PubMed · 3818245
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M H Schreiber. 1987. Dynamic tension.. https://doi.org/10.1097/00004424-198701000-00026
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Tumor progression after curative resection of gastrointestinal carcinomas is probably caused by pre- or intraoperative tumor cell dissemination. Disseminated tumor cells are generally detected by immunohistochemistry- or PCR-based molecular-biology methods. A consensus on which is the most adequate detection method has not yet been found, which makes the comparison of data difficult. The prognostic relevance of disseminated cells has been shown, at least in part, for esophageal, gastric, pancreatic, and colonic cancer. The data regarding hepatocellular cancer is conflicting. This article gives a critical review of tumor cell detection in gastrointestinal cancer.
The general potential and current position of minimally invasive surgery for the surgical treatment of malignant tumours of the gastrointestinal tract are discussed. A reliable validation of these procedures for tumour surgery is still impossible due to the lack of long-term results, the selective experience, and the ongoing process of learning and development. However, it seems clear that minimally invasive procedures will have an important position within surgical oncology. This is especially true with respect to improved staging of gastrointestinal tumours by laparoscopy and various palliative procedures that may be performed laparoscopically. Minimally invasive procedures may suffice for the treatment of certain, highly selected cases of preneoplastic and early cancerous lesions. The definitive acceptance of minimally invasive procedures in the future will require further clinical, preferably randomised trials, comparing the advantages of the minimally invasive access route to possible long-term disadvantages with regard to recurrence-free and overall survival.
BACKGROUND: During complex laparoscopic operations sometimes the situation of a "missing hand" will occur. Using a device for hand assistance, the surgeon can place one hand into the abdominal cavity to assist the laparoscopic procedures. METHOD: After a laparotomy of 7-8 cm length, the surgeon can bring one hand into the abdomen via a special device maintaining the pneumoperitoneum. This hand can be helpful, i.e. for exploration, for retraction of gut and organs or for extraction of the specimen. Indications are complex laparoscopic operations such as stomach or colonic resections or splenectomies. In obese patients or patients with extended adhesions, preparation can be facilitated. RESULTS: The literature review and the author's own results with 10 patients since 2000 show remarkable advantages in operative situations when the laparoscopic procedure is complicated or even impossible. In our 10 patients, all operations could be managed laparoscopically by using the HandPort device. CONCLUSIONS: Complicated operations can be performed laparoscopically without conversion to conventional laparotomy by using the hand assistance. These patients do not have to forgo to the benefit of minimally invasive operations.