Introduction. Rare but significant anatomical differences in the biliary ducts, such as having tw... more Introduction. Rare but significant anatomical differences in the biliary ducts, such as having two ducts, can create challenges in surgeries like laparoscopic cholecystectomy, according to a study that examined a case of double cystic duct found during cadaver dissection and its implications in practice. Material and method. In the study, dissections were done on 25 cadavers at the Anatomy Department of the University of Medicine Pharmacy Science and Technology in Târgu Mureș, where a cadaver with a secondary cystic duct anomaly was observed. A series of measurements and histological examinations were conducted to validate the results and juxtapose them with prior literature. Results. The secondary cystic duct showed a shape resembling the letter “Y,” with separate insertions of the ducts at the common hepatic duct level with the same macroscopic anatomical features. Histological examinations revealed normal biliary epithelium and tubular shaped structure. Conclusion.Finding a secondary duct underscores the importance of vigilance during surgery because such variations can raise the chances of bile duct damage during gallbladder cholecystectomy. It is advised to use imaging, before surgery and cholangiography during surgery to manage the risks linked to these abnormalities.
Transverse colon involvement by gastric cancer represents a significant clinical challenge, requi... more Transverse colon involvement by gastric cancer represents a significant clinical challenge, requiring sophisticated surgical techniques for effective management. Addressing this complexity requires an in-depth analysis of contemporary literature and clinical experiences to identify the most effective treatment strategies. This study aims to merge findings from specialized literature with clinical outcomes observed at the First Surgical Clinic SCJU Tg. Mures. By adopting a dual approach, we conducted a review of existing literature on the surgical management of gastric cancer extending to the transverse colon. We performed a retrospective analysis of cases treated at our institution. We evaluated surgical techniques, patient demographics, treatment protocols, and outcomes. As identified in systematic reviews and clinical trials over the past decade, the predominant strategy involves the combined resection of the stomach and affected colon segments. In our clinical practice, we managed four cases with personalized surgical treatments. Our findings revealed a 75% survival rate and a 50% comorbidity rate, with an average hospitalization duration of eight days. The findings highlight the necessity for personalized surgical approaches in managing complex gastric cancer cases involving the transverse colon. The study advocates integrating academic research with clinical practice to refine treatment protocols and enhance patient outcomes.
Objectives: Anastomotic leakage is a severe complication in patients undergoing colorectal surger... more Objectives: Anastomotic leakage is a severe complication in patients undergoing colorectal surgery, both by increasing morbidity/mortality and by increasing the likelihood of cancer recurrence.The current study aims to update the risk factors of anastomotic leakage in patients undergoing (elective or emergency) open surgery for colorectal cancer. Materials and Methods: A retrospective study was conducted on 87 patients, with a mean age of approximately 73 years, diagnosed and treated through open surgery for colorectal cancer during the previous five years. The study sample included 56 men and 31 women. Study data were extracted from clinical observation sheets, in which assessment of comorbidities was recorded using the Charlson Comorbidity Index. Results: Among the statistically significant risk factors for anastomotic leakage, we found obesity (19 cases),alcohol consumption and smoking (44 cases), preoperativechemoradiotherapy and/or anti-inflammatory drugs (8 cases),albumin and protein serum levels (27 cases),blood transfusion (39 cases),Charlson Comorbidity Index (63 cases), ASA score>II (22 cases),emergency vs. elective surgery (56 vs. 31 cases),tumor distance from anal verge(6 cases) and operative time (52 cases). Conclusions: Among modifiable risk factors, some of them (operating time, etc.) should be interpreted with caution, as they may be related to patient or logistical particularities. For other modifiable risk factors further investigations should be performed to find an optimal therapeutic approach. For example, resuscitative measures (administration of blood, albumin, etc.) are definitely necessary for systemic rebalancing, but they also carry a significant risk of local surgical complications, especially anastomotic leakage.
Introduction: Amyand's hernia, named after Claudius Amyand, is a rare hernia variant characterize... more Introduction: Amyand's hernia, named after Claudius Amyand, is a rare hernia variant characterized by the presence of the vermiform appendix within the hernial sac. Accounting for about 1% of all inguinal hernias, its exact development mechanism remains unclear. The clinical presentation can vary significantly, often mirroring symptoms of a hernia or acute appendicitis. Material & Method: A retrospective case series study was conducted at the General Surgery Clinic 1 of the SCJU Tg. Mures Emergency County Hospital. It involved a comprehensive review of medical records of patients diagnosed with Amyand's hernia who underwent emergency surgery. Data collected included demographics, clinical presentation, surgical management, postoperative complications, and follow-up details. Descriptive statistical analysis was performed using EasyMedStat software. Results: Over five years, seven cases of Amyand's hernia were reported, with an increase in 2023. The average age of the patients was 77.8 years, all male, demonstrating a higher incidence in older males. Symptom onset varied widely, from four months to nearly 20 years. Most patients experienced abdominal pain, with approximately half reporting fever. The primary diagnosis was often intestinal occlusion with an incarcerated inguinal-scrotal hernia. Surgical approaches varied, with the Lichtenstein operation being the most common. Mesh repair was used in most cases, and all patients underwent appendectomy. The median hospital stay was five days, with minimal postoperative complications. Conclusion: Amyand's hernia presents a surgical challenge due to its rarity and variable clinical presentation. This study underscores the need for individualized treatment strategies to optimize patient outcomes. The findings contribute to understanding Amyand's hernia, highlighting the importance of tailored surgical approaches and diligent postoperative care.
Background: Optimal reconstruction in distal gastric cancer resections remains controversial. Nor... more Background: Optimal reconstruction in distal gastric cancer resections remains controversial. North American and European (ESMO) oncological protocols do not provide indications for optimal surgical reconstructions. Asian oncological protocols recommend subtotal gastrectomy as the first indication for resections in distal gastrectomy. Material and methods: We used PubMed as the primary search engine to conduct a literature search review. We included studies published in the last five years (2019-2022) in the North American, European, and Asian regions. We excluded case presentations and used the terms - distal gastrectomy reconstructions/ gastric neoplasm/cancer as search keywords. Results: A total number of 74 studies were recorded. 41% (n=31) of the majority were from the Asian literature with two multicentric meta-analyses. The main reconstruction methods included in the studies were: gastro-duodenal and gastro-jejunal (Roux-en-Y, Braun). While each type of reconstruction has advantages and disadvantages, the gastro-duodenal technique, in most cases, is reported as an optimal choice regarding the postprocedural quality of life reports. Conclusions: Asian literature provides the most scientific data regarding optimal reconstruction in distal gastric neoplasm. Despite the presence of reflux esophagitis in gastro-duodenal anastomosis, it is recommended as a first choice for surgical reconstruction due to the low long-term postoperative complications. However, no protocols included indications for the optimal surgical technique. Further studies are required in the future to define optimal surgical management in this category of patients.
Background: Gastric cancer is the fifth most common cancer worldwide. Advances in the field of on... more Background: Gastric cancer is the fifth most common cancer worldwide. Advances in the field of oncology with radiotherapy, adjuvant chemotherapy associated with optimal surgical treatment can improve the outcome and patient quality of life (QOL). Current protocols, combined with early detection and better screening, have led to a decrease in the overall incidence of gastric cancer. Standardization of surgical treatment for gastric neoplasm following the patient's profile is important for a better outcome. Material and methods: A retrospective study was conducted that included all the patients diagnosed with gastric cancer enrolled in the First Surgical Clinic in Targu-Mures Emergency County Hospital between January 2015 and October 2021. Statistical data was obtained from the patients' files, operation protocol, and informatics system of the hospital. Results: We recorded a total number of (n=273) patients over the seven years. The average age of the patients was 71 years ranging from 29 to 93. We observed a male predominance of 69% with 31% female patients. The main surgical procedure performed for gastric cancer was subtotal gastrectomy (n=162) with a neoplasm location predominant at the antral-pyloric region (55%) with adenocarcinoma as the predominant histological diagnosis (73%). The mean hospitalization period was 20 days with a mortality rate of 9%. Conclusions: Gastrectomy and adequate lymph node resection can be challenging. Efforts provided by a multidisciplinary team can assure a good outcome regarding the patient's quality of life and the decrease of overall morbidity and mortality. If R0 is achievable, distal gastrectomy can be safely performed for patients with distal neoplasm.
Background. The COVID-19 pandemic has significantly impacted healthcare systems worldwide, raisin... more Background. The COVID-19 pandemic has significantly impacted healthcare systems worldwide, raising concerns about the quality of care for patients with various medical conditions, including gastric cancer. This retrospective study aims to compare the treatment outcomes and complications among patients treated for gastric cancer two years before and two years during the pandemic. Aims. The objective is to gain insights into the potential impact of the pandemic on the management of gastric cancer. Methods. An analysis was conducted on a cohort of patients who underwent surgical treatment for gastric cancer. The cohort consisted of patients treated two years before and two years during the pandemic. The medical records of these patients were reviewed to collect data on treatment outcomes, complications, and other relevant parameters. Statistical analysis was performed to compare the outcomes between the two groups. Results. The pandemic group had a higher incidence of emergency surgery, anastomosis fistulas, and gastric stenosis than the pre-pandemic group. While both groups reported spleen penetration, only the pandemic reported penetrations affecting other organs. The pandemic group had a longer operation time but shorter hospital stays, with a higher mortality rate. The pre-pandemic group had more patients receiving preoperative chemotherapy and more T2-stage cases based on the TNM classification. No significant differences were found in bleeding, wound infection, or evisceration. Conclusions. The higher rate of complications, particularly anastomosis fistula, and the lower utilization of preoperative chemotherapy during the pandemic highlight healthcare systems' challenges in providing optimal care during crises. The shorter hospitalization period observed during the pandemic suggests a potential adaptation to minimize patient exposure and optimize hospital resources.
