Journal of Laparoendoscopic & Advanced Surgical Techniques Impact Factor & Information

Publisher: Mary Ann Liebert

Journal description

A bimonthly peer-reviewed journal for practicing surgeons on the surgical techniques that encompass laparoscopy, endoscopy, and advanced surgical technology in all surgical disciplines. It is the first journal to focus on these techniques both in general surgery and in areas of specialization which include gastroenterology, gynecology, ENT, and cardiovascular and thoracic surgery.

Current impact factor: 1.19

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 1.187
2012 Impact Factor 1.066
2011 Impact Factor 1.4
2010 Impact Factor 1.198
2009 Impact Factor 1.012
2008 Impact Factor 0.912
2007 Impact Factor 0.606
2006 Impact Factor 0.718
2005 Impact Factor 0.648
2004 Impact Factor 0.862
2003 Impact Factor 1.127
2002 Impact Factor 0.873
2001 Impact Factor 1.069
2000 Impact Factor 0.783
1999 Impact Factor 0.787
1998 Impact Factor 0.098

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.18
Cited half-life 4.40
Immediacy index 0.31
Eigenfactor 0.01
Article influence 0.33
Website Journal of Laparoendoscopic & Advanced Surgical Techniques website
Other titles Journal of laparoendoscopic & advanced surgical techniques. Part A, Journal of laparoendoscopic and advanced surgical techniques
ISSN 1092-6429
OCLC 36334866
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Mary Ann Liebert

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • On author's personal website
    • On institutional repository, pre-print server or research network after 12 months embargo
    • Publisher's version/PDF cannot be used
    • Set statement to accompany deposit (see policy)
    • Publisher copyright and source must be acknowledged
    • NIH authors will have their final paper, (post peer review, copy-editing and proof-reading) deposited in PubMed Central on their behalf
    • Must link to publisher version with DOI
  • Classification
    ​ green

Publications in this journal

  • Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2015; DOI:10.1089/lap.2014.0675
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    ABSTRACT: To present our experience with laparoendoscopic single-site plus one-port donor nephrectomy (LESSOP-DN) and compare the outcomes with laparoscopic donor nephrectomy (LDN). Prospectively collected data from 169 consecutive LESSOP-DNs and 83 LDNs performed by a single surgeon in the same time period were analyzed retrospectively. No differences in mean operative time (136 versus 130 minutes; P=.15), warm ischemia time (3.4 versus 3.5 minutes; P=.42), blood loss (50 versus 45 mL; P=.41), transfusion rates (0 versus 1 case), hospital stay (4.0 versus 3.9 days; P=.48), or overall complication rate (12.0% versus 7.7%; P=.25) were observed between the LDN and LESSOP-DN groups. The LESSOP-DN group had a shorter time to return to 100% recovery (39 versus 74 days; P<.001), a smaller surgical incision (5.5 versus 8.2 cm; P<.001), higher scar satisfaction score (8.1 versus 6.4; P=.003), and lower analgesic requirements (79.0 versus 68.5 mg; P=.03) than the LDN group. Renal function of the recipient based on estimated glomerular filtration rate at 1 and 3 months was similar between the groups. Health-related quality of life (QOL) was significantly higher in the LESSOP-DN group in four domains of the health survey than in the LDN group. LESSOP-DN might be associated with smaller surgical incision, improved cosmetic satisfaction, less time to recovery, less analgesic requirement, improved donor QOL, and equivalent recipient graft function.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2015; 25(8):150601140035003. DOI:10.1089/lap.2014.0570
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    ABSTRACT: This retrospective study aims to compare open colectomy and hand-assisted laparoscopic surgery (HALS) in the management of acute obstructive right-sided colon cancer and to analyze and evaluate the feasibility and safety of HALS. Ten consecutive patients who underwent hand-assisted laparoscopic right hemicolectomy due to acute obstructive right-sided colon cancer were retrospectively well matched with 25 patients scheduled for a conventional laparotomy during the same time. Demographic, intraoperative, and postoperative data were assessed. The HALS group had the advantage in the length of incision (5.8±0.7 cm) over the conventional group (16±2.3 cm) (P<.05), and the mean blood loss during the operations was significantly less in the HALS group (30±15.2 mL) than in the laparotomy group (90±29.4 mL) (P<.05). Moreover, the time of postoperative ambulation was earlier (2.5±0.8 days versus 3.2±0.9 days) (P<.05). Seven cases underwent intestinal decompression for severe intestinal dilatation and had a satisfactory result. The hand-assisted device can fairly meet the demands of a minimally invasive operation and can protect the abdominal incision and avoid infection. There was no intergroup difference in complication rate, although the conventional group had a higher rate. In this study, compared with conventional laparotomy for acute obstructive right-sided colon neoplasm, HALS is associated with less blood loss, shorter incision, and earlier ambulation. Emergency laparoscopic-assisted right hemicolectomy can be safely performed in patients with obstructing right-sided colonic carcinoma. If practiced more, it might be advocated as a bridge between the conventional open approach and traditional laparoscopic surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2015; 25(7):150527123813009. DOI:10.1089/lap.2014.0645
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    ABSTRACT: Radical rectal resection following neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer is accompanied by relatively high morbidity. Local excision of rectal cancer may be more appropriate for some frail patients with severe comorbidities. Transanal endoscopic microsurgery (TEM), consisting of local excision of selected rectal cancers, has been associated with low rates of postoperative complications. Because neoadjuvant CRT for rectal cancer may be associated with increased complications, the suitability of TEM following CRT is still unclear. In this study we aimed to assess the clinical outcomes of patients undergoing TEM following neoadjuvant CRT. This study retrospectively analyzed all patients undergoing TEM for malignant rectal tumor in our institution between 2004 and 2010. They were divided into those who received CRT (CRT group) and those without CRT (non-CRT group). Demographics and clinical data were compared. Forty-four of 97 patients who underwent TEM were included: 13 CRT and 31 non-CRT. Age, comorbidities, and the duration of the procedure were similar for both groups. There were no significant group differences in tumor diameter (2.1 cm [range, 0.5-3.5 cm] and 2.9 cm [range, 0.5-4.2 cm], respectively; P=.125) or distance of the lower part of the tumor from the anal verge (6.7 cm [range, 5-10 cm] and 7.7 cm [range, 5-15 cm], respectively; P=.285). Two non-CRT patients had peritoneal entry, and 1 of them underwent protective ileostomy because of insecure rectal defect closure. One non-CRT patient underwent a re-operation for postoperative bleeding. The other perioperative complications were minor and included urinary retention requiring catheter placement (2 patients in each group), pulmonary edema (1 non-CRT patient), and pneumonia (1 non-CRT patient). All complications were managed conservatively. There was no wound disruption, major complication, or mortality in either group. With proper patient selection, TEM can be performed safely following CRT, without major complication or increased postoperative morbidity.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2015; 25(8):150527123853009. DOI:10.1089/lap.2014.0647
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    ABSTRACT: Purpose: We developed a system to objectively verify the endoscopic surgical skills of pediatric surgeons. Materials and Methods: We developed a thoracoscopic model of congenital diaphragmatic hernia mimicking a newborn's size. The examinees were divided into Experts (n=10) and Trainees (n=19), and each group performed two tasks (Task 1, reduction of a herniated intestine from the thoracic space to the abdomen; Task 2, perform three suture ligatures of a diaphragm defect using intracorporeal knot-tying). The end points were the time required to complete Task 1, time score calculated using the residual time from the time limit for Task 2, number of complete full-thickness sutures, maximum air-pressure tolerance, degree of diaphragm deformation, and the residual defect areas after suturing. We also evaluated the total path length and velocity of the forceps tips using a three-dimensional position measurement instrument. Results: The Experts had significantly superior results for the time for Task 1, time score, number of complete full-thickness sutures, maximum air-pressure tolerance, and degree of diaphragm deformation in Task 2 (all P<.05). We found that the total path length and average velocities for the left forceps were inferior to those of the right forceps in both tasks in the Trainees (both P<.05, respectively), whereas the Expert group showed no significant laterality in these tasks. Conclusions: Our model could validate the quality of endoscopic surgical skills and could differentiate between Expert and Trainee pediatric surgeons. The Experts could use their forceps equally well to perform tasks even in a small working space.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2015; DOI:10.1089/lap.2014.0259
  • Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2015;
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    ABSTRACT: Three-dimensional (3D) laparoscopes have been developed to maintain the perception of depth in the operating field. Two-dimensional (2D) imaging relies on tactile feedback, visual cues, and previous experience. The aim of this study was to test if 3D laparoscopic vision is superior to 2D laparoscopic vision in training novice operators in completing set laparoscopic tasks. The study population consisted of 20 interns and medical students. The participants were randomized to completing tasks using a 2D or 3D system. These included pegboard transfer (PT), continuous suturing (CS), and intracorporeal knot-tying (IK). The time to complete the task and number of errors made were recorded. Following adjustment for potential confounders, time to complete CS and IK was significantly longer among participants who used the 2D laparoscope compared with those who used the 3D laparoscope (CS, P<.0001; IK, P<.0001). This same effect was not demonstrated in time to perform PT (PT, P=.04). The 2D laparoscope was associated with a significant increase in the number of errors on the IK task (P<.0001) but not on the PT or CS tasks (PT, P=.35; CS, P=.26). The 3D system assists novice operators perform more complex laparoscopic tasks in a decreased amount of time and with fewer errors.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0608
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    ABSTRACT: Visceral and shoulder tip pain following laparoscopic cholecystectomy is mainly due to carbon dioxide (CO2) insufflation. Various methods have been adopted to eliminate residual CO2. We compared the postoperative analgesic efficacy of intraperitoneal normal saline (30 mL/kg) irrigation with preoperative oral acetazolamide administration in patients undergoing laparoscopic cholecystectomy. Sixty patients between 20 and 60 years of age were included in this prospective, randomized, double-blind study. Patients in Group I received placebo, Group II patients received preoperative oral acetazolamide (5 mg/kg), and Group III patients received intraperitoneal irrigation with 30 mL/kg of normal saline. Intravenous paracetamol (1 g) was administered every 6 hours for postoperative analgesia. Parietal and visceral pain scores at rest, on movement, and on coughing and shoulder tip pain were recorded using a visual analog scale after arrival in the postanesthesia care unit, at 1, 2, 4, 6, 12, and 24 hours after surgery. Rescue analgesia was provided with an intravenous fentanyl (1 μg/kg) bolus whenever the visual analog scale score was ≥4. Compared with Group I, Group III patients had significantly lower visceral pain scores at all time intervals except at 12 hours. Group III patients also recorded significantly lower visceral pain scores than Group II from 2 to 24 hours. There was no significant difference in shoulder tip pain. The total dose of fentanyl used was significantly less in Group III. Intraperitoneal normal saline irrigation is more effective than acetazolamide in reducing postoperative visceral pain after laparoscopic cholecystectomy and has significant opioid-sparing effect. However, its effect on shoulder pain is comparable to that of acetazolamide.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0507
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    ABSTRACT: The aims of this study were to measure the learning curve for laparoscopic choledochojejunostomy (LCJ), to describe the technical tips and to report the follow-up data. The results of LCJ performed on 84 patients were analyzed. Patients were divided into eight groups, by surgical order. The plateau of the learning curve was defined as the period during which the operative time showed a dramatic decrease. The exact operative time was recorded using video analysis. Compared with the first three groups, the fourth group showed a significantly shorter LCJ time. The subsequent groups showed a plateau, indicating that there were no more significant changes in the LCJ time. After the plateau of the learning curve was reached, the average LCJ time was 27.4±4.7 minutes. Six cases of postoperative bile leakage occurred, with all occurring before the plateau of the learning curve was reached. Five of the 6 cases of bile leakage had a nondilated common bile duct. Even for a surgeon experienced in laparoscopic surgery, there is a steep learning curve for the performance of LCJ. With careful video review, education of the surgical team, and various technical tips, the learning curve can be shortened. After the learning curve, experienced surgeons can perform LCJ with acceptable results.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0539
