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
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- LAPAROSCOPIC UNCINATECTOMY: A MORE CONSERVATIVE APPROACH TO THE UNCINATE PROCESS OF THE PANCREAS(2017) SURJAN, Rodrigo Cañada; BASSERES, Tiago; MAKDISSI, Fabio Ferrari; MACHADO, Marcel Autran Cesar; ARDENGH, José CelsoABSTRACT Background: The isolate resection of the uncinate process of the pancreas is a rarely described procedure but is an adequate surgery to treat benign and low grade malignancies of the uncinate process of the pancreas. Aim: To detail laparoscopic uncinatectomy technique and present the initial results. Method: Patient is placed in supine position with the surgeon between legs. Three 5-mm, one 10-mm and one 12-mm trocars were used to perform the isolated resection of the uncinate process of the pancreas. Parenchymal transection is performed with harmonic scalpel. A hemostatic absorbable tissue is deployed over the area previously occupied by the uncinate process. A Waterman drain is placed. Result: This procedure was applied to an asymptomatic 62-year-old male with biopsy proven low grade neuroendocrine tumor of the pancreatic uncinate process. A laparoscopic pancreaticoduodenectomy was proposed. During the initial surgical evaluation, intraoperative sonography was performed and disclosed that the lesion was a few millimeters away from the Wirsung. The option was to perform a laparoscopic uncinatectomy. Postoperative period until full recovery was swift and uneventful. Conclusion: Laparoscopic uncinatectomy is a safe and efficient procedure when performed by surgical teams with large experience in minimally invasive biliopancreatic procedures.
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.- One-stage laparoscopic bisegmentectomy 7-8 and bisegmentectomy 2-3 for bilateral colorectal liver metastases(2011) MACHADO, Marcel Autran C.; ALMEIDA, F. A.; MAKDISSI, F. F.; SURJAN, R. C.; CUNHA-FILHO, G. A.Bisegmentectomy 7-8 is feasible even in the absence of a large inferior right hepatic vein. To our knowledge, this operation has never been performed by laparoscopy. This study was designed to present video of pure laparoscopic bisegmentectomy 7-8 and bisegmentectomy 2-3 in one-stage operation for bilateral liver metastasis. A 67-year-old man with metachronous bilobar colorectal liver metastasis was referred for surgical treatment after neoadjuvant chemotherapy. CT scan disclosed two liver metastases: one located between segments 7 and 8 and another one in segment 2. At liver examination, another metastasis was found on segment 3. We decided to perform a bisegmentectomy 7-8 along with bisegmentectomy 2-3 in a single procedure. The operation began with mobilization of the right liver with complete dissection of retrohepatic vena cava. Inferior right hepatic vein was absent. Right hepatic vein was dissected and encircled. Upper part of right liver, containing segment 7 and 8, was marked with cautery. Selective hemi-Pringle maneuver was performed and right hepatic vein was divided with stapler. At this point, liver rotation to the left allowed direct view and access to the superior aspect of the right liver. Liver transection was accomplished with harmonic scalpel and endoscopic stapling device. Bisegmentectomy 2-3 was performed using the intrahepatic Glissonian approach. The specimens were extracted through a suprapubic incision. Liver raw surfaces were reviewed for bleeding and bile leaks. Operative time was 240 minutes with no need for transfusion. Recovery was uneventful. Patient was discharged on the fifth postoperative day. Patient is well with no evidence of disease 14 months after liver resection. Tumor markers are within normal range. Bisegmentectomy 7-8 may increase resectability rate in patients with bilateral lesions. This operation can be performed safely by laparoscopy. Preservation of segments 5 and 6 permitted simultaneous resection of segments 2 and 3 with adequate liver remnant.
- 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.
- Hepatectomia videolaparoscópica: experiência pessoal com 107 casos(2012) MACHADO, Marcel Autran Cesar; MAKDISSI, Fábio Ferrari; SURJAN, Rodrigo Cañada TrofoOBJECTIVE: To analyze our experience after 107 laparoscopic hepatectomies and discuss the technical evolution of laparoscopic hepatectomy in the last five years. METHODS: Between April 2007 and April 2012 we performed 107 laparoscopic hepatectomies in 105 patients. The mean age was 53.9 years (17 to 85). Fifty-three patients were male. All interventions were performed by the authors. RESULTS: from the total of 107 operations, there was need for conversion to open technique in three cases (2.8%). Sixteen patients (14.9%) had complications. Two patients died, a mortality of 1.87%. One death was due to massive myocardial infarction, unrelated to the procedure, which was uneventful and showed no conversion or bleeding. The other death was due to failure of the stapler. Twenty patients (18.7%) required blood transfusion. The most frequent type of hepatectomy was bisegmentectomy of segments 2-3, (33 cases), followed by right hepatectomy (22 cases). Seventy-two procedures (67.3%) were performed by the technique of Glissonian access. CONCLUSION: The dissemination of results is of utmost importance. The technical difficulties, complications and even death, inherent in this complex type of surgery, need to be clearly disclosed. This procedure should be performed in a specialized center with knowledgeable staff. The technique of laparoscopic Glissonian access, described by our staff, facilitates the realization of anatomical hepatectomies.
- Intrahepatic Glissonian approach for pure laparoscopic right hemihepatectomy(2011) MACHADO, M. A.; SURJAN, R. C.; MAKDISSI, F. F.To present a video of laparoscopic right hepatectomy using Glissonian technique. A new strategy for liver transection is presented. Liver is divided in three parts. The posterior part, containing short hepatic veins, is divided with stapler before liver transection. Anterior part is fully divided with harmonic scalpel, and the middle part, containing hepatic veins from segments 5 and 8, is the last part to be transected. A 41-year-old woman with right-sided hepatolithiasis and choledocholithiasis was referred for surgical treatment. Patient was positioned in left lateral position. Four trocars were used. Operation began with division of liver ligaments, right liver mobilization, and exposure of the retrohepatic vena cava. Cholecystectomy was performed, followed by intrahepatic access to the right Glissonian pedicle (containing arterial, portal, and bile duct branches of segments 5-8). Two small incisions were performed around hilar plate according to specific anatomic landmarks. A vascular clamp was introduced into those incisions, resulting in ischemic delineation of right liver. Clamp was replaced by a vascular stapler, and stapler was fired. Liver parenchyma was divided by harmonic scalpel combined with vascular stapler. The specimen was extracted through suprapubic incision. Intraoperative cholangiography confirmed a 2-cm common bile duct stone which was immediately removed by endoscopy (endoscopic retrograde cholangiopancreatography, ERCP). Falciform ligament was sutured to maintain the liver in its original anatomical position, avoiding hepatic vein kinking, and abdominal cavity was drained. Operative time was 180 min, with blood loss estimated at 50 ml, without need for transfusion. Postoperative recovery was uneventfully, and patient was discharged on the fourth postoperative day. Laparoscopic intrahepatic Glissonian approach is feasible and is a useful technique for rapid and safe control of the right liver pedicle, facilitating laparoscopic right hemihepatectomy. The special strategy described may help laparoscopic surgeons to safely perform this challenging procedure.