Marcel Autran Machado - Academia.edu (original) (raw)

Papers by Marcel Autran Machado

Journal of the Pancreas, 2016

Introduction Embryologically the pancreas develops by the fusion of dorsal and ventral pancreatic... more Introduction Embryologically the pancreas develops by the fusion of dorsal and ventral pancreatic elements. The ventral pancreatic bud gives rise to part of the head and uncinate process, while the remainder of the head, body, and tail of the pancreas develops from the dorsal pancreatic bud. Failure in this process may result in pancreatic duct variation. Several types have been described, including bifid pancreatic duct, ectopic pancreas and duplication anomaly. To our knowledge, pancreatic trifurcation has never been described so far. Aim To present a video of a laparoscopic partial pancreatectomy resection in a patient with trifurcation of pancreas and intermittent acute pancreatitis. Methods A forty-year-old woman suffering from intermittent episodes of acute pancreatitis with first onset at 2-years of age with multiple surgical interventions for abdominal abscess drainage until puberty when severity and number of episodes decreased. Three years ago, she experimented a new episode of severe acute pancreatitis with prolonged hospitalization and since then intermittent episodes. MRI revealed an anomalous pancreas with three pancreatic ducts. One of them with signs of obstruction and pancreatitis. Laparoscopic resection of the diseased pancreas was proposed. Results Operative time was 150 minutes. Blood loss was minimum. Recovery was uneventful and patient was discharged on the 4th postoperative day. Final pathology showed no signs of malignancy. Patient is well with no sign of the disease 12 months after operation. Conclusion Although anomaly of the pancreatic duct is extremely rare, this case should alert clinicians to be aware of such an anatomical variant that may alter the flow characteristics in the pancreatic ductal system resulting in an increased risk of relapsing episodes of acute pancreatitis. Our patient received the correct diagnosis only 38 years after the first episode of acute pancreatitis.

AME surgical video database, Oct 1, 2018

Journal of Visceral Surgery, Jun 1, 2016

Journal of surgical case reports, Feb 1, 2016

Modern liver techniques allowed the development of segment-based anatomical liver resections. Nev... more Modern liver techniques allowed the development of segment-based anatomical liver resections. Nevertheless, there is still a place for nonanatomical liver resections. However, in some cases, there is a need for enucleation of deep located liver tumors. The main problem with enucleation of a liver tumor deeply located in the middle of the liver is the control of bleeding resulting from the rupture of small or medium vessels. The authors describe a simple way to control the bleeding without the use of any special instrument or material. This technique can also be used to control bleeding from penetrating liver injury.

Journal of Visceral Surgery, Apr 1, 2017

Hpb, 2017

Background: Laparoscopic ALPPS (Associating Liver Partition and Portal vein ligation for Staged h... more Background: Laparoscopic ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) has been reported in individual reports, but has been the authors' default option since 2015. Methods: A retrospective analysis of all consecutive patients undergoing ALPPS at a single referral center was performed using a prospective database from July 2011 to June 2016. Feasibility was studied by assessing conversions. The 90-day mortality and complications were analyzed using a Dindo-Clavien score and the comprehensive complication index. Operative time, blood loss, volumetric growth, and hospital stay were examined. The CUSUM statistic was measured. Results: There was no mortality and no complication grade 3A observed in laparoscopic ALPPS. In open ALPPS, one patient died after the procedure and 10 out of 20 patients experienced complications grade 3A (p = 0.006). No liver failure was observed after laparoscopic ALPPS, and two patients in the open ALPPS developed complications that precluded the second stage. The hospital stay was shorter in the laparoscopic ALPPS group. Conclusion: Laparoscopic ALPPS is feasible as the default procedure for patients with very small FLR, and it is not inferior to the open approach. The use of laparoscopy in ALPPS should be encouraged to surgeons experienced with complex laparoscopy.

Surgical Endoscopy and Other Interventional Techniques, Nov 1, 2007

Hpb, 2019

up on the pancreatic pathoanatomy. Most patients with such findings have inoperable conditions, h... more up on the pancreatic pathoanatomy. Most patients with such findings have inoperable conditions, however very rarely inflammatory pseudotumors can mimick their appearance and surgical exploration provides the necessary safety to conduct a cortisone therapy that would be detrimental otherwise.

Hpb, Sep 1, 2018

pre-operative laboratory results and histopathological tumour characteristics. Statistical analys... more pre-operative laboratory results and histopathological tumour characteristics. Statistical analyses were based on penalised Cox-regression modelling and decision-tree approach. Results: We identified 73 patients (38 males) with a median age of 61.5 years (range: 31e79). The median period of follow-up was 49 (5e131) months. During follow up, 10 deaths (13.9%) were recorded and disease recurrence occurred in 12 patients (16.4%). The Kaplan-Meier predicted 1-, 3-and 5-year recurrence-free survival rates for the study's cohort were 98.6% (95% CI =[95.9, 100%]), 85.4% (76.9-94.8%) and 72% (58.7-88.2%) respectively. Cox multivariate analysis identified poor tumour differentiation (G3 stage-WHO 2010 classification) and lymph node ratio (LNR) as independent predictors for recurrence (p < 0.05). A pilot decision analysis for post-operative follow-up of patients was constructed. Decision tree modelling of all measured covariates yielded LNR >0.1 as the most significant criterion to guide postoperative surveillance. Conclusion: Our results highlight LNR as a potential criterion for risk stratification to guide postoperative surveillance. Prospective validation is now warranted.