Introduction: Bulk retroperitoneal lymphoma is a subtype of retroperitoneal lymphoma in which the... more Introduction: Bulk retroperitoneal lymphoma is a subtype of retroperitoneal lymphoma in which the tumor mass in the retroperitoneum measures 10 centimeters or more in its largest dimension. This type of lymphoma can occur in Hodgkin's and non-Hodgkin's lymphoma. Material and Methods: This paper presents the surgical treatment of a primary bulk retroperitoneal anaplastic lymphoma. Results: We present A 71-year-old patient admitted to Surgical Clinic 1 – SCJU Tg.Mures with a clinical accusation of intermittent abdominal pain, digestive turbulence, and weight loss, with the CT describing a tumor mass (10 cm) involving the superior mesenteric artery and aorta. Intraoperative exploration revealed a bulky tumor of 13/5/9 centimeters in size invasive in the superficial layers of the superior mesenteric artery and vein and abdominal aorta. Surgical fragmented excision was performed with no intraoperative and postoperative complications reported. The patient was discharged on postoperative day eight. Histopathological analysis revealed a negative resection margin revealing an anaplastic lymphoma. Conclusion: Treatment for bulk retroperitoneal lymphoma typically involves a combination of chemotherapy, radiation therapy, and surgery. The use of surgery for bulk disease can be more challenging depending on the size and location of the tumor, as well as the characteristics of the individual patient. Keywords: retroperitoneal, lymphoma, b-cells, bulk
Introduction: Some various tools and indices have been developed to measure the quality of life o... more Introduction: Some various tools and indices have been developed to measure the quality of life of patients who have undergone gastrectomy. One such tool is the EORTC QLQ-STO22 questionnaire, a module of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire. Material and Methods: We conducted a prospective analysis over three years (2019-2022) of all patients diagnosed and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures. The questionnaire was applied with 22 items that assess the specific symptoms and functional aspects of patients who have undergone gastrectomies, such as eating restrictions, reflux, pain, and anxiety. Results: We recorded 61 patients with an average age of 68 years and a male predominance of 72%. After the questionnaire, we observed a high predominant index score (3.4) (p=0.0011) in total gastrectomy patients. However, a better index score was reported regarding partial resection with gastric reconstruction (2.1) (p=0.0031). Of the different types of gastric reconstruction, the Pean-Billroth 1 anastomosis reported a 1.4 index score (p=0.001). Conclusion: The EORTC QLQ-STO22 questionnaire is a valid and reliable tool for assessing patients' quality of life who have undergone gastrectomy. It has been used in various clinical studies and trials to evaluate the impact of gastrectomy on patients' quality of life and assess the effectiveness of interventions to improve patients' well-being. Keywords: gastrectomy, gastric cancer, quality of life
The Parisian venereologist Jean Alfred Fournier first described Fournier's gangrene in 1883. Four... more The Parisian venereologist Jean Alfred Fournier first described Fournier's gangrene in 1883. Fournier's Gangrene Severity Index (FGSI) represents a numerical score that indicates the severity of the disease. It represents a valuable tool for calculating patient outcomes and applying the proper treatment to avoid local complications and high mortality rates. We conducted a retrospective study from 2010 to 2021 that included all patients diagnosed and treated for Fournier Gangrene (FG) in Surgical Clinic I Emergency County Hospital Tg.Mures. The diagnosis is based on patient history, local clinical examination, and paraclinical tests. Fournier's Gangrene Severity Index (FGSI) was calculated, and we divided the patients based on the FGSI score. One group had scores <9 points, while the other group included patients with a score >9. We recorded a total number of 23 patients. The main risk comorbidities were ischemic cardiomyopathy at 56.54% (n=13) and typed II diabetes at 43.4% (n=10). The FGSI index score was calculated in all patients with an average of 8.6± 2. 12 patients received a score >9, while 11 patients were ≤9. The overall mortality rate was 56.26% (n=13), with the high-score FGSI group recording mortality of 100%. Fournier's disease remains rare, with high mortality and morbidity rates. Therefore, early treatment must be applied to ensure proper treatment and a good outcome. FGSI score can be applied in patients to assess the overall severity of the disease and indicate the morbidity and mortality outcomes.
INTRODUCTION: LigaSure is a bipolar diathermy system that can achieve efficient vessel sealing. H... more INTRODUCTION: LigaSure is a bipolar diathermy system that can achieve efficient vessel sealing. Historically thyroid surgery involved meticulous devascularization of the gland with a high complication rate regarding hemostasis. However, recent applications of LigaSure technology show a reduction rate in intraoperative and early postoperative complications. OBJECTIVE: We aim to determine the best hemostasis surgical methods in thyroid surgery. MATERIAL AND METHODS: The study compares LigaSure applied and conventional knot technique thyroidectomy procedures in patients undergoing thyroid surgery. We conducted a retrospective study over five years and divided the patients into two groups. In addition, we recorded intraoperative and postoperative evaluations and thyroid pathology are involved from the patient's files. RESULTS: We recorded 105 patients who underwent thyroid surgery with an average age of 45. The Ligasure group included 42 and the conventional knot technique group 63. The postoperative hematoma was significantly higher in the conventional knot technique, 7% (p=0.022). However, intraoperative hemorrhagic complications were the same in both groups (p=0.221), with a lower blood loss rate in the Ligasure group (p=0.001). CONCLUSION: Ligasure vessel sealing system is safer than conventional knot techniques regarding intraoperative and postoperative hemostasis. Lower hemorrhagic rates can reduce patient morbidity and mortality with reduced hospital stay and surgical complications.
Introduction: Different reconstruction techniques are possible after gastrectomy in gastric neopl... more Introduction: Different reconstruction techniques are possible after gastrectomy in gastric neoplasms. Good nutritional status must be preserved, and there is a strong focus on the quality of life index that monitors post-operative morbidity. Pean-Billroth-I (physiological) and Roux-en-Y/Billroth-II (non-physiological) reconstruction are applied with their advantages and disadvantages. Material and Methods: We conducted a retrospective analysis over three years (2019-2021) of all patients diagnosed and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures with physiological and non physiological anastomosis. Data were obtained for the patient's files and operation protocols. Paraclinical and clinical follow-up was also analyzed. Results: We recorded 82 patients with an average age of 67 years and a male predominance of 72%. The predominant histological type was adenocarcinoma (88%). Physiological reconstructions revealed a better postoperative outcome with a 5% complication rate (p=0.0012) and a low recurrence rate of 2.5% (p=0.0033) with a better quality of life index. In addition, the non-physiological group recorded a better postoperative paraclinical evaluation (upper endoscopy): reflux evaluation -Los Angeles score (p=0.001). Conclusion: In conclusion, both anastomoses are feasible and safe and can be applied for the surgical treatment of gastric cancer. Physiological anastomosis reports lower surgical complications, morbidity, and mortality rates and offers a better quality of life index.
Introduction: Gallbladder-duodenal fistulas with hepatic abscesses are rare pathological complica... more Introduction: Gallbladder-duodenal fistulas with hepatic abscesses are rare pathological complications and present, usually in patients with an untreated gallstone. Courvoisier described them in 1890 as a rare complication of cholecystitis. Material and Methods: This paper presents the surgical treatment of a gallbladder-duodenal fistula with multiple hepatic abscesses. Results: We present a 67-year-old female patient admitted to the First Surgical Department SCJU Tg.Mures with clinical manifestation specific for cholecystitis. We performed an exploratory laparoscopy revealing an inflamed gallbladder with multiple liver abscesses. Conversion was required with anterograde cholecystectomy and the suturing of the gallbladder-duodenal fistula. In addition, we performed the exploration of the primary biliary tract revealing multiple gallstones and a suppurative angiocholitis. Liver abscesses (segment V, VI, VII) were evacuated with a Kehr drainage mounted. Postoperative care included antibiotic treatment with liver and renal functions monitorization. The patient was discharged on a postoperative day 19 with biliary Kehr drainage. Conclusion: Although rare gallbladder-duodenal fistula can represent a surgical challenge due to its nonspecific symptomatology. Morbidity and mortality are high when associated with extended hepatic abscesses.
