World journal of surgery
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World journal of surgery · Jul 2010
Flexible thoracoscopy may facilitate video-assisted thoracoscopic lobectomy.
Video-assisted thoracoscopic lobectomy was introduced in the early 1990s but has not yet gained widespread acceptance. The VATS approach is still controversial although several studies suggest less postoperative morbidity compared with open thoracotomy. Nevertheless, some patients report long-lasting chest wall pain following VATS procedures, and, in theory, such pain may be related to intercostal nerve injury. The present study presents our experience with a commercially available flexible thoracoscope. ⋯ Video-assisted thoracoscopic lobectomy by flexible thoracoscopy is feasible and in our opinion easier and safer compared with rigid thoracoscopy. In our experience all parts of the operation are better visualized and many surgical pitfalls may be avoided. Even during early phases of setting up the VATS lobectomy program, the duration of the operation is comparable with open surgery, and postoperative pain is low, possibly because porthole angulation is minimized.
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World journal of surgery · Jul 2010
Assessing operative performance in advanced laparoscopic colorectal surgery.
Competent technical skills performance in complex operations is vital for satisfactory patient outcome. Assessing these skills is therefore of paramount importance. In this study we aim to develop and validate a new tool that can assess both generic and specific technical skills in advanced complex laparoscopic colorectal surgery in the operating room. ⋯ This new assessment tool of generic and specific technical skills in advanced laparoscopic colorectal surgery is reliable and has face, content, concurrent, and construct validities. The tool has the possibility of being used as a surgical training and appraisal tool.
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World journal of surgery · Jul 2010
A modified Nuss procedure for late adolescent and adult pectus excavatum.
Although the Nuss procedure has been widely adopted as a standard procedure in children with pectus excavatum, reports focusing on its use in adults are rare. We retrospectively reviewed postoperative results to evaluate the safety and efficacy of the Nuss procedure in late adolescents and adults with pectus excavatum. ⋯ Using the thoracoscope, the compound bar technique, the 3-point wire fixation, the crane technique, and sometimes double bar insertion showed that the Nuss procedure could be performed safety and effectively in late adolescent and adult patients with pectus excavatum.
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World journal of surgery · Jul 2010
Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery.
Since breast-conserving surgery demonstrated identical long term survival on seven randomized trials, it has become the preferred treatment option over mastectomy. Oncoplastic surgery applying simple reshaping and displacement techniques allows inclusion of patients with large tumors in the group selected for breast-conserving surgery. However, the cosmetic outcome and the degree of patient satisfaction, especially in relation to the original breast volume and the percentage of breast tissue excised is not well documented. ⋯ This study showed high patient satisfaction and good cosmetic outcome after oncoplastic breast-conserving surgery, even in small breast sized Asian women. The application of oncoplastic technique allows large volume excision, and satisfaction remains high with breast volume excision less than 20% regardless of tumor location or distance of the tumor from the nipple. More complicated oncoplastic techniques, e.g., breast replacement, might be required if breast volume excision exceeds 20%.
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World journal of surgery · Jul 2010
Histone deacetylase inhibitors attenuate acute lung injury during cecal ligation and puncture-induced polymicrobial sepsis.
The histone deacetylase (HDAC) inhibitors have emerged as the useful reagents that epigenetically modulate the expression of various genes. In the present study, the effects of HDAC inhibitors on the expression of inflammation-related genes and lung injury during sepsis were investigated. ⋯ These data indicated that the HDAC inhibitors, based on modulating the key enzymes linked to acetylation modification, effectively attenuate intrapulmonary inflammatory response, thus significantly alleviating lung injury during sepsis.