Laparoscopic wedge resection for benign gastric tumors

BACKGROUND: Both laparoscopic wedge resection and formal laparoscopic resection are used in the treatment of benign and malignant gastric diseases. METHODS: We performed totally laparoscopic wedge resection using stapling devices and three or four trocars. Patients: Four patients were treated with this technique. All four suffered from gastrointestinal stromal tumors (GIST), and one presented with an additional gastric adenoma. Two were morbidly obese, and two had additional operations performed at the same time. Two patients were admitted for acute upper GI bleeding. RESULTS: All of the tumors were removed successfully. Operating time ranged from 135 to 215 min. Oral feeding commenced on days 2-4. Postoperative hospital stay ranged from 5 to 11 days. CONCLUSION: Laparoscopic wedge resection of benign gastric tumors is a safe, reliable method that should be further investigated and used on a broader scale.     

Laparoscopic resection for benign tumors of the stomach.

BACKGROUND: Of all gastric tumors, less than 5% are benign. The traditional treatment of symptomatic and some asymptomatic benign tumors has ranged from mucosal resection to limited gastrectomy. Since the advent of laparoscopy, many different laparoscopic approaches to resection of benign gastric tumors have now been described in the literature. METHODS: We reviewed our experience with laparoscopic approaches to surgical resection of 7 benign gastric tumors. The tumor locations were the body (posterior wall), 3 cases; body (anterior wall), 1 case; lesser curvature, 1 case; fundus, 1 case, and antrum, 1 case. Laparoscopic wedge resection was done in 6 cases. The seventh patient underwent a Billroth I procedure because he had leiomyoma at the antrum. There was no conversion to laparotomy. RESULTS: The mean operative time was 105+/-15 minutes, and mean blood loss was 50+/-15 mL. The mean length of hospital stay was 5 days. There were no complications or mortalities. Tumor size ranged from 2 cm to 6 cm in the greatest diameter. There has been no tumor recurrence with a mean follow-up of 26 months. DISCUSSION: Laparoscopic approach is slowly carving a niche for itself in the treatment of benign tumors of the stomach. The basic principles are obtaining a precise preoperative pathological diagnosis; accurate tumor localization; achievement of tumor-free margins; avoidance of spillage of stomach contents, careful dissection of tumors in the esophagogastric junction, and preventing tumor seeding. CONCLUSION: Based on ours and other studies, laparoscopic resection of benign gastric tumors is safe and feasible.     

Laparoscopic resection of liver tumors in children

BackgroundLaparoscopy for the resection of liver tumors in children has remained undeveloped in comparison to adults. Most of the indications for pediatric laparoscopic hepatic surgery have been limited to diagnostic laparoscopy (biopsy). Over the past ten years, however, laparoscopic liver resections for pediatric hepatic diseases have been performed successfully, and many case reports have been published.MethodsThe authors report 6 cases of laparoscopic hepatic resection of benign tumors in children. The most important aspects of surgical technique are presented. There were 3 boys and 3 girls, with age between 4 months and 16 years. The lesions were located in the following segments: II and III (4 patients), I (1), V (1). The maximum tumor size was 7 cm.ResultsOne anatomical (left bisegmentectomy) and 5 nonanatomical resections were performed. Conversion to laparotomy was necessary in 1 patient owing to bleeding from the posterior branch of the right hepatic artery. There were no postoperative complications and patients were discharged on postoperative day 4, 5, 5, 5, 7 and 3 accordingly. The postoperative pathology of the specimens confirmed their benign nature: infantile hemangioendothelioma (1), nested stromal epithelial tumor (1), focal nodular hyperplasia (3), mixed benign tumor (hamartoma + vascular malformation) (1).ConclusionsThis report demonstrates the feasibility of a laparoscopic hepatic resection in children. On the other hand, laparoscopic liver resection is challenging and teamwork and specific training are necessary.     

