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PubMed2004

The "Laparoscopic Neuro-Navigation" -- LANN: from a functional cartography of the pelvic autonomous neurosystem to a new field of laparoscopic surgery.

It is the objective of this study to etablish the technique of laparoscopic exposure of all pelvic somatic and autonomous nerves. In all our patients who underwent a laparoscopic surgical approach of the retroperitoneum, exposure and assessment of the exposed nerves using laparoscopic neuro-navigation were performed. Laparoscopic surgery allows the surgical approach to all pelvic nerves, particularly to the sciatic nerve, the pudendal nerve and the splanchnic pelvic nerves. We describe a cartography of the functional anatomy of the pelvic plexus and elaborate on the concept of "laparoscopic pelvic functional surgery".

Journal Article↗
PubMed2005

The Heilbronn laparoscopic training program for laparoscopic suturing: concept and validation.

BACKGROUND AND PURPOSE: More than a decade after the first description of laparoscopic nephrectomy, an increasing number of laparoscopic procedures are being performed worldwide. Nevertheless, there still exists a significant lack of standardized training programs to teach ablative and, most important, reconstructive laparoscopic operations (i.e., pyeloplasty, radical prostatectomy). We evaluated and validated a new standardized step-by-step program to improve laparoscopic skills and enable trainees not experienced in laparoscopy to perform a urethrovesical anastomosis. MATERIALS AND METHODS: In an inanimate model (pelvic trainer) with defined trocar positions, the 10 participants were exposed to six reconstructive exercises. The steps consist of improvement of hand-eye coordination (two-row metal-pin model; step I), linear and curved suturing with changing angles of the needle (chicken leg and catheter model; steps II-V), and performance of an anastomosis in a porcine bladder (step VI). Times of 3, 15, 15, 10, 20, and 30 minutes for steps I, II, III, IV,V, and VI, respectively, were defined as the goal before proceeding to the next stage. The time required to succeed in each step and the increase in the speed of suturing and knotting activities were analyzed with the Wilcoxon signed-rank test. RESULTS: After a mean of 40 hours of training, all participants were able to perform all steps within the specified times and complete an accurate urethrovesical anastomosis in 30 minutes. The time required to succeed before and after training showed a significant decrease (P < 0.05). Continual training in reconstructive procedures decreased the time needed for suturing activities by between 66.3% and 72.2%. The time needed for the knotting activities decreased by between 34.3% and 38.3%. CONCLUSIONS: Our program enabled participants not experienced in laparoscopy to increase reproducible performance in reconstructive laparoscopy. These results indicate that the challenging parts of reconstructive laparoscopy such as intracorporeal suturing can be taught using a standardized concept. This experience could be incorporated easily by every department developing a laparoscopic training program.

Anastomosis, Surgical↗
PubMed2005

Laparoscopic nephroureterectomy for tuberculous nonfunctioning kidneys compared with laparoscopic nephroureterectomy for other diseases.

OBJECTIVE: To summarize the results of 8 consecutive laparoscopic nephroureterectomies (LNUs) for tuberculous nonfunctioning kidneys and compare them with 10 LNUs performed for other benign etiologies (control group). MATERIALS AND METHODS: From November 1999 to February 2004, 8 patients underwent LNU for tuberculous ureteric stricture with a nonfunctioning kidney at our center. During the same time period, 10 LNUs were performed for other benign conditions. Hospital records were reviewed to obtain demographic data. In addition, operative time, intraoperative and postoperative complications, duration of postoperative ileus, and hospital stay was recorded. The outcomes of surgery for tuberculosis were compared with that for the control group. Patients were followed up for long-term complications of laparoscopic surgery. RESULTS: The two groups had a comparable demographic data. Nephroureterectomy was successfully performed laparoscopically in all 8 patients with tuberculosis. One patient in the control group, with a large staghorn renal and ureteral calculus, required conversion to open surgery due to dense perinephric adhesions. The outcome of surgery for tuberculosis was compared with outcomes in the control group using SPSS software. The mean operative time, blood loss, analgesic requirement, duration of postoperative ileus, and hospital stay of both groups was comparable, and the differences between them were statistically insignificant. CONCLUSION: The results of this study indicate that LNU for a tuberculous nonfunctioning kidney is a safe, effective, and less invasive treatment modality. Comparing our results with those of nephroureterectomy for other, benign diseases shows that the procedure has similar safety and efficacy even for tuberculous kidneys. Tuberculosis should not be considered a contraindication for a laparoscopic approach. Laparoscopic nephroureterectomy should be offered as the treatment modality of choice to all patients with tuberculous nonfunctioning kidney whose disease involves the kidney and ureters.

