[Show abstract][Hide abstract] ABSTRACT: Although natural orifice specimen extraction is now relatively widely performed, there have been no reports on gastric resection with specimen extraction through the transgastric route for peptic ulcer disease. A hybrid technique of the laparoscopic and endoscopic approach is presented in the case of a 58-year old male patient. Preoperative gastric fibroscopy showed postulcer pyloric and antral stenosis. Laparoscopic exploration confirmed gastric enlargement. Laparoscopic two-thirds gastrectomy was performed. The staple line suture of the residual stomach was excised and the specimen was extracted through the esophagus and mouth with a gastroscope. Finally, the residual stomach was closed again using linear endostaplers. Reconstruction was performed according to the Roux-en-Y method. Gastric resection using natural orifice specimen extraction (NOSE) may be a feasible operative procedure. The NOSE with the combination of standard laparoscopy and specimen extraction through a natural orifice can be considered as a bridge to natural orifice translumenal endoscopic surgery.
Videosurgery and Other Miniinvasive Techniques / Wideochirurgia i Inne Techniki Malo Inwazyjne 06/2014; 9(2):282-5. DOI:10.5114/wiitm.2014.41622 · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: This systematic review was performed to introduce the two-staged hepatectomy procedure (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy - ALPPS) and present its current results.Material and methods: We conducted a systematic literature search using the PubMed database with key words "ALPPS" or "staged liver resection". The inclusion criteria were randomized trials or cohort studies. Case reports were excluded. The primary end-point was the assessment of liver tissue hypertrophy after the ALPPS procedure. Morbidity and mortality evaluation were the secondary end-point. Results: After an electronic data search of PubMed with the selected key words, six cohort studies evaluating 96 patients met the inclusion criteria. There was no prospective randomised trial. Based on the results of the individual studies, liver hypertrophy ranged from 74 to 87%. Morbidity and mortality ranged from 53 to 71% and 0 to 13% respectively. Conlcusions: Despite the higher morbidity and mortality the ALPPS procedure could be a promising technique for a selected group of patients with multiple liver tumors. However long term results are not yet available. Key words: ALPPS - liver hypertrophy - portal vein ligation- liver resection - multiple liver metastases.
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to evaluate the prognostic significance of blood transfusion on recurrence and survival in patients undergoing curative resections for colorectal cancer. Retrospective analysis of prospectively collected data of patients after elective resections for colorectal cancer between January 2001 and December 2009 was undertaken. The main endpoint was overall survival, disease-free survival, and recurrence rate. These data were evaluated in relation to blood transfusion (group A, no blood transfusion; group B, one to two blood transfusions; group C, three and more blood transfusions). A total of 583 patients met the criteria for inclusion in the study. Of these, 132 (22.6 %) patients received blood transfusion in the perioperative period. There were 83 (14.2 %) patients who received one or two blood transfusions and 49 (8.4 %) patients who required three or more transfusions. Patients with three or more transfusions had a significantly worse 5-year overall survival, disease-free survival, and increased incidence of distant recurrences in comparison with the group without transfusion or the group with one or two transfusions. Multivariate analysis showed that the application of three or more blood transfusions is an independent risk factor for overall survival (P = 0.001; HR 2.158; 95 % CI 1.370–3.398), disease-free survival (P < 0.001; HR 2.514; 95 % CI 1.648–3.836), and the incidence of distant recurrence (P < 0.001; HR 2.902; 95 % CI 1.616–5.212). Application of three or more blood transfusions in patients operated for colorectal carcinoma is an adverse prognostic factor. Indications for blood transfusion should be carefully considered not only with regard to the risk of early complications, but also because of the possibility of compromising long-term results.
