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  • 1
    Electronic Resource
    Electronic Resource
    Prospective evaluation of a minimally invasive approach for treatment of bile-duct calculi in the high-risk patient (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 632 -635 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Bile duct stones — Laparoscopic cholecystectomy — Endoscopic sphincterotomy — High-risk patient — Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The best approach to bile duct stones in high-risk patients is controversial. We showed in a randomized trial that open surgery had a morbi-mortality similar to that of endoscopic sphincterotomy alone (ES) and less late biliary complications. The aim of this study was to evaluate a minimally invasive approach to duct stones in high-risk patients compared with open surgery or ES alone. Methods: Sixty high-risk patients (mean age 80 years) suspected of duct stones were treated by ES + laparoscopic cholecystectomy (LC). High-risk factors were: age 〉 70 years, Goldman cardiac index 〉 13, chronic pulmonary disease, liver cirrhosis, neurologic deficit, and severe obesity. Results: ERCP success was 87%. Duct stones were found in 75%. LC succeeded in 92%. Post-LC stay was 4 days. Overall morbidity was 19% and mortality was 3%. Recurrent symptoms (mean follow-up: 9 months) was 3.6%. When compared with open surgery or ES alone, ES + LC had a similar morbi-mortality, but shorter postop stay (p 〈 0.001). Late symptoms appeared in 20% after ES alone vs 4% after open surgery or ES plus LC (p 〈 0.04). Conclusions: Combined ES + LC is an effective alternative to open surgery or ES alone for treatment of duct stones in high-risk patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900409
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  • 2
    Electronic Resource
    Electronic Resource
    Mirizzi's syndrome (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 842 -845 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Bile duct stones — Laparoscopy — Cholecystocholedochal fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Mirizzi's syndrome (MS) is an unusual cause of obstructive jaundice. It can mimic bile duct cancer, and the role of laparoscopic surgery is not well defined. The aim of this paper is to report five cases and describe the pitfalls encountered in its diagnosis and treatment with a laparoscopic approach. Methods: From January 1992 to January 1996, five cases of MS out of 560 patients with gallstones prospectively treated and recorded were found (0.9%). Results: There were two men and three women, (mean age: 54 years [30–93]). In one case diagnosis of bile duct carcinoma was established but surgery revealed MS. Four cases were approached by laparoscopy, but all of them were converted: in two, due to a distorted anatomy, in a third due in the difficulty of visualizing the distal end of the bile duct, and in the last case due to the impossibility of retrieving the stones. All were treated with a cholecochorrhaphy over a T tube, except one, in which a hepaticojejunostomy was performed. Morbidity and mortality were nil, and they remain asymptomatic after a mean follow-up of 19 months (3–36). Conclusions: MS constitutes an important laparoscopic challenge, both to clearance of duct stones and to the proper reconstruction of the biliary duct. A prudent policy is to perform a dissection trial and convert if local conditions are not clear for an experienced laparoscopic surgeon.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900467
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  • 3
    Electronic Resource
    Electronic Resource
    Laparoscopic splenectomy: an evolving technique (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 389-392 
    Details
    ISSN: 1432-2218
    Keywords: Spleen ; Laparoscopy ; Splenectomy ; Lateral approach ; Anterior approach
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Laparoscopic splenectomy (LS) suffers from several technical problems for mobilization and manipulation of a solid organ. Lateral approach has been proposed as an alternative to the anterior approach which facilitates LS. The aim of this paper is to compare the results of LS using and anterior or lateral approach. Methods: Between February 1993 and May 1995, 27 LS were performed (group I, Ant-LS, n: 10; group II, Lat-SL, n: 17). LS was indicated in 19 patients for treatment of an idiopathic purpura, for spherocytosis in four; for AIDS-related thrombocytopenia in two; and for autoimmune anemia and leucopenia in two. Gallstones were associated in two cases and an ovarian cyst in another. Results: LS was completed in 8 patients of group I (80%) and 17 of group II (100%). Operative time (236±21 min vs 159±71 min p〈0.003), number of trocars (4.5±0.5 vs 4±0.5, p〈0.02), transfusion requirements (60 vs 17%, p〈0.04) and mean stay (6.5±3.6 days vs 4±2 days, p〈0.05) were significantly lower in the group of LS with a lateral approach. Conclusions: The lateral approach significantly facilitates the performance of LS compared with the anterior approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00191621
