Minilaparotomy for type II and III radical hysterectomy: technique, feasibility, and complications

The objective was to assess the feasibility, the operative and postoperative outcome, and complications in the use of minilaparotomy for type II and III radical hysterectomy (RH) and pelvic lymphadenectomy (PLN) in early-stage cervical/endometrial cancer. A pilot study on 91 consecutive patients submitted to type II and III RH and PLN for early-stage cervical/endometrial cancer was performed between March 2002 and May 2003 in the Division of Gynecologic Oncology (UCSC, Rome). Thirty-two of 91 cases (35.2%) were eligible for minilaparotomy. The mean operative time was 156.7 min, whereas the mean intraoperative estimate of blood loss was 303.7 ml. A mean number of 32.7 pelvic lymph nodes and 6.2 common iliac nodes were removed. Ileus and removal of bladder catheter were on mean postoperative day 2.4 and 3.4, respectively. The mean number of postoperative days spent in the hospital was 3.7. Intra- and postoperative parameters were compared to laparotomy controls and literature data on laparoscopy and Pfannenstiel incision, showing substantially comparable results. Minilaparotomy is acceptable for selected patients undergoing radical abdominal hysterectomy (RAH) and PLN and does not compromise the adequacy of the procedure. It can be considered as an alternative to the classic midline vertical incision or even to the Pfannenstiel incisions and laparoscopy.     

Endoscope-assisted minilaparotomic radical retropubic prostatectomy

OBJECTIVE: To assess the clinical efficacy of endoscope-assisted minilaparotomic radical retropubic prostatectomy (EAM-RRP) compared with conventional radical retropubic prostatectomy (cRRP). METHODS: From September 2001 to December 2003, 30 patients with localized prostate cancer were treated by EAM-RRP. The surgical manipulation was performed through the wound with thoracoscopic assistance, using standard surgical instruments. In all cases, 800 mL of blood was collected from the patient for autotransfusion. For both EAM-RRP and cRRP, the internal iliac and obturator lymph nodes were dissected before the prostate removal. Clinical indicators such as operation time, blood loss, and duration of postoperative urine incontinence were analysed in the two groups. RESULTS: The postoperative period before ambulation and the duration of postoperative urine incontinence were significantly shorter after EAM-RRP than after cRRP, while no significant difference was found in operation time, blood loss, and duration of urethral catheterization. None of the cases required allotransfusion. CONCLUSION: EAM-RRP, which had a shorter postoperative period before ambulation and continence, is considered a safe and useful technique for radical prostatectomy.     

小切口治疗小儿腹股沟疝的临床研究

目的:减少创伤。方法:随机对小儿腹股沟疝61例,行经外环投影处皮横纹小切口治疗,并与同期行传统方法治疗的85例进行对比研究,随访1—5年(平均2.3年)。结果:切口长度、平均手术时间、平均住院时间、住院费用及术后阴囊血肿等指标分别经t检验和卡方检验,均有显著性差异(P<0.01)。结论:经外环投影处皮横纹小切口治疗小儿腹股沟疝,具有创伤小、术后并发症少、恢复快、费用低等许多显著优点。     

LAPAROSCOPY-ASSISTED RADICAL NEPHRECTOMY IN COMBINATION WITH MINILAPAROTOMY: REPORT OF INITIAL 7 CASES

We recently developed a new procedure for laparoscopy-assisted radical nephrectomy in combination with minilaparotomy to remove kidneys with renal cell carcinoma. A pararectal incision approximately 7 cm in length was performed from the subcostal region. A 12-mm trocar was placed at the mid-clavicular line at the level of the umbilicus. An 11 -mm trocar was placed at the tip of the rib. Under laparoscopic and trans-minilaparotomic observation, intra-abdominal manipulation was begun. The contents of Gerota's fascia were freed from the surrounding tissues and removed through the abdominal incision. Seven patients have been successfully treated with this procedure. The operating time for this procedure was shorter than the time of laparoscopic nephrectomy. There were none of the adverse hemodynamic or ventilatory effects associated with pneumoperitoneum in this procedure. This procedure also resulted in less postoperative pain and a shorter convalescence period when compared with open nephrectomy.     

腹腔镜与小切口子宫肌瘤剥除术对机体细胞免疫功能影响的对比研究

目的 探讨腹腔镜与小切口子宫肌瘤剥除术对患者机体细胞免疫功能的影响.方法 选取腹腔镜及小切口子宫肌瘤剥除术患者100例,其中腹腔镜组49例,小切口组51例.采用流式细胞仪测定患者术前1天及术后第1天、第3天外周血中CD3、CD4＋、CD8＋及NK细胞表达变化,研究不同手术方式对患者细胞免疫的影响.结果 患者术后第1天、腹腔镜组和小切口组CD3、CD4＋、CD8＋及NK细胞同术前相比表达均明显降低,差异有统计学意义（P〈0.05）,患者术后第3天腹腔镜和小切口组CD3、CD4＋、CD8＋及NK细胞同术前相比均基本恢复,差异无统计学意义（P〉0.05）.同腹腔镜组比较,小切口组术前及术后CD3、CD4＋、CD8＋及NK细胞均无统计学意义（P〉0.05）.结论 腹腔镜与小切口子宫肌瘤剥除术对患者机体细胞免疫功能的影响无显著差异.     