Indian Journal of Surgery 04/2013; 75(2). DOI:10.1007/s12262-012-0427-6 · 0.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This case report presents the course of illness, as well as the diagnosis and therapy, of acute thrombosis and abdominal aortic dissection after Fogarty thrombectomy with the symptoms of acute limb ischaemia in a 42-year-old female patient suffering from heparin-induced thrombocytopenia. HIT is a severe iatrogenic complication emerging after unfractionated or low molecular weight heparin administration, with rather easy diagnosis; however, it is often neglected due to the rarity of its occurrence. Key words: heparin-thrombocytopenia-platelets-abdominal aortic dissection-abdominal aortic thrombosis.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2013; 92(11):650-3.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Intoxicated patients represent only a minimum of the total number of cadaveric donors; however, their significance within the transplant program in the Czech Republic has recently been emphasized in connection with the so-called methanol affair. Material and methods: A retrospective analysis of methanol-poisoned patients who were declared brain-dead and subsequently underwent organ removal for transplantation purposes in the University Hospital Ostrava was performed. In cooperation with other transplant centres (Institute for Clinical and Experimental Medicine, Transplant Centre of the University Hospital Hradec Králové, Centre for Cardiovascular and Transplantation Surgery in Brno) the graft function, postoperative morbidity and mortality was evaluated. Results: During the study period (since September 2012), organs from three brain-dead donors as a result of methanol intoxication were retrieved in the Transplant Centre of the University Hospital Ostrava. Subsequently, six kidneys were transplanted (3 males, 3 females). Postoperative complications occurred in two patients (33.3%), one patient died (16.7%). In one case (16.7%), the graft failed. None of the graft recipients developed clinical or laboratory signs of methanol poisoning. Conclusion: Death due to methanol intoxication is not a contraindication to organ donation, graft function and patient survival being comparable to organs from non-intoxicated donors. Key words: transplantation - methanol intoxication - organ donation.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2013; 92(4):201-204.
[Show abstract][Hide abstract] ABSTRACT: Parastomal hernia is a very common complication after stoma formation. Current surgical procedures for repairing parastomal hernia have unsatisfactory results. The aim of this study was to evaluate our initial experience with laparoscopic prophylactic mesh placement at the time of stoma formation.
Four patients underwent laparoscopic abdominoperineal rectal cancer resection with prophylactic parastomal mesh placement. A specially designed mesh made of polyvinylidene fluoride with central funnel (Dynamesh IPST) was implanted using an intraperitoneal onlay technique. The surgical data, the frequency of mesh-related complications as well as the rate of parastomal henias were evaluated.
The mean operating time for mesh placement was 15 min (10-25 min.). No mesh- related complications or infection was observed and no parastomal hernia could be detected clinically. To this date, the mean follow up time has been six months (4-8 months).
Laparoscopic prophylactic parastomal mesh placement might be a safe and effective procedure with a potential to reduce the risk of parastomal hernia, at least in the short run. However, our experience is limited due to the small number of patients included in the study. Additional large trials with long term follow up are necessary.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 04/2012; 91(4):216-8.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic surgery for colon cancer has been proven safe, but controversy continues over implementation of laparoscopic technique for rectal cancer. The aim of this study was to compare the long-term outcomes of laparoscopically assisted and open surgery for nonmetastatic colorectal cancer.
From January 2001 to December 2006 all patients with nonmetastatic adenocarcinoma of the colon and rectum were considered for inclusion in this prospective non-randomised trial. The primary endpoint was overall survival, disease free survival and recurrence rate. Analysis was by intention to treat.
A total of 365 resections were performed for nonmetastatic adenocarcinoma of the colon and rectum during the study period. Of those resections, 220 were colonic and 145 were rectal. In the patients with colon cancer 119 (54.1%) were operated laparoscopically and 101 (45.9%) by open surgery, in the patients with rectal cancer 75 (51.7%) were treated by laparoscopy and 70 (48.3%) by open technique. No statistically significant difference was found between the laparoscopic and open group regarding 5-year overall survival (p = 0.17 for colon cancer, p = 0.60 for rectal cancer), 5-year disease free survival (p = 0.25 for colon cancer, p = 0.81 for rectal cancer) and overall recurrence (p = 0.78 for colon cancer, p = 0.79 for rectal cancer). With respect to the tumor stage, in rectal cancer the probability of 5-year disease free survival was significantly higher in the laparoscopic group in stage III (p = 0.03).
Laparoscopic surgery for colorectal cancer is an oncologically safe procedure that is associated with a survival and recurrence rate equal to open surgery.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to asses our initial first experience with NOSE techniques in laparoscopic colorectal surgery with both transanal and transvaginal extraction.