Background: Nutritional status of the patients is very influential for postoperative complication... more Background: Nutritional status of the patients is very influential for postoperative complications and the quality of life index. One helpful tool in evaluating postoperative gastric neoplasm patients is The Controlling Nutritional Status (CONUT) score. Evaluation implies monitorization of serum albumin, lymphocyte, and total cholesterol levels. Objective: Our study aimed to assess the nutritional status and outcomes (CONUT score) of the patients treated for gastric neoplasm in Surgical Clinic I SCJU Tg.Mures. Material and methods: We conducted a prospective study over one and a half years that included patients diagnosed and treated for gastric neoplasm. We evaluated the nutritional parameters and calculated the CONUT score. In addition, comorbidities and postoperative surgical monitoring were registered. Results : We recorded 57 patients with an average age of 52 years. We observed a male predominance of 63% (n=36). In more than half of the patients, 57%, we recorded a low CONUT score (0-4 points). A high CONUT score (5-12 points) was associated with comorbidities, mainly anastomosis fistula and incision infection (p=0.0021). The main surgical procedure was subtotal gastrectomy 69% (n=39), with total gastrectomy associated with a high CONUT score (p=0.0011). Conclusions: Quality of life in patients treated for gastric neoplasm is a valuable asset that ensures a rapid recovery with social reintegration. CONUT score can be implemented in assessing the nutritional status of patients with surgical treatment to assess postoperative complications and nutritional management. Keywords: gastric neoplasm, nutrition status, CONUT score
Introduction: Kilgore published one of the first series of bilateral breast cancer in 1921. The
i... more Introduction: Kilgore published one of the first series of bilateral breast cancer in 1921. The incidence of bilateral breast carcinoma varies from 2 to 10 % worldwide. Based on current studies, the definition of bilateral synchronous represents both tumors' appearance from 1 month to 1 year with general classification as synchronous and metachronous. Material and methods: we conducted a retrospective study of the surgical management of bilateral breast carcinoma. We included patients treated at the First Surgical Clinic - SCJU Tg. Mures over five years (2017-2021). Surgical procedures, patient follow-up, and histopathological diagnosis were recorded. Results: we recorded a total number of eight cases. The majority were at intervals lower than four months (n=5), with two patients simultaneously diagnosed with bilateral breast carcinoma (synchronous carcinoma). The predominant histological variant was ductal carcinoma (n=4). BRCA1 and BRCA2 were present în 75% of cases, with 60% relating a family history of breast carcinoma. Only în one case, bilateral breast cancer was reported due to patient noncompliance for postoperative chemo and radiotherapy. Conclusion: the incidence of bilateral breast carcinoma remains low. However, periodical examination and screening must be applied in each patient with breast carcinoma în order to ensure an early diagnosis with a good surgical outcome and socio-economical integration.
The management of rectal cancer recognizes surgical resection as the most important
step towards ... more The management of rectal cancer recognizes surgical resection as the most important step towards a permanent cure. Respecting the oncological principles, functional preservation represents a priority in achieving an acceptable quality of life for the patient. This study aimed to compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR), in terms of postoperative outcome. We conducted a retrospective, observational study on a group of 147 patients with LAR or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative evolution was followed. The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution regarding patients’ demographic and biological parameters and tumor pathological features. A significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR procedures. We found no statistically significant differences between LAR and VLAR in terms of associated postoperative morbidity or mortality, neither in hospitalization time. There was no statistical difference in terms of early postoperative outcomes among LAR and VLAR. The most important factor in achieving good oncologic and functional results in low rectal cancer is choosing the adequate, tailored to the case surgical management.
Introduction: Carcinoma of the transverse colon is usually rare and accounts for 10% of all color... more Introduction: Carcinoma of the transverse colon is usually rare and accounts for 10% of all colorectal cancer. Diagnosis is often delayed with the progression of symptoms that are often insidious and tumors may be voluminous with locoregional involvement by the time of diagnosis. Material and Methods: This study aims to present the surgical management and challenges of advanced cancer of the transverse colon.Results: We present a 43-year-old with no personal history of gastroenterological pathology. After SARS-COVID 19 infection he developed mild gastrointestinal symptomatology. Routine checkups revealed an advanced tumor of the transverse colon with multiorgan involvement: stomach and small intestine (CT-scan). We performed a multi-visceral resection with extended right hemicolectomy, gastric antrectomy with gastro-jejunal isoperistaltic anastomosis (Lucke Rockwitz procedure), and ileocolic telescopic anastomosis. The postoperative evolution was favorable. Conclusion: Complex surgical therapy for colon cancer can be undertaken in selected patients. The procedures are often extensive requiring an experienced team to assure a good postoperative outcome and proper continuation of the oncological treatment.
Introduction: Postoperative complications can frequently occur after gastrectomy for gastric canc... more Introduction: Postoperative complications can frequently occur after gastrectomy for gastric cancer and are associated with poor
clinical outcomes, such as mortality and surgical re-intervention. The study aimed to identify the clinically most relevant complications
after gastrectomy.
Material and Methods: We conducted a retrospective study in which we included all the patients diagnosed with gastric cancer
enrolled in the First Surgical Clinic in Targu-Mures Emergency County Hospital between January 2015 and March 2021.
Results: We recorded a total number of 253 patients over the seven years. The average age of the patients was 71 years ranging
from 29 to 93. We observed a male predominance of 69% with 31% female patients. The main surgical procedure performed for
gastric cancer was subtotal gastrectomy with 152 cases. Anastomotic leakage had the greatest overall impact on re-interventions
with high mortality rates (45%) especially in patients with associated comorbidities. The most common encounter complication was
wound infection (60%). Postoperative bleeding was the least encountered complication (>3%).
Conclusion: Gastrectomy for cancer is a technically demanding surgical intervention. Control and treatment of postoperative
complications require an experienced surgical team. Patients with poor general conditions are most exposed to such complications.
Early detection of postoperative complications and attentive care especially in the patient’s nutritional status is required to assure a
good outcome for the patients.
Key words: gastric cancer, gastrectomy, postoperative complications
Introduction. Rare but significant anatomical differences in the biliary ducts, such as having tw... more Introduction. Rare but significant anatomical differences in the biliary ducts, such as having two ducts, can create challenges in surgeries like laparoscopic cholecystectomy, according to a study that examined a case of double cystic duct found during cadaver dissection and its implications in practice. Material and method. In the study, dissections were done on 25 cadavers at the Anatomy Department of the University of Medicine Pharmacy Science and Technology in Târgu Mureș, where a cadaver with a secondary cystic duct anomaly was observed. A series of measurements and histological examinations were conducted to validate the results and juxtapose them with prior literature. Results. The secondary cystic duct showed a shape resembling the letter “Y,” with separate insertions of the ducts at the common hepatic duct level with the same macroscopic anatomical features. Histological examinations revealed normal biliary epithelium and tubular shaped structure. Conclusion.Finding a secondary duct underscores the importance of vigilance during surgery because such variations can raise the chances of bile duct damage during gallbladder cholecystectomy. It is advised to use imaging, before surgery and cholangiography during surgery to manage the risks linked to these abnormalities.
Transverse colon involvement by gastric cancer represents a significant clinical challenge, requi... more Transverse colon involvement by gastric cancer represents a significant clinical challenge, requiring sophisticated surgical techniques for effective management. Addressing this complexity requires an in-depth analysis of contemporary literature and clinical experiences to identify the most effective treatment strategies. This study aims to merge findings from specialized literature with clinical outcomes observed at the First Surgical Clinic SCJU Tg. Mures. By adopting a dual approach, we conducted a review of existing literature on the surgical management of gastric cancer extending to the transverse colon. We performed a retrospective analysis of cases treated at our institution. We evaluated surgical techniques, patient demographics, treatment protocols, and outcomes. As identified in systematic reviews and clinical trials over the past decade, the predominant strategy involves the combined resection of the stomach and affected colon segments. In our clinical practice, we managed four cases with personalized surgical treatments. Our findings revealed a 75% survival rate and a 50% comorbidity rate, with an average hospitalization duration of eight days. The findings highlight the necessity for personalized surgical approaches in managing complex gastric cancer cases involving the transverse colon. The study advocates integrating academic research with clinical practice to refine treatment protocols and enhance patient outcomes.
Objectives: Anastomotic leakage is a severe complication in patients undergoing colorectal surger... more Objectives: Anastomotic leakage is a severe complication in patients undergoing colorectal surgery, both by increasing morbidity/mortality and by increasing the likelihood of cancer recurrence.The current study aims to update the risk factors of anastomotic leakage in patients undergoing (elective or emergency) open surgery for colorectal cancer. Materials and Methods: A retrospective study was conducted on 87 patients, with a mean age of approximately 73 years, diagnosed and treated through open surgery for colorectal cancer during the previous five years. The study sample included 56 men and 31 women. Study data were extracted from clinical observation sheets, in which assessment of comorbidities was recorded using the Charlson Comorbidity Index. Results: Among the statistically significant risk factors for anastomotic leakage, we found obesity (19 cases),alcohol consumption and smoking (44 cases), preoperativechemoradiotherapy and/or anti-inflammatory drugs (8 cases),albumin and protein serum levels (27 cases),blood transfusion (39 cases),Charlson Comorbidity Index (63 cases), ASA score>II (22 cases),emergency vs. elective surgery (56 vs. 31 cases),tumor distance from anal verge(6 cases) and operative time (52 cases). Conclusions: Among modifiable risk factors, some of them (operating time, etc.) should be interpreted with caution, as they may be related to patient or logistical particularities. For other modifiable risk factors further investigations should be performed to find an optimal therapeutic approach. For example, resuscitative measures (administration of blood, albumin, etc.) are definitely necessary for systemic rebalancing, but they also carry a significant risk of local surgical complications, especially anastomotic leakage.