Journal de Chirurgie Viscérale, Apr 1, 2017

Hpb, Apr 1, 2016

Results: On the 7th postoperative day, the % baseline volumes of the left lobe increased from a m... more Results: On the 7th postoperative day, the % baseline volumes of the left lobe increased from a median of 28% (8e37%) to 45% (31e73%) with an increase 65.2%(5e 194%). During the first intervention, the blood loss was 100 ml (range 0e900 ml), with one blood transfusion. The median surgical time was 125 min (range 120e 240 min). In the second intervention, the median surgical time was 150 min (range 90e330). Blood loss was 200 ml (range 0e1500), requiring a transfusion in 10patients (25%). Total morbidity was 57,5%. Seven patients present morbidity Dindo-Clavien ! IIIb. Mortality: 3 cases (7,5%). Hospital stay was 16 days (range 12e28). Conclusions: We believe that this is a simpler technique to carry out, with the same efficacy as ALPPS and that it is accessible to most liver surgery units.

Journal of visualized surgery, Oct 1, 2018

Hepatocellular carcinoma (HCC) is the commonest hepatic malignancy and is frequently associated w... more Hepatocellular carcinoma (HCC) is the commonest hepatic malignancy and is frequently associated with cirrhosis and vascular involvement. Liver resection (LR) is a potentially curative treatment to HCC, but is a challenging task in cirrhotic patients especially with tumor vascular invasion. The laparoscopic approach is associated with lower morbidity rates in cirrhotic patients, but is rarely reported in cases of involvement of the portal vein. We report a laparoscopic right hepatectomy with portal vein reconstruction in a cirrhotic HCC patient with advanced portal vein tumor thrombosis. This is a potentially curative and complex procedure that can be an effective technique in highly selected patients that usually would be considered only for palliative systemic treatment.

Journal of Visceral Surgery, Sep 1, 2019

Surgical Oncology-oxford, Jun 1, 2020

Background: The use of laparoscopic glissonean approach has many potential benefits such as short... more Background: The use of laparoscopic glissonean approach has many potential benefits such as shorter operative times, lower blood loss with low morbidity. Methods: The aim with this study was to perform an evaluation of 12 years of our experience with laparoscopic glissonean approach in liver surgery, from a technical standpoint using a prospective database. Anatomical laparoscopic liver resections using hilar dissection and non-anatomical resections were excluded from this study. Results: 327 patients (170 females and 157 males) with mean age of 56 years were included. 196 (60%) of procedures were major resections. 65% of procedures were performed in the last 5 years. 208 patients were operated on for secondary lesions. In 38 patients the liver was cirrhotic. Morbidity was 37.3% and 90-day mortality occurred in 2 patients (0.6%). Blood transfusion was necessary in 10.7% of patients. Median hospital stay was 4 days. Conclusions: Laparoscopic glissonean approach is a safe and feasible technique. It may be preferred in some clinical situations as it is associated with shorter operative times, lower blood loss, and low morbidity. It is superior to standard laparoscopic hepatectomy when an anatomical resection, especially if a segment or section is to be removed. However, application of this technique requires accurate preoperative tumor localization, identification of potential anatomic pedicle variations, as well as surgeon expertise.

Surgery, Sep 1, 2016

Objective. This study compares the Glissonian approach with the standard approach to laparoscopic... more Objective. This study compares the Glissonian approach with the standard approach to laparoscopic liver resection for safety and efficacy. Background. The standard laparoscopic approach to anatomic liver resection is the dissection of the elements of the Glissonian pedicle below the hilar plate. In contrast, the Glissonian approach identifies the intrahepatic pedicles by tentative clamping. Concerns have been raised about the safety of the Glissonian approach in laparoscopic liver surgery. The study was performed to examine the initial 7 years of experience in a single center with regard to safety and efficacy. Methods. All consecutive patients undergoing laparoscopic liver resections from April 2007 to April 2014 at a single referral center for liver tumors were included. An observational comparison was performed between Glissonian and standard laparoscopic liver resections performed by the same team but during different eras. The primary endpoint was safety of the procedures as assessed by the recently published comprehensive complication index. Secondary endpoints were parameters of surgical efficacy, such as operating time, blood loss, blood transfusion, conversion rate, duration of hospitalization, and pathologic margin of the specimen. Results. Between 2007 and 2014, 234 resections were performed laparoscopically at our institution, 120 using the conventional approach and 114 using the Glissonian approach. There was no difference in age, sex, tumor types, or comorbidities between the groups. The number of major liver resections was greater in the Glissonian group, yet there were fewer complications in the Glissonian group compared with the standard group (P < .05). Operative time was greater and more transfusions were given in the standard group; in addition, more patients had positive margins (P < .01). Overall hospital stay was less in the Glissonian group. Conclusions. In the 7-year experience of a single center, the Glissonian approach is not less safe and may seems to offer advantages when compared with the standard laparoscopic approach. (Surgery 2016;160:643-51.

Journal de Chirurgie Viscérale, Dec 1, 2019

Annals of Surgical Oncology, May 30, 2019

Background. Bile duct injuries after cholecystectomy remain a major concern because their inciden... more Background. Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. This video presents a robotic left hepatectomy and Roux-en-Y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy.

Annals of Surgical Oncology, Oct 12, 2016

Background. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) a... more Background. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows R0 resection even for patients with extremely small future liver remnants. The ALPPS procedure was initially described for two-stage right trisectionectomy. Reversal ALPPS is a denomination in which the future liver remnant is the right posterior section of the liver.