Embed Size (px)
Citation preview
Euro-Surgery - 2018
A n n u a l S u m m i t o n
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Surgery
Page 17
Day
1K
ey
no
te F
oru
m
A n n u a l S u m m i t o n
Surgery
Journal of Universal SurgeryISSN: 2254-6758
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Euro-Surgery 2018Page 18
Autologous fat grafting started more than 100 years ago, but continuous technical progress and research results increased interest in this procedure.
Ground-breaking was Coleman’s technique as a graft lipostructure and Klein tumescent technique of liposuction which facilitate application of this method. The author describes own research results of fat tissue harvesting (2009), preparing for transplantation through decantation and rubbing –pumping the fat tissue between two syringe, similar like producing sklero foam in phlebology. The overview of results of animals’ research and using of conditioning devices for preparation of fat are discussed. Despite the widely application: there is no evidence of harvesting, preparation and injection. The power point presentation shows preparation technique, preoperative and postoperative results and complications.
BiographyJanusz S Targonski has finished Medicine from University of Gdansk in 1967, consultant of Surgery and Service in Collegium Medicum in Bydgoszcz Poland. Since 1978 living in Germany, he has been the Head of Departament of Gen Surgery 1980-86, served in University Witten Herdecke, has completed his PhD in 1986 and in 1994 Co-worker in Praxis Klinik Hagen Center of Ambulatory Surgery, Hagen Germany.
Autologous fat grafting for facial filling and regenerationJanusz S TargonskiMedBeauty Institute, Dortmund, Germany
Janusz S Targonski, J Univer Surg 2018, Volume: 6DOI: 10.21767/2254-6758-C1-001
A n n u a l S u m m i t o n
Surgery
Journal of Universal SurgeryISSN: 2254-6758
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Euro-Surgery 2018Page 19
Pancreatic cancer is solid malignant, chemoresistant tumour with unfavourable prognosis. Radical resection with adjuvant chemotherapy is only potential
curable therapeutic modality enabling to prolong survival of 25% patients. Borderline conception contents active approach to primary non-resectable patients to reach resectability by neoadjuvant chemo (radio) therapy. Palliative and symptomatic therapy is indicated in about 70 % patients. In the case of suspicious of pancreatic cancer, patient should be referral to specialized centre. Effective diagnostic therapeutic approach only guarantees optimal quality of life of these patients.
BiographyRyska M, after Faculty of Medicine in 1978, he joined as an In-ternal Aspirant at the Surgical Clinic of the Faculty Hospital in Prague, in 1984 he worked for 4 months at the Surgical Clinic in Uppsala, Sweden, and from 1984 until 1992, a clinic assistant. In 1991 he graduated from a postgraduate surgical school at Hammersmith Hospital in London. In 1992 he habilitated from surgery (Friedly surgery in the treatment of choledocholithiasis) and until 1994 he worked as an assistant professor of surgery at the Surgical Clinic of the 3rd Medical Faculty of Charles Uni-versity). In 1994 he joined the IKEM Cardiovascular and Trans-plantation Surgery Clinic and after completing a four-month in-ternship at the Virchow University Surgical Clinic in Berlin under Prof. P. Neuhause started a liver transplant program at IKEM. In 1997 and 1998, he completed his monthly study stays in Mt. Sinai Hospital in New York and UCLA in Los Angeles. In 1998 he founded the IKEM Transplantation Surgery Clinic, where he worked as its head until 2004. Since 2004, when he was ap-pointed Professor of Surgery, in 2005 he founded the Surgical Clinic of the 2nd Medical Faculty of the Charles University and the University Hospital Prague. For 4 months he was the Chief Medical Officer of the 6th Army Hospital of the Czech Army in Kabul (2008). Since 1 July 2010 he has served as Deputy Direc-tor of the Prague National Institute for Science and Education. From 12/2011 to 7/2014 he was a member of the Government Council for Science, Research and Innovation. From 1.4. 2014 is the chair of the newly established Agency for Health Research.
