Józef Dzielicki

Laparoscopic splenectomy in children–a multicenter experience

PURPOSE Splenectomy is frequently required in children for various hematologic pathologic findings. Because of progress in minimally invasive techniques, laparoscopic splenectomy (LS) has become feasible. The objective of this report is to present a multicenter experience of 159 laparoscopic splenectomies. METHODS Records of 159 children, who underwent LS in 3 pediatric surgery centers between 1996 and 2006, were reviewed retrospectively with a special questionnaire. The indication for splenectomy were hematologic disorders (147), esophageal varices (6), splenic cyst (5), and tumor of the tail of the pancreas (1). The LS was performed using standard laparoscopic technique and instrumentation. RESULTS There were 75 boys and 84 girls. Median age was 12.5 years (range, 2-19.4 years). Laparoscopic splenectomy alone was performed in 118 cases and LS with cholecystectomy or cholecystotomy in 36. In 5 cases, LS was performed together with fundoplication. Eight LS required conversion to an open procedure for following reasons: severe bleeding (3), massive splenomegaly (1), anatomical (2), and technical aspects (2). Accessory spleens were identified in 20 cases (12.6%). There was no mortality. Complications consisted of 8 conversions and postoperatively of mild generalized infection in 3 children and abdominal bleeding that resulted in re-laparoscopy in 1 case. CONCLUSIONS Laparoscopic splenectomy can be safely and effectively performed in children.

The study of physicochemical properties of stabilizing plates removed from the body after treatment of pectus excavatum.

This paper presents the results of a physicochemical surface study and clinical observation of a new generation of plates for the treatment of pectus excavatum. Analysis of the data allowed us to investigate the effect of implant design and condition of their surface on the results of treatment of pectus excavatum. In the study, we performed an analysis of clinical data, obtained after a suitable period of treatment with the use of implants, as well as a study of physicochemical properties of stabilizing plates after their removal from the body. Surface roughness, the surface wettability and corrosion resistance were measured, and the results were compared with clinical observations. When removing the plates we found only slight inflammatory-periosteal reactions around the wire fixing transverse stabilizing plates to the ribs and locking the base plate correcting the distortion. The corrective plates did not shift or rotate during the entire treatment period, giving an optimal, oval and natural shape of the chest. The obtained values of the parameters investigated indicate that the reduction in resistance to pitting corrosion occurred in the areas where laser marking was made to identify the plate. The remaining plates, in spite of mechanical damage of the surface, were characterized by good corrosion resistance, a fact which is confirmed by the results of clinical evaluation.

Comparison of numerical and experimental analysis of plates used in treatment of anterior surface deformity of chest

The work discusses the results of numerical and experimental research of the plates for treatment of deformations of the frontal wall of chest. The conducted analyses included determination of: within numerical research, the state of displacement, strain and reduced stresses as well as reactions and moments of forces in supports, while within experimental research, the values of displacements at characteristic points of the system.

Laparoscopic appendectomy for simple and complicated appendicitis in children--safe or risky procedure.

Objectives The aim of the study was to present our experience and to assess the advantages of laparoscopic appendectomy, particularly in children with perforated appendicitis. Materials and Methods Between 1999 and 2005, 505 laparoscopic appendectomies were performed. In children aged between 2 and 18 years, number, sex, age, histologic type of appendicitis, additional surgical procedures, number and type of complications, time of procedure, and hospitalization were analyzed. Results There was no need for conversion even in perforated appendicitis and in technically difficult cases. In 21 (4.16%) children in postoperative period minor complications occurred. Average operating time was 43 minutes. Average hospital stay was 2.4 days. Conclusions Laparoscopic appendectomy is good alternative for classic appendectomy, irrespective of the degree of inflammation. Accurate cleaning and rinsing of the abdominal cavity essentially decreases the quantity of complications even in cases with perforated appendicitis. This suggests the expansion of indications toward laparoscopic appendectomy in case of all children with acute appendicitis.

Image Navigation in Minimally Invasive Surgery

This study presents the development of an image navigation system dedicated to assist a miniinvasive abdominal surgery. First, the system overview is discussed. Then, a development of a mesh model of abdominal structure is presented. Next, a system calibration including the component as well as patient registration is described.The evaluation of the system has been performed separately for each component. The accuracy of calibration as well as patient registration is reported. This yields the robustnes evaluation of the overall system.

Basic dissecting techniques in ultrasound-guided surgery.