Introduction: Amyand's hernia, named after Claudius Amyand, is a rare hernia variant characterize... more Introduction: Amyand's hernia, named after Claudius Amyand, is a rare hernia variant characterized by the presence of the vermiform appendix within the hernial sac. Accounting for about 1% of all inguinal hernias, its exact development mechanism remains unclear. The clinical presentation can vary significantly, often mirroring symptoms of a hernia or acute appendicitis. Material & Method: A retrospective case series study was conducted at the General Surgery Clinic 1 of the SCJU Tg. Mures Emergency County Hospital. It involved a comprehensive review of medical records of patients diagnosed with Amyand's hernia who underwent emergency surgery. Data collected included demographics, clinical presentation, surgical management, postoperative complications, and follow-up details. Descriptive statistical analysis was performed using EasyMedStat software. Results: Over five years, seven cases of Amyand's hernia were reported, with an increase in 2023. The average age of the patients was 77.8 years, all male, demonstrating a higher incidence in older males. Symptom onset varied widely, from four months to nearly 20 years. Most patients experienced abdominal pain, with approximately half reporting fever. The primary diagnosis was often intestinal occlusion with an incarcerated inguinal-scrotal hernia. Surgical approaches varied, with the Lichtenstein operation being the most common. Mesh repair was used in most cases, and all patients underwent appendectomy. The median hospital stay was five days, with minimal postoperative complications. Conclusion: Amyand's hernia presents a surgical challenge due to its rarity and variable clinical presentation. This study underscores the need for individualized treatment strategies to optimize patient outcomes. The findings contribute to understanding Amyand's hernia, highlighting the importance of tailored surgical approaches and diligent postoperative care.
Background: Optimal reconstruction in distal gastric cancer resections remains controversial. Nor... more Background: Optimal reconstruction in distal gastric cancer resections remains controversial. North American and European (ESMO) oncological protocols do not provide indications for optimal surgical reconstructions. Asian oncological protocols recommend subtotal gastrectomy as the first indication for resections in distal gastrectomy. Material and methods: We used PubMed as the primary search engine to conduct a literature search review. We included studies published in the last five years (2019-2022) in the North American, European, and Asian regions. We excluded case presentations and used the terms - distal gastrectomy reconstructions/ gastric neoplasm/cancer as search keywords. Results: A total number of 74 studies were recorded. 41% (n=31) of the majority were from the Asian literature with two multicentric meta-analyses. The main reconstruction methods included in the studies were: gastro-duodenal and gastro-jejunal (Roux-en-Y, Braun). While each type of reconstruction has advantages and disadvantages, the gastro-duodenal technique, in most cases, is reported as an optimal choice regarding the postprocedural quality of life reports. Conclusions: Asian literature provides the most scientific data regarding optimal reconstruction in distal gastric neoplasm. Despite the presence of reflux esophagitis in gastro-duodenal anastomosis, it is recommended as a first choice for surgical reconstruction due to the low long-term postoperative complications. However, no protocols included indications for the optimal surgical technique. Further studies are required in the future to define optimal surgical management in this category of patients.
Background: Gastric cancer is the fifth most common cancer worldwide. Advances in the field of on... more Background: Gastric cancer is the fifth most common cancer worldwide. Advances in the field of oncology with radiotherapy, adjuvant chemotherapy associated with optimal surgical treatment can improve the outcome and patient quality of life (QOL). Current protocols, combined with early detection and better screening, have led to a decrease in the overall incidence of gastric cancer. Standardization of surgical treatment for gastric neoplasm following the patient's profile is important for a better outcome. Material and methods: A retrospective study was conducted that included all the patients diagnosed with gastric cancer enrolled in the First Surgical Clinic in Targu-Mures Emergency County Hospital between January 2015 and October 2021. Statistical data was obtained from the patients' files, operation protocol, and informatics system of the hospital. Results: We recorded a total number of (n=273) patients over the seven years. The average age of the patients was 71 years ranging from 29 to 93. We observed a male predominance of 69% with 31% female patients. The main surgical procedure performed for gastric cancer was subtotal gastrectomy (n=162) with a neoplasm location predominant at the antral-pyloric region (55%) with adenocarcinoma as the predominant histological diagnosis (73%). The mean hospitalization period was 20 days with a mortality rate of 9%. Conclusions: Gastrectomy and adequate lymph node resection can be challenging. Efforts provided by a multidisciplinary team can assure a good outcome regarding the patient's quality of life and the decrease of overall morbidity and mortality. If R0 is achievable, distal gastrectomy can be safely performed for patients with distal neoplasm.
Background. The COVID-19 pandemic has significantly impacted healthcare systems worldwide, raisin... more Background. The COVID-19 pandemic has significantly impacted healthcare systems worldwide, raising concerns about the quality of care for patients with various medical conditions, including gastric cancer. This retrospective study aims to compare the treatment outcomes and complications among patients treated for gastric cancer two years before and two years during the pandemic. Aims. The objective is to gain insights into the potential impact of the pandemic on the management of gastric cancer. Methods. An analysis was conducted on a cohort of patients who underwent surgical treatment for gastric cancer. The cohort consisted of patients treated two years before and two years during the pandemic. The medical records of these patients were reviewed to collect data on treatment outcomes, complications, and other relevant parameters. Statistical analysis was performed to compare the outcomes between the two groups. Results. The pandemic group had a higher incidence of emergency surgery, anastomosis fistulas, and gastric stenosis than the pre-pandemic group. While both groups reported spleen penetration, only the pandemic reported penetrations affecting other organs. The pandemic group had a longer operation time but shorter hospital stays, with a higher mortality rate. The pre-pandemic group had more patients receiving preoperative chemotherapy and more T2-stage cases based on the TNM classification. No significant differences were found in bleeding, wound infection, or evisceration. Conclusions. The higher rate of complications, particularly anastomosis fistula, and the lower utilization of preoperative chemotherapy during the pandemic highlight healthcare systems' challenges in providing optimal care during crises. The shorter hospitalization period observed during the pandemic suggests a potential adaptation to minimize patient exposure and optimize hospital resources.
Introduction: Bulk retroperitoneal lymphoma is a subtype of retroperitoneal lymphoma in which the... more Introduction: Bulk retroperitoneal lymphoma is a subtype of retroperitoneal lymphoma in which the tumor mass in the retroperitoneum measures 10 centimeters or more in its largest dimension. This type of lymphoma can occur in Hodgkin's and non-Hodgkin's lymphoma. Material and Methods: This paper presents the surgical treatment of a primary bulk retroperitoneal anaplastic lymphoma. Results: We present A 71-year-old patient admitted to Surgical Clinic 1 – SCJU Tg.Mures with a clinical accusation of intermittent abdominal pain, digestive turbulence, and weight loss, with the CT describing a tumor mass (10 cm) involving the superior mesenteric artery and aorta. Intraoperative exploration revealed a bulky tumor of 13/5/9 centimeters in size invasive in the superficial layers of the superior mesenteric artery and vein and abdominal aorta. Surgical fragmented excision was performed with no intraoperative and postoperative complications reported. The patient was discharged on postoperative day eight. Histopathological analysis revealed a negative resection margin revealing an anaplastic lymphoma. Conclusion: Treatment for bulk retroperitoneal lymphoma typically involves a combination of chemotherapy, radiation therapy, and surgery. The use of surgery for bulk disease can be more challenging depending on the size and location of the tumor, as well as the characteristics of the individual patient. Keywords: retroperitoneal, lymphoma, b-cells, bulk
Introduction: Some various tools and indices have been developed to measure the quality of life o... more Introduction: Some various tools and indices have been developed to measure the quality of life of patients who have undergone gastrectomy. One such tool is the EORTC QLQ-STO22 questionnaire, a module of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire. Material and Methods: We conducted a prospective analysis over three years (2019-2022) of all patients diagnosed and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures. The questionnaire was applied with 22 items that assess the specific symptoms and functional aspects of patients who have undergone gastrectomies, such as eating restrictions, reflux, pain, and anxiety. Results: We recorded 61 patients with an average age of 68 years and a male predominance of 72%. After the questionnaire, we observed a high predominant index score (3.4) (p=0.0011) in total gastrectomy patients. However, a better index score was reported regarding partial resection with gastric reconstruction (2.1) (p=0.0031). Of the different types of gastric reconstruction, the Pean-Billroth 1 anastomosis reported a 1.4 index score (p=0.001). Conclusion: The EORTC QLQ-STO22 questionnaire is a valid and reliable tool for assessing patients' quality of life who have undergone gastrectomy. It has been used in various clinical studies and trials to evaluate the impact of gastrectomy on patients' quality of life and assess the effectiveness of interventions to improve patients' well-being. Keywords: gastrectomy, gastric cancer, quality of life
The Parisian venereologist Jean Alfred Fournier first described Fournier's gangrene in 1883. Four... more The Parisian venereologist Jean Alfred Fournier first described Fournier's gangrene in 1883. Fournier's Gangrene Severity Index (FGSI) represents a numerical score that indicates the severity of the disease. It represents a valuable tool for calculating patient outcomes and applying the proper treatment to avoid local complications and high mortality rates. We conducted a retrospective study from 2010 to 2021 that included all patients diagnosed and treated for Fournier Gangrene (FG) in Surgical Clinic I Emergency County Hospital Tg.Mures. The diagnosis is based on patient history, local clinical examination, and paraclinical tests. Fournier's Gangrene Severity Index (FGSI) was calculated, and we divided the patients based on the FGSI score. One group had scores <9 points, while the other group included patients with a score >9. We recorded a total number of 23 patients. The main risk comorbidities were ischemic cardiomyopathy at 56.54% (n=13) and typed II diabetes at 43.4% (n=10). The FGSI index score was calculated in all patients with an average of 8.6± 2. 12 patients received a score >9, while 11 patients were ≤9. The overall mortality rate was 56.26% (n=13), with the high-score FGSI group recording mortality of 100%. Fournier's disease remains rare, with high mortality and morbidity rates. Therefore, early treatment must be applied to ensure proper treatment and a good outcome. FGSI score can be applied in patients to assess the overall severity of the disease and indicate the morbidity and mortality outcomes.