Pancreatic cancer: radical surgery as a part of multimodal treatmentRyska M and Nikov ACharles University and Central Military Hospital, Prague
Ryska M et al., J Univer Surg 2018, Volume: 6DOI: 10.21767/2254-6758-C1-001
A n n u a l S u m m i t o n
Surgery
Journal of Universal SurgeryISSN: 2254-6758
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Euro-Surgery 2018Page 20
Aim: To describe difficulties, surprises and risks in urgent surgery in patients with complicated large paraesophageal hernia (PEH) and distal gastrointestinal obstacle.
Methods: Three cases with known PEH, I woman 78 yrs, II man 88 and III man 78, were urgently operated for strangulated/volvulised PEHs (I, II), and complete bowel obstruction due to strangulated dolichosigmoid volvulus (III). Cardiorespiratory embarrassment in all and sepsis in case I were encountered. Case I had coexistent incarcerated abdominal wall hernia, II had a previous-day gastroscopy that revealed a prepyloric lesion, and III a history of gastroesophageal reflux and constipation. Radiographies and chest-abdomen CT helped diagnosis. The findings are of in case I, after freeing the entrapped into the abdominal hernia bowel, the gastric fundus and body were found strangulated in mediastinum, fundus was ruptured, and antrum was ischaemic; total gastrectomy/splenectomy with stapled closure of esophagus and duodenum were performed. In case II, the whole stomach with prepyloric obstructive lesion was volvulised in mediastinum; distal gastrectomy/splenectomy, gastrojejunostomy, cruroraphy and fundopexy were performed. In case III, the strangulated dolichosigmoid volvulus was the prominent pathology, moreover, incarceration of gastric fundus and transverse colon in PEH sac were found; extended Hartmann's colectomy, caecopexy, reduction of PEH contents, cruroraphy and fundopexy were performed.
Results: Cases I and II were transferred intubated to ICU. Case I was never stabilized died after 50 hours; histology confirmed gastric necrosis. Case II was extubated at day 4, supported for pulmonary insufficiency, discharged at day 28; histology revealed antral ischaemia and obstructive prepyloric pT2 adenocarcinoma. Case III had uneventful outcome; histology revealed dolichosigmoid necrosis. Follow-up of cases II and III (16 and 4 months respectively) is uneventful as far as the hernia complications are concerned.
Conclusions: Obstructive conditions distal to large PEHs may trigger acute complications in hernia sac contents, independently of the prominent indication to urgent surgery.
BiographyAvgoustou C has specialized in General Surgery, working in the Greek National Health System since 1988, and his main areas of interest are Colon and Pelvic Surgery, Hepatobiliary Surgery, Gastric Surgery and Thyroid Surgery. He has been Director of Surgery in the Surgical Department of General Hospital of Nea Ionia ''Constantopoulion - Aghia Olga - Patission'' since 2008. He is Member of numerous Medical Societies. He has participated in hundreds of Congresses, with presentation of his work in 160, international in their majority. He has 111 publications, with 42 of them in international English-language Medical Journals. He has been trained in specific surgical topics, such as laparoscop-ic surgery, thoracic surgery, pelvic surgery etc.
Complicated paraesophageal hernia due to distal gastrointestinal obstructionAvgoustou C, Stamos N, Theodoropoulos Dand Fangrezos DGeneral Hospital of Nea Ionia ''Constantopoulion - Aghia Olga'',Athens, Greece
Avgoustou C et al., J Univer Surg 2018, Volume: 6DOI: 10.21767/2254-6758-C1-001
Euro-Surgery - 2018
A n n u a l S u m m i t o n
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Surgery
Page 33
Day
2K
ey
no
te F
oru
m
A n n u a l S u m m i t o n
Surgery
Journal of Universal SurgeryISSN: 2254-6758
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Euro-Surgery 2018Page 34
Introduction: According to a lack of knowledge, otoplasty often is regarded as a minor cos-metic procedure. Antihelix plasty has become a symbol for otoplasty. Due to the big variety of antihelical malformations it can be very challenging to get a truly natural result.