Adult↗
PubMed2003

Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy.

PURPOSE: Rectal injury is a potential complication of radical prostatectomy. Because laparoscopic radical prostatectomy is still a challenging procedure, we review the incidence and management of rectal injury in 1,000 cases of consecutive laparoscopic radical prostatectomy performed at our institution. MATERIALS AND METHODS: Of the first 1,000 laparoscopic transperitoneal radical prostatectomies performed between January 1998 and April 2002, 13 (1.3%) were complicated by rectal injury. Mean patient age was 66.5 years (range 58 to 76) and mean prostate specific antigen was 12.9 ng./ml. (range 2.9 to 26). Clinical stage was T1c, T2a and T2b in 5, 7 and 1 patient, respectively. Mean preoperative Gleason score was 5.8 (range 3 to 8). Once recognized the rectal defect was closed laparoscopically in 2 layers and tested for the absence of leakage. Broad-spectrum intravenous antibiotics were given for 7 days. Oral liquids were started the day after surgery with a low residue diet, and a regular diet was started on postoperative day 5. Healing of the vesicourethral anastomosis was confirmed by voiding cystourethrogram on postoperative day 5. RESULTS: All patients underwent a non-nerve sparing procedure except 1 in whom unilateral neurovascular bundle preservation was done. Of 13 injuries 11 were diagnosed and repaired intraoperatively, and 2 were diagnosed postoperatively. Of the 11 cases of intraoperative diagnosis and repair 9 healed primarily without colostomy and peritonitis was diagnosed in the remaining 2 on days 3 and 4, respectively. Of the latter 2 patients 1 required repair of a small rectal defect without colostomy while the other required colostomy. Colostomy was performed in the 2 patients with delayed diagnosis on days 3 and 4 but even then a rectourethral fistula developed in 1, necessitating secondary repair. Average urethral catheterization time was 8.6 days for the 9 patients with an uneventful immediate postoperative course and mean hospital stay was 6.8 days. For the remaining 4 patients urethral catheterization duration was 12, 13, 15 and 120 days, and hospital stay was 7, 16, 21 and 27 days, respectively. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy requires meticulous intraoperative repair in 2 layers, which allows primary healing without diversion colostomy. For injury prevention scrupulous attention is required during non-nerve sparing radical prostatectomy, particularly at the posterior surface of the prostatic apex.

Aged↗
PubMed2005

A three-armed randomized trial comparing open Burch colposuspension using sutures with laparoscopic colposuspension using sutures and laparoscopic colposuspension using mesh and staples in women with stress urinary incontinence.

OBJECTIVE: To compare open Burch colposuspension using sutures (OC) with laparoscopic colposuspension using sutures (LCS) and laparoscopic colposuspension using mesh and staples (LCM) in women with stress urinary incontinence. DESIGN: Prospective randomized trial. SETTING: Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden. POPULATION: Women with genuine stress urinary incontinence or mixed incontinence with a predominantly stress component attending the Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: The women were assessed objectively using a 48-h frequency-volume chart, a 48-h pad test and a standardized stress test. Subjectively, the women were assessed by a questionnaire including influence on quality of life. The women were randomized to OC using sutures (n = 79), LCS (n = 53) or LCM (n = 79). Anaesthesia/operation time, blood loss, complications and other related surgical parameters were compared. Main outcome measures. Objective and subjective cure rate. RESULTS: Objective cure rates 1 year after surgery were significantly higher in the OC and LCS groups compared to the LCM group analyzed by a standardized stress test. Subjective findings were in concordance with the objective results. Performing an OC was less time consuming than performing a LCS and resulted in more blood loss compared to the two laparoscopic techniques. Patients in the LCM group had a shorter duration of catheter use and hospital stay. CONCLUSION: The use of sutures, irrespective of whether the surgical approach was laparoscopic or open surgery, was superior to the laparoscopic mesh and staple technique.