In this prospective study, the authors analyzed data from patients in whom NOSE laparoscopic sigmoid, rectosigmoid and rectal resections were performed in the Department of Surgery, University Hospital Ostrava, from May 2011 to October 2011. A group of 7 patients was analyzed based on demographic characteristics (sex,age and BMI). Tumor localization, type of extraction (transanal/transvaginal), the number of removed lymph nodes, tumor size, histology and length of the specimen were also assessed. Furthermore, the following intraoperative data were evaluated: duration of the procedure, frequency of intraoperative complications and conversion rate. During the postoperative period, duration of hospitalization and morbidity rates were evaluated.
The patient group included 2 male (28.6%) and 5 female (71.4%) subjects, their median age was 70 years (61-80), BMI 26,76 (24.76-34.67). The pathology was located in the sigmoid colon in 4 cases (57.1%) and in the proximal rectum in 3 cases (42.9%). Transanal extraction was performed in 5 patients (71.4%) and transvaginal extraction in 2 patients (28.6%). The average number of harvested lymph nodes was 13 (10-15), the average lenght of specimen was 16 cm (13-20) and the average tumor size was 4 cm (2-6). Histologically, adenocarcinoma was confirmed in 6 cases (85.7%), and low grade adenoma in 1 case (14.3%). The median duration of surgery was 205 min (140-300) and no intraoperative complications were recorded. No surgical conversion was required. No postoperative complications occured and the median duration of of hospital stay was 7 days (5-11). CONSLUSION: In the selected group of patients, NOSE technique proved to be a safe technique for laparoscopic colorectal procedures, reducing the risk of incisional complications while maintaining the principles of oncological radicality. Therefore, it may be considered a bridge towards NOTES (Natural Orifice Transluminal Endoscopic Surgery), surgery without scars.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2012; 91(3):141-5.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to asses the role of laparoscopy based on experiences with 1000 miniinvasive colorectal procedures.
The prospective study of 1000 patients after elective laparoscopic procedures for colorectal diseases at Municipal Hospital Ostrava Fifejdy and the Surgical Clinic of University Hospital Ostrava between February 1993 and December 2010 was undertaken. Patients with both benign and malignant colorectal pathologies were included in the study. Except of baseline demographic data, the types of surgical procedure, conversion rates, peroperative complications, blood loss, operating time, number and reasons for reoperations, postoperative morbitidy and mortality, number of blood transfusions and length of hospital stay were analysed. For the analysis descriptive statistics methods were used.
There were 609 men (60.9%) and 391 women (39.1%). The mean age was 64 years (range 15-97 years), mean BMI was 26.7 (range 14.6-48.0). The most frequent operations were on the right colon (22.2%), sigmoid colon (21.7%) and low anterior resections of the rectum (20.4%). Peroperative complications were in 44 patients (4.4%). Reoperations were necessary in 105 patients (10.5%), postoperative morbidity was 22.6% and 30-day mortality was 4.1%.
Laparoscopy is safe and effective method in the treatment of both malignant and benign diseases of colon and rectum.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 08/2011; 90(8):457-62.
[Show abstract][Hide abstract] ABSTRACT: Colonoscopy is an effective both diagnostic and therapeutic method. Despite its wide use, however, colonoscopy may be associated with complications occurrence, of which the most serious is bleeding and perforation. Iatrogenic perforation can lead to the peritonitis with high morbidity and mortality. The relative frequency of perforation in diagnostic colonoscopies is 0.03-0.8%, for therapeutic colonoscopy 0.15-3%. The most iatrogenic perforations are located on sigmoid colon.
The endoscopic unit of University Hospital Ostrava performed a total of 7800 colonoscopy in the period between 1st January 2006 to 31st December 2010. In 8 patients (0.1%) occurred perforation of the colorectum. In all patients, this complication arose during diagnostic colonoscopy and was treated by surgery. Six patients (75%) were operated on within 24 hours from the performance of colonoscopy, 2 patients (25%) were operated after more than 24 hours. In 5 patients (62.5%) the left colon including rectum was perforated, in 3 patients (37.5%) perforation occurred in right colon.
Postoperative complications occurred in 7 patients, postoperative morbidity was 87.5%. In 1 patient (12.5%) surgical revision was necessary. 2 patients died within 30 days after surgery, mortality was 25%.
