RESUMO
Frantz tumors or solid pseudopapillary pancreatic neoplasm (SPN) are rare exocrine neoplasms that carry a favorable prognosis; they represent up to 3% of all tumors located in the region of the pancreas and have specific age and gender predispositions. In recent years, the rising curve of diagnosis is entitled to the evolution and access of diagnostic imaging. In this paper, we have retrospectively reviewed and described the clinical course of 40 patients with SPN from three institutions in Brazil, who had their diagnosis between 2005 and 2020, and analyzed the clinicopathological, genetic, and surgical aspects of these individuals. In accordance with the literature, most patients were women, 60% with unspecified symptoms at diagnosis, with tumors mainly located in the body and tail of the pancreas, of whom 70% underwent a distal pancreatectomy with sparing splenectomy as a standard procedure, and none of the cases have experienced recurrence to date. Surgery still remains the mainstay of treatment given the low metastatic potential, but more conservative approaches as observed in this cohort are evolving to become the standard of care. Herein, we present an in-depth analysis of cases focusing on the latest literature and report some of the smallest tumor cases in the literature. To our knowledge, this is the first report evaluating germline genetic testing and presenting a case of detected Li-Fraumeni syndrome.
Assuntos
Neoplasias Pancreáticas , Humanos , Feminino , Masculino , Brasil , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/diagnóstico , Estudos Retrospectivos , Pancreatectomia/métodos , Pâncreas/patologiaRESUMO
ABSTRACT The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe.
RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram a utilidade da tecnologia em diferentes procedimentos. Dose ideal, local e tempo da injeção do corante ainda não estão bem estabelecidos. Estudos comparativos de alta qualidade epidemiológica baseados em evidência ainda não estão disponíveis. No entanto, os resultados iniciais são bons e seguros.
Assuntos
Humanos , Diagnóstico por Imagem/métodos , Monitorização Intraoperatória , Cirurgia Assistida por Computador/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Raios Infravermelhos , Sistema Biliar/anatomia & histologia , Diagnóstico por Imagem/instrumentação , Estudos de Viabilidade , Verde de IndocianinaRESUMO
The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe. RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram a utilidade da tecnologia em diferentes procedimentos. Dose ideal, local e tempo da injeção do corante ainda não estão bem estabelecidos. Estudos comparativos de alta qualidade epidemiológica baseados em evidência ainda não estão disponíveis. No entanto, os resultados iniciais são bons e seguros.
Assuntos
Diagnóstico por Imagem/métodos , Raios Infravermelhos , Monitorização Intraoperatória , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Sistema Biliar/anatomia & histologia , Diagnóstico por Imagem/instrumentação , Estudos de Viabilidade , Humanos , Verde de IndocianinaRESUMO
The technique of a single-port laparoscopy was developed over the last years as an attempt to lower surgical aggression and improve the aesthetic results of the minimally invasive surgery. A new robotic platform used with the da Vinci® Robotic System Single-Site System® (Intuitive Surgical, Sunnyvale, California, United States) was recently launched on the global market and is still not documented in Brazil. The authors report on the first four robotic single-port cholecystectomies performed with this da Vinci® Robotic System in Brazil.
A técnica de um único portal laparoscópico foi desenvolvida ao longo dos últimos anos, numa tentativa de diminuir a agressão cirúrgica e melhorar ainda mais os resultados estéticos da cirurgia minimamente invasiva. Uma nova plataforma robótica, usada com o Sistema Robótico da Vinci®Single-Site System® (Intuitive Surgical, Sunnyvale, Califórnia, Estados Unidos), foi recentemente lançada no mercado mundial e é ainda inédita no Brasil. Os autores relatam as primeiras quatro colecistectomias robóticas com portal único realizadas com este Sistema Robótico da Vinci® no Brasil.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Colecistectomia Laparoscópica/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Anestesia Geral , Brasil , Invenções , Segurança do Paciente/normas , Procedimentos Cirúrgicos Robóticos/instrumentaçãoRESUMO
The technique of a single-port laparoscopy was developed over the last years as an attempt to lower surgical aggression and improve the aesthetic results of the minimally invasive surgery. A new robotic platform used with the da Vinci® Robotic System Single-Site System® (Intuitive Surgical, Sunnyvale, California, United States) was recently launched on the global market and is still not documented in Brazil. The authors report on the first four robotic single-port cholecystectomies performed with this da Vinci® Robotic System in Brazil.
