Laurent Brunaud — Page 2

PubMed2001

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura: outcome and long-term results.

The technical feasibility of laparoscopic splenectomy (LS) has been recently established. However, data regarding the efficacy of the procedure with long-term follow-up of patients with idiopathic thrombocytopenic purpura (ITP) are scarce. The objective of this study was to determine retrospectively the immediate efficacy and the long-term results of a standardized laparoscopic procedure applied to patients with ITP refractory to medical treatment. Laparoscopic splenectomy was performed in 35 patients for ITP between May 1993 and May 1998. The lateral approach was used in the last 27 patients. Data were recorded retrospectively on that group. Twenty-six patients (96%) underwent successful LS. Mean operative time for the laparoscopic procedure was 90 minutes. There were no postoperative deaths. Postoperative complications developed in three patients. Thrombocytopenia resolved after surgery in 93% of patients, but 7 patients (25%) experienced relapse during a mean 28-month follow-up. At present no patient needs medical therapy to maintain a normal platelet count. Laparoscopic splenectomy is feasible and safe in patients with ITP. Long-term results of LS for ITP are comparable to those achieved with open splenectomy.

Adolescent↗

PubMedDate not supplied

Early results of one-year robotic surgery using the Da Vinci system to perform advanced laparoscopic procedures.

Robotic technology has recently been introduced to gastrointestinal laparoscopic surgery. We prospectively evaluated early results of robotic surgery using the Da Vinci system in our department. Data were prospectively collected in 40 patients who underwent robotic surgery during a 1-year period. We performed 3 cholecystectomies, 10 anterior fundoplications for gastroesophageal reflux disease, 17 transperitoneal adrenalectomies, 2 Heller myotomies, 5 procedures for rectal prolapse, and 3 colpohysteropexies for genital prolapse. The results for robotic adrenalectomies and anterior fundoplications were compared with the results from patients who underwent these procedures laparoscopically without robotic assistance at our department during the same period. We encountered two conversions to laparotomy (5%) and one conversion to standard laparoscopy (2.5%). There was no morbidity imputable to the robotic approach and no deaths. The mean operative times were significantly longer in robotic groups compared with laparoscopic groups for adrenalectomies and fundoplications. The Da Vinci robotic system enables surgeons to perform advanced laparoscopic procedures with ease, safety, and precision. We believe that preferable indications for using this system are to perform surgery in narrow spaces (pelvic surgery) or when precise dissection is mandatory (Heller myotomy).

Adolescent↗