Iatrogenic perforation of the colorectum is one of the most serious complications during colonoscopy. Early and optimal treatment is crucial for the subsequent reduction of serious complications and mortality.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 07/2011; 90(7):389-92.
[Show abstract][Hide abstract] ABSTRACT: Worldwide, the number of suitable cadaverous donors is limited. Therefore, as a solution for patients with chronic renal failure appears to extend the group of living donors of healthy individuals who voluntarily donate kidney to relatives or emotionally related recipients. Given the altruistic circumstances of these operations, the main monitored parameters are security for donors and excellent graft function for recipients. Currently published works show that minimally invasive technique can guarantee comparable results with open access in both monitored parameters. The aim of this study is to asses our results with laparoscopic assisted living donor nephrectomy for transplantation.
In retrospective study we analyzed data of patients in whom laparoscopic donor nephrectomy was performed on the Surgical Clinic, University Hospital Ostrava in the period from May 13, 2002 to June 30, 2010. Group of 34 donors were analyzed according to demographic characteristics (sex, age, ASA classification and BMI). From the perioperative data were monitored length of operation and warm ischemia, blood loss, frequency of intraoperative complications and conversion rate. In the postoperative period were evaluated in donors length of postoperative hospitalization, frequency of early and late reoperations, causes of morbidity and mortality, dynamics of the levels of creatinine and in the recipients was monitored 1-year survival of the graft.
There were 14 men (41%) and 20 women (59%), median age was 48 years (25-77 years), BMI 26.9 (18.7-37.0), 53% of patients were ASA II, 44% ASA I, 1 patient (3%) ASA III. Median length of operation was 180 min (90-300 min), warm ischemia 120 s (58-240 s), blood loss 50 ml (30-1000 ml). There was no conversion. Intraoperative complications occured in 3 donors (8.8%). The length of hospital stay was 7 days (3-26 days), morbidity rate was 14.7%, without mortality. Early reoperations were in 2 patients (5.9%), late reoperations were performed in 4 patients (11.8%). In donors an average increase of creatinine value was 35.5 micromol/l the first postoperative day. One-year graft survival in our cohort was 94.1%.
For patients with terminal renal insufficiency the living donor kidney transplantation offers possibility to shorten time in waiting list and to ensure a better graft function with its longer survival. Minimally invasive laparoscopic technique (we prefer transperitoneal approach), represents a safe alternative to open operation.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 05/2011; 90(5):293-7.
[Show abstract][Hide abstract] ABSTRACT: The hitherto published data did not provide clear answer to whether the adjustment of poor runoff through infrainguinal by-pass can improve long-term patency of iliac interventions in patients with multiple-stage arterial lesion. Our intent was to respond to this question.
In the period since 1st January 2003 until 31st May 2005 we evaluated two groups of revascularized patients with similar angiographic affection of the iliac and femoropopliteal arteries and statistically comparable input parameters. In the first group incorporating 38 procedures the vascular surgeon performed hybrid intervention (group 1)--one-step iliac intervention with infrainguinal ipsilateral bypass, in the second group incorporating 43 patients angioradiologist performed single percutaneous iliac intervention in catheterization laboratory (group 2).
Observation median was 71 months (60-86). Three-year primary patency of iliac interventions was 83% in the hybrid group (group 1) and 72% in single angioplasty group (group 2). Five-year patency was 77% in group 1 and 69% in group 2. In secondary patency the three-year and five-year patency was 94% in group 1 and 83% in group 2. Statistically we did not prove that poor infrainguinal runoff is negative factor of primary patency of iliac intervention (K-M, log rank test, p = 0.58628), as well as secondary patency (p = 0.11474).
From the long-term perspective it is not possible to consider poor runoff to be independent risk factor of patency of iliac intervention. Infrainguinal bypass within the hybrid procedures shall not improve the results of iliac intervention.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2011; 90(1):46-51.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the results of laparoscopically-assisted (LAC) and open (OC) colorectal surgery in elderly patients (a 75 years) and to compare them to a cohort of younger patients (<75 years) undergoing similar surgical procedures.