Assuntos
Colecistectomia Laparoscópica/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Anestesia Geral , Brasil , Feminino , Humanos , Invenções , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/normas , Procedimentos Cirúrgicos Robóticos/instrumentaçãoRESUMO
PURPOSE: To test the use of diffusion-weighted magnetic resonance imaging (DW-MRI) to differentiate between different degrees of severity of acute pancreatitis (AP). METHOD: Thirty-six patients who underwent DW-MRI and magnetic resonance cholangiopancreatography were divided into patients with mild AP (mAP, n = 15), patients with necrotizing AP (nAP, n = 8), and patients with a normal pancreas (nP, n = 15; controls). The pancreas was divided into head, body, and tail, and each segment was classified according to image features: pattern 1, normal; pattern 2, mild inflammation; and pattern 3, necrosis. Apparent diffusion coefficients (ADCs) were measured in each segment and correlated with clinical diagnoses. RESULTS: A total of 108 segments was assessed (three segments per patient). Segments classified as pattern 1 in the nP and mAP groups showed similar ADC values (P = 0.29). ADC values calculated for the pancreatic segments grouped according to the different image patterns (1-3) were significantly different (P < 0.001). Comparisons revealed significant differences in signal intensity between all three patterns (P < 0.05). CONCLUSIONS: DW-MRI was a compatible and safe image option to differentiate tissue image patterns in patients with mAP, nAP, and nP, mainly in those with contraindications to contrast-enhanced MRI (which is classically required for determining the presence of necrosis) or computed tomography. ADC measures allowed precise differentiation between patterns 1, 2, and 3.
Assuntos
Imagem de Difusão por Ressonância Magnética , Pancreatite/diagnóstico , Doença Aguda , Adulto , Idoso , Meios de Contraste , Feminino , Gadolínio , Humanos , Aumento da Imagem , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND: In recent years, there has been renewed interest in using robotics in bariatric surgery for the treatment of morbid obesity. However, the high cost of a robotic surgical system has hindered its widespread use in developing countries. This study aims to compare the rate of morbidity, weight loss, and relative costs between laparoscopic (LSG) and robotic-assisted sleeve gastrectomy (RSG) performed for the treatment of obesity in a single center in Brazil. METHODS: From January 2011 to March 2013, 48 severely obese patients underwent either LSG or RSG at our institution and were prospectively followed up for 12 months. Patients were free to choose either approach and were informed of any extra costs that may be incurred. RESULTS: Thirty-two patients underwent LSG and 16 patients, RSG. No significant differences were observed between LSG and RSG groups regarding age, sex, BMI, incidence of comorbidities, duration of surgery, and length of hospital stay. Also, there were no significant between-group differences in BMI values evaluated at 6 and 12 months after surgery. Surgical costs were almost twice as high and total hospital costs were approximately 50 % higher in the robotic approach compared to the laparoscopic approach. CONCLUSION: Both RSG and LSG had excellent and similar post-operative clinical outcomes. However, the much higher costs of purchasing and maintaining the robotic system are still precluding the use of RSG as a routine approach in the treatment of morbid obesity in Brazil.