Adult↗
PubMed2004

Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy.

OBJECTIVE: To evaluate the complication rate and clinical follow-up of patients treated for T1 renal cancer by open or laparoscopic nephrectomy at the same institution, as this approach appears to be attractive for treating small renal cancers. PATIENTS AND METHODS: Between 1995 and 2002, 39 patients underwent retroperitoneal laparoscopic and 26 transperitoneal open radical nephrectomy for T1 renal cancer (TNM 1997). Variables before during and after surgery, e.g. cancer recurrence, were compared between the groups. RESULTS: There were no differences between the laparoscopic and open groups in age, sex ratio, weight, height, fitness score, operative duration (134 vs 133 min), minor or major complications, tumour diameter, Fuhrman grade or length of follow-up. Patients who underwent laparoscopic surgery had less blood loss (133 vs 357 mL, P < 0.001), less need for transfusion (none vs 150 mL, P = 0.04), a lower consumption of analgesia drugs, and shorter hospitalization (5.5 vs 8.8 days, P < 0.001). With a mean follow-up of 20.4 months there was no recurrence or tumour progression. CONCLUSION: Laparoscopic radical nephrectomy for patients with T1 renal cancer is a safe, reliable procedure that decreases hospitalization time and bleeding, and ensures the same cancer control as open nephrectomy.

Adult↗
PubMed2003

Laparoscopic Swedish adjustable gastric banding: 6-year follow-up and comparison to other laparoscopic bariatric procedures.

BACKGROUND: The advantages of laparoscopy over open surgery are well known. The aim of this study was to compare our results with Swedish adjustable gastric banding (SAGB) with other laparoscopically performed bariatric procedures (gastric bypass, LapBand, vertical banded gastroplasty). METHODS: Between January 1996 and December 2001, 454 patients (381 women, 73 men) underwent laparoscopic SAGB. All data (demographic and morphologic, co-morbidities, operative, and follow-up) were prospectively collected in a computerized databank. RESULTS: Mean follow-up was 30 months (range 1-66). Average total weight loss was 35.5 kg after 1 year, reaching an average total of 54 kg after 3 years. Mean excess weight loss was 72% after 3 years, and the BMI decreased from 46.7 to 28.1 kg/m(2). Patients with co-morbidities reported marked improvement of their accompanying diseases. Complications requiring reoperation occurred in 7.9%. There was no mortality. The clinical outcome compared with the other laparoscopic bariatric procedures showed no significant difference. CONCLUSION: All laparoscopically performed bariatric procedures are very promising. The great advantage of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach, totally reversible and adjustable to the patients' needs.

Adolescent↗
PubMedDate not supplied

Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients.

BACKGROUND: The feasibility and outcomes of conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGBP) was evaluated. METHODS: From November 2000 to March 2004, all patients who underwent laparoscopic conversion of LAGB to LRYGBP were retrospectively analyzed. The procedure included adhesiolysis, resection of the previous band, creation of an isolated gastric pouch, 100-cm Roux-limb, side-to-side jejuno-jejunostomy, and end-to-end gastro-jejunostomy. RESULTS: 70 patients (58 female, mean age 41) with a median BMI of 45+/-11 (27-81) underwent attempted laparoscopic conversion of LAGB to an RYGBP. Indications for conversion were insufficient weight loss or weight regain after band deflation for gastric pouch dilatation in 34 patients (49%), inadequate weight loss in 17 patients (25%), symptomatic proximal gastric pouch dilatation in 15 patients (20%), intragastric band migration in 3 patients (5%), and psychological band intolerance in 1 patient. 3 of 70 patients (4.3%) had to be converted to a laparotomy because of severe adhesions. Mean operative time was 240+/-40 SD min (210-280). Mean hospital length of stay was 7.2 days. Early complication rate was 14.3% (10/70). Late major complications occurred in 6 patients (8.6%). There was no mortality. Median excess body weight loss was 70+/-20%. 60% of patients achieved a BMI of <33 with mean follow-up 18 months. CONCLUSION: Laparoscopic conversion of LAGB to RYGBP is a technically challenging procedure that can be safely integrated into a bariatric treatment program with good results. Short-term weight loss is very good.

