Zhukayev, Beibit contra Huesler, Marc-Andrea

Resumen General del Evento

El encuentro de tenis entre Beibit Zhukayev y Marc-Andrea Huesler se llevará a cabo el 7 de junio de 2025 a las 13:30. Este enfrentamiento presenta un emocionante choque de estilos y habilidades en la cancha. Beibit Zhukayev, conocido por su potente servicio y habilidad en condiciones rápidas, se enfrenta a Marc-Andrea Huesler, un jugador que destaca por su resistencia y capacidad para extender los partidos.

Este partido capta la atención por las diversas estrategias que cada jugador podría emplear. Zhukayev podría aprovechar su altura y servicio para imponer condiciones rápidas, mientras que Huesler intentará desestabilizarlo con un juego sólido de fondo de cancha y cambios tácticos. Este choque promete ser una batalla intensa con oportunidades para ambos jugadores.

Pronósticos para la Competencia 1: # Laparoscopic splenectomy with spleno-renal shunt for splenic artery aneurysm: a case report 2: Author: Kazuhisa Kadowaki, Toru Koizumi, Takaaki Takegami, et al. 3: Date: 12-14-2023 4: Link: https://doi.org/10.1186/s40792-023-01757-9 5: Surgical Case Reports: Case Report 6: ## Abstract 7: BackgroundSplenic artery aneurysm is a rare condition that accounts for 4–6% of visceral arterial aneurysms. Mini-invasive approaches, including laparoscopic surgery, for splenic artery aneurysm have attracted attention recently as a safe and effective treatment method. Various procedures are available; however, loss of splenic function and injury to the spleen are sometimes unavoidable. 8: Case presentationThis report presents the first case of laparoscopic splenectomy with spleno-renal shunt for splenic artery aneurysm in Japan. A 67-year-old man was referred to our hospital because of a 16-mm splenic artery aneurysm discovered by routine ultrasonography examination. Although his symptoms remained stable, laparoscopic surgery was indicated because of the abdominal congestion caused by the enlarged aneurysm. Given the relatively small number of laparoscopic procedures for splenic artery aneurysm, we deemed it necessary to preserve his splenic function even if the spleen was resected. We thus performed laparoscopic splenectomy with spleno-renal shunt to save splenic vessels. A 6-mm aneurysmal site was clipped laparoscopically without any complication, and the spleno-renal shunt was connected without any postoperative complications. A one-year follow-up showed no abnormalities on CT scan or blood tests. 9: ConclusionsLaparoscopic treatment is a feasible and safe method for patients with a symptomatic splenic artery aneurysm or symptomatic abdominal congestion caused by the enlarged aneurysm. Moreover, our approach may preserve splenic function after laparoscopic splenectomy for splenic artery aneurysm. 10: ## Introduction 11: Splenic artery aneurysm (SAA) is a rare condition that accounts for 4–6% of visceral arterial aneurysms [1]. The size of SAA is generally 2 cm and its incidence in women is reportedly due to the hemodynamic changes during pregnancy [2]. SAAs often regress into a thrombosed state without causing symptoms; however, they can lead to fatal complications, such as rupture, when ruptured [3]. Hence, the treatment was previously indicated only for symptomatic patients with cohort studies suggesting that rupture occurs in patients with a diameter greater than 2 cm [4, 5]. Currently, treatment is indicated even for asymptomatic patients with a diameter greater than 2 cm because conservative treatment is reportedly ineffective [6]. 12: The mini-invasive approach for SAA has attracted attention recently as a safe and effective treatment method [7]. Various procedures are available; however, loss of splenic function and injury to the spleen are sometimes unavoidable [8]. Hence, splenic preservation must be considered when performing laparoscopic surgery for SAA. 13: We herein presented the first case of laparoscopic splenectomy with spleno-renal shunt for SAA in Japan. Our treatment may preserve splenic function after laparoscopic splenectomy for SAA. 14: ## Case presentation 15: A 67-year-old man was referred to our hospital because a 16-mm SAA was discovered on abdominal ultrasound examination as part of a physical examination at another hospital. He reported no symptoms such as abdominal pain or epigastric discomfort. No previous medical history of abdominal diseases or surgery was observed. 16: ## Preoperative findings 17: Blood test results were within the normal range (white blood cells, 5400/μL; platelets, 29.5 × 104/μL; aspartate aminotransferase, 20 IU/L; alanine aminotransferase, 11 IU/L; lactate dehydrogenase, 167 IU/L; direct bilirubin, 0.4 mg/dL; total bilirubin, 1.1 mg/dL; C-reactive protein, 0.07 mg/dL; carbohydrate antigen 19-9, 5.8 U/mL; protein induced by vitamin K absence or antagonist (PIVKA)-II, 6 mAU/mL; carcinoembryonic antigen, 1.6 ng/mL; and alpha-fetoprotein, 3.7 ng/mL). Abdominal CT scan revealed a dilated pancreatic portion of the splenic artery with an approximately 16 × 10-mm dimension (Fig. 1A). The pancreatic portion of the splenic artery showed multiple aneurysms with a maximum diameter of approximately 13 mm and contrast enhancement in the wall (Fig. 1B). Abdominal Doppler ultrasonography revealed both the low flow and high flow states in the SAA. 18: **Fig. 1**Preoperative contrast-enhanced CT scan findings of the splenic artery aneurysm (SAA). The presence of multiple aneurysms in the pancreatic portion of the splenic artery (A). The maximum diameter of the aneurysm was approximately 13 mm (B) 19: The patient reported no symptoms of abdominal congestion caused by the enlarged aneurysm; however, laparoscopic surgery was indicated on the basis of the risk of SAA rupture according to our previous experience [9]. Given the relatively small number of laparoscopic procedures for SAA [10], it was deemed necessary to preserve his splenic function even if the spleen was resected. This procedure is more useful because a previous study reported that patients with splenectomy may develop postoperative complications such as infection and thrombosis [11]. 