Introduction: Laparoscopic liver surgery has developed rapidly in the last 25 years, bringing new possibilities of treating liver tumours. Therefore, patients undergoing liver resection for colorectal cancer liver metastases can benefit from the less invasive laparoscopic approach, retaining necessary oncological radicality. This paper evaluates experience with laparoscopic liver surgery for colorectal liver metastases in our institution and compares it to laparotomic approach. Methods: A retrospective analysis of prospectively collected database of patients undergoing liver resection for colorectal cancer liver metastases from 2007 to 2017 was performed. Results: A total of 172 patients was included in the study. The mean of disease-specific survival was 87.66 months for laparotomic resection in comparison with 98.63 months within laparoscopic approach. The 10-year survival rate was 56.2 % for laparoscopic approach while laparotomic approach reached 47.8 %. There is not statistically significant difference in survival between both groups, the p-value = 0.310. Laparoscopic operative approach reaches statistically significant difference in postoperative complications 4.76 % vs 14.62% (p-value = 0.004). Conclusions: Results of laparoscopic liver resections for colorectal cancer liver metastases are statistically similar or better in comparison to laparotomic resections, even considering long-term disease-specific survival. Therefore, a laparoscopic approach to liver resection is beneficial in all patients, who are suitable for this type of approach, offering the same oncological radicality, but requiring an adequately experienced surgeon.

• MeSH
• analýza přežití MeSH
• dospělí MeSH
• kolorektální nádory chirurgie   sekundární   MeSH
• laparoskopie * metody   MeSH
• laparotomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory jater * chirurgie   diagnóza   sekundární   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• bezpečnost vybavení MeSH
• design vybavení MeSH
• hepatektomie přístrojové vybavení   metody   MeSH
• katetrizační ablace přístrojové vybavení   metody   MeSH
• krvácení při operaci prevence a kontrola   MeSH
• laparoskopie přístrojové vybavení   metody   MeSH
• laparoskopy * MeSH
• prasata MeSH
• senzitivita a specificita MeSH
• techniky in vitro MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• dopisy MeSH

INTRODUCTION: The liver is the most common site of colorectal metastases (colorectal liver metastases - CLM). Surgical treatment in combination with oncological therapy is the only potentially curative method. Unfortunately, only 10-25% of patients are suitable for surgery. Traditionally, open liver resection (OLR) is usually performed. However, laparoscopic liver resection (LLR) has become popular worldwide in the last two decades. AIM: To evaluate the effectiveness and benefits of radiofrequency minor LLR of CLM in comparison with OLR. MATERIAL AND METHODS: The indication for surgery was CLM and the possibility to perform minor laparoscopic or OLR not exceeding two hepatic segments according to Couinaud's classification. RESULTS: Sixty-six minor liver resections for CLM were performed. Twenty-five (37.9%) patients underwent a laparoscopic approach and 41 (62.1%) patients underwent OLR. The mean operative time was 166.4 min for LLR and 166.8 min for OLR. Average blood loss was 132.3 ±218.0 ml during LLR and 149.5 ±277.5 ml during OLR. Length of hospital stay was 8.4 ±2.0 days for LLR and 10.5 ±5.8 days for OLR. All resections were R0. There was no case of mortality. Postoperative complications were recognized in 9 (13.6%) patients: 8 in the group of OLR patients and 1 in the LLR group. The median survival time for LLR was 70.5 months and for OLR 61.9 months. The 5-year overall survival rate was higher for LLR vs. OLR - 82.1% vs. 69.8%. The average length of disease-free interval after LLR was greater (52.2 months) in comparison with OLR (49.4%). The 5-year disease-free interval was 63.2% for LLR and 58% for OLR. CONCLUSIONS: Outcomes and oncological radicality of minor laparoscopic liver resections of CLM are comparable to outcomes of OLR.

• Publikační typ
• časopisecké články MeSH

The aim of this experimental study was to verify a new semi-spherical surgical tool for bipolar radiofrequency liver ablation, which can solve some of the disadvantages of the commonly used device, such as the long duration of ablation. A total of 12 pigs which were randomly divided into two groups were used. Each pig underwent resection of the two liver lobes. In group 1, pigs were treated with the commonly used device; in group 2 the newly developed semi-spherical device was used. During surgery and the post-surgical period, many categories were observed and later analyzed. The blood count and biochemistry were monitored on days 0, 14 and 30 from the operation. On day 14 since the liver resection, pigs underwent diagnostic laparoscopy to evaluate their condition focusing on the site of the liver lobe resection. On day 30 after operation, all pigs were euthanized and subjected to histopathological examination. Histopathological evaluation of thermal changes at the resection margin showed strong thermal alteration in both groups. Data between both groups were compared using median test for continuous variables and Fisher’s exact test for categorical variables. Statistical analyses were performed with IBM SPSS software version 18.0. Statistical analysis of collected data did not prove any significant (P < 0.05) differences between the commonly used device and the newly designed surgical tool.

• Klíčová slova
• RONJA,
• MeSH
• chirurgické nástroje * klasifikace   MeSH
• experimenty na zvířatech MeSH
• hepatektomie metody   přístrojové vybavení   MeSH
• játra chirurgie   patologie   účinky záření   MeSH
• modely u zvířat MeSH
• pooperační období MeSH
• prasata MeSH
• radiofrekvenční ablace * metody   přístrojové vybavení   škodlivé účinky   MeSH
• výsledek terapie MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

Úvod: Správné zhodnocení jaterních pseudolézí pomocí multidetektorového CT či MR je velmi důležité z důvodu odlišení těchto benigních změn od primárních či sekundárních malignit v jaterním parenchymu. Metoda: Autoři provedli systémový přehled literatury v databázi PubMed s vyhledáváním slov játra, pseudoléze v angličtině a češtině od roku 2000 do roku 2014. Výsledky: Autoři předkládají přehled literatury. Dále autoři retrospektivně zhodnotili soubor pacientů léčených pro jaterní onemocnění ve FN Ostrava, kdy se setkali s touto abnormalitou celkem v 7 případech. U 3 pacientů byla provedena diagnostická laparoskopie s vizuální kontrolou léze, s upřesněním diagnostiky pomocí peroperační ultrasonografie (IOUS) a s excizí části ložiska pro následné histologické vyšetření. Histologický nález u všech 3 pacientů odpovídal steatotickému postižení jater. Další 2 pacienti byli operováni pro jiná ložiska metastazujícího kolorektálního karcinomu a revize suspektní léze byla provedena během operačního výkonu otevřenou cestou. Kromě vizuální kontroly a peroperačního IOUS byla provedena excize k histologickému vyšetření, které prokázalo známky velkokapénkové i malokapénkové steatózy a nepřítomnost maligních změn. Poslední dva pacienti jsou dále sledováni v hepatologické poradně a jsou v rámci dispenzarizace kontrolováni v 6měsíčních intervalech. Závěr: Autoři prezentují vlastní zkušenosti získané v rámci mezioborové spolupráce na multidisciplinárních konferencích a připojují literární údaje o této neobvyklé problematice. Správným vyhodnocením nálezů této variety zejména u onkologických pacientů je možno zabránit zbytečným biopsiím, duplicitním vyšetřením a diagnostickým laparoskopiím či explorativním laparotomiím.