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  • 4
    Electronic Resource
    Electronic Resource
    Effect of spleen size on splenectomy outcome (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 559-562 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopic splenectomy — Open splenectomy — Splenomegaly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic splenectomy (LS) is gaining acceptance as an alternative to open splenectomy (OS). However, splenomegaly presents an obstacle to LS, and massive splenomegaly has been considered a contraindication. Analyses comparing the procedure with the open approach are lacking. The purpose of this study was to analyze the effect of spleen size on operative and immediate clinical outcome in a series of 105 LS compared with a series of 81 cases surgically treated by an open approach. Methods: Between January 1990 and November 1998, 186 patients underwent a splenectomy for a wide range of splenic disorders. Of these patients, 105 were treated by laparoscopy (group I, LS; data prospectively recorded) and 81 were treated by an open approach (group II, OS analyzed retrospectively). Patients also were classified into three groups according to spleen weight: group A, 〈400 g; group B, 400–1000 g; and group C, 〉1000 g. Age, gender, operative time, perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia, length of stay, and morbidity were recorded in both main groups. Results: Operative time was significantly longer for LS than for OS. However, LS morbidity, mortality, and postoperative stay were all lower at similar spleen weights. Spleens weighing more than 3,200 g required conversion to open surgery in all cases. When LS outcome for hematologic malignant diagnosis was compared with LS outcome for a benign diagnosis, malignancy did not increase conversion rate, morbidity, and transfusion, even though malignant spleens were larger and accessory incisions were required more frequently. Postoperative hospital stay was significantly longer in malignant than in benign diagnosis (5 ± 2.4 days vs. 4 ± 2.3 days; p 〈 0.05). Conclusions: In patients with enlarged spleens, LS is feasible and followed by lower morbidity, transfusion rate, and shorter hospital stay than when the open approach is used. For the treatment of this subset of patients, who usually present with more severe hematologic diseases related to greater morbidity, LS presents potential advantages.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901040
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  • 5
    Electronic Resource
    Electronic Resource
    Peritoneal response to a septic challenge (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 792-796 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Pneumoperitoneum — Peritoneal sepsis — Laparotomy — Wall lift
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic surgery has a lower incidence of surgical infection than open surgery. Differential factors that may modify the bacterial biology and explain this finding to some extent include CO2 atmosphere, less desiccation of intraabdominal structures, fewer temperature changes, and a better preserved peritoneal and systemic immune response. Previous data suggest that the immune response and acute phase response are better preserved after laparoscopy. Therefore, we designed a study to evaluate the early peritoneal response to sepsis in an experimental peritonitis model comparing open surgery with CO2 and abdominal wall lift laparoscopy. Methods: The study subjects comprised 360 mice distributed into the following four groups: group 1, n= 72 (controls); group 2, n= 96 (open surgery), 2–3 cm laparotomy, with abdominal cavity exposed to the air for 30 min; group 3, n= 96, CO2 laparoscopy (5 mmHg pneumoperitoneum) for 30 min; group 4, n= 96, wall lift laparoscopy for 30 min. Intraabdominal contamination in the four groups was induced with 1 ml of E. coli suspension (1 × 104 CFU/ml) 10 min before abdomen closure. Peritoneal fluid and blood samples were obtained 1.5, 3, 24, and 72 h after surgery, and TNF, IL-1, and IL-6 were measured (via ELISA), as well as quantitative culture. Results: The number of CFU (colony-forming units) obtained in peritoneal fluid and positive blood culture rates were significantly lower in the laparoscopic groups than in the open group. IL-1 peritoneal levels were significantly lower after 24 h and 72 h in the laparoscopy groups. IL-6 levels decreased sharply in the laparoscopy groups at 24 h and 72 h. There were no differences between the two types of laparoscopy models (CO2 and wall lift). Conclusions: Peritoneal response to sepsis is better preserved after laparoscopy than after open surgery. CO2 does not seem to influence bacterial growth. According to these findings, laparoscopy entails less local trauma and better preserved intraabdominal conditions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901101