Patients who underwent elective laparoscopically-assisted or open colorectal surgery in the period between January 2001 and December 2009 were included in the analysis. The primary end point was the incidence of short-term postoperative morbidity and mortality, long-term overall and colorectal cancer specific survival which were analyzed in relation to the age and operative technique.
During the study period, 557 elective laparoscopic and 404 elective open colorectal operations were performed. 190 patients (20 %) were older than 75 years, 99 of which underwent laparoscopic and 91 open surgery. In geriatric patients, the open approach was associated with increase of postoperative morbidity, statistically nonsignificant (LAC > or = 75 years 30% vs. OC < 75 years 40%, p = 0,151). In the laparoscopic procedures, the morbidity rate did not differ in both age groups (LAC > or = 75 years 30% vs. LAC < 75 years 28%, p = 0,702). Conversely open procedures in elderly patients were associated with a significant increase of postoperative complications compared to younger patients (OC > or = 75 years 40% vs. OC < 75 years 29%, p= 0,033). There was no difference in postoperative mortality rate between laparoscopic and open approach in geriatric patients (LAC > or = 75 years 5% vs. OC > or = 75 years 3%, p=0,548). Mortality rate did not differ in both age groups operated laparoscopically (LAC > or = 75 years 5% vs. LAC < 75 years 3%, p = 0,322) even by open approach (OC > or = 75 years 3% vs. OC <75 years 2%, p = 0,433). Although five year overall survival was significantly lower in the older age group (LAC > or = 75 years 43 +/- 8% vs. LAC < 75 years 58 +/- 4 %, p = 0,049; OC - 75 years 35 +/- 7% vs. OC < 75 years 56 +/- 4%, p = 0,006), five year colorectal cancer specific survival was not different between both age groups (LAC > or = 75 years 76 +/- 9% vs. LAC < 75 years 75 +/- 4%, p = 0,693; OC > or = 75 years 67 +/- 7% vs. OC < 75 years 69 +/- 4%, p = 0,824). In the elderly patients surgical technique did not influenced overall five year survival (LAC > or = 75 years 43 +/- 8% vs. OC > or = 75 years 35 +/- 7%, p = 0,428), even five year colorectal cancer specific survival (LAC . or = 75 years 76 +/- 9% vs. OC a 75 years 69 +/- 7%, p = 0,393).
Laparoscopically-assisted colorectal surgery should be particularly considered in geriatric patients, for the reason of lower incidence of postoperative complications. Oncological safety of miniinvasive approach in the treatment of colorectal cancer is valid also for the specific group of elderly patients.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 10/2010; 89(10):628-33.
[Show abstract][Hide abstract] ABSTRACT: Esophagectomy was performed by transhiatal approach from laparotomy or laparotomy combinated with thoracotomy till the beginning of 90th of 20th century. These procedures are associated with high morbidity (40-80%) and mortality (5-15%) rate. There is a tendency of using minimally invasive approach in esophageal surgery with preserving oncological radicality. Based on our experiences with minimally invasive esophagectomy and gastric replacement we would like to introduce a technique which is considered optimal in our department.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 08/2009; 88(8):422-4.
[Show abstract][Hide abstract] ABSTRACT: Retrorectal cysts are rare benign lesions in the presacral space which are frequently diagnosed in middle-aged females. We report here our experience with two symptomatic female patients who were diagnosed as having a retrorectal cyst and managed using a laparoscopic approach. The two patients were misdiagnosed as having an ovarian cystic lesion after abdominal ultrasonography. Computer tomograghy (CT) scan was mandatory to establish the diagnosis. The trocar port site was the same in both patients. An additional left oophorectomy was done for a coexisting ovarian cystic lesion in one patient in the same setting. There was no postoperative morbidity or mortality and the two patients were discharged on the 5th and 6th post operative days, respectively. Our cases show that laparoscopic management of retrorectal cysts is a safe approach. It reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space.