Objective & Methods: The filing technique allows creating a smooth curvature of the supe-rior crus and antihelical body by anterior access thus avoiding complications like hypertrophic scars or keloids in the post auricular space. If needed, the inferior crus must be addressed and released.
Results: Since 17 years the presented method was performed in more than 2000 ears. It has proven to be superior to the standard techniques.
BiographyRaunig Hermann after completing his studies of Medicine at the University of Graz Hermann Raunig, went on to obtain a degree in Otolaryngology in Leoben. He is a Member of the Eu-ropean Academy of Facial Plastic Surgery and the Austrian Academy of Cosmetic Surgery and Aesthetic Medicine. Furthermore, he undertook advanced specialist training as a Clinical Fellow in Facial Plastic and Cosmetic surgery from renowned centers in Swizerland, Germa-ny, USA and South Africa. Additionally, he has published a soft technique for otoplasty and has written several chapters in a textbook about otoplasty. He works at his private practice as well as an ENT consultant at the hospital Spittal an der Drau. His main focus and surgical specialties as an ENT include: Otoplasty, Rhinoplasty and Blepharoplasty.
The importance of antihelix plasty in otoplasty (release of the inferior crus)Raunig HermannHospital Spittal, Spittal an der Drau, Austria
Raunig Hermann, J Univer Surg 2018, Volume: 6DOI: 10.21767/2254-6758-C1-001
A n n u a l S u m m i t o n
Surgery
Journal of Universal SurgeryISSN: 2254-6758
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Euro-Surgery 2018Page 35
Introduction: Awake craniotomy with intraoperative brain mapping, allows for maximum tumor resection while monitoring neurological function and is used for lesions involving the eloquent areas of the brain, such as Broca's, Wernicke’s, or the primary motor area. Common techniques are MAC, using an unprotected airway, or the AAA technique, using a partially or totally protected airway.
Method: A prospective data collection and retrospective data analysis was conducted on 81 patients who underwent an awake craniotomy for an eloquent brain lesion over a 9 year period. 50 underwent anesthesia with the MAC technique and 31 patients underwent the AAA technique by a single surgeon and a team of anesthesiologists. MAC technique’s method has no set protocol for sedation, different medications for MAC based on the comfort level of anesthesiologist, requirements of the patient and whether the scalp block is working well. AAA technique’s method uses Propofol was used for induction followed by laryngeal mask airway placement. Anesthesia was maintained with sevoflurane until the patient was spontaneously ventilating and asleep. A complete scalp block was performed in all patients. Infiltrative block is performed at the pinning site, incision site and after craniotomy around the nerves supplying the duramater. Bupivacaine or Ropivacaine 0.5% with 1:200,000 of epinephrine is usually used
Resullts: The MAC and AAA groups had similar pre-operative patient and tumor characteristics. Mean operative time was shorter in the MAC group (283.5 minutes vs. 313.3 minutes; P: 0.038). Hypertension was the most common intraoperative complication seen (8% in the MAC group vs. 9.7% in the AAA group; P: 0.794). Intraoperative seizure occurred at a rate of 4% in the MAC group and 3.2% in the AAA group (P: 0.858). Awake cases were converted to general anesthesia in no patients in the MAC group and in 1 patient (3.2%) in the AAA group (P: 0.201). No cases were aborted in either group. The mean hospital length of stay was 3.98 days in the MAC group and 3.84 days in the AAA group (P: 0.833).
BiographyPunita Tripathi was a practicing Cardiac Anesthesiologist at India’s premier medical institute the All India Institute of Med-ical Sciences (AIIMS), New Delhi, before coming over to USA in 1996. There after she completed her Residency in Anesthe-siology from Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA in 2002. Since 2002 she is on Fac-ulty at Johns Hopkins University, Baltimore, MD. For the past five years she has been Director of Neurosurgical Anesthesia at Johns Hopkins Bayview Medical Center and has been ac-tively involved in writing protocols for Awake Craniotomy and Anesthesia for Neurosurgical cases. Her areas of interests are Neurosurgical Anesthesia, Thoracic Anesthesia and Obstetric Anesthesia. She has authored papers in reputable journals and written book chapters.