Adult↗
PubMed2006

Laparoscopic gastric re-banding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation.

BACKGROUND: The authors assessed whether laparoscopic rebanding or laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the best approach for failed gastric banding after pouch dilatation. METHODS: Between January 2000 and June 2005, 489 patients underwent laparoscopic gastric banding, and of these, 33 (6.7%) required rescue procedures for pouch dilatation. Each reoperated patient was contacted to obtain information about their postoperative course. Additionally, preoperative weight and BMI, weight loss at 1 year postoperatively, weight at time of pouch dilatation and the time-period between the primary operation and pouch dilatation were analyzed. RESULTS: The most common operation for pouch dilatation was band repositioning or rebanding (16 patients). Band removal without replacement was performed in 7 patients. 8 patients underwent conversion to a LRYGBP. 1 patient underwent laparoscopic gastric sleeve resection and 1 patient received an intragastric balloon. Patients who underwent conversion to LRYGBP are very content and, although weight loss has been nearly the same as after gastric banding, they would prefer the gastric bypass operation to the gastric banding. CONCLUSION: Conversion to LRYGBP appears to offer significant advantages, and appears to be the rescue therapy of choice after failed laparoscopic gastric banding.

Dilatation, Pathologic↗
PubMed1995

Laparoscopic sonography during abdominal laparoscopic surgery: technique and imaging findings.

Laparoscopy is becoming the preferred approach for managing several abdominal disorders. The main limitations of laparoscopic surgery and diagnostic laparoscopy are the loss of the surgeon's tactile feedback and the inability to undertake a complete internal evaluation of solid parenchyma. Probes for laparoscopic sonography have been introduced to compensate for the limitations of laparoscopic surgery and to increase the diagnostic efficacy of laparoscopy [1]. In this article we describe our experience with laparoscopic sonography and illustrate the normal anatomic findings and some applications in biliary surgery and other abdominal laparoscopic procedures.

Abdomen↗
PubMed1999

Laparoscopic splenectomy for immune thrombocytopenic purpura--long-term result of 40 laparoscopic splenectomies.

Laparoscopic surgery has recently extended its indications and it has also become an acceptable surgical approach for splenectomy. In the last five years, we have performed 40 laparoscopic splenectomies for immune thrombocytopenic purpura. Thirty-five patients were female and 5 patients were male. The mean age was 34, varying from 17 to 56. After learning to perform laparoscopic splenectomy with five ports, we are now usually using three or four ports in a right lateral kidney position. There was no case of conversion to exploratory laparotomy. The mean hospital stay was 7 days. There was no perioperative mortality; but in 2 cases we had postoperative subphrenic abscesses which were successfully managed by catheter drainage. Since undergoing laparoscopic splenectomy, 28 patients (70%) were weaned effectively from their steroid medications. Eight patients (20%) have been on small doses of steroid, and 4 patients (10%) have been on the same doses of steroid with no response. The patient group with rapidly increasing platelet count after splenectomy showed a statistically significant relation with the complete response group (p < 0.001). Laparoscopic splenectomy is a safe and reasonable operative procedure for patients with immune thrombocytopenic purpura.

Adolescent↗
PubMed1997

[Clinical study of gasless laparoscopic adrenalectomy in 17 cases--comparison between laparoscopic adrenalectomy with and without pneumoperitoneum].

