity injuries in wartime. There is an emphasis of attainment and maintenance of transportability of the injured. For the first fixation procedure external fixation, plaster or their combination should be applied. The author's new method combines the use disposable and the sophisticated dynamic axial fixation device that can be attached onto the same common pin system. The cheap disposable device is applied for the time of the transportation and is replaced later with the definitive device later if needed. The new Manuflex Maxi single use fixators are cost effective and can be used with good results even in peace time surgery. It has shown excellent biomechanical characteristics compared to Orthofix.]
Lege Artis Medicinae
[ With the spreading use of the laparoscope in the urological surgery laparoscopic varicocelectomy may become an alternative treatment of varicocele. The method can be advantageous mainly for patients with bilateral cases compared to the open operation. The authors report on two cases that have been the first urological laparoscopic operations in Hungary.]
Clinical Oncology
[During the last decade liver surgery underwent major improvement: mortality rates reduced meanwhile new surgical approaches converted surgeons’ consideration on many advanced cases likely to be resectable. Liver is the most frequent site for tumor metastases and liver metastasis surgery experienced major changes as well. As long as liver resection related mortality rates have decreased indication for operative treatment of liver metastasis with certain primary tumors (stomach, pancreas) gained reconsideration and became reasonable. New surgical methods and approaches (laparoscopy, portal vein embolization) came into everyday application meantime several researches were completed enabling oncological aspect interpretation. Laparoscopy is a proven rational way of approach not only in cases of primary but metastatic liver tumors too: short and long term survival rates and oncological results are comparable with the results of open surgery. Although reports on large number series have not yet been published, it seems that practice of laparoscopy can bring increased number of cases where resection of primary tumor and synchronous liver metastasis can be performed simultaneously. Treatment strategies including surgical procedure overwhelm results of schemes planned with chemotherapy lines only even for patients suffering from advanced metastatic disease with necessary extended liver resection together with major vessel resection or for those who require liver resection following portal occlusion method. Consent opinion in best therapeutic option by oncologist and surgeon is essential to reach optimal liver metastasis patient treatment.]
Lege Artis Medicinae
[A case report of a 85 year old male patient is presented. Fistula between gall-bladder and skin was developed five years before admission to hospital. Gall-stones passed through the fistula. The planned endoscopic sphincterotomy couldn't performed as the intrapancreatic part of the common bile duct showed narrowing. Cholecystectomy and choledocho-doudenostomy was performed without any complication. By appropriate timing of an operation and more proper evaluation of the patient's general condition formation of the fistula could have been prevented. ]
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