INTRODUCTION: LigaSure is a bipolar diathermy system that can achieve efficient vessel sealing. H... more INTRODUCTION: LigaSure is a bipolar diathermy system that can achieve efficient vessel sealing. Historically thyroid surgery involved meticulous devascularization of the gland with a high complication rate regarding hemostasis. However, recent applications of LigaSure technology show a reduction rate in intraoperative and early postoperative complications. OBJECTIVE: We aim to determine the best hemostasis surgical methods in thyroid surgery. MATERIAL AND METHODS: The study compares LigaSure applied and conventional knot technique thyroidectomy procedures in patients undergoing thyroid surgery. We conducted a retrospective study over five years and divided the patients into two groups. In addition, we recorded intraoperative and postoperative evaluations and thyroid pathology are involved from the patient's files. RESULTS: We recorded 105 patients who underwent thyroid surgery with an average age of 45. The Ligasure group included 42 and the conventional knot technique group 63. The postoperative hematoma was significantly higher in the conventional knot technique, 7% (p=0.022). However, intraoperative hemorrhagic complications were the same in both groups (p=0.221), with a lower blood loss rate in the Ligasure group (p=0.001). CONCLUSION: Ligasure vessel sealing system is safer than conventional knot techniques regarding intraoperative and postoperative hemostasis. Lower hemorrhagic rates can reduce patient morbidity and mortality with reduced hospital stay and surgical complications.
Introduction: Different reconstruction techniques are possible after gastrectomy in gastric neopl... more Introduction: Different reconstruction techniques are possible after gastrectomy in gastric neoplasms. Good nutritional status must be preserved, and there is a strong focus on the quality of life index that monitors post-operative morbidity. Pean-Billroth-I (physiological) and Roux-en-Y/Billroth-II (non-physiological) reconstruction are applied with their advantages and disadvantages. Material and Methods: We conducted a retrospective analysis over three years (2019-2021) of all patients diagnosed and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures with physiological and non physiological anastomosis. Data were obtained for the patient's files and operation protocols. Paraclinical and clinical follow-up was also analyzed. Results: We recorded 82 patients with an average age of 67 years and a male predominance of 72%. The predominant histological type was adenocarcinoma (88%). Physiological reconstructions revealed a better postoperative outcome with a 5% complication rate (p=0.0012) and a low recurrence rate of 2.5% (p=0.0033) with a better quality of life index. In addition, the non-physiological group recorded a better postoperative paraclinical evaluation (upper endoscopy): reflux evaluation -Los Angeles score (p=0.001). Conclusion: In conclusion, both anastomoses are feasible and safe and can be applied for the surgical treatment of gastric cancer. Physiological anastomosis reports lower surgical complications, morbidity, and mortality rates and offers a better quality of life index.
Introduction: Gallbladder-duodenal fistulas with hepatic abscesses are rare pathological complica... more Introduction: Gallbladder-duodenal fistulas with hepatic abscesses are rare pathological complications and present, usually in patients with an untreated gallstone. Courvoisier described them in 1890 as a rare complication of cholecystitis. Material and Methods: This paper presents the surgical treatment of a gallbladder-duodenal fistula with multiple hepatic abscesses. Results: We present a 67-year-old female patient admitted to the First Surgical Department SCJU Tg.Mures with clinical manifestation specific for cholecystitis. We performed an exploratory laparoscopy revealing an inflamed gallbladder with multiple liver abscesses. Conversion was required with anterograde cholecystectomy and the suturing of the gallbladder-duodenal fistula. In addition, we performed the exploration of the primary biliary tract revealing multiple gallstones and a suppurative angiocholitis. Liver abscesses (segment V, VI, VII) were evacuated with a Kehr drainage mounted. Postoperative care included antibiotic treatment with liver and renal functions monitorization. The patient was discharged on a postoperative day 19 with biliary Kehr drainage. Conclusion: Although rare gallbladder-duodenal fistula can represent a surgical challenge due to its nonspecific symptomatology. Morbidity and mortality are high when associated with extended hepatic abscesses.
Background: Nutritional status of the patients is very influential for postoperative complication... more Background: Nutritional status of the patients is very influential for postoperative complications and the quality of life index. One helpful tool in evaluating postoperative gastric neoplasm patients is The Controlling Nutritional Status (CONUT) score. Evaluation implies monitorization of serum albumin, lymphocyte, and total cholesterol levels. Objective: Our study aimed to assess the nutritional status and outcomes (CONUT score) of the patients treated for gastric neoplasm in Surgical Clinic I SCJU Tg.Mures. Material and methods: We conducted a prospective study over one and a half years that included patients diagnosed and treated for gastric neoplasm. We evaluated the nutritional parameters and calculated the CONUT score. In addition, comorbidities and postoperative surgical monitoring were registered. Results : We recorded 57 patients with an average age of 52 years. We observed a male predominance of 63% (n=36). In more than half of the patients, 57%, we recorded a low CONUT score (0-4 points). A high CONUT score (5-12 points) was associated with comorbidities, mainly anastomosis fistula and incision infection (p=0.0021). The main surgical procedure was subtotal gastrectomy 69% (n=39), with total gastrectomy associated with a high CONUT score (p=0.0011). Conclusions: Quality of life in patients treated for gastric neoplasm is a valuable asset that ensures a rapid recovery with social reintegration. CONUT score can be implemented in assessing the nutritional status of patients with surgical treatment to assess postoperative complications and nutritional management. Keywords: gastric neoplasm, nutrition status, CONUT score
Introduction: Kilgore published one of the first series of bilateral breast cancer in 1921. The
i... more Introduction: Kilgore published one of the first series of bilateral breast cancer in 1921. The incidence of bilateral breast carcinoma varies from 2 to 10 % worldwide. Based on current studies, the definition of bilateral synchronous represents both tumors' appearance from 1 month to 1 year with general classification as synchronous and metachronous. Material and methods: we conducted a retrospective study of the surgical management of bilateral breast carcinoma. We included patients treated at the First Surgical Clinic - SCJU Tg. Mures over five years (2017-2021). Surgical procedures, patient follow-up, and histopathological diagnosis were recorded. Results: we recorded a total number of eight cases. The majority were at intervals lower than four months (n=5), with two patients simultaneously diagnosed with bilateral breast carcinoma (synchronous carcinoma). The predominant histological variant was ductal carcinoma (n=4). BRCA1 and BRCA2 were present în 75% of cases, with 60% relating a family history of breast carcinoma. Only în one case, bilateral breast cancer was reported due to patient noncompliance for postoperative chemo and radiotherapy. Conclusion: the incidence of bilateral breast carcinoma remains low. However, periodical examination and screening must be applied in each patient with breast carcinoma în order to ensure an early diagnosis with a good surgical outcome and socio-economical integration.
The management of rectal cancer recognizes surgical resection as the most important
step towards ... more The management of rectal cancer recognizes surgical resection as the most important step towards a permanent cure. Respecting the oncological principles, functional preservation represents a priority in achieving an acceptable quality of life for the patient. This study aimed to compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR), in terms of postoperative outcome. We conducted a retrospective, observational study on a group of 147 patients with LAR or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative evolution was followed. The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution regarding patients’ demographic and biological parameters and tumor pathological features. A significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR procedures. We found no statistically significant differences between LAR and VLAR in terms of associated postoperative morbidity or mortality, neither in hospitalization time. There was no statistical difference in terms of early postoperative outcomes among LAR and VLAR. The most important factor in achieving good oncologic and functional results in low rectal cancer is choosing the adequate, tailored to the case surgical management.
Introduction: Carcinoma of the transverse colon is usually rare and accounts for 10% of all color... more Introduction: Carcinoma of the transverse colon is usually rare and accounts for 10% of all colorectal cancer. Diagnosis is often delayed with the progression of symptoms that are often insidious and tumors may be voluminous with locoregional involvement by the time of diagnosis. Material and Methods: This study aims to present the surgical management and challenges of advanced cancer of the transverse colon.Results: We present a 43-year-old with no personal history of gastroenterological pathology. After SARS-COVID 19 infection he developed mild gastrointestinal symptomatology. Routine checkups revealed an advanced tumor of the transverse colon with multiorgan involvement: stomach and small intestine (CT-scan). We performed a multi-visceral resection with extended right hemicolectomy, gastric antrectomy with gastro-jejunal isoperistaltic anastomosis (Lucke Rockwitz procedure), and ileocolic telescopic anastomosis. The postoperative evolution was favorable. Conclusion: Complex surgical therapy for colon cancer can be undertaken in selected patients. The procedures are often extensive requiring an experienced team to assure a good postoperative outcome and proper continuation of the oncological treatment.
Introduction: Postoperative complications can frequently occur after gastrectomy for gastric canc... more Introduction: Postoperative complications can frequently occur after gastrectomy for gastric cancer and are associated with poor
clinical outcomes, such as mortality and surgical re-intervention. The study aimed to identify the clinically most relevant complications
after gastrectomy.
Material and Methods: We conducted a retrospective study in which we included all the patients diagnosed with gastric cancer
enrolled in the First Surgical Clinic in Targu-Mures Emergency County Hospital between January 2015 and March 2021.
Results: We recorded a total number of 253 patients over the seven years. The average age of the patients was 71 years ranging
from 29 to 93. We observed a male predominance of 69% with 31% female patients. The main surgical procedure performed for
gastric cancer was subtotal gastrectomy with 152 cases. Anastomotic leakage had the greatest overall impact on re-interventions
with high mortality rates (45%) especially in patients with associated comorbidities. The most common encounter complication was
wound infection (60%). Postoperative bleeding was the least encountered complication (>3%).