PURPOSE: To determine the efficiency of gasless laparoscopic adrenalectomy, this procedure was compared to that with pneumoperitoneum. PATIENTS AND METHODS: Between February 1994 and December 1996, 17 gasless laparoscopic adrenalectomy were performed in 5 men and 12 women, 36 to 79 years old. Clinical diagnosis was primary aldosteronism in 8, pheocromocytoma in 2, incidentaloma in 4 and adrenal cyst in 3. When gasless laparoscopic adrenalectomy was performed, the laparoscope was inserted through the upper margin of the umbilicus by open laparotomy. To create a workable space, a 1.2 mm Kirschner wire was advanced subcutaneously below the costal arch and attached to a retractor. Operating time, estimated blood loss, changes of the end tidal CO2 concentration during operation, operative complications and postoperative course were compared to those with pneumoperitoneum in 12 cases. RESULTS: In both procedures, satisfying workable spaces were created in all cases. The mean operating time and estimated blood loss were 245 min and 201 ml without pneumoperitoneum, 317 min and 274 ml with pneumoperitoneum, respectively. The mean changes of end tidal CO2 concentration during operation were 3.2 mmHg without pneumoperitoneum and 5.1 mmHg with pneumoperitoneum. As operative complications, open operations were required in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum) to control intraoperative bleeding. They had the histories of transabdominal operations. Postoperative bleeding was observed in 2 cases (1 without pneumoperitoneum and another with pneumoperitoneum). One of them (with pneumoperitoneum) needed surgical management for hemostasis. Fever over 38 degrees C that occurred in 1 case with pneumoperitoneum appeared to be absorption fever. No differences were observed in the number of the days to the start of oral intake and for postoperative hospitalization between the two groups. CONCLUSIONS: Gasless laparoscopic adrenalectomy is available for most adrenal tumors. Suction could be used unrestrictedly and there were no hemodynamic or ventilatory effects due to pneumoperitoneum. This procedure appears to be safe and advantageous for the treatment of most adrenal tumors.

Adrenal Gland Diseases↗
PubMed1999

[Rational laparoscopic intervention in laparoscopically-assisted vaginal hysterectomy (LAVH): prospective study].

INTRODUCTION: Despite evidence that the vaginal route of surgery is associated with fewer complications and faster recovery, more than two-thirds of hysterectomies are performed abdominally. Diagnostic and operative laparoscopy leads to an increasing number of hysterectomies performed vaginally, although laparoscopy may lead to serious complications. The object of the study was to evaluate the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. METHOD: 100 consecutive women subjected to hysterectomy were indicated for laparoscopically assisted vaginal hysterectomy. The procedures were performed by the same surgical team experienced in laparoscopy and vaginal route hysterectomy which evaluated the rational share of laparoscopy during laparoscopically assisted vaginal hysterectomy. The mean age of the patients was 48.1 years (range 34-71 years). 7 were nulliparae. 69 patients were indicated for operation due to myomas, 20 for the previous operation in the pelvic area, 6 for adnexal cystic masses, 5 for the associated indications. At the same time bilateral adenexectomy was performed in 74 patients. Uterine descensus was diagnosed in 9 patients preoperatively and the operations for stress urine incontinence were performed in 7 cases (Kelly-Stoeckel 4 and Pereyra 3 respectively). Ovarian vessels were coagulated by bipolar coagulation during laparoscopy and uterine vessels were ligated by the vaginal route. RESULTS: The uterus was extripated electively by the abdominal route in 2 patients after diagnostic laparoscopy (unfavourabl localised intraligamentous myoma, distended bowels after using Tractrium by the anestesiologist). Hysterectomy by the vaginal route was completed in 98 patients. The mean operation time was 80 minutes (range 55-180 minutes) and the mean operation time of the laparoscopic part of the operation was 35 minutes (range 25-45 minutes). The estimated blood loss was 300 ml (range 100-550 ml). In 2 patients lysis of dense pelvic adhesions during the laparoscopic part caused that the vaginal part of surgery was safe. 10 complications were encountered postoperatively (3 cases of bleeding from the vaginal vault and 1 from ovarian vessels respectively, 3 cases of pelvic inflammatory disease, 2 injuries of the urinary bladder were recognized and treated peroperatively and 1 case of stress urinary incontinence 10 weeks after hysterectomy). DISCUSSION: According to the literature a different extent of surgical laparoscopy in vaginal hysterectomy is possible. Nulliparity or uterine myomas are no contraindications for vaginal hysterectomy. The main contribution of surgical laparoscopy for vaginal hysterectomy consists in lysis of dense adhesions in the pelvic area and in evaluating or operating adnexal cystic masses. Other indications are controversial because of prolonging the operative time and general risks of diagnostic and surgical laparoscopy. CONCLUSION: The main contribution of laparoscopy for the purposes of vaginal hysterectomy remains the assessment and treatment of dense pelvic adhesions or adnexal pathology rather than hysterectomy itself. Bipolar coagulation of ovarian vessels decreases the blood loss in cases of enucleation of morcellation of myoma(s) during the vaginal part of the operation.

