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
3 resultados
Resultados de Busca
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- Laparoscopic Pylorus-Preserving Pancreatoduodenectomy with Double Jejunal Loop Reconstruction: An Old Trick for a New Dog(2013) MACHADO, Marcel Autran C.; MAKDISSI, Fabio F.; SURJAN, Rodrigo C. T.; MACHADO, Marcel C. C.Background: Pancreatoduodenectomy is an established procedure for the treatment of benign and malignant diseases located at the pancreatic head and periampullary region. In order to decrease morbidity and mortality, we devised a unique technique using two different jejunal loops to avoid activation of pancreatic juice by biliary secretion and therefore reduce the severity of pancreatic fistula. This technique has been used for open pancreatoduodenectomy worldwide but to date has never been described for laparoscopic pancreatoduodenectomy. This article reports the technique of laparoscopic pylorus-preserving pancreatoduodenectomy with two jejunal loops for reconstruction of the alimentary tract. Materials and Methods: After pancreatic head resection, retrocolic end-to-side pancreaticojejunostomy with duct-to-mucosa anastomosis is performed. The jejunal loop is divided with a stapler, and side-to-side jejunojejunostomy is performed with the stapler, leaving a 40-cm jejunal loop for retrocolic hepaticojejunostomy. Finally, end-to-side duodenojejunostomy is performed in an antecolic fashion. Results: This technique has been successfully used in 3 consecutive patients with pancreatic head tumors: 2 patients underwent hand-assisted laparoscopic pylorus-preserving pancreatoduodenectomy, and 1 patient underwent totally laparoscopic pylorus-preserving pancreatoduodenectomy. One patient presented a Grade A pancreatic fistula that was managed conservatively. One patient received blood transfusion. Mean operative time was 9 hours. Mean hospital stay was 7 days. No postoperative mortality was observed. Conclusions: Laparoscopic pylorus-preserving pancreatoduodenectomy with double jejunal loop reconstruction is feasible and may be useful to decrease morbidity and mortality after pancreatoduodenectomy. This operation is challenging and may be reserved for highly skilled laparoscopic surgeons.
- 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.
- Laparoscopic Resection of Hilar Cholangiocarcinoma(2012) MACHADO, Marcel Autran C.; MAKDISSI, Fabio F.; SURJAN, Rodrigo C.; MOCHIZUKI, MikiBackground: Surgical resection is the only curative treatment for hilar cholangiocarcinoma. Laparoscopic hepatectomy has been used to treat several types of liver neoplasms. However, technical issues have limited the adoption of laparoscopy for the treatment of hilar cholangiocarcinoma. To date there is only one report of minimally invasive procedure for hilar cholangiocarcinoma in the literature. The present video-assisted procedure shows a laparoscopic resection of hilar cholangiocarcinoma. Patient and Methods: A 43-year-old woman with progressive jaundice due to left-sided hilar cholangiocarcinoma was referred for treatment. The decision was to perform a laparoscopic left hepatectomy with lymphadenectomy and resection of extrahepatic bile ducts. Biliary reconstruction was performed using the hybrid method. Results: Operative time was 300 minutes with minimum blood loss and no need for blood transfusion. Recovery was uneventful, and the patient was discharged on postoperative Day 7. Pathology revealed a well-differentiated cholangiocarcinoma with negative lymph nodes and clear surgical margins. The patient is well with no signs of the disease 18 months after the procedure. Conclusions: Laparoscopic left hepatectomy with lymphadenectomy is safe and feasible in selected patients and when performed by surgeons with expertise in liver surgery and minimally invasive techniques. The use of a hybrid method may be needed for biliary reconstruction, especially in cases where position and size of remnant bile ducts may jeopardize the anastomosis. Further studies are still needed to confirm the benefit of this approach over conventional surgery for hilar cholangiocarcinoma.