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    ABSTRACT: Thoracoscopic plication of the diaphragm is an alternative to conventional surgical treatment of diaphragmatic evisceration via thoracotomy in neonates and infants. The aim of this study is to compare results of treatment by these two methods in the past 11 years. We studied the data of 35 neonates who underwent standard posterolateral thoracotomy (18 patients; Group I) or video-assisted thoracoscopic surgery (17 patients; Group II) for diaphragmatic plication. The two groups were compared for patient demographics, operative reports, and postoperative parameters. The groups were similar in terms of demographics and preoperative parameters. There was a significant difference in mean operative time between the open and thoracoscopic procedure (71.67 minutes versus 51.76 minutes; P<.05). Duration of care in the neonatal intensive unit and length of hospital stay were significantly shorter in Group II (5.89 days versus 3.23 days [P<.05] and 13.06 days versus 9.88 days [P<.05]). Early postoperative complications (hemothorax, pneumothorax) were frequent in the thoracotomy group (Group I) (16.67% versus 0%; P>.05). Recurrence of diaphragmatic evisceration was observed only in the thoracotomy group (11.11% versus 0%; P=.486). Thoracoscopic plication of the diaphragm in infants in the first 3 months of life demonstrates better results than open surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0205
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    ABSTRACT: Laparoscopic low anterior resection is commonly performed, but there is controversy about the optimal specimen extraction site. The purpose of the study was to evaluate the outcomes of two different specimen extraction sites. In this prospective study of total laparoscopic low anterior resection for rectal cancer, we compared the outcomes of specimen extraction from a right lower quadrant trocar site that is also used for a defunctioning ileostomy (21 patients) or a Pfannenstiel incision (25 patients). The median visual analog pain score on postoperative Days 1 and 3 and meperidine requirement were significantly higher in the Pfannenstiel than in the ileostomy site group. Time to resumption of oral diet and hospital stay were significantly shorter in the ileostomy site than in the Pfannenstiel group. All four parastomal hernias were observed in the ileostomy site group. Use of the stoma site for specimen extraction in total laparoscopic low anterior resection for rectal cancer may minimize abdominal wall incisions, decrease postoperative recovery time, decrease pain level and analgesic requirement, and improve cosmesis. Although this procedure may increase the incidence of parastomal hernia, hernia repair may be performed during ileostomy takedown surgery, and the temporary stoma site (which also is the right lower quadrant trocar entry site) may be suggested as a proper specimen extraction site.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(5). DOI:10.1089/lap.2014.0545
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    ABSTRACT: There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for benign esophageal disorders in children. Eleven children (six boys, five girls) with a median age of 30.5 months (range, 1 month-11 years) who underwent treatment with SEMSs for a benign esophageal condition between February 2006 and January 2014 were recruited to this retrospective study. Etiologies included esophageal atresia with postoperative stricture (n=4), recurrent fistula (n=1), and/or anastomotic leak (n=1), as well as iatrogenic perforation of the esophagus following endoscopy (n=4) or laparoscopic fundoplication (n=1). As part of an interdisciplinary cooperation patients were jointly managed from the Department of Pediatric Surgery and Central Interdisciplinary Endoscopy at our institution. Median duration of individual stent placement was 29 days (range, 17-91 days). In 4 cases up to four different SEMSs were placed successively over time. There were no complications noted at stent insertion or removal. At follow-up, 6 patients (55%) were successfully treated without further intervention. Two children each (18%) underwent one