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Liver Metastasis Resection. A Technique That Makes It Easier. Authors: de Santibañes E, Sánchez Clariá R, Palavecino M, Beskow A, Pekolj J. Background: Liver resection is the only therapeutic option that achieves long-term survival for patients with hepatic metastases. We propose a tech...nique that causes traction and counter traction on the resection area, thus easily exposing the structures to be ligated. Since the parenchyma protrudes like a cork from a bottle we named this procedure “Corkscrew Technique”. Objective: To describe an original surgical technique to resect liver metastases. Technique: We delimite the resection area at 2 cm from the tumor. We place separated stitches, in a radiate way. The needle diameter must allow passing far from the deepest margin of the tumor. The stitches must be tractioned all together to separate the tumor from the normal parenchyma. Material and Methods: Between years 1983 and 2006, we perform 1270 liver resection. We used the corkscrew technique like only procedure in 612 patients whereas in 129 patients we associated it to an anatomic resection. Results: Mortality was 1%. Morbidity was 16% with a reoperation rate of 3%. Conclusions: The Corkscrew Technique is simple and safe, it spares surgical time, avoids blood loss, ensures free tumor margins and it is easy to perform.
This is the CT of a 43 year old male patiënt with infected necrotizing pancreatitis that will undergo a VARD procedure; Videoscopic Assisted Retroperitoneal Debridment. Two weeks before this procedure two large bore percutaneous drains were placed in the peripancreatic collection. The patient i...s placed in supine position with the left side 30 degrees elevated. A 5-7 cm subcostal incision is made in the left flank. With help of CT images and by following the percutaneous drain, the subcutaneous tissue and the fascia are dissected and we enter the retroperitoneal peripancreatic collection. First, with a regular suction device any pus encountered is removed. Two long sympathectomy hooks are inserted in order to keep in the incision open. We than insert the zero degree laparoscope. The first necrosis encountered is removed under direct sight with the use of long grasping forceps. Following the percutaneous drain deeper into the cavity, parts of loosely adherent necrotic material are removed. Gently pulling we remove the necrotic tissue. The suction device is helpful in removing any fluid obstructing the view. Complete necrosectomy is not the ultimate aim of this procedure. Only loosely adherent pieces of necrosis are removed thereby keeping the risk of tearing underlying blood vessels to a minimum. In the rare case of extensive bleeding, the retroperitoneal cavity can be easily packed, either awaiting the bleeding to definitely stop or to act as a bridge to angiographic coiling. This patient is now 6 weeks after onset of disease. We always try to postpone surgical intervention, if possible up to 30 days. On the left side of the collection is the percutaneous drain. In this patient the drain had worked well for 2 weeks. When the patient deteriorated again it was decided to perform the VARD procedure. Large pieces of necrotic pancreas can be removed with VARD. This is a big advantage ov VARD over pure endosopic or percutaneous techniques. When all the necrotic tissue is removed we clean the cavity. Two drains are left in situ as a postoperative lavage system. The VARD procedure is performed via a 6 cm incision, which is closed and continuous postoperative lavage started immediately.
Repair performed with the PROLIFT Pelvic Floor Repair System - the total implant. The objective of the PROLIFT procedure is to achieve a a complete anatomic repair of pelvic floor defects in a standardized way. The repair is achieved by the placement of the synthetic non-absorbable polyprolylen mesh... implant via a vaginal approach.
Vasculitis is an inflammation of your blood vessels. It causes changes in the walls of blood vessels, including thickening, weakening, narrowing and scarring. These changes restrict blood flow, resulting in organ and tissue damage. There are many types of vasculitis, and most of them are rare. Vasculitis might affect just one organ, such as your skin, or it may involve several. The condition can be short term (acute) or long lasting (chronic). Vasculitis can affect anyone, though some types are more common among certain groups. Depending on the type you have, you may improve without treatment. Or you will need medications to control the inflammation and prevent flare-ups. Vasculitis is also known as angiitis and arteritis.