In agreement with other studies [3, 4, 21, 22, 32], the diagnosis of perforated PUD in this study was made from history and identification of free air under the diaphragm in plain abdominal and chest radiographs, and the diagnosis was confirmed at laparotomy. The value of the radiological investigation has been compared with other writers and with current radiological techniques; 80-90% of cases are correctly diagnosed [4, 33]. In case of perforated PUD ulcer, free intraperitoneal gas is less likely to be seen if the time interval between the perforation and radiological examination in short [4]. Recently, Computerized tomography (CT) scans with oral contrast are now considered the reliable method of detecting small pneumoperitonium before surgery and the gold standard for the diagnosis of a perforation [34, 35]. Abdominal ultrasonography has also been found to be superior to plan radiographs in the diagnosis of free intra-peritoneal air [35]. None of these imaging studies were used in the diagnosis of free intra-peritoneal air in our study. We relied on plain radiographs of the abdominal/chest to establish the diagnosis of free intra-peritoneal air which was demonstrated in 65.8% of cases. We could not establish, in our study, the reason for the low detection rate of free air under the diaphragm.
In this study, Graham's omental patch of the perforations with either a pedicled omental patch or a free graft of omentum was the operation of choice in our centre. Similar surgical treatment pattern was reported in other studies [3, 4, 21, 22]. This is a rapid, easy and life-serving surgical procedure that has been shown to be effective with acceptable mortality and morbidity [22, 39]. Although this procedure has been associated with ulcer recurrence rates of up to 40% in some series, Graham's omental patch of PUD perforations remains a surgical procedure of choice in most centres and to avoid recurrence the procedure should be followed by eradication of H. pylori[22, 40]. Simple closure of perforation with omental patch and the use of proton pump inhibitors have changed the traditional definitive peptic ulcer surgery of truncal vagotomy and drainage procedures [41]. Definitive surgery is indicated only for those who are reasonably fit and presented early to the hospital for surgery [22]. Definitive peptic ulcer surgery increases operative time, exposes the patient to prolonged anaesthesia and also increases the risk of postoperative complications. This is especially true in developing countries including Africa where patients often present late with severe generalized peritonitis [23]. In the present study, only one patient who presented early with stable haemodynamic state underwent definitive peptic ulcer surgery of truncal vagotomy and drainage. Recently, laparoscopic repair of perforated peptic ulcer has also been reported, [42] and this is believed to help reduce postoperative morbidity and mortality [43].
Clinical surgery alfred cuschieri pdf free 18
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The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.
Da Vinci robot-assisted thymectomy has been used in the past several years in China, however, practical experience in performing this approach in China remains limited. Thus, the study aimed to evaluate the experience of da Vinci robot-assisted thymectomy in China. From June 2010 to December 2012, 55 patients with diseases of the thymus underwent thymectomy using the da Vinci surgical HD robotic system. The clinical data of the da Vinci robot-assisted thymectomies were compared with the data of video-assisted thoracoscopic thymectomies in the same period. All da Vinci robot operations were successful. This is a retrospective analysis which demonstrated that compared with video-assisted thoracoscopic thymectomy in the same period, the clinical outcomes of da Vinci robot-assisted thymectomy were not significantly different. The da Vinci robot-assisted thymectomy is a safe, minimally invasive, and convenient operation, and shows promise for general thoracic surgery in China. Copyright 2014 John Wiley & Sons, Ltd.
This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.
To summarize the research progress of peripheral nerve surgery assisted by Da Vinci robotic system. The recent domestic and international articles about peripheral nerve surgery assisted by Da Vinci robotic system were reviewed and summarized. Compared with conventional microsurgery, peripheral nerve surgery assisted by Da Vinci robotic system has distinctive advantages, such as elimination of physiological tremors and three-dimensional high-resolution vision. It is possible to perform robot assisted limb nerve surgery using either the traditional brachial plexus approach or the mini-invasive approach. The development of Da Vinci robotic system has revealed new perspectives in peripheral nerve surgery. But it has still been at the initial stage, more basic and clinical researches are still needed.
Da Vinci surgical system is the most advanced minimally invasive surgical platform in the world, and this system has been widely used in cardiac surgery, urology surgery, gynecologic surgery and general surgery. Although the application of this system was relatively late in thyroid surgery, the number of thyroidectomy with Da Vinci surgical system is increasing quickly. Having reviewed recent studies and summarized clinical experience, compared with traditional open operation, the robotic thyroidectomy has the same surgical safety and effectiveness in selective patients with thyroid cancer. In this paper, several aspects on this novel operation were demonstrated, including surgical indications and contraindications, the approaches, surgical procedures and postoperative complications, in order to promote the rational application of Da Vinci surgical system in thyroidectomy. 2ff7e9595c