single dilatation after stent removal and remained well afterward. Three patients (27%) did not improve following stenting and required definite surgery. Minor stent-related complications were noted in 5 cases (45%), including gastroesophageal reflux (n=2), silent stent migration (n=2), and pneumonia (n=1). SEMSs for benign esophageal disorders in children can be used safely and effectively in selected cases, including esophageal anastomotic strictures, esophageal leaks following primary surgery, or perforations postdilatation. An SEMS can be applied either as an emergency procedure or as an adjuvant treatment further to endoscopy or previous surgery. Establishment of a standardized approach in the pediatric population is mandatory.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0203
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    ABSTRACT: Although endoscopic thoracic sympathectomy (ETS) offers permanent cure of palmar hyperhidrosis (PH), compensatory hyperhidrosis (CH) often complicates the procedure. We analyzed the outcomes of a 2-month interval for unilateral sequential ETS (S-ETS) in comparison with simultaneous bilateral ETS (B-ETS), notably regarding CH and associated plantar hyperhidrosis, in treating patients with PH. Four hundred seven patients with intractable PH were randomly assigned into two groups: the B-ETS group (204 patients) and the S-ETS group (203 patients). Three hundred sixty-four patients completed the study. Complication rates were comparable for both groups. No patient died perioperatively, and no conversion was necessary. Treatment success on follow-up was 97.2% for S-ETS and 96.7% for B-ETS. The incidence of CH was decreased substantially from 131 (71.1%) patients in the B-ETS group to 22 (12.2%) patients in the S-ETS group (P<.001), with no patient suffering severe CH in the S-ETS group compared with 33 (25.5%) patients in the B-ETS group. Eighty-four (58.3%) patients in the S-ETS group had simultaneous disappearance or decreased perspiration on the soles. All patients in the S-ETS group were satisfied, whereas 37.9% of B-ETS patients were unsatisfied with their operation, mostly because of CH and recurrences. Although both sympathectomies were effective, safe, and minimally invasive methods for treatment of PH, unilateral sequential ETS appeared to be a more optimal technique in terms of reduction of CH to a minimum and improvement of associated plantar hyperhidrosis.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(5). DOI:10.1089/lap.2014.0620
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    ABSTRACT: We describe our experience with the use of a modified technique for laparoscopic internal inguinal ring closure (peritoneal incision and double "N" stitch placement). We evaluate the technique in terms of feasibility, efficacy, and safety. From November 2003 to March 2014 we performed 1700 herniorraphies by laparoscopy. We selected 123 patients treated with the "double N" technique by the same surgical team, and we reviewed their notes analyzing demographic data, operative times, intra- and postoperative complications, and recurrence rate. The technique used is a modification of the Schier technique. Our technique consists of a partial lateral peritoneal 180° incision around the internal inguinal ring and in the placement of a double stitch. The first stitch is used to approximate the muscles with the inguinal ligament, and the second one is used to close the peritoneum above them. The female to male ratio was 22:101. Mean age at surgery was 4.3 years (range, 1 month-12 years). Mean operative time was 30 minutes (range, 20-50 minutes). There were 60 bilateral cases. There were no intraoperative complications. Two patients had reactive hydrocele treated conservatively, and 1 patient developed umbilical infection. We did not identify any recurrence. Our early results suggest that the "double N" laparoscopic technique to close the internal inguinal ring in children is safe and efficient. We therefore suggest using this approach in children with a patent internal inguinal ring of >1 cm. The recurrence rate is low, but it should be better assessed by studies with longer follow-up.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; DOI:10.1089/lap.2014.0410