Adult↗
PubMed2000

Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial. HALS Study Group.

BACKGROUND: We compare the use of the HandPort(TM)device in hand-assisted laparoscopic surgery (HALS) to standard laparoscopic surgery (SLS) in the treatment of colorectal disease. METHODS: A prospective, randomized, multicenter study was conducted with the participation of 10 advanced laparoscopic surgeons. Forty patients with indications for elective resection of benign colorectal disease or incurable malignant disease were randomized to one of the two treatment arms (22 HALS, 18 SLS). Main outcome measures included operative time, blood loss, HandPort(TM) performance, postoperative pain, time to oral intake, return of bowel function, length of stay, morbidity, and functional recovery. RESULTS: The patients in each group were similar with regard to age, sex, weight, diagnosis, coexisting medical disease, and preoperative functional status. Operative time was comparable for hand-assisted laparoscopy (152 +/- 66 min) and standard laparoscopy (141 +/- 54 min) (p = 0.58). Incision length for specimen extraction/bowel anastomosis was similar (HALS 7.4 cm vs SLS 7.0 cm). Three of 22 HALS cases (14%) were converted, as compared with four of 18 (22%) in the laparoscopy group (p = 0.68). Return of bowel function occurred by the 3rd postoperative day for the majority of patients in both groups (HALS 77%, SLS 78%). There was no difference in length of stay (HALS 7.0 days [range, 2-12] vs SLS 6.0 days [range, 2-10], p = 0.25). Severity of postoperative pain and rate of functional recovery were equivalent. One major complication occurred in each group. There were three wound infections in the laparoscopy group. No patient required reoperation, and there were no deaths. CONCLUSIONS: Hand-assisted laparoscopic surgery is safe and effective for benign and noncurative colorectal resection. As compared to standard laparoscopic surgery, hand-assisted laparoscopy retains the benefits of minimally invasive surgery and may allow the surgeon to perform complex operations more easily.

Colonic Diseases↗
PubMed2001

Laparoscopic excision of retroperitoneal tumors: technique and review of the laparoscopic experience.

A technique for laparoscopic excision of benign retroperitoneal tumors, including a teratoma and two cystic lesions, is described. Laparoscopic resection of a 12-cm retroperitoneal teratoma was accomplished with the patient in the left lateral decubitus position. Medial mobilization of the ascending colon and the duodenum was required for access to the lesion. Resections of two cystic lesions (measuring 20 cm and 12 cm) were performed with the patients in the lithotomy position. The colon required medial mobilization in both cases to gain access to the cysts. Once the cysts were dissected from surrounding structures, they were punctured, and the aspirated fluid was sent for cytologic analysis. There were no complications or conversions. Mean operating time was 122 minutes (range, 80-190). Patients were discharged 1 day after surgery, requiring only nonsteroidal anti-inflammatory medications for analgesia. Retroperitoneal tumors can be resected laparoscopically with careful preoperative investigation and meticulous laparoscopic technique. A major advantage of laparoscopic resections is that the patient recovers rapidly with minimal morbidity.

Adult↗
PubMedDate not supplied

[Laparoscopic appendectomy as first choice intervention in the treatment of inflammatory diseases of the appendix. Analysis of 397 laparoscopic interventions].

Despite the increasingly widespread use of laparoscopy, especially for gallbladder diseases, laparoscopic appendectomy has not yet met with universal acceptance. The aim of the present retrospective study was to illustrate the technical aspects and the results of 397 laparoscopic appendectomies carried out at the Surgical Department of the San Giovanni Battista Hospital in Zagarolo, Rome, from January 1993 to December 2000. The patients included 260 females with a mean age of 35.5 years and 137 males with a mean age of 38.5 years. All the appendectomies were carried out laparoscopically, with a conversion index of 0%, by two surgeons, utilising only three trocars and the Veress needle technique. Mean operating time was 22.5 min (range: 15-30 min). The mean postoperative hospital stay was 1.5 days. Morbidity was 1.76% (7 cases) and mortality nil. The authors emphasise the numerous advantages of laparoscopic techniques in their experience, including the excellent cosmetic results, reduced postoperative pain, rapid functional recovery, and lower incidences of adhesions, wound infections and laparocele, and believe that laparoscopic appendectomy is a reliable operation for treating all inflammatory diseases of the appendix.

