[Show abstract][Hide abstract] ABSTRACT: Standardized surgical technique, the use of ultrasonic dissection and neuro- monitoring, have reduced morbidity in thyroid surgery, so that aesthetic aspects and endoscopic or minimally-invasive thyroid surgery have become more important for the patients.
We report on minimally-invasive and endoscopic procedures with either a cervical or extracervical access. Besides current literature we discuss our own results.
The critical evaluation of these procedures shows that the standards of endocrine surgery are not at all times entirely observed.
We therefore suggest requirements for endoscopic thyroid resection: The access trauma must be minimal, the aesthetic result must be optimal--without visible scars--and the size of the resected thyroid tissue should be the same as in open surgery. It has to be possible to resect the tissue en bloc. Only if the quality of the endoscopic thyroid resection is ensured aesthetic aspects may begin to play a role. If all these demands are fulfilled, the advantages of endoscopic resections do not only cover aesthetic aspects. The first results show less perioperative pain and a shorter stay in hospital. However, to prove this, further studies are necessary.
[Show abstract][Hide abstract] ABSTRACT: Neck surgery is one of the latest applications of minimally invasive surgery. We applied a new technique for totally endoscopic thyroidectomy, the axillo-bilateral-breast approach (ABBA). This approach does not leave a scar on the neck.
Between February 2005 and October 2005, 13 patients were treated by ABBA for uni- or multinodular goitres. Surgery is performed under general anaesthesia and in supine position. 5 mm bilateral skin incisions are made on the margin of the areola of nipple. They are used to insert and subcutaneously push forward a 20 cm long, 5 mm trocar to the jugular fossa. A further 5 mm incision is performed in the right axilla. The right breast trocar is the optical trocar. A Maryland clamp in axillary position and 5 mm harmonic scalpel via the left breast trocar permit a clear view of the further subfascial preparation. The caudal hyoidal muscles are longitudinally split along the linea alba. Using delicate blunt dissection, both thyroid lobes are exposed. After isthmus transection is performed, the upper thyroid pole is being mobilized. The upper pole vessels are isolated and divided close to the thyroid capsule. Preparation of the retrothyroidal area includes visualization of the recurrent laryngeal nerve. The resection is performed without bleeding with a harmonic scalpel. Via the axillary approach, with the incision being widened, a 20 mm trocar is inserted and advanced up to the thyroid lodge to remove the specimen.
The average operation time was 132 minutes. No patient had to be converted to a conventional approach. Hypocalcaemia or recurrent laryngeal nerve palsy were not observed postoperatively.
Our preliminary results show that the ABBA technique is a feasible, safe procedure with excellent cosmetic benefits. The small scars in the right axilla and bilateral nipple areola are almost invisible.
[Show abstract][Hide abstract] ABSTRACT: The axillobilateral breast approach (ABBA) is a procedure allowing thyroid resection without scarring at the neck. We operated on a series of 26 patients with this technique.
Via incisions at the edge of the mamilla and axilla, trocars are placed subcutaneously under the platyma. Dissection is performed bluntly and with an ultrasonographic scalpel under videoscopic control. The procedure itself corresponds to conventional surgery. The specimen is removed through the axillary trocar.
Twenty-six female patients underwent thyroid resection using the ABBA technique. Subtotal resection was performed in 24. Mean operation times were 111 min (unilateral) and 187 min (bilateral). In none of these cases was conversion necessary. One transient recurrent laryngeal nerve palsy and one paresis of the arm plexus were found postoperatively.
In selected patients the ABBA technique is feasible and safe with the mandatory radicalness. The primary aim of this method is the cosmetic result.
Der Chirurg 01/2008; 78(12):1139-44. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: During the 20th Century, laparoscopic surgery achieved high standards and significantly reduced morbidity. In order to make surgery simpler and safer, a new concept, natural orifice surgery (NOS), has recently been introduced. The approach to the abdominal cavity may be transoral-transgastric, transvaginal-transdouglas or transanal-transrectal. This article describes the logic behind this approach and the expected challenges.
In order to realize this goal, we founded the first European based working group on NOS. This group concentrates on the development of transdouglas procedures in women by using the transdouglas endoscopic device (TED). This is a wide, multi-channel instrument, which will enable surgery to be performed via a single entry.