Laparoscopic resection of benign tumors of the posterior gastric wall

Laparoscopic wedge excision of benign gastric tumors using stapling instruments alone is not feasible for distal lesions and some tumors arising from the posterior gastric wall. An alternative transgastric approach to distal posterior wall lesions utilizing an anterior gastrotomy for access has been successfully applied in two reported cases.     

Laparoscopic ultrasound guidance for laparoscopic resection of benign gastric tumors

Laparoscopic excision of gastric leiomyoma is technically feasible and safe, but it may fail to localize the exact placement of the lesion because of the lack of tactile sensitivity. The authors present two cases of small gastric leiomyomas that were resected by a totally laparoscopic approach, assisted with intraoperative laparoscopic ultrasonography because the lesions could not be palpated. A gastric wedge resection with tumor-free margins was performed with an endostapler device. Use of a harmonic scalpel to divide the gastroepiploic vessels facilitated the laparoscopic procedure.     

Laparoscopic resection of a benign liver tumor in a child

Laparoscopy for the resection of liver masses in children has remained undeveloped despite the wide acceptance of laparoscopy in the field of pediatric surgery. The authors report a case of nonanatomical laparoscopic hepatic resection of a large mesenchymal hamartoma in a 2-year-old boy. The procedure was performed using an innovative approach with a combination of different technologies that allowed for a safe and precise resection. This case demonstrates the feasibility of a nonanatomical laparoscopic hepatic resection, even for very large tumors. Both technical expertise and use of novel technologies are necessary to ensure a precise and controlled resection.     

Laparoscopic liver resection

In experienced hands and with appropriate case selection, laparoscopic liver resection has proven to be a safe procedure with the added benefit of minimal-assess surgery. Successful laparoscopic liver resection, from wedge resection to formal lobectomy, had been reported for both benign and malignant disease of the liver. We present a young female with a solitary hepatocellular carcinoma in the left lateral segment in whom we successfully performed laparoscopic segmentectomy with the aid of a laparoscopic ultrasonic surgical aspirator, Harmonic Scalpel and laparoscopic ultrasound. She was discharged home on day 5. There was no complication.      

Laparoscopic liver resection

BACKGROUND: This paper describes a 10-year experience of laparoscopic liver surgery, including several major hepatectomies for malignant tumours. METHODS: Of 243 hepatectomies carried out between January 1995 and December 2004, 113 (46.5 per cent) were performed by laparoscopy and 89 were included in this retrospective study. RESULTS: Twenty-four laparoscopic hepatectomies (27 per cent) were for benign disease and 65 (73 per cent) for malignant tumours, including hepatocellular carcinoma (HCC) in 16 patients and colorectal metastasis (CRM) in 41. Minor hepatectomy was performed in 51 patients and major hepatectomy (three or more Couinaud segments) in 38. Conversion to laparotomy was necessary in 12 patients and perioperative blood transfusion in eight. One patient with cirrhosis who underwent right hepatectomy for HCC with conversion to open surgery died 8 days after surgery. Major morbidity occurred in eight patients (16 per cent) having minor hepatectomy and in 11 (29 per cent) of those having a major resection. The 3-year overall and disease-free survival rates for patients with CRM (mean follow-up 30 months) were 87 (11 patients at risk) and 51 (6 patients at risk) per cent respectively. Corresponding values for patients with HCC (mean follow-up 40 months) were 85 (10 patients at risk) and 68 (5 patients at risk) per cent. CONCLUSION: In experienced hands, the results of laparoscopic liver surgery are similar to those for laparotomy.     

Liver resection for benign liver tumors: indications and outcome

BACKGROUND: The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS: Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS: The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS: Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.     