Awake craniotomy anesthesia: A comparison between the monitored anesthesia care (MAC) versus the asleep-awake-asleep (AAA) techniquePunita Tripathi1, Chikezie I Eseonu1 and Alfredo Quinones-Hinojosa21Johns Hopkins University, Baltimore, Maryland, USA2Mayo Clinic, Jacksonville, Florida, USA
Punita Tripathi et al., J Univer Surg 2018, Volume: 6DOI: 10.21767/2254-6758-C1-001
A n n u a l S u m m i t o n
Surgery
Journal of Universal SurgeryISSN: 2254-6758
A u g u s t 0 6 - 0 7 , 2 0 1 8 P r a g u e , C z e c h R e p u b l i c
Euro-Surgery 2018Page 36
The paper is about long-time experiences in sealing truncal varicose veins: 6 years follow up in treatment of 1100 cases and 2000 truncal varicose veins. Since 18 years by now, varicosis has been increasingly treated endovenously. At the start, the rather
inconvenient VNUS®Closure plus - procedure and the more convenient linear laser procedure were used, and these were followed in 2006 / 2007 by the bipolar RFITT® catheter, the VNUS® Closure Fast system and the radial laser. Thus, in the course of the last few years, plenty of experience has been gathered with endoluminal therapy, quality criteria have been defined and standards for the different techniques have been developed. I have begun with endovenous therapy in 2002, at first we have used the linear laser system, and in 2007 we changed to the RFITT - system and also began with the micro foam therapy. We at Saphenion in Berlin and Rostock have applied the Venaseal - Closure System for the first time in a great saphenous vein on 1st Aug’ 2012. Now we are working since 6 years with the super glue. We want to report about our actually long time experiences of a prospective single center comparative study of VenaSeal® – glue in the treatment of 2000 truncal varicose veins in 1100 patients.
BiographyDr. Ulf Thorsten Zierau, Born in 1960 at Magdeburg (GDR), he studied medicine at Humboldt - Universität Berlin from 1982 - 1988, bachelor of medicine 1987, promotion and doctor of medicine 1988, assistant in surgery / vascular surgery in Charité Berlin from 1988 - 1994 (Prof. Wolff, Prof Bürger), specialization in vascular surgery in vein - center Mühlenberg Klinik Malente and university of cologne 1994 - 1996, chief of department vascular surgery at hospital Gransee from 1996-1997, own practice in vascular surgery and phlebologie since 2/1997 in Berlin, since 2012 also in Rostock. Dr. Zierau one of the first vascular surgeons who were allowed to work by means of catheter technology in the arterial system. This was due to the special training in the Chartitè, as well as to a study visit to the Stanford University in USA. There, together with a colleague from Potsdam and a colleague from Nuernberg, he was able to study catheter technology in the vascular system for the first time - and then put it into practice. So it was obvious that from 2002 we also used the various catheter systems in the venous system. And so it was only logical that Dr. Zierau - although a passionate surgeon and vascular surgeon - consistently works with the gentlest treatment methods when it comes to removing spider veins and varicose veins. This led to an all-changing decision in 2012 - no more radical surgery on the venous system! No stripping and no phlebectomy (check mark method) With the departure from the old surgical methods, the scalpel lost importance. Important were catheter and ultrasound. Overall, the path consistently led to gentle treatments, which resulted in a faster healing through the minimal intervention.Specialist in surgery, vascular surgeon and phlebologist - specialized in diagnostics and therapy of varicose veins and venous diseases - own practice since 1997 in Berlin - since 2002 catheter-assisted treatment methods - since 2012 Praxisklinik Rostock and the consequent dedication to minimally invasive catheter-assisted and ultrasound-guided therapies. - since 2017 member of the German Society of Phlebology (venous medicine).
6 years’ experience with the VenaSeal - system in treatment of truncal varicose veinsUlf Thorsten ZierauSaphenion, Germany
Ulf Thorsten Zierau, J Univer Surg 2018, Volume: 6DOI: 10.21767/2254-6758-C1-001