Adolescent↗
PubMed2005

A new era in laparoscopic surgery. Evaluation of robot-assisted laparoscopic procedures.

OBJECTIVE: To present the experience with the advanced technology of robot-assisted laparoscopic surgery at our institute. METHODS: We reviewed and present patients who had robot-assisted laparoscopic surgical procedures, between April 2003 and March 2004, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. All procedures were carried out using the da Vinci system (Intuitive Surgical, Mountain View, Ca, USA). We recorded the time for system setup, operating time, morbidity and postoperative hospital stay. RESULTS: We performed 42 robot-assisted laparoscopic operations. The most frequently performed operations were robot-assisted cardiac procedures (n=25), laparoscopic cholecystectomy (n=9) other operations were: thymectomy (4), apical bullectomy (2), and one for each adrenalectomy, and lung volume reduction. The median time to install and drape the robotic system was 15 minutes. In 2 patients (4.7%) we converted the procedures to conventional laparoscopy or open. There was postoperative wound infection at the site of the port in one patient. The average postoperative hospital stay was similar to conventional laparoscopic procedures. CONCLUSION: Robot-assisted minimally invasive surgery is feasible, safe and may become the surgical procedure of the future.

Adult↗
PubMed2005

[The laparoscopic approach to renal tumors outcome of 121 laparoscopic radical and partial nephrectomy procedures].

BACKGROUND AND PURPOSE: We present and review a single center experience with laparoscopic renal surgery for renal cancer including laparoscopic radical and partial nephrectomy. PATIENTS AND METHODS: During the period September 2002 - January 2005, 180 patients underwent laparoscopic renal surgery at our center for several indications. A total of 121 patients underwent radical nephrectomy (76) or partial nephrectomy (45) for solid renal tumors. Their data was recorded and analyzed including age, indication for surgery, operative time, blood loss, intra- and postoperative complications, conversion rates, histological results and outpatient follow-up. RESULTS: The mean age at surgery was 65 years (range: 21-89 years). The indications for surgery were solid, enhancing renal masses. For tumors larger than 4 cm, a radical nephrectomy was performed. Tumors that were smaller than 4 cm were removed by partial nephrectomy. The mean operative time was minutes (range: 70-280 minutes) and the mean blood loss was 220 cc (range: 30-700 cc). The mean blood loss was significantly lower in the radical nephrectomy group (120 cc) than in the partial nephrectomy group (320 cc). In eight patients major intraoperative complications were noted including injury of the hilar vessels (5 cases), inferior vena cava (1 case), large bowel and spleen (one patient) and duodenum (1 case). Conversion to open surgery was needed in nine patients (7.4%), four in the radical nephrectomy and five in the partial nephrectomy group. Major postoperative complications were recorded in two patients who underwent radical nephrectomy (pneumothorax and incarcerated inguinal hernia) and in two patients who underwent partial nephrectomy (urine leakage). The pathological examination demonstrated renal cell carcinoma in 109 cases, oncocytoma in 6 cases, angiomyolipoma in 2 cases, sarcoma of the kidney and metastasis from lung cancer in one case each and a hemorrhagic cyst in one case. In all patients who underwent radical nephrectomy negative surgical margins were obtained, in three patients after partial nephrectomy the surgical margins were focally involved by tumor. The mean tumor size was 5.1 cm and 3.1 cm after radical or partial nephrectomy respectively. During follow-up, none of the patients developed local or distant recurrence. CONCLUSIONS: The laparoscopic approach to kidney cancer seems to be safe and oncologically sound. The low morbidity rate together with the inherent advantages of laparoscopic surgery make this approach attractive and we believe it should be considered the new standard of care for renal cancer.

Adult↗