Day 3 :
- Acute care Surgery,Perioperative Surgery,Advancements in Surgery
Location: Dubai
Session Introduction
Mohammed Ghunaim Francois Pattou,
University of Lille II School of Medicine, France
Title: Risks and benefi ts of prophylactic lymph node dissection during thyroidectomy for suspicious nodule
Biography:
Mohammed Ghunaim is the Chairman of General Surgery, Bariatric and Endocrine Surgery at the University Hospital of Lille, France. He is Professor since 2004. He has published more than 50 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Introduction: Th e FNA has become essential for the surgical management of thyroid nodule. When cytology indicates a possible malignancy, some teams combine a prophylactic thyroidectomy and lymphadenectomy. Up to date, the risk and benefi t ratio of prophylactic lymphadenectomy has not been evaluated particulary in case of uncertain diagnosis (Bethesda score=3/4). Materials & Methods: Retrospective study was conducted in 227 patients (179 women, 48 men) consecutive operated since July 2010 for a suspected thyroid nodule, isolated or dominant, and who had a preoperative ultrasound and fi ne needle aspiration in an expert single center. Th e intervention consisted of a total thyroidectomy with or without a cervical lymph node dissection (removal of at least 6 nodes). Th e dissection was considered prophylactic in the absence of suspicious lymph nodes identifi ed in the preoperative ultrasound. Results: FNA results were correlated by Bethesda pathological diagnosis of malignancy (B3: 23%, B4: 31%, B5: 73%, B6: 90%). Preoperative ultrasound found no adenopathy in 201 patients (88.6%), including 139 (69% ) underwent a prophylactic lymphadenectomy (≥6 nodes). In this case, the median number of lymph nodes removed was 14 (IQR=9 to 19). Lymph node involvement was found in 0/14 patients B3 (0%), 0/72 B4 patients (0%), 8/72 patients B5 (11%) and 10/42 patients B6 (24%). Th e overall rate of postoperative complications (hypocalcemia, laryngoscopy abnormal, cervical hematoma, surgical site infection) was 49% in cases of prophylactic dissection and 28% in the absence of dissection (p=0.001, Chi 2). Performing dissection signifi cantly increased length of hospital stay (1.5±1.0 vs. 2.2±2.0 days, p<0.001). In multivariate analysis, the implementation of prophylactic lymphadenectomy increased the risk of complications by 47% (OR 2.033, 95% CI: 1.003 to 4.118, p=0.049), regardless of tumor size (p=0.81). Conclusion: 1. During a thyroidectomy for suspicious nodule, prophylactic lymphadenectomy increases postoperative morbidity of 47% and lengthens hospitalization. 2. Role of prophylactic lymph node dissection seems to be questionable when Bethesda’s score is less than 5 regardless of tumor size.
Fabio Assis Moreira Fontes
Universidade do Estado do Rio Janeiro,France
Title: Gender reassignment surgery
Biography:
Fabio Assis Moreira Fontes is an assistant professor from the State University of Rio de Janeiro , France. His research interest includes General surgery, Obstetrics and Gynaecological Surgery.
Abstract:
Objective: To promote greater integration in knowledge about the surgical techniques currently used in the male / female sex reassignment surgery in Brazil and worldwide. Another secondary aim is to facilitate access to information about the transgender transformation and help in demystifying the subject. Methods: Th ree main databases: PUBMED, LILACS and BVS were used; from which were selected 19 articles published in the last 15 years. Articles with experimental character regarding surgical experience on sex reassignment surgery in specialized services in the world were included. Conclusion: It is not up to the medical doctor to judge the sexual identity or option, and yes, impartially, off er the patients the best care, the best treatment taking into account the individual needs and respect the right of choice of the patient to decide who to be. Discussion: Th e gold standard considered by most bibliographies is the technique that uses the genital retail for the creation of the neovagina. Aft er the usual bilateral orchiectomy, the penis is dissected in its anatomical components: Corpora cavernosa, the glans, urethra, neurovascular bundle and vascularized penile skin. Many modifi cations of this technique have been described, but in general, there are three main groups of such modifi cations: (a) Use of inverted penile skin in the form of an inverted tube skin as the only retail on a abdominal pedicle fl ap; (B) Dividing the penis skin pedicle cylinder to create a rectangular fl ap, which is then increased by a rectangular scrotal skin with a posterior pedicle fl ap to increase the size of neovagina; (C) Th e penile skin fl ap can also be extended with a long and vascularized urethral fl ap, which is harvested and then incorporated into the penile skin fl ap. Th is work is going to review the literature of these and other alternatives and current techniques
Robert Caiazzo
Lille II University School of Medicine, France
Title: Trans-axillary thyroid surgery robot assisted multicentre study of benefi ts and complications in short term
Biography:
Robert Caiazzo is Professor of Surgery in the Faculty of Medicine at the University of Lille II, Lille, France. He is the member of the Department of General and Endocrine Surgery at Lille University Hospital. His research is devoted to the surgical treatment of endocrine and metabolic disease and focused on metabolic surgery for type 2 diabetes. He has authored or co-authored 25 papers in reputed journals. He is also the Principal Investigator of several ongoing clinical trials of bariatric surgery in Lille.
Abstract:
Introduction: Th e trans-axillary thyroid surgery robot assisted, developed in South Korea, is an alternative to cervicotomy with great cosmotic benefi t. Its distribution in Europe and US remains limited to a few centers experts, mainly because of its technical difficulty. Most studies are Asian with sometimes confl icting results and no multicenter European study was available. Aim: Our aim was to evaluate the functional results, aesthetic and oncological and identify the specifi c complications of transaxillary robot assisted thyroid surgery. Materials & Methods: Retrospective multicenter study of patients undergoing partial or total thyroidectomy in Lille, Nancy and Geneva with a postoperative follow-up of at least 6 months. Pre- and intraoperative data were extracted from medical records and follow-up data were collected by contacting every patient by phone. Results: 98 interventions were carried out from January 2010 to August 2014, in 93 consecutive patients: 47 lobectomies including 5 totalization of thyroidectomy and 51 total thyroidectomy for suspected thyroid nodules in 69 pateints, 15 toxic nodules or goiter, 8 symptomatic goiter and Graves' disease in 6 patients. Th e operating averaging times were 175±57 minutes for lobectomies and 195±39 minutes for total thyroidectomy. Th e patients evaluated the quality of scar as 7.5 / 10. Th ere was no serious complication, there was 9.2% recurrent paralysis including one defi nitif and 10.2% of hypocalcemia including 1 persistant hypocalcemia. Postoperative pain was moderate with EVA score of less than 4/10 in 58.2% (n=57) and controlled by level I and II of analgesics allowing one day surgery for 4 patients. At 6 months, the rate of mechanical pain was 6.1% (n=6), the rate of cervical adhesions was 19.4% (n=19) and the rate of pre-pectoral dysesthesia was 51% (n=50). Th ese dysesthesia were associated with functional impairment and neuropathic pain in 5.1% (n=5) of patients, necessitating specialized consultation. Th ese symptoms have improved under short treatment by gabapentin and motor physical therapy. Patients whose pathology revealed the presence of cancer, had a mean of follow-up of 25±11 months. Th e patients who received their complementary therapy-I 131, the thyroglobulins were below 1 ng / ml (0.1±0.3 [0 to 0.4]) and all scans of revaluation with 5mCi were normal except two showing an ordinary fi xation without corresponding thyroid ultrasound residue. Conclusion: Th is study shows the results of the trans-axillary thyroid surgery in its learning curve for European patients. Th is approach allows the absence of cervical scar but it is associated with specifi c complications related to subcutaneous dissection path.
Leonardo Silva Soares
Universidade do Estado do Rio Janeiro, Brazil
Title: Surgery for metabolic syndrome
Biography:
Leonardo Silva Soares is a Professor of surgery from State University of Rio de Janeiro , Brazil. His research is devoted to the surgical treatment of metabolic syndrome.
Abstract:
Objective: Th is bibliographic review aims to analyze the diff erent surgical therapeutic approaches and their benefi ts before patients with metabolic syndrome and its comorbidities. Methods: We performed literature in MedLine, SciELO, Lilacs and Academic Search from 1998 to 2015 with one exception article published in 1998. I have read 70 articles and selected 29 articles based on keywords. Results: Th e current literature presents several studies with signifi cant results of surgical treatment of comorbidities, which translate the associated metabolic syndrome. Conclusion: The metabolic surgery (bariatric) can eff ectively treat major components of the metabolic syndrome, when it is associated with obesity, leading to their cure. Turning directly and indirectly, and reducing all mortality rates generated by cardiovascular diseases
Marcel Henrique Arcuri & Marcella Akemi Haruno de Vilhena
Universidade do Estado do Rio Janeiro, Brazil
Title: Neuro-endocrine tumors: A case report and a review
Biography:
Marcel Henrique Arcuri & Marcella Akemi Haruno de Vilhena is a professor of surgery in the Department of Neurosurgery from The State University of Rio de Janeiro , Brazil. His research interest are Abdominal surgery, Neurosurgery.
Abstract:
Neuro-endocrine (NE) tumors (NETs) of the gastro entero-pancreatic system have slow growth and indolent evolution; usually at diagnosis they already present metastasis. It is difficult to quantify the real incidence of NETs whereas there is a difference in the cancer registries; however the estimate is 1 to 7 per 100,000 populations per year, representing 0.49% of all cancers. NETs are characterized by the secretion of active peptides, like somatostatin, which may cause physiologic eff ects, such as carcinoid syndrome. Th e most common primary sites are small bowel, large bowel and pancreas, but with less frequency other parts of the body are aff ected. At diagnosis, 65-90% of patients already have synchronic neuro-endocrine liver metastases (NELM). Th ose with metastasis have a 5-year survival 13-54% vs. 75-99% from those who doesn't have it. Th e treatment is controversy, but the resection surgery of the primary tumor and the liver metastasis is the only potential treatment for cure. However, in case of unresectability of hepatic metastases, the therapeutic approach will be chosen among radio frequency ablation, ases ablation, trans-arterial embolization or liver transplantation. Th erefore the objective of the present study is to discuss a case report of a NELM including its surgery treatment, showing a comparison with other results.
Mathias Antonio Haruno de Vilhena
Universidade do Estado do Rio Janeiro, Brazil
Title: Second Recurrence Of A Lumbosacral Chordoma: A Case Report And A Review
Biography:
Mathias Antonio Haruno de Vilhena is Professor from State University of Rio de Janeiro , Brazil. His research includes all types of Bone cancers, Orthopeadic surgery, Perioperative surgery.
Abstract:
Chordoma is a rare type of cancer that occurs in the bones of the skull and spine. Th ey are thought to arise from remnants of the embryonic notochord; generally are slow growing, but relentless and tend to recur after treatment. Because of their proximity to critical structures such as the spinal cord, brainstem, nerves and arteries, they are diffi cult to treat and require highly specialized care. Th e annual incidence of chordoma is approximately one new case per million people per year. Nevertheless, chordomas are the most common tumor of the sacrum and cervical spine. With an average overall survival of 7-9 years, the number of people living with chordoma (prevalence) is approximately 8 per million. Th ere is no actual consensus of a second recurrence sacral chordoma best approach. Th erefore, the intention of our study is to present a case report describing the surgical treatment associated with a literature review.
Gabriel Nobrega de Arruda, Andre Augusto Torres Prado & Monique Tavares Maia
Universidade do Estado do Rio Janeiro, Brazil
Title: Ambulatory surgery in patients above 60years, a single institution experience in the last fi ve years (2010-2015)
Biography:
Gabriel Nobrega de Arruda, Andre Augusto Torres Prado & Monique Tavares Maia is a Professor of surgery from State University of Rio de Janeiro , Brazil. His research interests include General surgery, Orthopaedic surgery.
Abstract:
Chordoma is a rare type of cancer that occurs in the bones of the skull and spine. Th ey are thought to arise from remnants of the embryonic notochord; generally are slow growing, but relentless and tend to recur after treatment. Because of their proximity to critical structures such as the spinal cord, brainstem, nerves and arteries, they are diffi cult to treat and require highly specialized care. Th e annual incidence of chordoma is approximately one new case per million people per year. Nevertheless, chordomas are the most common tumor of the sacrum and cervical spine. With an average overall survival of 7-9 years, the number of people living with chordoma (prevalence) is approximately 8 per million. Th ere is no actual consensus of a second recurrence sacral chordoma best approach. Therefore, the intention of our study is to present a case report describing the surgical treatment associated with a literature review.
Ashjan Mohammed Almuhanna
Hail University,Saudi Arabia
Title: Ultrasound Prevalence of Gall bladder Disease in Hail, Saudi Arabia
Biography:
Ashjan Mohammed Almuhanna is an assistant professor from the Hail University,Saudi Arabia. His research interests include Abdominal surgey, Perioperative surgery, Gastrointestinal surgery.
Abstract:
Objective: Cholestasis is one of the most common gastrointestinal disorders requiring hospitalization. While diff erent factors infl uence gallstone formation, these factors are not the same in diff erent cultures or geographical locations. We determined the prevalence of gallbladder disease as assessed by ultrasonography and its complications in Hail City, Saudi Arabia. Methods: Patients who underwent emergency or elective abdominal ultrasonography at King Khalid Hospital, the largest tertiary hospital in the Hail region of Saudi Arabia, between January 2013 and December 2013 were retrospectively analyzed. Results: Of the 4552 patients analyzed, 494 (10.9%) had gallstones. Of these 494 patients, 173 (35%) were male, 321 (65%) were female and 337 (68.2%) were aged >35 years. Th ree hundred twenty-six patients (66%) had multiple stones, whereas 168 patients (34%) had a single stone. Marked and mild wall thickening were found in 180 patients (36.4%) and 155 patients (31.4%), respectively. Common bile duct dilatation was present in 36 patients (7.3%), fatty liver in 106 patients (21.5%), hepatomegaly in 36 patients (7.3%), cirrhosis in 20 patients (4%) and ascites in 21 patients (4.3%). Of the 494 patients, 335 (67.8%) were symptomatic. Saudi females had the highest prevalence of gallbladder disease (60.1%) followed by Saudi males (31.6%), non- Saudi females (4.9%), and non-Saudi males (3.8%). Conclusion: Th e prevalence of gallbladder disease was higher in Hail City compared with other cities in Saudi Arabia.