Madrid Norte Sanchinarro San Pablo University Hospital

Madrid, Spain

Madrid Norte Sanchinarro San Pablo University Hospital

Madrid, Spain
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Ielpo B.,Madrid Norte Sanchinarro San Pablo University Hospital | Caruso R.,Madrid Norte Sanchinarro San Pablo University Hospital | Prestera A.,Madrid Norte Sanchinarro San Pablo University Hospital | De Luca G.M.,Madrid Norte Sanchinarro San Pablo University Hospital | And 6 more authors.
Journal of the Pancreas | Year: 2015

Context Arterial pseudoaneurysm is an uncommon lethal complication following hepato-pancreato-biliary surgery. Objective Aim of this study is to present and discuss the experience of a high volume oncological center. Methods Since 2007 all major surgeries performed at Sanchinarro Oncological Center have been included in a prospective database looking for postoperative arterial pseudoaneurysm. Results Until June 2014, among 559 hepato-pancreato-biliary procedures, a total of 14 arterial pseudoaneurysms have been identified (2.5%). Sentinel bleeding was in 57% of cases. Failed arterial embolization occurred in 2 cases. Overall mortality rate was 28.5%. We also identified 3 asymptomatic pseudoaneurysms, one of them managed without embolization, developing a sudden bleeding and died after surgery. Conclusions According to our experience, pseudoaneurysm incidence is higher than reported in current literature and it can be successfully managed through arterial embolization. Furthermore, we found 3 asymptomatic pseudoaneurysms, whose management is still controversial. © 2015, E.S. Burioni Ricerche Bibliografiche. All rights reserved.


Vicente E.,Madrid Norte Sanchinarro San Pablo University Hospital | Quijano Y.,Madrid Norte Sanchinarro San Pablo University Hospital | Ielpo B.,Madrid Norte Sanchinarro San Pablo University Hospital | Duran H.,Madrid Norte Sanchinarro San Pablo University Hospital | And 5 more authors.
Updates in Surgery | Year: 2015

Aim of this study is to assess the incidence and outcome of small for size syndrome after ALPPS procedure. This novel procedure is claimed to induce accelerated and increased growth of future liver remnant after major hepatectomies. We prospectively collected data on nine consecutive patients undergoing ALPPS procedure at our center. Main patients’ characteristics, outcome and postoperative complications, including small for size syndrome were analyzed. Main interval between two stages of ALPPS was 15.1 days. Mean future liver remnant hypertrophy was 93.2 %. Severe complications occurred in 44.4 % of patients and mortality occurred in two cases (22.2 %). Small for size syndrome occurred in two cases (22.2 %). The first one was detected intraoperatively during first stage. It was successfully managed by spleno-renal venous shunt. Second case was not promptly detected and died on postoperative day 64. This case series provides evidence that SFFS can be an important complication after ALPPS procedure. If it is not promptly detected and properly managed it can be a cause of death as occurred in our case. © 2015, Italian Society of Surgery (SIC).


Quijano Y.,Madrid Norte Sanchinarro San Pablo University Hospital | Vicente E.,Madrid Norte Sanchinarro San Pablo University Hospital | Ielpo B.,Madrid Norte Sanchinarro San Pablo University Hospital | Duran H.,Madrid Norte Sanchinarro San Pablo University Hospital | And 9 more authors.
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2016

Introduction: The use of robotic surgery in liver resection is still limited. Our aim is to present our early experience of robotic liver resection. Materials and Methods: It is a retrospective review of Sanchinarro University hospital experience of robotic liver resection performed from 2011 to 2014. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed. Results: Twenty-one procedures have been performed and 13 (65%) of them were for malignancy. There were 2 left hepatectomies, 1 right hepatectomy, 1 associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), 1 bisegmentectomy and 3 segmentectomies, 9 wedge resections, and 3 pericystectomies. The mean operating time was 282 minutes (range, 90 to 540 min). Overall conversion rate and postoperative complication rate were 4.7% and 19%, respectively. The mean length of hospital stay was 13.4 days (range, 4 to 64 d). Conclusion: From our early experience, robotic liver surgery is a safe and feasible procedure, especially for major hepatectomies. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