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    ABSTRACT: The aim of this study was to evaluate the clinical application and superiority of the da Vinci(®) Si Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in total parathyroidectomy for secondary hyperparathyroidism. Total parathyroidectomy was performed with the da Vinci Si Surgical System by the four-trocar axillo-bilateral-breast approach. The patients were placed in the supine position, and the operation procedure included creating the workspace, docking, and consoling stages. The camera arm is centered in the working space. Three working arms are then placed adjacent to the camera. The Harmonic(®) scalpel (Ethicon Endo-surgery, Inc., Cincinnati, OH) was used for hemostasis and gland resection, and dissected parathyroid was taken out by a specimen pouch. Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation in 6 patients was successfully performed with the da Vinci Si Surgical System. There were no operation-related complications and no conversions to open or endoscopic surgery. Mean operation time was 156 minutes. Patients were discharged from the hospital 6 days after surgery. The postoperative cosmetic result was satisfactory, with minimal numbness and tingling on the anterior chest. This initial study shows that robotic total parathyroidectomy via the axillo-bilateral-breast approach is a safe and feasible alternative to selected patients, especially those with esthetic concerns.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0234
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    ABSTRACT: One of the latest methods for management of pancreaticogastrostomy (PG) leakage after pancreaticoduodenectomy (PD) is endoscopic vacuum therapy. PD was performed on a 72-year-old man suffering from a nonfunctioning pancreatic neuroendocrine tumor of the head of the pancreas. On postoperative Day 6 after the primary surgery, postoperative pancreatic fistula (POPF) of the PG was revealed. Based on the International Study Group of Pancreatic Fistula recommendations, total parenteral nutrition, a regimen of somatostatin analogs, and intravenous antibiotics were implemented. The patient was qualified for a re-exploration because of the doubtful safety of percutaneous drainage of fluid collection detected in the ultrasonography scan. However, this management was not efficient. Endoscopic vacuum treatment (E-VAC) was initiated. The E-VAC was placed directly into the POPF site using a modified "percutaneous endoscopic gastrostomy (PEG)-like" technique. Over the next few days, the E-VAC was started. The volume of fluid collection from percutaneous drainage rapidly decreased, whereas the volume of E-VAC the following day after vacuum therapy was approximately 1000 mL. There were no signs of leakage of PG confirmed with endoscopy, and there was no fluid collection from peripancreatic drainage. The E-VAC therapy was stopped after 6 days. The patient's general condition improved significantly. There were no abnormalities observable in both clinical and imaging examinations. In selected patients, the "PEG-like" modification can be used successfully in the management of POPF. This technique allows the E-VAC to be placed directly in the POPF site under the endoscopic camera, which is what makes this method safe and efficient.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0463
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    ABSTRACT: To determine the best way to perform diaphragmatic plication for diaphragmatic eventration (DE) using minimally invasive surgery. We conducted a retrospective review of pediatric cases of DE treated between 2007 and 2012. Thoracoscopic plication (TP) is performed using single-lung ventilation with three 5-mm ports; laparoscopic plication (LP) is performed using three or four 5-mm ports. The choice of technique was determined preferentially by the treating surgeon. There were 20 subjects (13 treated by LP and 7 treated by TP). Etiology of DE was phrenic nerve injury (LP, n=11; TP, n=1) and muscular deficiency (LP, n=2; TP, n=6). Mean age (LP, 18 months; TP, 25 months) and weight (LP, 8.0 kg; TP, 9.7 kg) at surgery were not significantly different. Mean operating time was 155.6 minutes in LP and 167.0 minutes in TP (P=not significant). Mean intraoperative end-tidal CO2 was 41.9 mm Hg (range, 35-52 mm Hg) in LP and 36.9 mm Hg (range, 33-41 mm Hg) in TP (P=.01). Mean duration of postoperative ventilation was 1.2 days in LP and 1.3 days in TP (P=not significant). Mean time taken to recommence feeding postoperatively was 1.6 days in both groups (P=not significant). Complications were one conversion to thoracotomy in TP, 1 case of atelectasis in each group (P=not significant), and 6 cases of recurrence in LP versus none in TP (P=.04). Both TP and LP are beneficial for treating small children with DE. However, there is a higher incidence of recurrence after LP, and the role of TP in cardiac patients requiring subsequent surgery is debatable.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0237