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  • 6
    Electronic Resource
    Electronic Resource
    Impact of hematological diagnosis on early and late outcome after laparoscopic splenectomyrid="" (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 556 -560 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Anemia — Autoimmune thrombopenia — Hematological disease — Laparoscopic splenectomy — Splenectomy — Splenomegaly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Laparoscopic splenectomy (LS) is now regarded as the treatment of choice for autoimmune thrombopenia (ITP). However, there have been few reports describing the application of LS to other splenic diseases, such as malignant entities and conditions associated with splenomegaly. Hematological diseases have specific clinical features that can influence immediate outcome after LS. Although the long-term effects of LS are unknown, a risk of splenosis has been suggested. Therefore, we designed a study to analyze the impact of primary hematological disease on immediate and late outcome in a prospective series of LS patients. Methods: We performed a prospective analysis of 111 LS done between February 1993 and March 1999. The patients were classified by hematological indications into the following four groups: (a) group 1, low platelet count. This group was further subdivided into group 1A, idiopathic thrombocytopenic purpura (ITP) (n= 48) and group 1B, HIV-related ITP (n= 8); (b) group 2, anemia. This group was further subdivided into group 2A, autoimmune hemolytic anemia (n= 8), and group 2B, spherocytosis (n= 11); (c) group 3, malignancy (n= 28); and (d) group 4, others (n= 8). Immediate outcomes were recorded prospectively. Hematological status and late complications were reviewed after a mean follow-up of 24 ± 18 months. Results: There were no significant differences between the groups in terms of conversion, transfusion requirements, and morbidity, although transfusion and morbidity were slightly higher in group 3. However, hospital stay was significantly longer in groups 3 and 4 than in groups 1 and 2. Long-term follow-up showed satisfactory hematological results in ≥75% of patients (group 1A, 82%; group 1B, 88%; group 2A, 88%; group 2B, 100%; group 3, 75%; group 4, 88%). Overall, late morbidity was 8.3% and mortality was 6.2%, mainly due to deaths in group 4 (six of 22 patients). Conclusion: LS is a safe and reproducible procedure for most hematological indications, with a similar immediate outcome for benign diseases and a long-term hematological response comparable to the standard results that have been observed in open series.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000149
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  • 7
    Electronic Resource
    Electronic Resource
    Laparoscopic resection of a retroperitoneal cystic lymphangioma (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1425-1426 
    Details
    ISSN: 1432-2218
    Keywords: Cystic lymphangioma ; Resection ; Retroperitoneal organ
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The success of laparoscopic cholecystectomy has expanded the scope of laparoscopic procedures and resection of retroperitoneal organs and selected cystic intraadominal masses have been performed by minimally invasive surgical techniques. We report the case of a 45-year-old that presented a retroperitoneal cystic lymphangioma that was successfully excised by a laparoscopic approach. Laparoscopic surgical techniques should be considered for treatment of selected cystic lesions of intrabdominal or retroperitoneal origin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187350
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  • 8
    Electronic Resource
    Electronic Resource
    Conservative laparoscopic treatment of a posttraumatic splenic cyst (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 71-72 
    Details
    ISSN: 1432-2218
