Prostatectomy-pros and cons on open surgery/laparoscopic surgery/robot-assisted surgery

We have 3 options when perfoming prostatectomy for the treatment of localized prostate cancer. Those are retropubic radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy. We compared the characteristics and results of these techniques. Robot-assisted laparoscopic radical prostatectomy could be superior to the others in many ways. However, it would be very difficult to adopt it in Japan because it would pose economical difficulties. The administrative assistance in the insurance systems requireds much more than we have.     

Antibiotic prophylaxis in clean surgery: vascular surgery

The commonest and most dangerous infective complication in vascular surgery is prosthetic graft infection. Despite the use of routine systemic antibiotic prophylaxis, graft infection occurs after 3-5% of all prosthetic vascular reconstructions. Infection is associated with a high rate of major morbidity and mortality, with significant time and cost implications. Management can be difficult and the outcome is often disappointing. Data from Italian Registry of Prosthetic Graft Infections show that the commonest site of infection is the aorto-femoral district and that involved bacteria are usually gram-positive in early and low-grade infections and gram-negative in late and high-grade infections. Results are poor, with a mortality rate of 15% for elective surgery and of 60% for emergency interventions. We report the results of a multicenter randomized controlled trial of rifampicin-bonded Dacron grafts in aorto-femoral surgery, in which our Department was involved. Data demonstrate a reduction in total early wound and graft infection rates, and 2-year results show a small, non-significant reduction in graft infection (1.7% in study group, 2.3% in control group). The same results were obtained in two other multicenter trials.     

Razor-blade surgery

The razor blade can be a valuable tool in the performance of many minor surgical procedures. It is extremely sharp, flexible, inexpensive, readily available, and easy to use. The technique and specific applications are reviewed and discussed.     

Oncovascular surgery

Background

Surgical resection remains the cornerstone for the curative treatment of oncological disease. When a tumour mass encases a critical arterial or venous structure, successful symptom relief and long-term oncological control may be achieved through careful preoperative planning within a multi-disciplinary team incorporating oncological and vascular specialists. To highlight the strategic issues pertaining to the vascular management of these patients, this review addresses the principles in planning oncovascular surgery, namely where cancer resection necessitates concurrent ligation or reconstruction of a major vascular structure.

Design

A multiple electronic health database search was performed, including Medline, Embase, and Scopus.

Results

The published outcomes for different malignancies suggest that survival is dependent upon complete clearance of the primary pathology and tumour biology rather than vascular-related complications.

Conlcusion

Major vessel involvement of a tumour mass should not necessarily be considered a barrier to en bloc resection and hence curative surgery. Radical surgical resection may offer the only chance for cure or palliation for these patients. Detailed preoperative planning within an extended multi-disciplinary team that includes vascular specialists is essential for these complex patients.     

Open surgery in the era of minimally invasive surgery

The benefits and popularity of minimally invasive surgery are undeniable around the globe. However, open surgery is necessary and learning open surgery skills is still a necessity. Open surgery allows for better exposure to the surgical field and provides tactile sensation to facilitate the stereo visual assessment to precisely remove the lesion.Open surgery is still the key to surgical training, and the skills learned from open surgeries remain crucial for unforeseen circumstances and certain c...     

Endoscopic skull base surgery: principles of endonasal oncological surgery

Endoscopic endonasal surgery can be applied to the management of benign and malignant sinonasal neoplasms with good results. For tumors that involve the skull base, an endoscopic "craniofacial resection" can be performed with en bloc excision of the involved dura. Preliminary experience with completely endoscopic excision of olfactory neuroblastomas indicates good local control and few complications. Advantages of endoscopic endonasal surgery include improved visualization and decreased morbidity compared to traditional approaches.     

加速康复外科在腹部肿瘤外科的应用

加速康复外科（enhanced recovery after surgery，ERAS）是围手术期治疗基于循证医学的模式转变，目标是缩短患者的术后康复时间，降低术后并发症，同时节约医疗成本。临床实践证明，ERAS方案是有益且可行，其效果在结直肠手术中尤为显著。本研究对ERAS的发展、核心内容及其在不同腹部肿瘤外科和特定患者群中的应用情况进行综述。      

加速康复外科在胃肠手术中的应用经验浅析

加速康复外科(enhanced recovery after surgery,ERAS)是指围术期采取一系列有循证医学证据的措施,优化围术期的全过程,核心是降低患者生理和心理创伤应激,减少术后并发症,促进患者术后快速康复.目前虽然ERAS在各个外科专业中得到迅速发展与推广,但各级医院在临床实施ERAS过程中仍存在较多困难,其原因较复杂,各种实施方案也尚未规范化.针对上述情况.本文结合笔者所在中心在胃肠手术中实施ERAS的经验以及最新循证医学证据进行述评.     

肿瘤整形外科技术在头皮肿瘤手术中的应用

目的回顾性总结应用肿瘤整形外科技术修复头皮肿瘤切除后继发创面的经验,探讨其优势。方法对38例头皮良、恶性肿瘤患者依照肿瘤处理原则,在切除肿瘤后,对继发缺损创面分别采用植皮、邻位皮瓣、大网膜+皮片游离移植、皮肤软组织扩张等方法进行修复。结果 38例中4例皮瓣远端小部分坏死,创面延期愈合;3例皮片部分(10%～15%)坏死或水疱形成;1例扩张器外露;1例大网膜坏死;29例伤口Ⅰ期愈合。20例经3个月～12年随访:1例因所植皮片部分菲薄而出现小面积溃疡,经再次植皮后痊愈;3例死亡(肺部转移2例,脑溢血1例);16例外形较满意。结论头皮肿瘤切除后的继发缺损创面用整形外科技术进行完好修复,可减轻或消除患者的心理负担,提高生存质量。     

Dermatologic cosmetic surgery

Many cosmetic surgery procedures performed today were either developed or refined by dermatologic surgeons. The role played by dermatologic surgeons in the development of dermabrasion, hair transplantation, liposuction, blepharoplasty, face-lift, cutaneous implants, fat transplantation, chemical peel, and sclerotherapy is described.     

促进术后恢复综合方案在结直肠手术中的应用

促进术后恢复综合方案(ERAS)创新性地整合了围手术期被证明有效的干预措施,以达到减少机体应激反应、支持正常功能恢复和减少术后并发症为目的.目前,已有多个临床研究采用了ERAS方案,均显示了良好的效果.     

Reconstructive surgery of the pelvis after surgery for rectal cancer

The role of the reconstructive surgeon has increased with an increasingly aggressive surgical approach to locally advanced rectal carcinoma. Multiple options exist for pelvic floor reconstruction. Muscle and myocutaneous flaps for pelvic-floor reconstruction provide well vascularized tissues which may also serve as a biologic spacer. Flaps help to prevent post-radiation fistulae, small bowel obstruction, and pelvic sidewall adherence; flaps also may serve as a barrier to radiation injury. Often a more stable perineal wound closure is achieved. In cases that involve vaginal resection, flaps make neo-vaginal reconstruction possible. Pre-operative consultation with the reconstructive surgeon allows planning of complex, multi-disciplinary procedures, and facilitates patient understanding of the proposed procedure.