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
9 resultados
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Agora exibindo 1 - 9 de 9
- Unprecedented case of duodenal papillary disinsertion after endoscopic papillectomy for a neuroendocrine tumor(2015) ARDENGH, Jose Celso; BONOTTO, Michele Lemos de; SURJAN, Rodrigo; LIMA, Julio Pereira; MACHADO, Marcel Autran
- A novel technique for hepatic vein reconstruction during hepatectomy(2016) SURJAN, Rodrigo C.; BASSERES, Tiago; PAJECKI, Denis; PUZZO, Daniel B.; MAKDISSI, Fabio F.; MACHADO, Marcel A. C.; BATTILANA, Alexandre Gustavo BellorioSurgical resection is the treatment of choice for malignant liver tumours. Nevertheless, surgical approach to tumours located close to the confluence of the hepatic veins is a challenging issue. Trisectionectomies are considered the first curative option for treatment of these tumours. However, those procedures are associated with high morbidity and mortality rates primarily due to post-operative liver failure. Thus, maximal preservation of functional liver parenchyma should always be attempted. We describe the isolated resection of Segment 8 for the treatment of a tumour involving the right hepatic vein and in contact with the middle hepatic vein and retrohepatic vena cava with immediate reconstruction of the right hepatic vein with a vascular graft. This is the first time this type of reconstruction was performed, and it allowed to preserve all but one of the hepatic segments with normal venous outflow. This innovative technique is a fast and safe method to reconstruct hepatic veins.
- Enucleation of liver tumors: you do not have to feel blue about it(2015) SURJAN, Rodrigo C.; MAKDISSI, Fabio F.; BASSERES, Tiago; MACHADO, Marcel A. C.Enucleation of hepatic tumors is a low-morbidity technique with adequate oncological results that is useful in many clinical settings. Compared with anatomical liver resections, it offers the advantage of maximal hepatic parenchymal preservation. However, some technical adversities may occur during the enucleation of liver tumors, such as difficulty in finding the lesions by intraoperative ultrasonography after hepatic transection or further visually spotting the tumor within the parenchyma if a first specimen is retracted not containing the lesion. We describe an innovative technique that overcomes these possible adversities and makes the enucleation of liver tumors easier and more precise.
article Laparoscopic Partial Pancreatectomy in a Patient with Pancreas Trifurcation and Recurrent Acute Pancreatitis(2016) MACHADO, Marcel Autran; BASSERES, Tiago; SURJAN, Rodrigo C.; MAKDISSI, Fabio F.Introduction Embryologically the pancreas develops by the fusion of dorsal and ventral pancreatic elements. The ventral pancreatic bud gives rise to part of the head and uncinate process, while the remainder of the head, body, and tail of the pancreas develops from the dorsal pancreatic bud. Failure in this process may result in pancreatic duct variation. Several types have been described, including bifid pancreatic duct, ectopic pancreas and duplication anomaly. To our knowledge, pancreatic trifurcation has never been described so far. Aim To present a video of a laparoscopic partial pancreatectomy resection in a patient with trifurcation of pancreas and intermittent acute pancreatitis. Methods A forty-year-old woman suffering from intermittent episodes of acute pancreatitis with first onset at 2-years of age with multiple surgical interventions for abdominal abscess drainage until puberty when severity and number of episodes decreased. Three years ago, she experimented a new episode of severe acute pancreatitis with prolonged hospitalization and since then intermittent episodes. MRI revealed an anomalous pancreas with three pancreatic ducts. One of them with signs of obstruction and pancreatitis. Laparoscopic resection of the diseased pancreas was proposed. Results Operative time was 150 minutes. Blood loss was minimum. Recovery was uneventful and patient was discharged on the 4th postoperative day. Final pathology showed no signs of malignancy. Patient is well with no sign of the disease 12 months after operation. Conclusion Although anomaly of the pancreatic duct is extremely rare, this case should alert clinicians to be aware of such an anatomical variant that may alter the flow characteristics in the pancreatic ductal system resulting in an increased risk of relapsing episodes of acute pancreatitis. Our patient received the correct diagnosis only 38 years after the first episode of acute pancreatitis.- First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report(2023) SURJAN, R. C. T.; SILVEIRA, S. P.; FIGUEIRA, E. R. R.; ARDENGH, J. C.Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct adenocarcinoma (PDAC) of the pancreatic body have become a well-established approach. To improve oncologic resection and lymph node (LN) dissection, technical alternatives have emerged on the last few years, such as the radical antegrade modular pancreatosplenectomy (RAMPS). While it is accepted that 12 LNs should be retrieved during distal pancreatosplenectomies, during RAMPS procedure the mean harvest is described to be 21 LNs (range, 11–30). With the objective of performing extended and tailored lymphadenectomies during robotic distal pancreatosplenectomies, we developed a novel technique for LN dissection with the use of real-time near-infrared robotic fluorescence and direct injection of indocyanine green in the pancreas as a contrast agent. Case Description: The patient presented pathologically confirmed PDAC on the body of the pancreas and was submitted to totally robotic distal pancreatosplenectomy. After exposing the pancreatic body and under intraoperative sonography guidance, 1 mL of indocyanine green was injected on the pancreas just proximal to the tumor. Using robotic fluorescence, we could clearly identify the lymphatic drainage of the pancreatic body, in order to perform fluorescence-guided, extended and tailored lymphadenectomy. Operative time was 4 hours and 43 minutes. Forty-three LNs were retrieved. Surgical margin was free from neoplasia. Postoperative period was uneventful. Conclusions: Fluorescence-guided extended lymphadenectomy with intrapancreatic injection of indocyanine green is a novel technique that may improve oncological results and staging during robotic distal pancreatosplenectomies for the treatment of PDAC of the pancreatic body.