Conclusion: Gastrectomy for cancer is a technically demanding surgical intervention. Control and treatment of postoperative
complications require an experienced surgical team. Patients with poor general conditions are most exposed to such complications.
Early detection of postoperative complications and attentive care especially in the patient’s nutritional status is required to assure a
good outcome for the patients.
Key words: gastric cancer, gastrectomy, postoperative complications
The presentation titled "Institute for Surgical Excellence: Its Role in the Standardization of Tr... more The presentation titled "Institute for Surgical Excellence: Its Role in the Standardization of Training and Accreditation in Robotic Surgery" explores the mission and impact of the Institute for Surgical Excellence (ISE), a non-profit organization established in 2014. The institute aims to address complex healthcare challenges associated with emerging surgical technologies to enhance patient outcomes and safety.
The course focuses on the Fundamentals of Robotic Surgery (FRS), which includes consensus conferences designed to standardize robotic-assisted surgery (RAS). These conferences, led by experts like Drs. Richard Satava, Roger Smith, and Vipul Patel, emphasize key aspects such as instrument handling, task coordination, safety protocols, and ergonomic practices in robotic surgery.
The curriculum planning for RAS includes practical tasks such as docking/instrument insertion, knot tying, vessel dissection, and other essential robotic surgery techniques. By providing clear outcome measures and structured training guidelines, the ISE plays a pivotal role in improving surgical training, accreditation, and patient safety in the evolving field of robotic surgery.
This course is integral in setting global standards for robotic surgery and ensuring that the next generation of surgeons is equipped with the necessary skills and knowledge to perform these advanced procedures effectively and safely.
This course, titled "The Origins of Minimally Invasive and Robotic Surgery and Their Impact on Su... more This course, titled "The Origins of Minimally Invasive and Robotic Surgery and Their Impact on Surgical Practice: A Sociological and Technological History," is a comprehensive exploration of the evolution of surgical techniques, particularly focusing on minimally invasive and robotic methods. It covers the historical progression from early surgical innovations, including the development of the endoscope and the first laparoscopic procedures, to the advent of robotic surgery systems like the da Vinci robot.
The course emphasizes the significant technological advancements that have shaped modern surgery, as well as the sociological impact these innovations have had on surgical practice, education, and patient care. Through the study of various key milestones—from the pre-industrial era to the current widespread use of robotic surgery—the course provides valuable insights into how these advancements have enhanced surgical outcomes, education, and the overall practice of surgery. It also critically discusses the challenges and disadvantages of these technologies, including the loss of tactile feedback and the potential for a less intuitive surgical experience.
By the end of the course, participants gain an understanding of the historical, technological, and sociological contexts of modern surgery, with a focus on the continuing evolution of minimally invasive and robotic surgical techniques.
The presentation "From Laparoscopy to Robotic and Digital Surgery" outlines the evolution of surg... more The presentation "From Laparoscopy to Robotic and Digital Surgery" outlines the evolution of surgical techniques from traditional laparotomy to modern robotic and digital surgery. It highlights the paradigm shift initiated by laparoscopy, the impact of video endoscopy, and the introduction of robotic systems, such as telepresence platforms and surgical robots. The presentation also touches on future trends, including the integration of 5G technology and the potential of fully digital surgical pl
The presentation provides an overview of AI's development, starting from philosophical roots, thr... more The presentation provides an overview of AI's development, starting from philosophical roots, through foundational theories in logic and computation, to key milestones like neural networks, expert systems, and modern AI applications in speech recognition and reinforcement learning.
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Papers by Catalin Cosma
(ESMO) oncological protocols do not provide indications for optimal surgical reconstructions. Asian oncological protocols
recommend subtotal gastrectomy as the first indication for resections in distal gastrectomy. Material and methods: We used
PubMed as the primary search engine to conduct a literature search review. We included studies published in the last five years
(2019-2022) in the North American, European, and Asian regions. We excluded case presentations and used the terms - distal
gastrectomy reconstructions/ gastric neoplasm/cancer as search keywords. Results: A total number of 74 studies were recorded.
41% (n=31) of the majority were from the Asian literature with two multicentric meta-analyses. The main reconstruction methods
included in the studies were: gastro-duodenal and gastro-jejunal (Roux-en-Y, Braun). While each type of reconstruction has
advantages and disadvantages, the gastro-duodenal technique, in most cases, is reported as an optimal choice regarding the
postprocedural quality of life reports. Conclusions: Asian literature provides the most scientific data regarding optimal
reconstruction in distal gastric neoplasm. Despite the presence of reflux esophagitis in gastro-duodenal anastomosis, it is
recommended as a first choice for surgical reconstruction due to the low long-term postoperative complications. However, no
protocols included indications for the optimal surgical technique. Further studies are required in the future to define optimal
surgical management in this category of patients.
the retroperitoneum measures 10 centimeters or more in its largest dimension. This type of lymphoma can occur in
Hodgkin's and non-Hodgkin's lymphoma.
Material and Methods: This paper presents the surgical treatment of a primary bulk retroperitoneal anaplastic
lymphoma.
Results: We present A 71-year-old patient admitted to Surgical Clinic 1 – SCJU Tg.Mures with a clinical accusation of
intermittent abdominal pain, digestive turbulence, and weight loss, with the CT describing a tumor mass (10 cm)
involving the superior mesenteric artery and aorta. Intraoperative exploration revealed a bulky tumor of 13/5/9
centimeters in size invasive in the superficial layers of the superior mesenteric artery and vein and abdominal aorta.
Surgical fragmented excision was performed with no intraoperative and postoperative complications reported. The
patient was discharged on postoperative day eight. Histopathological analysis revealed a negative resection margin
revealing an anaplastic lymphoma.
Conclusion: Treatment for bulk retroperitoneal lymphoma typically involves a combination of chemotherapy,
radiation therapy, and surgery. The use of surgery for bulk disease can be more challenging depending on the size
and location of the tumor, as well as the characteristics of the individual patient.
Keywords: retroperitoneal, lymphoma, b-cells, bulk
undergone gastrectomy. One such tool is the EORTC QLQ-STO22 questionnaire, a module of the European
Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire.
Material and Methods: We conducted a prospective analysis over three years (2019-2022) of all patients diagnosed
and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures. The questionnaire was applied with 22 items
that assess the specific symptoms and functional aspects of patients who have undergone gastrectomies, such as
eating restrictions, reflux, pain, and anxiety.
Results: We recorded 61 patients with an average age of 68 years and a male predominance of 72%. After the
questionnaire, we observed a high predominant index score (3.4) (p=0.0011) in total gastrectomy patients. However,
a better index score was reported regarding partial resection with gastric reconstruction (2.1) (p=0.0031). Of the
different types of gastric reconstruction, the Pean-Billroth 1 anastomosis reported a 1.4 index score (p=0.001).
Conclusion: The EORTC QLQ-STO22 questionnaire is a valid and reliable tool for assessing patients' quality of life who
have undergone gastrectomy. It has been used in various clinical studies and trials to evaluate the impact of
gastrectomy on patients' quality of life and assess the effectiveness of interventions to improve patients' well-being.
Keywords: gastrectomy, gastric cancer, quality of life
OBJECTIVE: We aim to determine the best hemostasis surgical methods in thyroid surgery.
MATERIAL AND METHODS: The study compares LigaSure applied and conventional knot technique thyroidectomy procedures in patients undergoing thyroid surgery. We conducted a retrospective study over five years and divided the patients into two groups. In addition, we recorded intraoperative and postoperative evaluations and thyroid pathology are involved from the patient's files.
RESULTS: We recorded 105 patients who underwent thyroid surgery with an average age of 45. The Ligasure group included 42 and the conventional knot technique group 63. The postoperative hematoma was significantly higher in the conventional knot technique, 7% (p=0.022). However, intraoperative hemorrhagic complications were the same in both groups (p=0.221), with a lower blood loss rate in the Ligasure group (p=0.001).
CONCLUSION: Ligasure vessel sealing system is safer than conventional knot techniques regarding intraoperative and postoperative hemostasis. Lower hemorrhagic rates can reduce patient morbidity and mortality with reduced hospital stay and surgical complications.
Material and Methods: We conducted a retrospective analysis over three years (2019-2021) of all patients diagnosed and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures with physiological and non physiological anastomosis. Data were obtained for the patient's files and operation protocols. Paraclinical and clinical follow-up was also analyzed.
Results: We recorded 82 patients with an average age of 67 years and a male predominance of 72%. The predominant histological type was adenocarcinoma (88%). Physiological reconstructions revealed a better postoperative outcome with a 5% complication rate (p=0.0012) and a low recurrence rate of 2.5% (p=0.0033) with a better quality of life index. In addition, the non-physiological group recorded a better postoperative paraclinical evaluation (upper endoscopy): reflux evaluation -Los Angeles score (p=0.001).
Conclusion: In conclusion, both anastomoses are feasible and safe and can be applied for the surgical treatment of gastric cancer. Physiological anastomosis reports lower surgical complications, morbidity, and mortality rates and offers a better quality of life index.
Material and Methods: This paper presents the surgical treatment of a gallbladder-duodenal fistula with multiple hepatic abscesses.
