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Scarica La Rivista Rivista trimestrale di Chirurgia Generale e Specialistica fondata nel 1959 da Tommaso Greco APRILE - GIUGNO 2011 Volume 17Nuova Serie N. 2 Tariffa R.O.C.: Poste Italiane s.p.a. - Spedizione in a.p. - D.L. 353/2003 (conv. in L. 27.02.2004 n. 46) art. 1, comma 1, DCB (Firenze), con I.R. VOL. 17 - Nuova serie - N. 2 Sommario Aprile - Giugno 2011 Articoli Allegato CD-ROM n. 2 - 2011 131 Informazioni per gli autori ARTICOLI ORIGINALI EDITORIALE 145 La chirurgia transanale per prolasso rettale esterno Transanal surgery for external rectal prolapse Alfonso Carriero Nell’ambito di una teoria unitaria del prolasso rettale, è ormai dimostrata una relazione importante tra età dei pazienti e grado del prolasso, cosa che supporta l’ipotesi che il prolasso rettale interno sia un precursore di quello esterno. Dopo avere analizzato le possibili ipotesi fisiopatologiche sulla formazione del prolasso rettale esterno, con le conseguenti opzioni chirurgiche della chirurgia transanale, sono messe a confronto le varie procedure chirurgiche transanali, in particolare la retto-sigmoidectomia perineale secondo Altemeier, intervento attualmente rivalutato soprattutto se combinato alla plastica degli elevatori dell’ano. Il contributo della laparoscopia è ancora in fase di discussione e il suo ruolo nella chirurgia del prolasso rettale esterno potrà meglio evidenziarsi nel tempo. SINGLE-SITE LAPAROSCOPIC SURGERY 154 Trattamento laparoscopico dell’ernia iatale con accesso single-port: esperienza preliminare su 4 casi Single-port laparoscopic hiatal hernia repair: a preliminary experience with 4 cases Felice Pirozzi, Pierluigi Angelini, Vincenzo Cimmino, Francesco Galante, Camillo La Barbera, Francesco Corcione A partire dalla fine degli anni ’90, l’accesso laparoscopico si è imposto come gold standard nella chirurgia del giunto gastro-esofageo. Il recente sviluppo della chirurgia degli orifizi naturali (NOTES) e l’introduzione di port multicanale ha indotto gli autori a verificare la fattibilità dell’approccio single-site anche nella chirurgia funzionale della giunzione gastro-esofagea. Con l’esperienza acquisita in oltre 380 procedure laparoscopiche effettuate per il trattamento dell’ernia iatale, gli autori illustrano la loro esperienza iniziale con l’approccio laparoscopico single-site, analizzandone gli aspetti tecnici e fornendo valutazioni preliminari sui possibili vantaggi e svantaggi. 161 Approccio LESS e chirurgia resettiva epatica: l’evoluzione delle tecniche mini-invasive Casistica di un singolo centro LESS surgery and liver resection: evolution of minimally invasive procedures A single-center case series Marco Catena, Francesca Ratti, Federica Cipriani, Michele Paganelli, Fabio Ferla, Luca Aldrighetti La sicurezza e l’efficacia dell’accesso laparoscopico per le lesioni epatiche localizzate nel lobo di sinistra hanno favorito la diffusione dell’approccio mini-invasivo e, negli ultimi tempi, anche della tecnica LESS (Laparo-Endoscopic Single-Site) nel tentativo di ridurre l’aggressività biologica di questo tipo di chirurgia. Attraverso un’analisi retrospettiva di un database raccolto prospetticamente, gli autori valutano i risultati ottenuti in una serie di pazienti sottoposti a chirurgia resettiva epatica laparoscopica con tecnica LESS. Vol. 17 - N. 2 117 166 Emicolectomia sinistra laparoscopica con accesso singolo per patologia colica benigna: esperienza iniziale Single-access laparoscopic left hemicolectomy for benign colon disease: a preliminary experience Umberto Bracale, Marco Barone, Giovanni Merola, Giusto Pignata L’obiettivo di diminuire il trauma chirurgico ha indotto alcuni chirurghi a tentare di ridurre il numero e la grandezza dei trocar, fino alla realizzazione di dispositivi monotrocar nei quali è possibile inserire più strumenti. La Laparoendoscopic Single-Site (LESS) surgery è in rapida diffusione, anche se ad oggi l’utilizzo di tale approccio nella chirurgia colica (Single-Access Laparoscopic Colectomy - SALC) è ancora estremamente limitato, soprattutto per l’emicolectomia sinistra. Gli autori analizzano retrospettivamente i risultati della loro esperienza iniziale con la SALC sinistra eseguita per patologia colica benigna. 174 Emicolectomia sinistra laparoscopica con accesso singolo per diverticolite complicata Single-incision laparoscopic left colectomy for complicated diverticulitis Fabio Vistoli, Stefano Signori, Simone D’Imporzano, Gabriella Amorese, Ugo Boggi La chirurgia laparoscopica del colon-retto, confrontata con la chirurgia tradizionale open, è sicura, non pregiudica i risultati oncologici e si associa ad un miglioramento dei risultati a breve termine. Per incontrare le richieste di una buona cosmesi da parte di un numero crescente di pazienti, sono state sviluppate nuove strategie chirurgiche per evitare o limitare il numero e le dimensioni delle incisioni cutanee; gli approcci più recenti sono costituiti dalla chirurgia endoscopica transluminale attraverso orifizi naturali (Natural Orifice Transluminal Endoscopic Surgery - NOTES) e dalla chirurgia laparoscopica con una singola incisione (Single-Incision Laparoscopic Surgery - SILS). Gli autori riferiscono la loro esperienza iniziale con la SILS nella resezione del colon sinistro per diverticolite complicata. 180 Resezione laparoscopica single-port del colon destro Single-port laparoscopic right colectomy Luigi Boni, Gianlorenzo Dionigi, Stefano Rausei, Fabrizio Cantore, Matteo Di Giuseppe, Silvia Maria Tenconi, Renzo Dionigi Con l’intento di ridurre il trauma chirurgico, negli ultimi anni si stanno affermando tecniche sempre più mini-invasive, quali la Natural Orifice Transluminal Endoscopic Surgery (NOTES) e la Single-Port Laparoscopic Surgery (SPLS). La NOTES, tuttavia, non è ancora applicabile a diversi campi della chirurgia come ad esempio quella del colon, forse per la mancanza di una strumentazione adeguata e di una tecnica standardizzata e validata. La SPLS, invece, potrebbe giocare un ruolo di primo piano nel panorama chirurgico, anche se a tutt’oggi sono ancora pochi stati pochi gli studi pubblicati sulle resezioni coliche con tale tecnica. Gli autori descrivono la loro tecnica di SPLS per l’emicolectomia destra ed i risultati preliminari a breve termine. 186 Single-incision laparoscopic colectomy per cancro del colon destro: esperienza preliminare Single-incision laparoscopic right colectomy for cancer: a preliminary experience Mario Godina, Tina Scibelli, Paola Menegon, Nicola Bragato, Fulvio Bettineschi La Single-Incision Laparoscopic Surgery (SILS) è la naturale evoluzione della chirurgia mini- invasiva e la Single-Incision Laparoscopic Colectomy (SILC) sta rapidamente emergendo nel campo della chirurgia mini-invasiva del colon e del retto. Essa associa il vantaggio cosmetico della Natural Orifice Transluminal Endoscopic Surgery (NOTES) al vantaggio di poter eseguire la procedura chirurgica con strumentario laparoscopico standard. Gli autori illustrano la loro esperienza preliminare con la SILC in 3 pazienti affetti da cancro del colon destro, contribuendo così ad una maggiore comprensione della fattibilità, delle carenze e dei potenziali benefici di questa tecnica innovativa. Vol. 17 - N. 2 119 191 Laparo-endoscopic single-site surgery in ginecologia Laparo-endoscopic single-site surgery in gynecology Cristiano Rossitto, Anna Fagotti, Francesco Fanfani, Maria Lucia Gagliardi, Valerio Gallotta, Carolina Bottoni, Cristina Moruzzi, Giovanni Scambia L’approccio laparoscopico è una valida alternativa alla laparotomia in molteplici condizioni cliniche. La LESS (Laparo-Endoscopic Single-Site) surgery è relativamente recente e, per quanto riguarda il suo utilizzo in ginecologia, la letteratura è ancora limitata, anche se il numero di pubblicazioni è in continua crescita. Questo articolo si propone di approfondire lo stato dell’arte della LESS surgery in ginecologia, esaminando i dispositivi attualmente disponibili e discutendo il potenziale ruolo futuro di questa chirurgia. CHIRURGIA DEL RETTO 199 StarrOne: resezione transanale del retto con una unica suturatrice circolare StarrOne: transanal rectal resection using only one circular stapler Nando Gallese Dopo il grande sviluppo della Stapled Anopexy (SA) con suturatrici meccaniche circolari per il trattamento del prolasso muco-emorroidario, l'ideatore della SA, Antonio Longo, ha formulato la “teoria unitaria del prolasso”, realizzando interventi sempre più complessi fino alla resezione transanale del retto a tutto spessore con anastomosi retto-rettale (Stapled Trans-Anal Rectal Resection - STARR). L’autore, dopo aver illustrato gli aspetti tecnici e storici nell'impiego delle suturatrici meccaniche in proctologia, riferisce la propria esperienza con le nuove suturatrici circolari CPH32 e CPH34 (Chex Healtcare - Glasgow, Gran Bretagna) nel trattamento della defecazione ostruita (da prolasso ed invaginazione rettale) e del rettocele. La metodica che utilizza tali suturatrici è stata denominata STARR One-Stapler (Stapler Trans-Anal Rectal Resection with only One Stapler) o più semplicemente StarrOne. CHIRURGIA ENDOCRINA 206 Accesso sotto-mesocolico nella surrenalectomia laparoscopica sinistra Submesocolic approach in left laparoscopic adrenalectomy Marcello Paci, Giancarlo D’Ambrosio, Daniele Scoglio, Pietro Ursi, Giovanni Lezoche, Bernardina Fabiani, Salvatore Campo, Edoardo de Werra, Andrea Balla, Alessandro Maria Paganini L’avvento delle tecniche mini-invasive ha cambiato l’approccio chirurgico al surrene e la surrenalectomia laparoscopica (SL) è diventata la terapia standard nel trattamento delle
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