Laparoscopic resection of retroperitoneal benign schwannoma

Schwannomas are particularly rare neoplasms among tumors of the retroperitoneal space. Only 0.3-3.2% of benign schwannomas are found in retroperitoneal locations. As these tumors are usually asymptomatic and discovered by chance or in the course of the evaluation of an unrelated health problem, they may cause the delay of early diagnosis and treatment. With recent advances in the field of minimally invasive surgery, several laparoscopic approaches to retroperitoneal schwannomas have been reported. In this paper, we present the case of a 59-year-old female patient with an asymptomatic retroperitoneal mass that was found during a regular medical checkup. The mass was located between the inferior vena cava (IVC) and aorta under the pancreaticoduodenal unit (site of lymph node 16b1), compressing the IVC. She underwent successful laparoscopic surgery for retroperitoneal schwannoma. In addition, we summarized the literature on cases regarding the laparoscopic management of the retroperitoneal schwannoma.     

Laparoscopic radiofrequency-assisted liver resection

Laparoscopic liver resection has not yet gained wide acceptance among hepatic surgeons, mainly because of the difficulties encountered in dealing with possible intraoperative bleeding. A new technique of laparoscopic liver resection is presented. A 43-year-old man with a large and symptomatic hemangioma underwent a laparoscopic radiofrequency energy-assisted liver resection. After induction of pneumoperitoneum, four trocars were introduced and intraoperative ultrasonography and coagulative desiccation were performed along a plane of tissue 1 cm away from the edge of the lesion using the Cool-Tip radiofrequency probe and a 500-kHz, radiofrequency generator. The necrosed band of parenchyma then was divided and the specimen removed. The operative time was 300 min with a resection time of 240 min. The intraoperative blood loss was 75 ml. The postoperative course was uneventful and the patient was discharged on postoperative day 6. Laparoscopic radiofrequency-assisted liver resection is feasible, and with greater experience may contribute to the wider use of mini-invasive video-assisted liver surgery.     

腹腔镜下左半肝切除术

肝内胆管结石是指结石位于肝内胆管。这种疾病在西方不多见而易发于东亚地区,(肝内胆管中的)结石和(或)狭窄等因素使肝内胆管反复发生化脓性感染,不仅加重胆管的狭窄和阻塞,并加重肝实质的损害,导致肝纤维化,萎缩;感染急性发作时又易发生菌血症、感染性休克、胆源性肝脓肿、胆管溃疡致胆道出血,病变晚期则可发生胆汁性肝硬化、门脉高压症等一系列严重的后果。近年来,因为左半肝较容易操作的解剖位置使得腹腔镜下左半肝切除术在肝胆外科手术中很快得到关注,研究和临床经验表明左半肝切除术用于肝胆管结石症,兼具解除肝管梗阻(结石,尤其合并存在的肝胆管狭窄)和去除化脓性感染病灶的双重效果,有效地提高了肝胆管结石的远期治疗效果。     

Laparoscopic resection of large adrenal tumors

Background The maximum size of adrenal tumors that should be removed with a laparoscopic approach is controversial. It has been suggested that laparoscopic adrenalectomy is appropriate only for adrenal tumors <6 cm in size. We report our experience with laparoscopic adrenalectomy in patients with adrenal tumors of ≥6 cm compared with patients with smaller tumors. Methods We retrospectively reviewed a consecutive series of patients who had a laparoscopic adrenalectomy. Patients were considered candidates for laparoscopic adrenalectomy if their computed tomography (CT) scan showed a well-encapsulated tumor confined to the adrenal gland. Results Sixty laparoscopic adrenalectomies were performed in 53 patients. Twelve of the adrenalectomies (20%) were for tumors that were ≥6 cm (median, 8 cm; range, 6 to 12 cm). There have been no local or regional recurrences but one patient with adrenocortical carcinoma developed pulmonary metastases. When the 12 patients with large tumors were compared with the 36 patients with tumors <6 cm, the median operative time (190 vs. 180 minutes;P=.32), operative blood loss (100 vs. 50 mL;P=.53), and postoperative hospital stay (2 vs. 2 days;P=1.0) were similar. Conclusions The size of an adrenal tumor should not be the primary factor in determining whether a laparoscopic adrenalectomy should be performed. Large adrenal tumors that are confined to the adrenal gland on CT can be removed with a laparoscopic approach.