Simulation of various intra-abdominal operations, such as staging, cholecystectomy, appendectomy, myomectomy und ovarectomy, using TED has already been carried out. Practical studies are planned in the near future.
The feasibility of NOS has been demonstrated in various experimental studies. We believe that this technique will create a spectrum of innovative and high quality operations and will improve patient safety.
Der Chirurg 07/2007; 78(6):537-42. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die Laparoskopie hat im 20. Jahrhundert alle operativen Disziplinen revolutioniert. Niedrige Morbidität und bessere Lebensqualität wurden in zahlreichen Studien nachgewiesen. Mit dem Ziel, diese Ergebnisse weiter zu verbessern, wurde die Chirurgie durch natürliche Körperöffnungen eingeführt, die sog. ,,Natural Orifice Surgery“ (NOS). Hierbei erfolgt der Einstieg in die Bauchhöhle transoral-transgastrisch, transvaginal-transdouglas oder transanal-transrektal. In der vorliegenden Arbeit möchten wir unsere Vision von NOS vorstellen.Am 23.06.2006 haben wir die erste Europa-basierte NOS-Arbeitsgruppe gegründet und beschlossen, den Transvaginal-transdouglas-Zugang als Schwerpunkt zu fördern. Speziell dafür wurde ein Endoskop entworfen, das ,,Transdouglas Endoscopical Device“ (TED). Das TED beinhaltet neben Optik und Lichtquelle Kanäle, durch die z. B. Schere, Klemme und Sauger eingeführt werden. Eingriffe sind sowohl im kleinen Becken als auch im Oberbauch möglich.Aktuell werden mit dem TED Eingriffe wie Staging, Cholezystektomie, Appendektomie, Myomektomie und Ovarektomie in Computersimulation durchgeführt. Präklinische Studien stehen unmittelbar bevor. Die Machbarkeit diverser intraabdomineller Eingriffe durch natürliche Körperöffnungen wurde experimentell eindrucksvoll nachgewiesen. Auf den Erfahrungen der Laparoskopie basierend, sind wir überzeugt, dass NOS weitere postoperative Vorteile für Patienten bringen wird.
Der Chirurg 05/2007; 78(6):537-542. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is conflicting evidence, whether or not minimally invasive adrenalectomy (MA) is associated with an increased perioperative cardiovascular instability in phaeochromocytomas compared to conventional open adrenalectomy (CA).
In a retrospective analysis of 49 patients with phaeochromocytoma we compared 27 cases of MA to 22 cases of CA by assessing intraoperative haemodynamic parameters and perioperative complications. Patients undergoing MA for adrenocortical adenomas (aldosteronomas n = 15, inactive adenomas n = 13) served as controls. Additionally, we investigated the effect of phenoxybenzamine (POB) pretreatment on intraoperative cardiovascular stability in 42 patients (ranked by maximum daily POB-dose) by comparing the highest (n = 10) with the lowest (n = 10) POB dose quartile (0.32 +/- 0.2 and 2.17 +/- 0.6 mg/kg/day, P < 0.001).
In phaeochromocytomas we found no significant difference in intraoperative haemodynamic parameters or complications when comparing MA with CA. In comparison to adrenocortical adenomas, MA in phaeochromocytomas was associated with a significantly higher maximum systolic BP (188 +/- 29 vs 154 +/- 22 mmHg, P < 0.001), more frequent hypertensive episodes (1[0-4]vs 0[0-1], P < 0.001), more episodes of systolic BP > 200 mmHg (0[0-4]vs 0[0-1], P = 0.03) and a higher demand for intraoperative fluids (3194 ml vs 1750 ml, P < 0.001). Most haemodynamic parameters did not differ significantly between high-dose POB pretreatment and low-dose POB pretreatment, but high-dose POB pretreatment was associated with a significantly higher intraoperative heart rate (120 +/- 19.5 vs 94 +/- 15.2 min(-1), P < 0.01).
There is no significant difference in haemodynamic stability between MA and CA in phaeochromocytomas, but it is significantly inferior when compared to MA for cortical adenomas. We could not detect a beneficial effect of high-dose compared to low-dose POB pretreatment on intraoperative cardiovascular stability.
[Show abstract][Hide abstract] ABSTRACT: There are few reports on laparoscopic rectum resection demonstrating its feasibility and efficacy in patients with rectal cancer. Most patient series are small, and results must be considered preliminary and medium-term. Our large prospective conducted study aimed to assess the effectiveness of a totally laparoscopic resection for rectum carcinoma with emphasis on perioperative and long-term oncological outcomes.