PubMed | Madrid Norte Sanchinarro San Pablo University Hospital
Type: Journal Article | Journal: Updates in surgery | Year: 2015

Aim of this study is to assess the incidence and outcome of small for size syndrome after ALPPS procedure. This novel procedure is claimed to induce accelerated and increased growth of future liver remnant after major hepatectomies. We prospectively collected data on nine consecutive patients undergoing ALPPS procedure at our center. Main patients characteristics, outcome and postoperative complications, including small for size syndrome were analyzed. Main interval between two stages of ALPPS was 15.1 days. Mean future liver remnant hypertrophy was 93.2%. Severe complications occurred in 44.4% of patients and mortality occurred in two cases (22.2%). Small for size syndrome occurred in two cases (22.2%). The first one was detected intraoperatively during first stage. It was successfully managed by spleno-renal venous shunt. Second case was not promptly detected and died on postoperative day 64. This case series provides evidence that SFFS can be an important complication after ALPPS procedure. If it is not promptly detected and properly managed it can be a cause of death as occurred in our case.


PubMed | Madrid Norte Sanchinarro San Pablo University Hospital
Type: Evaluation Studies | Journal: Surgical laparoscopy, endoscopy & percutaneous techniques | Year: 2016

The use of robotic surgery in liver resection is still limited. Our aim is to present our early experience of robotic liver resection.It is a retrospective review of Sanchinarro University hospital experience of robotic liver resection performed from 2011 to 2014. Clinicopathologic characteristics, and perioperative and postoperative outcomes were recorded and analyzed.Twenty-one procedures have been performed and 13 (65%) of them were for malignancy. There were 2 left hepatectomies, 1 right hepatectomy, 1 associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), 1 bisegmentectomy and 3 segmentectomies, 9 wedge resections, and 3 pericystectomies. The mean operating time was 282 minutes (range, 90 to 540 min). Overall conversion rate and postoperative complication rate were 4.7% and 19%, respectively. The mean length of hospital stay was 13.4 days (range, 4 to 64 d).From our early experience, robotic liver surgery is a safe and feasible procedure, especially for major hepatectomies.


PubMed | Madrid Norte Sanchinarro San Pablo University Hospital
Type: Journal Article | Journal: Surgical oncology | Year: 2016

ALPPS procedure is gaining interest. Indications and technical aspects of this technique are still under debate [1]. Only 4 totally laparoscopic ALPPS procedures have been described in the literature and none by robotic approach [2-4]. This video demonstrates the technical aspects of totally robotic ALPPS.A 58 year old man with sigmoid adenocarcinoma with multiple right liver metastases extended to segment IV and I underwent Xelox and 5 Fluoro-uracil neoadjuvancy. Preoperative CT volumetric scan showed a FLR/TLV (Future Liver Remnant/Total Liver Volume) of 28%. ALPPS totally robotic procedure was planned using the DaVinci Si.Tumor resection from the FLR (including segment I) is followed by parenchymal transection between the FLR and the diseased part of the liver with concomitant right portal vein ligation. Small branches to segment IV from left portal vein have been resected along the round ligament, at this step. The right biliary tract was resected as it was partially debilitated after its dissection as partially encircled by a metastasis at segment IV. Second stage was performed totally robotic on 13th postoperative days with a FLR/TLV of 40%. No strong adherences are found, making this stage much easer than open approach. During this step, right hepatic artery and right supra hepatic vein are resected. Finally, the specimen was retrieved inside a plastic bag through a Pfannenstiel incision. Postoperative pathology showed margins free from disease.ALPPS procedure performed by robotic approach could be a safe and feasible technique in experienced centers with advanced robotic skills.

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