World Journal of Gastroenterology 12/2008; 14(42):6581-3. · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In European countries, choledochal cysts are rare anomalies of the bile tract. At the Surgery Department of the University Hospital Ostrava, a case of a patient with cystic lesion of the pancreatic head was solved. According to ultrasonography and computer tomography it was assumed to be a pancreatic pseudocyst. Only after a complete additional examination of the pancreatico-biliary system, was it diagnosed Ia-type cystic dilatation of the common bile duct, accompanied by stenosis in its terminal part. With regard to the age of the first clinical symptoms, their character and histopathological findings, congenital origin is assumed in both of these anomalies. After provisional percutaneous transhepatic biliary drainage, a duodenohemipancreatectomy was performed with complete cyst excision. Until now, nine months later, the patient has shown absolutely no clinical difficulties.
[Show abstract][Hide abstract] ABSTRACT: Biliary ileus is a rare complication of cholelithiasis, counting for 1-4% of all intestinal obstructions. The aim of the work is to summarize diagnostic and treatment options, assess significance of laparoscopy in this rare form of ileus, based on the authors' own experience and available literature.
The retrospective study analyzed data of patients operated for biliary ileus in the Surgical clinic of the Faculty Hospital in Ostrava during 2002-2006. The following criteria were assessed in the patient group including 9 subjects: gender, age, secondary disorders. ASA (American Society of Anesthesiologists) classification of the subjects, symptomatology, results of preoperative visualization methods examinations and intervals between the disease onset and the procedure. The following peroperative data were collected: duration of the procedure, type of the procedure, complications, obstruction site and concrement size. Duration of postoperative hospitalization and complications arising during this period were recorded.
Concrements were extracted through laparotomy in 5 patients, in 3 subjects the procedure was conducted laparoscopically. In 1 subject, the concrement extraction procedure was conducted together with cholecystectomy and a cholecystoduodenal fistule closure. No complications were recorded peroperatively, in case of the laparoscopic procedure, conversion was not requred. Obstruction site was localized on the jejunum in 3 subjects, on the ileus in 6 subjects. The concrement size ranged from 2x3 cm to 4x6 cm. The mean procedure duration was 61 minutes. The median of postoperative hospitalization was 12 days. During the postoperative period, complications were recorded in 6 subjects, 1 patient exited due to multiorgan failure.
Early timely diagnostics with a significant role of the CT examination is inevitable in patients with rare forms of intestinal obstruction. Adequate surgical management considering the patient's overall condition must be introduced. Taking into consideration the patients age and their polymorbidity, extraction of concrements via enterotomy remains the method of first choice. Duration of postoperative hospitalization depends on frequent complication rates.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 03/2007; 86(2):103-5.
[Show abstract][Hide abstract] ABSTRACT: The colon injury during a colonoscopy is a rare, however a serious complication, requiring, mostly, a surgical management. Only few patients may undergo a conservative treatment. The authors discuss the problem of the iatrogenic colon perforation during the colonoscopy and they assess a benefit of the miniinvasive surgery in the diagnostics and treatment algorithm. The main benefit is seen in the reduction of the surgical intervention risks, in the surgical trauma minimalisation, in more favourable postoperative status and in the possibility of the definitive injury management.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 12/2004; 83(11):559-61.
[Show abstract][Hide abstract] ABSTRACT: Manually assisted laparoscopic nephrectomy from a live donor combines the advantage of a mini-invasive approach with the advantage of the assisting hand in the abdominal cavity to which the surgeon is used from classical operations. The authors performed the first nephrectomy from a live donor by this method on May 13, 2002. Our initial experience with five nephrectomies by this method indicate that every subsequent operation was shorter and the period of warm ischemia was also shorter. There was no postoperative complication. In the second operation suppuration of the minilaparotomy occurred which protracted hospitalization and the convalescent period. The prerequisite of these operations is a certain amount of experience with laparoscopic operations. This type of nephrectomy has the general advantages of a miniinvasive approach, i.e. greater postoperative comfort and a shorter convalescence as compared with an open operation. The period of warm ischaemia does not differ markedly from nephrectmies by the classical procedure.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 05/2003; 82(4):188-91.
[Show abstract][Hide abstract] ABSTRACT: Hand-assisted laparoscopic surgery extends the possibilities of laparoscopic operations while preserving the miniinvasive character of the operation. The objective of the work is, based on the authors' experience with a group of 28 patients operated by this method for diseases of the colorectum to describe the surgical technique, present their results and emphasize the indications and advantages of this procedure.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 12/2002; 81(11):560-3.