Between November 1992 and July 2003, 194 unselected patients were resected laparoscopically for rectal carcinoma. Patients with locally advanced rectum carcinoma (uT3/uT4) and no evidence of distant metastases were candidates for neoadjuvant chemoradiation. Adjuvant treatment was administered to patients with UICC stage II/III disease. All patients were followed up prospectively to evaluate complications and late outcomes. Survival probability analysis was performed using the Kaplan-Meier method. Study selection was made by Medline search using the following key words: rectal cancer, rectal neoplasms, laparoscopy, and resection. Single case reports and abstracts were excluded. When surgical series were reported more than once, only the most recent reports were considered and listed.
The most common procedures were low anterior resection with total mesorectum excision in 65.5% of patients and high anterior resection in 25.3%. Average operative time was 174 min. Average number of lymph nodes removed was 25.4 and length of specimen resected was 27.6 cm. Resection was curative in 145 patients and palliative in 49 cases. UICC tumor stages were as follows: stage I: 25.2%, stage II: 27.3%, stage III: 30.4%, and stage IV: 17%. Intraoperative complications were <1% for lesions of the ureter, urinary bladder, and deferent duct. Conversion to conventional surgery was necessary in two cases (1%). The most common postoperative complication was anastomotic leakage in 13.5% of patients. There was no postoperative mortality. Follow-up evaluation ranged from 1 to 128 months with a mean of 46.1 months. The most common late complication was incisional hernia in 3.6% of patients. Port-site metastases occurred in one patient (0.5%). Tumor recurrence developed in 23 of the 145 curative resected patients (11.7% distant metastases and 4.1% local recurrence). Overall local recurrence rate was 6.7% (4.1% after curative resection and 14.3% after palliative resection). Overall survival rate was 90.6% at 1 year, 74.5% at 3 years, and 66.3% at 5 years. Overall 5-year survival rate was 76.9% after curative resection and 31.8% after palliative resection. Cancer-related survival rate was 94% at 1 year, 82.4% at 3 years, and 78.9% at 5 years. At 5 years it was 87.7% after curative resection and 48.5% after palliative resection. At 5 years, the survival rate was 100% for stage I, 94.4% for stage II, 66.6% for stage III, and 44.6% for stage IV.
Our results and the literature review clearly demonstrate that laparoscopic resection for rectal cancer is not associated with higher morbidity and mortality. Established oncological and surgical principles are respected and long-term outcomes are at least as good as those after open surgery.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis.
The data were collected within the framework of an ongoing prospective multicenter study carried out by the Lapa roscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30-100 procedures; Group III, < 30 procedures).
Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I-IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates.
An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable ntraoperative and postoperative complication rates, operating time, and mortality rates.
Diseases of the Colon & Rectum 12/2004; 47(11):1883-8. · 3.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Use of laparoscopic resection for colorectal malignancy has raised concerns regarding local cancer control and the lack of long-term results. Most reported data are preliminary and medium-term results, at best. The aim of this study is to analyse all patients who underwent a laparoscopic resection for colorectal cancer at our department between November 1992 and July 2003. The cohort comprised a total of 394 patients (194 rectal cancer and 200 colon carcinoma). The most common procedures were high and low anterior resection with total mesorectum excision (TME) (176), followed by sigmoidectomy (89), right hemicolectomy (57), and left hemicolectomy (42). Mean operating time was 176 minutes. Conversion was necessary in 4 of the patients. Mean number of lymph nodes removed was 27. The postoperative complication rate was 20.1% (rectum) and 12.5% (colon). One patient died of myocardial infarction. Mean follow up was 45 (0.3-135) months. Port site metastasis occurred in 2 patients. The local recurrence rate was 4.1% after curative rectum resection and 0.5% in the colon group. After curative resection, the overall 5-year survival rate was 76.9% (rectum), and 81.4% (colon). Cancer-related survival rate after 5 years was 87.7% (rectum), and 91.3% (colon). Our results demonstrate that laparoscopic resection for colorectal cancer is not associated with higher morbidity and mortality rates. Established oncological principles are respected and long-term results are at least as good as those after open surgery.
Surgical technology international 02/2004; 13:93-9.