Ultrasound-guided surgery is an area of minimally-invasive surgery where surgical procedures are performed with the aid of ultrasound imaging throghout the operation. This requires the operator to posses a certain degree of experience in endoscopic procedures, and to be adeptly skillfull in conducting US examinations. It is combining and finely tuning together these two elements that allows to perform efficiently an ultrasound-guided surgical procedure. Accessing an affected site correctly is of utmost importance in surgery, being oftentimes decisive in terms of the procedures final outcome. In ultrasound-guided procedures, the operative site is accessed percutaneously, with a single point incision, yet tissues situated deeper within are dissected with dissecting techniques in a fluid evironment, typical for this area of surgery. Dissecting techniques in ultrasound-guided surgery are currently divided into basic ones which employ either a hydrodissection needle, surgical instruments, electrosurgical instruments, a thread, or a combination thereof, and advanced ones where either a balloon, a hook dissection technique, or a hybrid one is used. Hydrodissection with a needle was devised based on the rule of complementarity, and is the most frequently applied technique in ultrasound-guided surgery. The immense possibilities that go along with this modality will be of huge benefit to any surgeon, regardless of their field. Dissection with a variety of surgical instruments and electrosurgery instruments is a standard practice in all surgery areas, yet the method of imaging we employ in ultrasound-guided surgery results in certain modifications of these techniques. It is, however, learning the thread technique that facilitates a precise and oftentimes extensive dissection. This technique is successfully applied for dissecting muscle, ligament, tendon, vascular and other structures. Having mastered dissecting techniques allows to perform any minimally-invasive procedure efficiently, be they ultrasound-guided, artroscopic, or endoscopic ones. Various surgical techniques are bridged, resulting in applying the so-called hybrid ones. Their strength lies in excellent imaging results allowing to conduct a surgical procedure both in a body cavity and within a parenchymal organ.

Preoperative Planning of Surgical Treatment with the Use of 3D Visualization and Finite Element Method

This chapter describes a method of engineering support of preoperative planning of surgical procedures with the use of engineering tools, such as state-of-the-art software for medical image processing, or a finite element method. The procedure of pre-operative planning consists in matching individual cases of incision sites and directions, visualization and selection of areas for resection as well as planning the technique of implant positioning and fixation. Also, the final visualization of the result of the planned medical procedure can be performed. This paper presents procedural propositions in surgery planning in the cases of corrections of the head shape in patients with craniosynostosis, corrections of the chest deformity such as pigeon chest and stabilization of the lumbar spine. 3D models created on the basis of computer tomography (CT) or magnetic resonance imaging (MRI) enabled it to conduct a biomechanical analysis as well as an objective quantitative and qualitative virtual evaluation of the surgical procedure. Preoperative planning support gives the physician an opportunity to prepare for the operation in a better way, which results in the selection of the best possible variant of an operative technique, reduction of time of the surgical procedure and minimization of the risk of intraoperative complications.

The advantages of combining sonotopogram with indication and fixation in invasive ultrasound

The usefulness of sonotopogram, that is mapping of the operated area basing on ultrasound, is obvious and currently unquestionable. It is performed in order to improve safety level of a patient treated by means of invasive techniques. It constitutes an excellent complement of the Perioperative Control Card. At the beginning it was used in sonosurgical procedures, with time it has become an element of all surgical techniques. It undergoes multiple changes depending on the surgeons needs. A particularly interesting phenomenon is the combination of the invasive techniques in order to facilitate the performance of medical procedures. Because of some relationship we are going to present the combination of sonotopogram with fixation and indication techniques. They are puncture techniques which are relatively rarely used in invasive ultrasound and surgical procedures. It seems that this results from the ignorance of their potential and the technique of their performance. Great simplicity makes them universal and allows to combine them freely. This simple combinations can be extended practically endlessly – similarly to domino bricks. For example, the next element of the technique combining can be the removal of an indicated and fixated element or a nailing. It is an excellent example of the complementarity rule – it should facilitate the understanding of Allin1 techniques and sonosurgery and also help in everyday practice of doctors performing invasive procedures. The use of these methods should be propagated not only in ultrasound but also in everyday medical practice in all the specialties. The presentation of the examples of particular techniques and their combination enables to bring closer their practical use.

The assessment of usefulness of the qualification card and ultrasonographic consultation

The result of therapeutic success is always the effect of medical professionals cooperation. The creation of adequate mechanisms of cooperation of these teams demands time and appropriate examples. In the understanding of differentiated behaviors in the line patient – diagnostician – surgeon, particularly the mechanism of the cascade of errors formation, giving simple examples may help – their awareness will facilitate the formation of an adequate pattern of diagnostic-therapeutic chain. The therapeutic team formed in this way provides optimal forms of cooperation and positive result. One of the elements of the cooperation is the surgical procedure qualification card which is an example of the communication between surgeon and diagnostician. The propagation of proven examples seems to be justified by practical reasons. The introduction of the surgical procedure qualification card enabled maintaining of the preoperative and postoperative diagnoses in the range from 88.4% to 89.29%, the barrier of 90% however is still not achieved. The diagnoses discrepancy is still the most often occurring patient safety incident and our results should head towards its mineralization. In particularly complicated cases we come back to a well-known form of medical consultation, that is the form of examination and treatment establishment basing on simultaneous physical and ultrasound examination – hence the colloquial name of ultrasound consultation. The universality of medical consultation makes out of it an excellent tool, particularly in cases of significant discrepancy between physical and ultrasound examination. This is excellent form of the experience exchange and learning about mutual possibilities. We believe that the mechanisms presented will influence the improvement of patient security.