Assuntos
Gastrectomia , Custos Hospitalares , Laparoscopia , Obesidade Mórbida/cirurgia , Procedimentos Cirúrgicos Robóticos , Redução de Peso , Adulto , Brasil , Estudos de Coortes , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/economia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/economia , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Deep infiltrating pelvic endometriosis with bowel involvement is one of the most aggressive forms of endometriosis. Nowadays, robotic technology and telemanipulation systems represent the latest developments in minimally invasive surgery. The aim of this study is to present our preliminary results and evaluate the feasibility of robotic-assisted laparoscopic colorectal resection for severe endometriosis. METHODS: Between September 2009 and December 2011, 10 women with colorectal endometriosis underwent surgery with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). We evaluated the following parameters: short-term complications, clinical outcomes and long-term follow-up, pain relief recurrence rate, and fertility outcomes. RESULTS: Extensive ureterolysis was required in 8 women (80%). Ovarian cystectomy with removal of the cystic wall was performed in 7 women (70%). Torus resection was performed in all women, with unilateral and bilateral uterosacral ligament resection in 1 woman (10%) and 8 women (80%), respectively. In addition to segmental colorectal resection in all cases, partial vaginal resection was necessary in 2 women (20%). An appendectomy was performed in 2 patients (20%). The mean operative time with the robot was 157 minutes (range, 90-190 minutes). The mean hospital stay was 3 days. Six patients had infertility before surgery, with a mean infertility time of 2 years. After a 12-month follow-up period, 4 women (67%) conceived naturally and 2 (33%) underwent in vitro fertilization. CONCLUSION: We show that robotic-assisted laparoscopic surgery for the treatment of deep infiltrating bowel endometriosis is feasible, effective, and safe.
Assuntos
Colo Sigmoide/cirurgia , Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/cirurgia , Doenças Retais/cirurgia , Reto/cirurgia , Adulto , Doenças do Colo/patologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/patologia , Robótica , Ureter/cirurgiaRESUMO
BACKGROUND/AIMS: Pancreatic cystic lesions are increasingly being recognized. Magnetic resonance imaging (MRI) is the method that brings the greatest amount of information about the morphologic features of pancreatic cystic lesions. To establish if diffusion-weighted MRI (DW-MRI) can be used as a tool to differentiate mucinous from nonmucinous lesions. METHODS: Fifty-six patients with pancreatic cystic lesions (benign, n = 46; malignant, n = 10) were prospectively evaluated with DW-MRI in order to differentiate mucinous from nonmucinous lesions. Final diagnosis was obtained by follow-up (n = 31), surgery (n = 16) or endoscopic ultrasound-guided fine needle aspiration (n = 9). Serous cystadenoma was identified in 32 (57%) patients. RESULTS: The threshold value established for the differentiation of mucinous from nonmucinous lesions was 2,230.06 s/mm(2) for ADC of 700. DWI-MRI behavior between mucinous and nonmucinous groups revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy to be 80, 98, 92, 93 and 93%, respectively (p < 0.01, power of sample = 1.0). In the comparison of the diffusion behavior between mucinous (n = 13) and serous (n = 32) lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100, 97, 92, 100 and 98%, respectively (p < 0.01, power of sample = 1.0). The results of endoscopic ultrasound-guided fine needle aspiration were similar to those of DW-MRI. CONCLUSIONS: DW-MRI can be included as part of the array of tools to differentiate mucinous from nonmucinous lesions and can help in the management of pancreatic cystic lesions. and IAP.
Assuntos
Adenocarcinoma Mucinoso/diagnóstico , Cistadenoma Seroso/diagnóstico , Imageamento por Ressonância Magnética/métodos , Neoplasias Pancreáticas/diagnóstico , Pseudocisto Pancreático/diagnóstico , Adenocarcinoma Mucinoso/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Biópsia por Agulha Fina , Cistadenoma Seroso/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/metabolismo , Cisto Pancreático , Neoplasias Pancreáticas/metabolismo , Pseudocisto Pancreático/metabolismo , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Appendiceal diverticulitis is an uncommon condition, mimicking appendicitis, but with greater risk of perforation and complications. Preoperative diagnosis is rare, but can be achieved by ultrasonography as identification of the diverticulum and classical signs of appendicitis. We report a case of ultrasonographic diagnosis of a perforated appendiceal diverticulitis in an adult male and discuss this condition.
A diverticulite do apêndice é uma patologia incomum, eventualmente confundida com a apendicite cecal, tendo, porém, maior risco de perfuração e de outras complicações. Seu diagnóstico pré-cirúrgico é raramente realizado, mas pode ser obtido pela ultrassonografia com a demonstração de um divertículo associado a sinais clássicos de apendicite. Relatamos o caso de um homem adulto em que foi possível o diagnóstico ultrassonográfico de diverticulite do apêndice cecal e revisamos os principais aspectos relacionados a essa condição.