Inflammatory response to surgical trauma in patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a randomised multicentre study

Objective The aim of the study was to evaluate the inflammatory response to surgical trauma in minilaparotomy cholecystectomy (MC) compared to laparoscopic cholecystectomy (LC). Assessment of inflammatory response to surgical trauma in MC has not been addressed properly. Therefore, we investigated five interleukins (IL) and C-reactive protein (CRP) in MC versus LC group in a prospective randomised trial. Methods Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n?=?56) or LC (n?=?50) groups. Plasma levels of five interleukins (IL-1β, IL-1ra, IL-6, IL-8, IL-10) and hs-CRP were measured at three time points; before operation (PRE), immediately after operation (POP1) and six hours after operation (POP2). The primary end-point of the study was to compare the plasma levels of five interleukins and CRP in LC versus MC group. Results The demographic variables and the surgical data were similar in the study groups. The patients in the MC group had higher elevation of the CRP mean values post-operatively (p?=?0.01). However, the patients in the MC group had higher elevation of the IL-1ra mean values post-operatively, the mean pre-/post-operative IL-1ra values being 299/614?pg/ml in the MC group versus 379/439?pg/ml in the LC group (p?=?0.003). There was no statistical significance in IL-6 mean values between the MC and LC groups pre- and post-operatively (POP1). However, the patients in the MC group had higher IL-6 mean values six hours post-operatively (POP2), the mean IL-6 values being 27.6?pg/ml in the MC group versus 14.8?pg/ml in the LC group (p?=?0.037). In addition, the patients in the MC group had higher elevation of the IL-6 mean values post-operatively, the mean pre-/post-operative IL-6 values being 4.1/27.6?pg/ml in the MC group versus 3.8/14.8?pg/ml in the LC group (p?=?0.04). There was no statistical significance in IL-8, IL-10, and IL-1β mean values between the MC and LC groups pre- and post-operatively. Conclusion Our results suggest that the inflammatory response in MC versus LC groups was similar based on the IL-8, IL-10, and IL-1β values. A new finding with possible clinical relevance in the present work is higher relative elevation of the IL-1ra and IL-6 mean values post-operatively in the MC group.     

Minilaparotomy versus conventional laparotomy for Burchh’s colposuspension: A comparative study

Objectives

To compare the safety, efficacy and cost effectiveness of minilaparotomy surgery for Burch’s colposuspension with standard laparotomy method.

Study Design

A retrospective study of 24 cases of genuine stress incontinence who were operated for Burch colposuspension by minilaparotomy (incision <6cm, n=16) and laparotomy (incision >6cm, n=8) in the two hospitals over the last seven years (June 1997 to December 2004) by the authors were evaluated.

Intervention

Patient’s history, clinical examination, investigations, preoperative, intraoperative and postoperative data were recorded and compared in minilaparotomy and laparotomy groups.

Results

Mean operative time was significantly less in minilaparotomy (35 min) than in laparotomy group (42 min). Mean blood loss was equal in the two groups. Postoperative complications were fever in three (18.8%) and two (25%) cases, wound infection in one (6.3%) and two (25%) cases respectively and were significantly less in minilaparotomy group. Mean hours of mobility, starting normal diet and discharge from hospital were 8 and 24 hours; 1, 5 and 3 days; 5 and 7 days respectively in the two groups. Complete cure rate was 87.5%, in both the groups.

Conclusion

Minilaparotomy Burch colposuspension appears to be a safe and feasible method for surgical management of genuine stress incontinence and is superior to conventional laparotomy as there are minimum perioperative and preoperative complications and the patients can be discharged early from the hospital without the need of expensive equipment.     

Gasless laparoscopy-assisted live donor nephrectomy: The initial 5 cases

Summary

Since March 1993, we have performed gasless laparoscopy-assisted nephrectomy (GLAN) for patients with renal tumours and have found that it is a useful minimally invasive procedure. We have recently also performed GLAN for living kidney donors. The objectives of the present study were to evaluate the efficacy of GLAN for living kidney transplantation and to compare the results of GLAN and open donor nephrectomy. Since March 1995, we have performed GLAN for five living kidney donors. The surgical outcome and the post-operative graft function were compared with the results for donors operated on by open nephrectomy. The mean operating time and mean blood loss were 292.8 min and 185.2 ml in the five GLAN procedures. There were no operative or post-operative complications apart from blood loss of 500 ml in one obese donor whose right kidney was removed. Although the operating time was longer, the post-operative recovery of the donors was significantly more rapid than with open donor nephrectomy. GLAN could be advantageous for living kidney donors since it is minimally invasive. However, we feel that right-sided GLAN cannot currently be recommended in individuals with abundant perinephric fat.     

Mini-Gastric Bypass by Mini-Laparotomy: A Cost-Effective Alternative in the Laparoscopic Era

BACKGROUND: Laparoscopic mini-gastric bypass (MGB) is being increasingly performed worldwide. Results of MGB by mini-laparotomy (minilap MGB) are hereby reported. METHODS: 126 patients undergoing minilap MGB from October 2004 to October 2006, were reviewed at an academic institution. RESULTS: Mean age was 35 +/- 11.4 years (range 15-72), preoperative BMI was 44 +/- 6.9 kg/m2 (range 35-61.8) and 80 (63.4%) were women. Co-morbidities were present in 42 (33.3%). Operative time was 144 +/- 15.8 minutes (range 120-160) and length of hospital stay was 3.32 +/- 0.62 days (range 2-18). There was no hospital mortality, and the in-hospital complication rate was 4.7%. No anastomotic leakage occurred, and the incidence of wound sepsis was 2.3%. The mean total cost of the procedure was 3408 +/- 547 USD (range 2967-6876). Five patients (3.9%) developed incisional hernias and 3 (2.3%) marginal ulcers. BMI at 6 months was 33.0 +/- 3.1 kg/m2 (range 26.8-43.5, P < 0.001) compared with preoperative value. At 1 year, mean excess weight loss was 68.4% and comorbidities resolved in 85%. CONCLUSION: Minilap MGB is a simple, safe, effective and low-cost gastric bypass. It represents an attractive cost-effective alternative to laparoscopic MGB.