Introduction: Accurate detection of hepatic pseudolesions using multi-detector CT and MRI examinations is crucial for the differentiation of benign alterations from primary and secondary malignant lesions in hepatic parenchyma. Method: The authors conducted a systematic literature review in PubMed. “Liver“ and “pseudolesion“ were used as keywords in English and Czech, and papers/articles published from 2000 to 2014 were retrieved. Results: The authors presented a literature review. In addition, the authors performed a retrospective evaluation of a group of patients treated for liver disease at University Hospital Ostrava where this anomaly was encountered in 7 cases. In 3 of the patients, diagnostic laparoscopy was done, with visual examination of the lesion accompanied by intraoperative ultrasound exam (IOUS) and partial excision, to establish the diagnosis. Subsequent histological assessment of the specimens confirmed the diagnosis of a steatotic lesion in each of these 3 patients. Additional 2 of the 7 patients underwent liver surgery for concurrent metastatic lesions of colorectal cancer and an open-access revision of the suspected lesions was performed. Visual inspection and intraoperative ultrasound (IOUS) was followed by excisional biopsy. The histology revealed macro- and micro-vesicular steatosis and excluded malignant changes. The last 2 patients still continue to be followed–up regularly on a 6-month routine check-up basis at our hepatology unit. Conclusion: The authors presented their own experience gained through inter-disciplinary cooperation at Multidisciplinary conferences. A literature overview of this unusual subject is also included. Particularly in oncologic patients, correct interpretation of these pseudolesions may help to avoid unnecessary biopsies, further imaging examinations and diagnostic laparoscopies and/or explorative laparotomies.

• MeSH
• diferenciální diagnóza MeSH
• játra * anatomie a histologie   krevní zásobení   patologie   ultrasonografie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie využití   MeSH
• nádory jater * diagnóza   MeSH
• počítačová rentgenová tomografie využití   MeSH
• retrospektivní studie MeSH
• senzitivita a specificita MeSH
• ztučnělá játra MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

The aim of this study is to inform about the development of a new semispherical surgical instrument for the bipolar multielectrode radiofrequency liver ablation. Present tools are universal; however they have several disadvantages such as ablation of healthy tissue, numerous needle punctures, and, therefore, longer operating procedure. Our newly designed and tested semispherical surgical tool can solve some of these disadvantages. By conducting an in vivo study on a set of 12 pigs, randomly divided into two groups, we have compared efficiency of the newly developed instrument with the commonly used device. Statistical analysis showed that there were no significant differences between the groups. On average, the tested instrument RONJA had shorter ablation time in both liver lobes and reduced the total operating time. The depth of the thermal alteration was on average 4 mm larger using the newly tested instrument. The new radiofrequency method described in this study could be used in open liver surgery for the treatment of small liver malignancies (up to 2 cm) in a single application with the aim of saving healthy liver parenchyma. Further experimental studies are needed to confirm these results before clinical application of the method in the treatment of human liver malignancies.

• MeSH
• biopsie MeSH
• elektrody MeSH
• játra patologie   chirurgie   MeSH
• katetrizační ablace přístrojové vybavení   MeSH
• Sus scrofa MeSH
• techniky in vitro MeSH
• termografie MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Echinokokóza či jinak hydatidóza je parazitární zoonóza způsobená larvální formou tasemnice Echinococcus. Její výskyt je celosvětový, mezi endemické oblasti v Evropě patří zejména regiony v okolí Středozemního moře. V České republice je její výskyt vzácný. Toto onemocnění může postihnout kterýkoliv orgán či tkáň v lidském těle, nejčastěji postiženými oblastmi jsou však játra (60 %) a plíce (20 %). Autoři prezentují případy dvou pacientů bulharské národnosti s jaterní formou echinokokózy operovaných tentýž den na dvou různých chirurgických pracovištích v České republice. Základem léčby je chirurgické odstranění ložiska v kombinaci s antiparazitární léčbou benzimidazoly (albendazol, mebendazol). Léčbu antiparazitiky je nutné zahájit předoperačně a měla by trvat 1–2 měsíce po operaci. Úspěšnost léčby je možné sledovat pomocí zobrazovacích metod, zejména PET/CT a sérologie. Pacienty po chirurgické i konzervativní terapii je nutné dlouhodobě sledovat pro riziko recidivy onemocnění.