- Endoscopic Ultrasound-Guided Tissue Acquisition Versus Fine Needle Aspiration for Diagnosis of Pancreatic Ductal Adenocarcinoma(2023) OMAIRI, Tarik W.; MICELLI-NETO, Otavio; TAGLIERI, Eloy; ARAUJO-FILHO, Jesse C. de; FARIA, Andressa Tome R. de; GOLDMAN, Suzan M.; SURJAN, Rodrigo Canada T.; MACHADO, Marcel A.; VENCO, Filadelfio E.; ARDENGH, Jose C.Objectives: Compare the 22G needle versus EchoTip ProCore & REG; 20 (Cook Medical, Bloomington, IN, USA) on their handling, specimen suitability, amount of tissue obtained, diagnostic performance, the possibility of immunohistochemistry, and rate of adverse events. Materials and methods: This is a retrospective, comparative study of consecutively examined patients with pancreatic masses who underwent endosonography-guided fine needle aspiration (FNA) via the 22G needle, and endosonography-guided tissue acquisition (TA) via ProCore 20 (PC20). The operator evaluated needle insertion and subjectively classified the specimen. The pathologist measured the samples, classified the amount of tissue, and determined the influence of bleeding on the interpretation. Results: A total of 129 patients participated in the study, out of whom 52 underwent endosonographyguided FNA with 22G and 77 underwent endosonography-guided TA with a PC20 needle. Malignant lesions were found in 106, and 23 had benign lesions. The duodenal route was used in 62% of patients. The 22G needle was easier to introduce (p=0.0495). However, PC20 obtained a larger amount (p<0.01) with fewer punctures (p<0.001). The PC20 also yielded a larger average microcore diameter (p=0.0032). Microhistology was adequate for 22G and PC20 in 22 (42.2%) and 50 (78.1%) specimens, respectively (p<0.001). Bleeding was not significantly different (p>0.999). Immunohistochemistry was possible in 36 (69.2%) and 40 (51.9%) specimens obtained by 22G and PC20, respectively (p=0.075). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 22G were 93.5%, 100%, 100%, 66.7%, and 94.2%, respectively; and for PC20, it was 95%, 100%, 100%, 85%, and 96.1%, respectively. Mild bleeding was the most common early adverse event, occurring in 2/52 (3.8%) 22G and 4/77 (5.2%) PC20 cases (p>0.05). Conclusions: The PC20 required fewer punctures and reduced the need for immunohistochemistry as it yielded better and larger microcores. Its ease of insertion into the target lesion makes it a good option to obtain satisfactory microcore specimens in difficult positions, such as the transduodenal route.
- Robotic approach for the treatment of giant colonic diverticulum(2022) BUSTAMANTE-LOPEZ, L. A.; SILVEIRA, S. D. P.; SURJAN, R. C. T.
- First Robotic Roux-en-Y Gastric Bypass for the Treatment of Refractory Gastroesophageal Reflux Disease in a Patient With Systemic Sclerosis(2023) SURJAN, Rodrigo Canada T.; SILVEIRA, Sergio; FIGUEIRA, Estela R.Systemic sclerosis (SSc) is an immune-mediated disease that results in fibrosis of the skin and internal organs. Refractory gastroesophageal reflux disease (GERD) associated with severe esophageal dysmotility is common in SSc patients, and surgical treatment with usual anti-reflux procedures such as fundoplications is associated with dismal symptomatic relief and postoperative dysphagia. We report the first robotic short -limb Roux-en-Y gastric bypass (RYGB) with a short Roux limb for the treatment of GERD in a patient with SSc with intense esophageal dysmotility. The operative time was two hours. The procedure and postoperative course were uneventful. The patient presented complete relief of gastroesophageal reflux symptoms and no postoperative dysphagia in a two-year follow-up. Therefore, short-limb RYGB is a safe and very effective alternative for the treatment of severe GERD in patients with SSc. The robotic surgical platform may have some advantages compared to conventional laparoscopy.
- Innovative technique for gastric retraction during laparoscopic distal pancreatectomy: the marionette(2015) SURJAN, Rodrigo C.; BASSERES, Tiago; MAKDISSI, Fabio F.; MACHADO, Marcel A. C.Laparoscopic distal pancreatectomies became more common in the past few years as a safe and effective treatment option for benign and low-grade malignant tumors of the body and tail of the pancreas. Adequate exposure and wide operative field are crucial to perform this procedure, and this is achieved by retraction of the stomach with an angled liver retractor or a grasper through a subxiphoid trocar, that is usually used only to this purpose. We developed an innovative technique to retract the stomach during laparoscopic distal pancreatectomies that provides excellent operative field and frees the subxiphoid trocar to be used in other tasks during the surgery.