Results: We present a 67-year-old female patient admitted to the First Surgical Department SCJU Tg.Mures with clinical manifestation specific for cholecystitis. We performed an exploratory laparoscopy revealing an inflamed gallbladder with multiple liver abscesses. Conversion was required with anterograde cholecystectomy and the suturing of the gallbladder-duodenal fistula. In addition, we performed the exploration of the primary biliary tract revealing multiple gallstones and a suppurative angiocholitis. Liver abscesses (segment V, VI, VII) were evacuated
with a Kehr drainage mounted. Postoperative care included antibiotic treatment with liver and renal functions monitorization. The patient was discharged on a postoperative day 19 with biliary Kehr drainage.
Conclusion: Although rare gallbladder-duodenal fistula can represent a surgical challenge due to its nonspecific symptomatology. Morbidity and mortality are high when associated with extended hepatic abscesses.
Objective: Our study aimed to assess the nutritional status and outcomes (CONUT score) of the patients treated for gastric neoplasm in Surgical Clinic I SCJU Tg.Mures. Material and methods: We conducted a prospective study over one and a half years that included patients diagnosed and treated for gastric neoplasm. We evaluated the nutritional parameters and calculated the CONUT score. In addition, comorbidities and postoperative surgical monitoring were registered. Results : We recorded 57 patients with an average age of 52 years. We observed a male predominance of 63% (n=36). In more than half of the patients, 57%, we recorded a low CONUT score (0-4 points). A high CONUT score (5-12 points) was associated with comorbidities, mainly anastomosis fistula and incision infection (p=0.0021). The main surgical procedure was subtotal gastrectomy 69% (n=39), with total gastrectomy associated with a high CONUT score (p=0.0011).
Conclusions: Quality of life in patients treated for gastric neoplasm is a valuable asset that ensures a rapid recovery with social reintegration. CONUT score can be implemented in assessing the nutritional status of patients with surgical treatment to assess postoperative complications and nutritional management.
Keywords: gastric neoplasm, nutrition status, CONUT score
incidence of bilateral breast carcinoma varies from 2 to 10 % worldwide. Based on current
studies, the definition of bilateral synchronous represents both tumors' appearance from 1
month to 1 year with general classification as synchronous and metachronous.
Material and methods: we conducted a retrospective study of the surgical management of
bilateral breast carcinoma. We included patients treated at the First Surgical Clinic - SCJU Tg.
Mures over five years (2017-2021). Surgical procedures, patient follow-up, and histopathological
diagnosis were recorded.
Results: we recorded a total number of eight cases. The majority were at intervals lower than
four months (n=5), with two patients simultaneously diagnosed with bilateral breast carcinoma
(synchronous carcinoma). The predominant histological variant was ductal carcinoma (n=4).
BRCA1 and BRCA2 were present în 75% of cases, with 60% relating a family history of breast
carcinoma. Only în one case, bilateral breast cancer was reported due to patient noncompliance
for postoperative chemo and radiotherapy.
Conclusion: the incidence of bilateral breast carcinoma remains low. However, periodical
examination and screening must be applied in each patient with breast carcinoma în order to
ensure an early diagnosis with a good surgical outcome and socio-economical integration.
step towards a permanent cure. Respecting the oncological principles, functional preservation
represents a priority in achieving an acceptable quality of life for the patient. This study aimed to
compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR),
in terms of postoperative outcome.
We conducted a retrospective, observational study on a group of 147 patients with LAR
or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency
County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low
rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less
than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative
evolution was followed.
The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution
regarding patients’ demographic and biological parameters and tumor pathological features. A
significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR
procedures. We found no statistically significant differences between LAR and VLAR in terms of
associated postoperative morbidity or mortality, neither in hospitalization time.
There was no statistical difference in terms of early postoperative outcomes among
LAR and VLAR. The most important factor in achieving good oncologic and functional results in low
rectal cancer is choosing the adequate, tailored to the case surgical management.
delayed with the progression of symptoms that are often insidious and tumors may be voluminous with locoregional involvement
by the time of diagnosis.
Material and Methods: This study aims to present the surgical management and challenges of advanced cancer of the transverse
colon.Results: We present a 43-year-old with no personal history of gastroenterological pathology. After SARS-COVID 19 infection he
developed mild gastrointestinal symptomatology. Routine checkups revealed an advanced tumor of the transverse colon with
multiorgan involvement: stomach and small intestine (CT-scan). We performed a multi-visceral resection with extended right hemicolectomy,
gastric antrectomy with gastro-jejunal isoperistaltic anastomosis (Lucke Rockwitz procedure), and ileocolic telescopic
anastomosis. The postoperative evolution was favorable.
Conclusion: Complex surgical therapy for colon cancer can be undertaken in selected patients. The procedures are often extensive
requiring an experienced team to assure a good postoperative outcome and proper continuation of the oncological treatment.
clinical outcomes, such as mortality and surgical re-intervention. The study aimed to identify the clinically most relevant complications
after gastrectomy.
Material and Methods: We conducted a retrospective study in which we included all the patients diagnosed with gastric cancer
enrolled in the First Surgical Clinic in Targu-Mures Emergency County Hospital between January 2015 and March 2021.
Results: We recorded a total number of 253 patients over the seven years. The average age of the patients was 71 years ranging
from 29 to 93. We observed a male predominance of 69% with 31% female patients. The main surgical procedure performed for
gastric cancer was subtotal gastrectomy with 152 cases. Anastomotic leakage had the greatest overall impact on re-interventions
with high mortality rates (45%) especially in patients with associated comorbidities. The most common encounter complication was
wound infection (60%). Postoperative bleeding was the least encountered complication (>3%).
Conclusion: Gastrectomy for cancer is a technically demanding surgical intervention. Control and treatment of postoperative
complications require an experienced surgical team. Patients with poor general conditions are most exposed to such complications.
Early detection of postoperative complications and attentive care especially in the patient’s nutritional status is required to assure a
good outcome for the patients.
Key words: gastric cancer, gastrectomy, postoperative complications
(ESMO) oncological protocols do not provide indications for optimal surgical reconstructions. Asian oncological protocols
recommend subtotal gastrectomy as the first indication for resections in distal gastrectomy. Material and methods: We used
PubMed as the primary search engine to conduct a literature search review. We included studies published in the last five years
(2019-2022) in the North American, European, and Asian regions. We excluded case presentations and used the terms - distal
gastrectomy reconstructions/ gastric neoplasm/cancer as search keywords. Results: A total number of 74 studies were recorded.
41% (n=31) of the majority were from the Asian literature with two multicentric meta-analyses. The main reconstruction methods
included in the studies were: gastro-duodenal and gastro-jejunal (Roux-en-Y, Braun). While each type of reconstruction has
advantages and disadvantages, the gastro-duodenal technique, in most cases, is reported as an optimal choice regarding the
postprocedural quality of life reports. Conclusions: Asian literature provides the most scientific data regarding optimal
reconstruction in distal gastric neoplasm. Despite the presence of reflux esophagitis in gastro-duodenal anastomosis, it is
recommended as a first choice for surgical reconstruction due to the low long-term postoperative complications. However, no
protocols included indications for the optimal surgical technique. Further studies are required in the future to define optimal
surgical management in this category of patients.
the retroperitoneum measures 10 centimeters or more in its largest dimension. This type of lymphoma can occur in
Hodgkin's and non-Hodgkin's lymphoma.
Material and Methods: This paper presents the surgical treatment of a primary bulk retroperitoneal anaplastic
lymphoma.
Results: We present A 71-year-old patient admitted to Surgical Clinic 1 – SCJU Tg.Mures with a clinical accusation of
intermittent abdominal pain, digestive turbulence, and weight loss, with the CT describing a tumor mass (10 cm)
involving the superior mesenteric artery and aorta. Intraoperative exploration revealed a bulky tumor of 13/5/9
centimeters in size invasive in the superficial layers of the superior mesenteric artery and vein and abdominal aorta.
Surgical fragmented excision was performed with no intraoperative and postoperative complications reported. The
patient was discharged on postoperative day eight. Histopathological analysis revealed a negative resection margin
revealing an anaplastic lymphoma.
Conclusion: Treatment for bulk retroperitoneal lymphoma typically involves a combination of chemotherapy,
radiation therapy, and surgery. The use of surgery for bulk disease can be more challenging depending on the size
and location of the tumor, as well as the characteristics of the individual patient.
Keywords: retroperitoneal, lymphoma, b-cells, bulk
undergone gastrectomy. One such tool is the EORTC QLQ-STO22 questionnaire, a module of the European
Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire.
Material and Methods: We conducted a prospective analysis over three years (2019-2022) of all patients diagnosed
and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures. The questionnaire was applied with 22 items
that assess the specific symptoms and functional aspects of patients who have undergone gastrectomies, such as
eating restrictions, reflux, pain, and anxiety.
Results: We recorded 61 patients with an average age of 68 years and a male predominance of 72%. After the
questionnaire, we observed a high predominant index score (3.4) (p=0.0011) in total gastrectomy patients. However,
a better index score was reported regarding partial resection with gastric reconstruction (2.1) (p=0.0031). Of the
different types of gastric reconstruction, the Pean-Billroth 1 anastomosis reported a 1.4 index score (p=0.001).
Conclusion: The EORTC QLQ-STO22 questionnaire is a valid and reliable tool for assessing patients' quality of life who
have undergone gastrectomy. It has been used in various clinical studies and trials to evaluate the impact of
gastrectomy on patients' quality of life and assess the effectiveness of interventions to improve patients' well-being.
Keywords: gastrectomy, gastric cancer, quality of life
OBJECTIVE: We aim to determine the best hemostasis surgical methods in thyroid surgery.
