[Craniotomy and the temporal branch of the facial nerve]. / Kraniotomie ve vztahu k temporální vetvi lícního nervu.

The surgical anatomy of the temporal branch of the facial nerve was studied in the anatomical laboratory. The temporal branch divides into an anterior, middle (frontal), and a posterior ramus after it pierces the parotid fascia. The anterior ramus innervates orbicularis oculi and corrugator supercilii muscles; the middle branch is for the ipsilateral frontalis muscle. The posterior branch innervates the anterior and superior auricular and tragus muscles. Below the zygomatic arch, the temporal branch of the facial nerve is located in the subcutaneous tissue. Above the arch, it continues in the subgaleal space with the superficial temporal fascia deeply. The terminal twigs of the temporal branch penetrate the galea to reach their target muscles that are all located superficial to the galea. There is a significant variability in the course of the temporal branch of the facial nerve. Occasionally, the terminal twigs of the middle ramus may penetrate superficial layer of superficial temporal fascia and run in the intrafascial fat pad before entering the frontalis muscle. There are four available operative techniques in this anatomical location. The subgaleal dissection of a temporofrontal scalp flap is associated with a high incidence of postoperative palsy of the temporal branch of the facial nerve and cosmetically bothersome results. Reflecting the scalp and temporalis muscle together as a single layer is the safest procedure. Unfortunately, this technique can not be used for the transzygomatic approaches and the bulky temporalis muscle may compromise basal exposure in the pterional route. Third technique was described and propagated by Yasargil. He proposed a subgaleal dissection up to the anterior one-fourth of the temporalis muscle where the dissection has to be deepened between the two layers of the superficial temporal fascia (in the interfascial fat pad). This approach may also infrequently injure the temporal branch in case of anatomical variation. The last available operative technique raises the superficial temporal fascia together with the scalp.

[AESOP 3000--computer-assisted surgery, personal experience]. / AESOP 3000--pocítacove asistovaná chirurgie, nase zkusenosti.

At present the most widely used system of CAS is a vocally controlled manipulator of the laparoscope AESOP 3000 (Automated Endoscopic System for Optimal Positioning) which makes it possible to implement some operations without the assistance of another surgeon ("Solo-surgery"). Because of financial costs the so far little used equipment ZEUS or DA VINCI are already "master-slave" systems with several robot arms where the surgeon operates by means of manipulators in the controlling unit without direct contact with the patient. At the First Surgical Clinic, General Faculty Hospital and First Medical Faculty Charles Universitx the authors use the robot system AESOP 3000 since March 2000, in particular in laparoscopic gastric banding on account of obesity, in laparoscopic cholecystectomies, laparoscopic gastroenteroanastomoses and operations in the area if the hiatus. This system made it possible to reduce the number of assisting physicians. E.g. in gastric banding one assistant is sufficient, in laparoscopic cholecystectomy it is possible to operate only with a suture nurse. The application of AESOP is particularly useful in laparoscopic appendectomies and inguinal hernioplasties where it makes possible so-called "solo-surgery" or "one man surgery". No doubt, it is however necessary to have the possibility to call immediately another doctor to the operation theatre in case of necessary conversion of laparoscopy of laparotomy. The authors did not record any case of unwanted movement of the robot arm or another serious technical problem. As compared with a manually guided laparoscope during the use of AESOP the number of unwanted or inadequate shifts of the optical equipment or its angular rotation decreased considerably.

[Treatment of metastatic liver tumors]. / Moznosti ovlivnení metastatických nádoru jater.

We had operated 72 patients for hepatic metastatic malignancies from 1991 to 2000. In 66 cases were colorectal metastases. Extend of operations were from no anatomical resections, segmentectomies to hemihepatectomies. Operating lethality was 5.5% and long time survival only 10%. In the same period we took arterial port for 22 patients for regional chemotherapy. Response rate was 20% patients. The first experience with radiofrequency ablation (we had 12 ablation procedure) show, that minimal invasive treatment (RFA) is good procedure for high-risk patients. If the patient is able to hepatic resection it will be still standard for treatment.

[Massive intestinal hemorrhage as the first sign of diverticular disease of the colon]. / Masivní enteroragie jako první príznak divertikulární choroby tracníku.

Retrospective and prospective analysis of massive enterorrhagia (m.e.). The aim of the study is the analysis of frequent causes of m.e--diverticular disease of the colon (DDC). The total number of patients with m.e. was 154 and the proportion of DDC in this total group was 17%, i.m. 24 patients. The total number of patients with the acute symptomatic DDC was 198 and the proportion of haemorrhagic DDC in this total group was 13.3%. The dominant form is conservative therapy (88.4%), surgical therapy was performed in 11.6% of cases. Discontinuous types of operations predominated. The analysis of the group and comparison with problems of m.e. in the literature.

[The acute phase reaction in laparoscopic and open surgery of inguinal hernias]. / Reakce akutní fáze pri laparoskopické ci otevrené chirurgii tríselné kýly.

The acute phase response to tissue injury is art of the wound healing process after surgery. The aim of study was to determine levels of acute phase proteins and levels of thrombocytes in patients with laparoscopic surgery (intraabdominal preperitoneal repair) and in patients with open surgery (tension free repair). Exclusion criteria in both groups of patients: malignity, diabetes mellitus, obesity (BMI > 30), infection, hypoproteinemia, hepatic or renal insufficiency and hypertension. Type of anaesthesia: general. Perioperative preventive antithrombotic medication: LMWH 5 days after surgery. The observed parameters were estimated before, one hour, 2nd and 7th days after surgery. Statistical test: ANOVA, statistical by significant difference p < 0.05. The results of the study demonstrate an increase of acute phase proteins CRP, OROSO and Fb in both groups of patients in comparison to their levels before surgery. In this respect we did not find a difference between the two types of operation. In patients with laparoscopic surgery the observed peak of FBG increase (+69%) was on the 2nd day after surgery followed by a slight drop of values in comparison to the results of open surgery patients with a FBG increase on the 2nd day (+42%) and with continuation on the 7th (%) postoperative day. The peak of CRP values was on the 2nd day in both groups. OROSO values increased even on the 7th day. The same situation occurred with Plt levels (p < 0.05). We suggested, that laparoscopic and open surgery of inguinal hernia repair are both followed by an acute phase response related to the tissue injury and this response perists even 1 week after surgery. But the recovery time of some parameters of the acute phase response (e.g. orosomucoid and fibrinogen levels) to the basical preoperative state is longer in patients with open type of surgery. We do not confirm differences in the degree of risk of postoperative thrombophilia in both types of surgery and suggest, that the prevention of thromboembolic complications is indicated in both types of surgery.