[Show abstract][Hide abstract] ABSTRACT: Our aim here was interpret data on the perioperative course, oncological quality, and preliminary long-term results of laparoscopic colorectal surgery carried out with a curative intent.
The data were collected within the framework of a prospective multicenter observational study that has been ongoing since 1 Aug 1995 and includes 46 hospitals. Of a total of 3133 patients, 826 (26.4%) underwent a curative resection for colorectal carcinoma.
The average age of the patients was 67.9 years; the sex distribution was almost 1:1. UICC staging of tumors (stages I, II, and III) showed the following figures: 301/36.4%, 265/32.1%, and 260/31.5%. In the majority of cases, an oncologically radical resection with high transection of the supplying vessels was performed. Intraoperative seeding of tumor cells was reported in 1.8% of the patients. In eight cases, the seeding was due to spontaneous rupture of the tumor. A mean of 13.5 lymph nodes in the resected specimen were investigated histopathologically (10.9 lymph nodes in stage I, 15 each in stages II and III). Depending on the individual hospital, we found a remarkable variation in the number of lymph nodes investigated. With a mean follow-up period of 2.1 years, Kaplan-Meier survival function showed acceptable results, both for rectal and colonic carcinoma, in comparison with conventional colorectal surgery. A stage-related consideration of the survival data yielded similar results.
All in all, the results show that a laparoscopic colorectal procedure can meet oncological radicality criteria, even though certain reservations-in particular, in the case of procedures done with a curative intent-have not been completely eliminated.
[Show abstract][Hide abstract] ABSTRACT: Incidentally detected adrenal tumors are a common finding during abdominal ultrasonography, computed tomography, and magnetic resonance imaging. Although most of these lesions are benign adenomas, adrenocortical carcinomas and metastases constitute 5% to 10% of all tumors. Adrenal biopsy may be helpful, but its diagnostic value is controversial and disputed, and prospective studies have not yet been performed. Therefore, the diagnostic accuracy of adrenal core biopsy was evaluated in a prospective multicenter study involving 8 surgical centers in Germany and Austria. A total of 220 biopsies from surgical specimens of the adrenal gland were punctured in an ex vivo approach and processed for pathohistologic diagnosis using paraffin sections, routine staining, and immunohistochemistry (keratin KL1, vimentin, S100 protein, chromogranin A, synaptophysin, neuron-specific enolase, D11, MiB-1, and p53 protein). The evaluating pathologist was blinded for clinical data from the patients. A total of 89 adrenal adenomas (40.5%), 22 adrenal carcinomas (10.0%), 55 pheochromocytomas (25.0%), 15 metastases (6.8%), 16 adrenal hyperplasias (7.2%), and 23 other tumors (10.5%) were studied. Nine cases were excluded due to incomplete data (n = 2) or insufficient biopsy specimen (n = 7). In the remaining 211 tumors, compared with the final diagnoses of the surgical specimen, bioptic diagnoses were absolutely correct in 76.8% of the cases, nearly correct in 13.2% of the cases, and incorrect in 10% of the cases. Pheochromocytomas were correctly diagnosed in 96% of the cases, cortical adenomas were correctly or nearly correctly reported in 91% of the cases, cortical carcinomas were correctly or nearly correctly reported in 76% of the cases, and metastases were correctly or nearly correctly reported in 77% of the cases. Of the 39 malignant lesions, only 4 were misclassified, 2 as benign and 2 as possibly malignant. This resulted in an overall sensitivity for malignancy of 94.6% and specificity of 95.3%. Our findings suggest that adrenal core biopsy is a useful method for identifying and classifying adrenal tumorous lesions if sufficient biopsy specimens can be obtained. However, in clinical practice it remains to be shown whether the benefits of biopsy outweigh the risks of the procedure.
Human Pathlogy 03/2003; 34(2):180-6. · 2.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite reservations about compliance with oncologic radical criteria, laparoscopic resection of the sigmoid colon is increasingly being used with curative intent in oncologic surgery of the colorectum. The aim of the present study was to obtain further information on the perioperative course, the oncologic radicalness of the procedure, and medium-term outcome.
The data presented here were obtained from a prospective, multicenter study conducted in Germany and Austria. These data were acquired from an analysis of subgroups derived from a total of 3,133 recruited patients.