Echinococcosis, also referred to as hydatidosis, is a parasitic infection caused by the tapeworm Echinococcus in its larval stage. It has worldwide distribution and endemic areas in Europe include especially the regions surrounding the Mediterranean Sea. In the Czech Republic, its incidence tends to be quite rare. Although it may affect any organ or tissue in the human body, the liver (60%) and lungs (20%) are the most frequently affected sites. The authors present two cases of Bulgarian patients with hepatic echinococcosis operated on the same day at two different surgical departments in the Czech Republic. Treatment is based on the surgical removal of the cysts in combination with anti-parasite treatment by benzimidazoles (Albendazol, Mebendazol). Treatment with anti-parasitic drugs needs to be started preoperatively and should continue for at least 1–2 months after surgery. The success of the treatment can be monitored by imaging methods, especially PET/CT and serology. Patients after surgical as well as conservative therapy need to be followed up on an outpatient basis due to the long-term risk of recurrence.

• Klíčová slova
• HabibSealer 4X,
• MeSH
• albendazol aplikace a dávkování   MeSH
• benzimidazoly aplikace a dávkování   MeSH
• dospělí MeSH
• echinokokóza jater epidemiologie   farmakoterapie   chirurgie   MeSH
• hepatektomie metody   MeSH
• katetrizační ablace využití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

INTRODUCTION: Hand-assisted laparoscopic liver surgery, a newly developed technique based on an innovative concept, has proved useful and safe for a variety of less invasive hepatectomies. Radiofrequency-assisted hepatic resection has been reported to be safe, associated with minimal morbidity and mortality and decreased intraoperative blood loss and transfusion requirements. AIM: We describe how we perform hand-assisted laparoscopic radiofrequency-assisted hepatic resection using a bipolar radiofrequency device. RESULTS: The use of the hand port has allowed the surgeon to use his hand in direct liver manipulation, mobilization, and retraction. It was also useful for tactile tumour localization. Radiofrequency-assisted hepatic parenchymal transection was performed on 15 patients using a bipolar device (Habib 4X) with minimal blood loss (74 ml), and very decent operative and resection times (92 min, 33 min respectively). CONCLUSIONS: This combined procedure offers a safe, effective and rapid liver resection technique. This might encourage surgeons to perform a minimally invasive approach for liver resection more frequently.

• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgie klasifikace   metody   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• chirurgie
• NLK Publikační typ
• učebnice vysokých škol

OBJECTIVES: Virtual colonoscopy is less invasive than conventional colonoscopy and does not require a conscious sedation. BACKGROUND: Virtual colonoscopy using the abdominal spiral computed tomography scanning allows a total colonic evaluation with minimal invasiveness. METHODS: We studied 48 patients with a virtual colonoscopy using oral iodinated contrast. Colonic lavage was achieved with an oral polyethylene glycols preparation. We examined patients who had refused a colonoscopic examinations, or patients with a stenotic processes, in which it was not possible to examine the proximal colon using standard methods. RESULTS: Our indications for CT virtual colonoscopy were following: firstly, when colonic examination by other methods (colonoscopy, barium enema) failed or was not possible, and secondly, to exclude tumour duplicity in cases with an already verified colon tumour. 26 patients underwent a virtual colonoscopy examination based on the first indication, and 22 patients based on the second indication. CONCLUSION: In summary, our results show that virtual colonoscopy is a promising method in detecting individuals with significant colorectal lesions. The aim of the present study was to assess the ability of virtual colonoscopy using oral contrast to detect patients with colorectal lesions who need a colonoscopy (Tab. 2, Fig. 3, Ref. 4). Full Text (Free, PDF) www.bmj.sk.

• MeSH
• kolonografie počítačovou tomografií metody   MeSH
• kontrastní látky MeSH
• lidé MeSH
• Check Tag
• lidé MeSH