20: ## Surgical procedure 21: We planned to insert a vessel-sealing device through three ports and clip the aneurysmal site through two additional ports under ultrasonography guidance (Fig. 2). A 12-mm trocar was inserted in the umbilical region as the main port; three 5-mm trocars were inserted under laparoscopic guidance along the left abdomen midway between the xiphoid process and iliac crest. The spleen was located between the left lobe of the liver and pancreas, and the splenic artery was identified originating from the celiac artery (Fig. 3A). Proximal and distal vessels of the aneurysm were separated using a vessel-sealing device, and then two titanium clips (CEC7M Clip Cutter/Electric Dissector) were placed at proximal and distal sites on both ends of the aneurysm (Fig. 3B). We preserved the short gastric vein and dorsal pancreatic vein. A median pancreas ligation was then performed using endo-GIA gold clips (Fig. 3C). The white substance of the spleen was separated from the capsule by injection of saline solution into the subcapsular space until it bulged (Fig. 3D). The distal marginal branch of the hilar vessels supplying the tail of the spleen and branches from short gastric veins were preserved using bulldog clamps, and then, spleno-renal shunts were connected using an 8-mm polytetrafluoroethylene (PTFE) graft (Medtronic Vascutek Terumo Corp., Tokyo, Japan) (Fig. 3E). 22: **Fig. 2**Intraoperative setup. Three ports were used to create subcapsular space by injecting saline into the subcapsular space under ultrasonography guidance. Two ports were used to perform vascular reconstruction 23: **Fig. 3**Intraoperative findings during laparoscopic splenectomy with spleno-renal shunt for SAA. The spleen was visible adjacent to the liver (A). After proximal and distal clipping around the aneurysm (B), a median pancreas ligation was performed (C). Subsequently, we observed that saline injected into the subcapsular space bulged the spleen (D). An 8-mm PTFE graft (Medtronic Vascutek Terumo Corp., Tokyo, Japan) was then used for spleno-renal shunt (E) 24: ## Specimen finding 25: The resected stomach showed a slightly congested spleen corresponding to the esophagus rather than cardiac hernia. 26: ## Pathological findings 27: Several arteriole lesions were observed in multiple sites along the splenic artery. 28: ## Postoperative course 29: We observed no postoperative complications such as pancreatic fistulae or intraabdominal hemorrhage, and thus discharged the patient on postoperative day seven. Three consecutive CT scans showed no detectable liver abscess or pseudoaneurysms. 30: ## One-year follow-up 31: A CT scan at one-year postoperatively showed no abscess formation or pseudoaneurysm development in the liver. Blood test results were within normal range (white blood cells 6100/μL; platelets 40.6 × 104/μL; aspartate aminotransferase 21 IU/L; alanine aminotransferase 14 IU/L; direct bilirubin 0.3 mg/dL; total bilirubin 0.9 mg/dL; C-reactive protein 0.03 mg/dL; carbohydrate antigen 19-9 4.2 U/mL; PIVKA-II 11 mAU/mL; carcinoembryonic antigen 1.3 ng/mL; and alpha-fetoprotein 3.2 ng/mL). 32: ## Discussion 33: Prior reports suggest that treatment for SAA is indicated even when asymptomatic in patients with a diameter greater than 2–3 cm [4, 12]. Mini-invasive approaches have been increasingly favored for SAA due to their safety and effectiveness as treatment methods [13]. Several surgical approaches have been reported [14], including total nephrectomy with or without spleno-renal shunt [15]; splenectomy with or without spleno-renal shunt [16]; partial liver resection with partial pancreatic resection [17]; Roux-en-Y cystojejunostomy and cystoplasty [18]; standard liver transplantation [19]; subtotal stomach-preserving splenectomy [20]; splenic preserving ligation of the proximal splenic artery; and open or laparoscopic common hepatic artery (CHA) ligation or CHA bypass. 34: Laparotomy has long been regarded as the standard treatment for SAA [14]. However, there are concerns about loss of splenic function and injury to the spleen during open surgery [8]. Moreover, open surgery carries high postoperative morbidity due to extensive adhesions caused by previous surgery or acute pancreatitis [14]. Since minimally invasive surgery became popular in abdominal procedures including colorectal surgery [21], minimally invasive techniques have also been applied to SAA [22]. Laparoscopic procedures have been recently advocated as superior in terms of low invasiveness and fewer adverse effects when compared to conventional surgery [22]. Furthermore, a laparoscopic procedure is beneficial for patients who have a history of open abdominal surgery or acute pancreatitis because it minimizes additional adhesions. 