MATERIAL AND METHODS: The study compares LigaSure applied and conventional knot technique thyroidectomy procedures in patients undergoing thyroid surgery. We conducted a retrospective study over five years and divided the patients into two groups. In addition, we recorded intraoperative and postoperative evaluations and thyroid pathology are involved from the patient's files.
RESULTS: We recorded 105 patients who underwent thyroid surgery with an average age of 45. The Ligasure group included 42 and the conventional knot technique group 63. The postoperative hematoma was significantly higher in the conventional knot technique, 7% (p=0.022). However, intraoperative hemorrhagic complications were the same in both groups (p=0.221), with a lower blood loss rate in the Ligasure group (p=0.001).
CONCLUSION: Ligasure vessel sealing system is safer than conventional knot techniques regarding intraoperative and postoperative hemostasis. Lower hemorrhagic rates can reduce patient morbidity and mortality with reduced hospital stay and surgical complications.
Material and Methods: We conducted a retrospective analysis over three years (2019-2021) of all patients diagnosed and treated for gastric cancer in the Surgical Clinic 1-SCJU.Tg Mures with physiological and non physiological anastomosis. Data were obtained for the patient's files and operation protocols. Paraclinical and clinical follow-up was also analyzed.
Results: We recorded 82 patients with an average age of 67 years and a male predominance of 72%. The predominant histological type was adenocarcinoma (88%). Physiological reconstructions revealed a better postoperative outcome with a 5% complication rate (p=0.0012) and a low recurrence rate of 2.5% (p=0.0033) with a better quality of life index. In addition, the non-physiological group recorded a better postoperative paraclinical evaluation (upper endoscopy): reflux evaluation -Los Angeles score (p=0.001).
Conclusion: In conclusion, both anastomoses are feasible and safe and can be applied for the surgical treatment of gastric cancer. Physiological anastomosis reports lower surgical complications, morbidity, and mortality rates and offers a better quality of life index.
Material and Methods: This paper presents the surgical treatment of a gallbladder-duodenal fistula with multiple hepatic abscesses.
Results: We present a 67-year-old female patient admitted to the First Surgical Department SCJU Tg.Mures with clinical manifestation specific for cholecystitis. We performed an exploratory laparoscopy revealing an inflamed gallbladder with multiple liver abscesses. Conversion was required with anterograde cholecystectomy and the suturing of the gallbladder-duodenal fistula. In addition, we performed the exploration of the primary biliary tract revealing multiple gallstones and a suppurative angiocholitis. Liver abscesses (segment V, VI, VII) were evacuated
with a Kehr drainage mounted. Postoperative care included antibiotic treatment with liver and renal functions monitorization. The patient was discharged on a postoperative day 19 with biliary Kehr drainage.
Conclusion: Although rare gallbladder-duodenal fistula can represent a surgical challenge due to its nonspecific symptomatology. Morbidity and mortality are high when associated with extended hepatic abscesses.
Objective: Our study aimed to assess the nutritional status and outcomes (CONUT score) of the patients treated for gastric neoplasm in Surgical Clinic I SCJU Tg.Mures. Material and methods: We conducted a prospective study over one and a half years that included patients diagnosed and treated for gastric neoplasm. We evaluated the nutritional parameters and calculated the CONUT score. In addition, comorbidities and postoperative surgical monitoring were registered. Results : We recorded 57 patients with an average age of 52 years. We observed a male predominance of 63% (n=36). In more than half of the patients, 57%, we recorded a low CONUT score (0-4 points). A high CONUT score (5-12 points) was associated with comorbidities, mainly anastomosis fistula and incision infection (p=0.0021). The main surgical procedure was subtotal gastrectomy 69% (n=39), with total gastrectomy associated with a high CONUT score (p=0.0011).
Conclusions: Quality of life in patients treated for gastric neoplasm is a valuable asset that ensures a rapid recovery with social reintegration. CONUT score can be implemented in assessing the nutritional status of patients with surgical treatment to assess postoperative complications and nutritional management.
Keywords: gastric neoplasm, nutrition status, CONUT score
incidence of bilateral breast carcinoma varies from 2 to 10 % worldwide. Based on current
studies, the definition of bilateral synchronous represents both tumors' appearance from 1
month to 1 year with general classification as synchronous and metachronous.
Material and methods: we conducted a retrospective study of the surgical management of
bilateral breast carcinoma. We included patients treated at the First Surgical Clinic - SCJU Tg.
Mures over five years (2017-2021). Surgical procedures, patient follow-up, and histopathological
diagnosis were recorded.
Results: we recorded a total number of eight cases. The majority were at intervals lower than
four months (n=5), with two patients simultaneously diagnosed with bilateral breast carcinoma
(synchronous carcinoma). The predominant histological variant was ductal carcinoma (n=4).
BRCA1 and BRCA2 were present în 75% of cases, with 60% relating a family history of breast
carcinoma. Only în one case, bilateral breast cancer was reported due to patient noncompliance
for postoperative chemo and radiotherapy.
Conclusion: the incidence of bilateral breast carcinoma remains low. However, periodical
examination and screening must be applied in each patient with breast carcinoma în order to
ensure an early diagnosis with a good surgical outcome and socio-economical integration.
step towards a permanent cure. Respecting the oncological principles, functional preservation
represents a priority in achieving an acceptable quality of life for the patient. This study aimed to
compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR),
in terms of postoperative outcome.
We conducted a retrospective, observational study on a group of 147 patients with LAR
or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency
County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low
rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less
than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative
evolution was followed.
The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution
regarding patients’ demographic and biological parameters and tumor pathological features. A
significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR
procedures. We found no statistically significant differences between LAR and VLAR in terms of
associated postoperative morbidity or mortality, neither in hospitalization time.
There was no statistical difference in terms of early postoperative outcomes among
LAR and VLAR. The most important factor in achieving good oncologic and functional results in low
rectal cancer is choosing the adequate, tailored to the case surgical management.
delayed with the progression of symptoms that are often insidious and tumors may be voluminous with locoregional involvement
by the time of diagnosis.
Material and Methods: This study aims to present the surgical management and challenges of advanced cancer of the transverse
colon.Results: We present a 43-year-old with no personal history of gastroenterological pathology. After SARS-COVID 19 infection he
developed mild gastrointestinal symptomatology. Routine checkups revealed an advanced tumor of the transverse colon with
multiorgan involvement: stomach and small intestine (CT-scan). We performed a multi-visceral resection with extended right hemicolectomy,
gastric antrectomy with gastro-jejunal isoperistaltic anastomosis (Lucke Rockwitz procedure), and ileocolic telescopic
anastomosis. The postoperative evolution was favorable.
Conclusion: Complex surgical therapy for colon cancer can be undertaken in selected patients. The procedures are often extensive
requiring an experienced team to assure a good postoperative outcome and proper continuation of the oncological treatment.
clinical outcomes, such as mortality and surgical re-intervention. The study aimed to identify the clinically most relevant complications
after gastrectomy.
Material and Methods: We conducted a retrospective study in which we included all the patients diagnosed with gastric cancer
enrolled in the First Surgical Clinic in Targu-Mures Emergency County Hospital between January 2015 and March 2021.
Results: We recorded a total number of 253 patients over the seven years. The average age of the patients was 71 years ranging
from 29 to 93. We observed a male predominance of 69% with 31% female patients. The main surgical procedure performed for
gastric cancer was subtotal gastrectomy with 152 cases. Anastomotic leakage had the greatest overall impact on re-interventions
with high mortality rates (45%) especially in patients with associated comorbidities. The most common encounter complication was
wound infection (60%). Postoperative bleeding was the least encountered complication (>3%).
Conclusion: Gastrectomy for cancer is a technically demanding surgical intervention. Control and treatment of postoperative
complications require an experienced surgical team. Patients with poor general conditions are most exposed to such complications.
Early detection of postoperative complications and attentive care especially in the patient’s nutritional status is required to assure a
good outcome for the patients.
Key words: gastric cancer, gastrectomy, postoperative complications
The course focuses on the Fundamentals of Robotic Surgery (FRS), which includes consensus conferences designed to standardize robotic-assisted surgery (RAS). These conferences, led by experts like Drs. Richard Satava, Roger Smith, and Vipul Patel, emphasize key aspects such as instrument handling, task coordination, safety protocols, and ergonomic practices in robotic surgery.
The curriculum planning for RAS includes practical tasks such as docking/instrument insertion, knot tying, vessel dissection, and other essential robotic surgery techniques. By providing clear outcome measures and structured training guidelines, the ISE plays a pivotal role in improving surgical training, accreditation, and patient safety in the evolving field of robotic surgery.
This course is integral in setting global standards for robotic surgery and ensuring that the next generation of surgeons is equipped with the necessary skills and knowledge to perform these advanced procedures effectively and safely.
The course emphasizes the significant technological advancements that have shaped modern surgery, as well as the sociological impact these innovations have had on surgical practice, education, and patient care. Through the study of various key milestones—from the pre-industrial era to the current widespread use of robotic surgery—the course provides valuable insights into how these advancements have enhanced surgical outcomes, education, and the overall practice of surgery. It also critically discusses the challenges and disadvantages of these technologies, including the loss of tactile feedback and the potential for a less intuitive surgical experience.
By the end of the course, participants gain an understanding of the historical, technological, and sociological contexts of modern surgery, with a focus on the continuing evolution of minimally invasive and robotic surgical techniques.
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