A total of 292 patients from 36 hospitals underwent laparoscopic resection of the sigmoid colon with curative intent. The definitive histopathologic work-up of surgical specimens revealed the following International Union Against Cancer tumor stages: 122 Stage I, 86 Stage II, and 84 Stage III. The mean operating time was 172 minutes, and the mean intraoperative blood loss was 241 ml. The conversion rate to open surgery was 5.5 percent, the majority of such conversions being made necessary by vascular lesions. Sixty-five of the patients reported at least one postoperative problem or complication (22.3 percent); the mortality rate was 2.7 percent. With a mean of 13.4 recovered lymph nodes and a mean aboral safety margin of 72 mm, the formal criteria for the assessment of oncologic radicalness were met. Intraoperative cell dissemination occurred in two patients. The long-term results, which, at a mean follow-up of 2.1 years and a follow-up rate of 73.3 percent, must be considered preliminary, show a calculated stage-related survival rate of 88.8, 90.9, and 64.1 percent, respectively, for the International Union Against Cancer Stages I, II, and III.
Laparoscopic sigmoid resection can be performed technically reliably-also with curative intent-with acceptable complication and mortality rates and, to date, with survival rates that are at least comparable with those achieved with open surgical procedures.
Diseases of the Colon & Rectum 01/2003; 45(12):1641-7. · 3.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic Incisional Hernia Repair – Is It Necessary that the Mesh Used in Intraperitoneal Onlay Mesh Technique Has Specific CharacteristicsDifferent trials showed advantages of laparoscopic incisional hernia repair over open mesh repair in terms of convalescence and low recurrence rates. Due to the direct contact of mesh and intestine, the choice of the appropriate prosthetic material is of great importance in performing the intraperitoneal onlay mesh (IPOM) technique. The ‘ideal’ mesh should lead to scar formation and provide adequate strength to the repair and, at the same time, should avoid formation of visceral adhesion. The basic elements of the available biomaterials are expanded polytetrafluorethylene (ePTFE), polyester, and polypropylene. On the basis of our experience and reports in the literature, the biocompatibility properties and the complications of various meshes are analyzed and discussed. None of these biological materials can be described with the term ‘ideal mesh’. All available prosthetic materials lead to a foreign-body reaction but are associated with an acceptable complication rate. With respect to the short history of laparoscopic hernia repair and the lacking of data, the question which mesh is the better one cannot yet be answered.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic Resection of Rectal Carcinomas in the ElderlySeveral studies dealing with open surgery in malignant tumors have shown that the postoperative course does not depend so much on age per se as it is related to the individual functional state and medical problems present before surgery. On the other hand, many investigations reported benefits for laparoscopic colorectal surgery in terms of faster postoperative recovery, morbidity, and mortality. In order to assess the outcome of laparoscopic rectal resection in patients aged 70 years or older, we retrospectively compared this patient group with patients under 70 years of age who also underwent laparoscopic rectum resection for rectal cancer at our hospital between July 1993 und October 2002. A total of 179 patients was studied. 123 patients were under 70 years of age (group A), and 56 were 70 years or older (group B). Both groups were well balanced in terms of tumor stages and surgical methods used. The most common procedures were low anterior resection (60% in group A and 61% in group B), followed by high anterior resection (22% in group A and 25% in group B). The postoperative complication rate was 18.4% (15.4 vs. 21.4%). The most common complication in both groups was the anastomotic leakage (10.6 vs. 12.5%). There were no perioperative deaths in either group. Incisional hernia was the most common late complication in both groups (3.2 vs. 7.1%). After a median follow-up of 39 months (range 1–112 months) the records of 97% of the patients could be investigated. There were no differences with respect to the median survival time between the two patients groups (47 vs. 42 months after curative resection and 22 vs. 23 months after palliative operation). This study shows that laparoscopic rectum resection for rectal cancer is not associated with higher morbidity and mortality when comparing patients over 70 years of age with younger patients.
[Show abstract][Hide abstract] ABSTRACT: We report the findings of a prospective multicenter observational study carried out by the Study Group for Laparoscopic Colorectal Surgery on patients undergoing laparoscopic or laparoscopic-assisted surgery for rectal prolapse. The study investigated the safety of various laparoscopic techniques in terms of perioperative and postoperative general and technique-specific complications and compared the results with those reported for open surgery in this area.
Of the 150 patients undergoing laparoscopic or laparoscopic-assisted colorectal surgery for rectal prolapse 124 received rectopexy combined with resection and 26 rectopexy alone. In 85 patients a mesh was employed during rectopexy. The conversion rate was 5.3%.
Perioperative complications (21 surgical and 35 general perioperative) were recorded in 37 patients (24.7%). The reoperation rate was 5.3% (bleeding 2, anastomotic leak 2, ileus 4). No procedure-specific perioperative complications were observed. In particular, reduced surgical trauma led to fewer severe postoperative complications such as cardiopulmonary problems (3.3%).
The techniques of conventional prolapse surgery can readily be translated to the laparoscopic modality, since oncological criteria do not have to be considered. The usually elderly patients in this group benefit to a particular degree from the known advantages associated with reduced surgical trauma. Perioperative morbidity is determined largely by the surgeon's experience. We therefore believe that rectal prolapse is a suitable indication for the minimally invasive modality in the hands of trained surgeons.
Langenbeck s Archives of Surgery 08/2002; 387(3-4):130-7. · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Within a 5-year period, 380 rectal carcinoma patients undergoing laparoscopic abdominoperineal excision or laparoscopic anterior resection were recruited to a multicenter study by 23 institutions in Germany and Austria. This study was initiated by the Laparoscopic Colorectal Surgery Study Group.
One hundred forty-nine patients (39.2%) underwent abdominoperineal resection (APR), and 231 patients (60.8%) were treated by anterior resection (AR). The mean operating time was 208 min, and the conversion rate was 6.1%. Intraoperative complications, mostly vascular or bowel injuries, were observed in 22 patients (5.8%). Overall, a total of 257 postoperative complications and problems occurred in 143 patients, resulting in a morbidity rate of 37.6%. In the AR group, the anastomotic leakage rate increased as the distance of the tumor from the anal verge decreased. The perioperative mortality rate was low (6/1.6%). Most of the patients received a high transsection of the inferior mesenteric artery with radical lymph node dissection (342/90.0%); the mean number of recovered lymph nodes was 13.0, with considerable variation among the individual institutions. Intraoperative tumor cell spillage was reported in 12 patients (3.2%). Sufficient follow-up findings are available for 288 (77%) patients. To date, 19 patients have sustained a local recurrence (6.6%), and 30 (10.4%) have developed distant metastases. Within the (admittedly limited) mean follow-up of 24.8 months, the overall survival rate is 86.6%, the disease-free survival (freedom from both local recurrence and distant metastases) rate is 62.4% for APR, with the corresponding rates for AR being 71.7 and 54.8%, respectively, as established by the Kaplan-Meier function. These data show no alarmingly high recurrence rates at this time.
In principle, laparoscopic anterior resection with curative intent generates considerably more reservations than laparoscopic abdominoperineal resection, which is technically much easier to perform.
[Show abstract][Hide abstract] ABSTRACT: The evidence of innovative surgical procedures is based on study results, general acceptance, and individual experiences. In Germany, 47% of all hospitals agreed to laparoscopic colonic surgery. In our own clientele, we noted a morbidity of 6.8% and a lethality of 0%. Up to now, studies of laparoscopic surgery for sigmoid diverticulitis showing a high level of evidence are still missing. Case-control studies and case studies describe some advantages of this procedure.
Kongressband / Deutsche Gesellschaft für Chirurgie. Deutsche Gesellschaft für Chirurgie. Kongress. 02/2002; 119:63-6.
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic pancreatic resections are rare procedures. A particular position is held by the left resection. In animal trials and 37 operations performed to date, this laparoscopic procedure has been positively assessed. The diseases operated upon were nearly exclusively benign. From November 1998 to July 2001, we performed 5 laparoscopic distal pancreatic resections at our hospital. The indications were: 2 adenocarcinomas; 1 neuroendocrine carcinoma; 1 high malignant T-cell lymphoma, and 1 cystadenoma. Additional procedures in 3 patients were: gastrectomy and resection of the left liver in the case with T-cell lymphoma; resection of a distant metastasis in the liver in the case with advanced pancreatic carcinoma, and a partial adrenalectomy in the case with cystadenoma. We did not note any intra- or postoperative complications in our patients. First of all, benefit is to be found in the early postoperative course. All oncosurgical criteria could be fulfilled.
Digestive Surgery 02/2002; 19(6):507-10. · 1.47 Impact Factor