35: Reconstruction methods at the time of splenectomy include total nephrectomy with or without spleno-renal shunt, which is suitable for preserving renal function in patients with hydronephrosis or renal dysfunction [15]. Splenectomy without any reconstruction is contraindicated if a gastrosplenic ligament cannot be dissected safely due to the risk of damaging major vessels when connecting shunts under laparoscopic guidance [16]. Partial liver resection with partial pancreatic resection is suitable for cases with multiple vascular anomalies; however, it could increase postoperative morbidity and mortality [17]. Finally, standard liver transplantation is indicated only for patients with malignant biliary obstruction or concomitant liver failure [19]. 36: The present technique is a modified version of a previously reported method [23] that may preserve residual splenic function after splenectomy for SAA while minimizing surgical complications when compared to conventional reconstruction methods, such as Roux-en-Y cystojejunostomy and cystoplasty [18], subtotal stomach-preserving splenectomy [20] and splenic preserving ligation of the proximal splenic artery from celiac artery. Open or laparoscopic CHA ligation or CHA bypass may sometimes cause transient liver dysfunction due to decreased liver blood flow [24]. Additionally, it may cause gastric varices on endoscopy of gastroesophageal varices owing to gastric blood supply derived from celiac flow [25]. Among all these procedures, we selected “laparoscopic splenectomy with spleno-renal shunt” as the optimal treatment because it can preserve both splenic function and renal function. 37: Taniguchi et al. reported about eight cases of laparoscopic cholecystectomy following laparoscopic splenectomy with spleno-renal shunt for SAA [26]; however, it was not designated as surgical treatment for SAA but rather as postoperative reconstruction following accidental spleen injury during elective surgery for cholelithiasis. Moreover, there are few reports about laparoscopic splenectomy with spleno-renal shunt with regard to SAA practically considered as surgical treatment. 38: This procedure requires experience in laparoscopic surgery including visceral vessel reconstruction. In addition, comprehensive analysis considering residual spleen size and renal function (including hydration status) is necessary to prevent postoperative infection or bleeding owing to hereditary spherocytosis and/or thrombocytopenia [27]. 39: ## Conclusions 40: Laparoscopic treatment is a feasible and safe method for patients with SAA that is symptomatic or causing symptomatic abdominal congestion owing to size enlargement without experiencing complications such as pancreatitis, hematoma or pseudoaneurysm formation after surgery. Furthermore, this procedure may preserve both splenic function and renal function after laparoscopic splenectomy for SAA. ** TAGS ** – ID: 1 start_line: 7 end_line: 7 information_type: scientific background brief description: Background information on the incidence of splenic artery aneurysms as a percentage of visceral arterial aneurysms. level of complexity: A factual obscurity: B formulaic complexity: N/A is a chain of reasoning: false assumptions: N/A final_conclusion: Splenic artery aneurysm is rare and accounts for 4–6% of visceral arterial aneurysms. reasoning_steps: [] is_self_contained: true relies_on_figure: N/A dependencies: [] – ID: 2 start_line: 11 end_line: 11 information_type: scientific background brief description: Information on the incidence of SAA in women and its tendency to regress without causing symptoms. level of complexity: A factual obscurity: B formulaic complexity: N/A is a chain of reasoning: false assumptions: N/A final_conclusion: Female incidence of SAA is higher due to hemodynamic changes during pregnancy. reasoning_steps: [] is_self_contained: true relies_on_figure: N/A dependencies: [] – ID: 3 start_line: 17 end_line: 17 information_type: raw data (tabular etc) brief description: Preoperative findings from blood tests and CT scans. level of complexity: A factual obscurity: A formulaic complexity: N/A is a chain of reasoning: false assumptions: N/A final_conclusion: The patient’s blood test results were within normal range and CT scan revealed SAA. reasoning_steps: [] is_self_contained: true relies_on_figure: N/A dependencies: – brief description: Preoperative clinical data type: raw data paper location: N/A – ID: 4 start_line: 19 end_line: 19 information_type: empirical result discussion brief description: Justification for choosing laparoscopic surgery based on risk of rupture and preserving splenic function. level of complexity: B factual obscurity: B formulaic complexity: N/A is a chain of reasoning: true assumptions: Based on previous experience with SAA rupture risks. final_conclusion: Laparoscopic surgery was indicated to mitigate risk and preserve splenic function. reasoning_steps: – assumption: Risk of SAA rupture based on previous experience conclusion: Surgical intervention is indicated description: Clinical decision based on risk assessment and surgical trends. – assumption: Limited number of laparoscopic procedures for SAA conclusion: Preservation of splenic function is important description: Deduction based on surgical outcomes associated with splenectomy. is_self_contained: true relies_on_figure: N/A dependencies: – brief description: Previous experience with SAA rupture risks type: empirical result discussion paper location: ‘l: 19 – 19’ – ID: 5 start_line: