RODRIGO CAñADA TROFO SURJAN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
LIM/37 - Laboratório de Transplante e Cirurgia de Fígado, Hospital das Clínicas, Faculdade de Medicina
5 resultados
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- A New Technique for Liver Retraction During Single-Port Laparoscopic Surgery(2014) SURJAN, Rodrigo C. T.; MAKDISSI, Fabio F.; MACHADO, Marcel Autran C.Establishing a clear operative viewing field and adequate working space are essential steps for safe laparoscopic surgery. This aim of this article is to report a new technique of liver retraction during upper gastrointestinal laparoscopic surgery. This technique is fast and simple and precludes the use of special devices. It avoids the use of a subxiphoid trocar exclusive for liver retraction. This technique was designed to be used in single-port laparoscopic surgery but can be used in standard laparoscopic surgery to reduce the number of trocars. The first step is to perform division of the left triangular ligament. The fibrous appendix is identified. A window in the falciform ligament is created. The fibrous appendix is sutured to the peritoneum in the right subcostal area. The left lobe of the liver passes through the window in the falciform ligament, avoiding liver congestion. Optimum exposure of the upper gastrointestinal area is achieved. This new technique is easy and can be performed in various types of laparoscopic gastrointestinal surgeries without the need for specific skills or devices. We believe that our liver retraction technique is useful in single-port laparoscopic surgery and allows an excellent exposure of the upper gastrointestinal tract.
- Totally Laparoscopic Right Hepatectomy with Roux-en-Y Hepaticojejunostomy for Right-Sided Intraductal Papillary Mucinous Neoplasm of the Bile Duct(2014) MACHADO, Marcel Autran; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.Intraductal papillary neoplasm of the bile duct is a precursor lesion of cholangiocarcinoma. We present a video of a totally laparoscopic right hepatectomy with hilar dissection and lymphadenectomy, en-bloc resection of the extrahepatic bile duct, and Roux-en-Y hepaticojejunostomy in a patient with intraductal papillary neoplasm of the right hepatic duct. A 58-year-old woman with right upper quadrant pain was referred for evaluation. Abdominal ultrasonography revealed dilatation of intrahepatic and extrahepatic bile ducts. Magnetic resonance imaging showed a stop in the right bile duct, with dilatation of the distal bile duct. The decision was to perform a totally laparoscopic right hepatectomy with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy. The operative time was 400 min. Estimated blood loss was 400 ml, without the need for transfusions. Postoperative recovery was uneventful, and the patient was discharged on the 10th postoperative day. The abdominal drain was removed on the 14th postoperative drain with no signs of biliary leakage. Final pathology confirmed the diagnosis of intraductal papillary neoplasm without malignant transformation. Surgical margins were free. Patient is well with no evidence of the disease 14 months after the procedure. Laparoscopic right hepatectomy with hepaticojejunostomy is feasible and safe, provided it is performed in a specialized center and with staff with experience in hepatobiliary surgery and advanced laparoscopic surgery. Currently this operation is reserved for selected cases. This video can help oncologic surgeons to perform this complex procedure.
conferenceObject Totally Laparoscopic Right Hepatectomy With Roux-en-Y Hepaticojejunostomy(2014) MACHADO, Marcel C.; SURJAN, Rodrigo C.; MAKDISSI, Fabio F.; MACHADO, Marcel Autran- Single-port for laparoscopic gastric resection with a novel platform(2014) MACHADO, Marcel Autran; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.INTRODUCTION: Laparoscopic gastrointestinal resections using single-port are possible, but triangulation problems and the need of articulated instruments difficult the procedures. AIM: To present a surgical alternative using single-port laparoscopic device on gastric resection. TECHNIQUE: The patient is placed in a supine and reverse Trendelenburg position with surgeon between patient's legs. First assistant was on the right side of the patient with the monitor placed on the patient's cranial side. With the patient under general anesthesia, a transumbilical 3 cm skin incision is performed. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector is introduced through this incision. Three 5-12 mm operating ports were introduced through the single-port device. Due to the gel cap and sleeves, no articulated instruments are necessary. CO2 pneumoperitoneum is established at 12 mmHg. A rigid 30 degree 10 mm laparoscope is introduced. Operation begins with access to the lesser sac by opening the omentum along the greater curvature of the stomach using harmonic scalpel. Once the stomach is fully exposed and a stay suture is place around the tumor. Gastric wall is divided with cautery 1 cm away from the tumor. Tumor is excised. Gastric wall is sutured with two-layer running suture. No drain was used. Umbilical incision was closed. RESULTS: This procedure was used in one patient with gastric duplication. Operative time was 200 minutes. Blood loss was minimal. Recovery was uneventful and patient discharged on postoperative day 2. Final aspect of the umbilical incision was good. CONCLUSIONS: Gastric resection with single-port laparoscopic platform is feasible and may be safely performed in selected patients.
- A New Instrument for Intrahepatic Access of Glissonian Pedicles During Anatomical Liver Resections(2014) MAKDISSI, Fabio F.; MACHADO, Marcel Autran C.; SURJAN, Rodrigo C.The knowledge of liver anatomy has led to a rapid evolution based on the intrahepatic distribution of the portal pedicle. One great advance in liver surgery was the used of segment-based liver resections. Techniques based with intrahepatic Glissonian access of portal pedicles were described to safely perform anatomical liver resections. We have earlier described a standardized intrahepatic access to right and left liver segments' pedicles without hilar dissection for anatomical hepatectomies. To improve the intrahepatic Glissonian technique, we designed a new atraumatic instrument for liver pedicle retrieval based on the anatomical liver landmarks. This new instrument was successfully employed in seventeen consecutive liver resections with minimum blood loss and without any complications related to its use. This new instrument, atraumatic retriever, replaces the right angle dissector or Gray clamp. The new instrument can slide easily and smoothly around Glissonian pedicle with a simple movement. This new instrument is a useful adjunct for performing intrahepatic access for liver resections. It can also be used to compass delicate anatomical structures such as esophagus and major abdominal vessels. The retriever can further be used in other common situations, including access for Pringle maneuver, encircling proximal esophagus during total gastrectomies or esophagectomies, and access for total vascular exclusion of the liver. This instrument can also be adapted to be used for laparoscopic liver resections.