    Keywords: Splenic cyst ; Posttraumatic splenic cyst ; Conservative treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopy has recently been demonstrated to be a useful alternative to open surgery for the surgical treatment of spleen disorders, and it can also facilitate a conservative approach for treatment of selected spleen lesions. We present the laparoscopic spleen-preserving treatment of a post-traumatic spleen cyst. A 28-year-old female presented a mass in the left hypochondrium immediately after an uneventful pregnancy. CT revealed a splenic cyst of 10×8 cm. Laparoscopic exploration showed a cyst located in the lower pole of the spleen. All the cyst wall not covered by spleen tissue (70%) was excised, and the fragment of cyst wall was recovered through a bag. The patient recovered uneventfully and was discharged 72 hours later. The laparoscopic approach should be considered for evaluation and treatment of selected benign cystic lesions of liver, retroperitoneum or spleen origin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187891
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  • 9
    Electronic Resource
    Electronic Resource
    Laparoscopic surgery for splenic disorders (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 66-72 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Splenic disorder — Open splenectomy — Laparoscopic splenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Laparoscopic splenectomy (LS) has recently been gaining acceptance as an alternative to open splenectomy. However, several aspects, such as learning curve, residual splenic function, and management of large spleens, remain controversial. In this paper we present the analysis of technical details and immediate and late outcome of a consecutive series of 64 cases of splenic disorders approached by laparoscopy. Between Feb-1993 and April-1997, 64 patients with a wide range of splenic disorders were treated by laparoscopy, and prospectively recorded. Age, body mass index, operative time, number of trocars, perioperative transfusion, spleen weight, conversion rate, mode of spleen retrieval (bag or accessory incision), postoperative analgesia, stay and morbidity were analyzed. Late failures after LS were reevaluated with 99mTc-heat-damaged red blood cells scintigraphy and CT. LS was performed in 61 patients, and two cases with splenic cyst and one splenic artery aneurysm received a laparoscopic partial cystectomy and aneurysmectomy. LS was performed through an anterior approach in 12 patients and laterally in 49. Conversion rate was 6.5%. Accessory spleens were found in 7 patients (7/61, 11.5%). Morbidity was 16%. There was no correlation between the weight of the spleen, platelet count or obesity with operative time. A lateral approach was associated with a decrease in operative time (p 〈 0.002), postoperative stay (p 〈 0.001), transfusion (p 〈 0.04) and number of trocars (p 〈 0.001). Operative time was significantly longer in large spleens (〉1000 gr) (p 〈 0.001). However, there were no differences in transfusion rate, stay, morbidity or conversion rate. After a follow up of 12 m, 10 patients revealed a low platelet count. Scintigraphy showed residual splenic tissue in 3 (ITP). A wide range of splenic disorders can be treated by laparoscopy, including enlarged spleens. This technique should be continually audited, but initial results reflect the approach's safety and advantages provided that great technical care is taken and an exhaustive search for accessory spleens is conducted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900597
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  • 10
    Electronic Resource
    Electronic Resource
    Laparoscopic splenectomy: an evolving technique (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 389-392 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Spleen — Laparoscopy — Splenectomy — Lateral approach — Anterior approach
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The success of laparoscopic cholecystectomy has favored the application of this technique in abdominal surgery. Laparoscopic splenectomy (LS) suffers from several technical problems for mobilization and manipulation of a solid organ. Lateral approach has been proposed as an alternative to the anterior approach which facilitates LS. The aim of this paper is to compare the results of LS using and anterior or lateral approach. Methods: Between February 1993 and May 1995, 27 LS were performed (group I, Ant-LS, n: 10; group II, Lat-SL, n: 17). LS was indicated in 19 patients for treatment of an idiopathic purpura, for spherocytosis in four; for AIDS-related thrombocytopenia in two; and for autoimmune anemia and leucopenia in two. Gallstones were associated in two cases and an ovarian cyst in another. Results: LS was completed in 8 patients of group I (80%) and 17 of group II (100%). Operative time (236 ± 21 min vs 159 ± 71 min p 〈 0.003), number of trocars (4.5 ± 0.5 vs 4 ± 0.5, p 〈 0.02), transfusion requirements (60 vs 17%, p 〈 0.04) and mean stay (6.5 ± 3.6 days vs 4 ± 2 days, p 〈 0.05) were significantly lower in the group of LS with a lateral approach. Conclusions: The lateral approach significantly facilitates the performance of LS compared with the anterior approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649910071
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