Seminars in laparoscopic surgery最新文献

The success of laparoscopic fundoplication has extended the use of the laparoscopic approach to treating more difficult situations such as paraesophageal hernias (PEHs) or type III (mixed) hiatal hernia. The results have shown that laparoscopic repair is feasible and safe. However, several series have shown recurrence rates of up to 42% as a result of difficulty in the closure of the hiatal gap. Some authors recommend the use of prosthetic mesh to reinforce the hiatal closure. This review analyses the different techniques proposed to prevent recurrence after laparoscopic repair of PEHs. The information currently available shows that the use of a mesh for hiatal repair is safe and prevents recurrence. However, data on the long-term results are lacking, and infrequent but severe complications may arise. The mesh should be used selectively, and the decision to proceed should be based on clinical experience.

Traditional monopolar and bipolar electrosurgery remain very useful in laparoscopic surgery. The need for meticulous hemostasis and the tedium of vessel ligation in advanced cases has propelled the development of new energy source devices that have proved to be remarkably helpful in both laparoscopic and open surgery. Energy sources in the form of argon beam coagulation, ultrasonic coagulation, and bipolar vessel sealing systems have revolutionized laparoscopic surgery. Although each of these energy sources has improved the efficiency and safety of minimally invasive techniques, they can also be associated with distressing complications. This report describes the biophysics of these tools, their spectrum of effectiveness, and methods of application that may improve our ability to perform surgery in a safe and proficient manner.

Many techniques for creating the gastrojejunal anastomosis while performing laparoscopic gastric bypass in obese patients have been described. The stapled anastomoses comprise the circular stapler technique, using either a 21- or a 25-mm anvil, and the linear stapler technique. The handsewn anastomosis, which seems to offer some advantages over the mechanical technique, is being performed with increased frequency. The three techniques are described here and discussed in the light of our own experience.

Laparoscopic ventral hernia repair, a topic of great debate today, has evolved to be a feasible and safe procedure. It has been shown to be as effective as open repair, with a lower recurrence rate. Despite the excellent results of the laparoscopic repair of ventral hernias, numerous controversies are associated with this procedure, such us how to create the pneumoperitoneum, how to perform adhesiolysis, how to manage the hernia sac, the evolution and complications related to postoperative seroma, the type and size of the mesh, and how to insert and fix the mesh. This paper addresses many of these issues and provides data about the advances and limitations associated with laparoscopic ventral hernia repair, together with the description of our results. Also analyzed are future aspects of laparoscopic ventral hernia repair related to prosthetic materials and methods of fixation, especially those regarding bioactive materials and biosurgery.

With the challenges that the health sector now faces in accordance with readjustments and demands for increased efficiency, resource utilization, and innovation, we have initiated a project to develop the future operating room for advanced laparoscopic surgery. New hospitals are being built that contain numerous operating room theaters. To share experiences and avoid repeating the same mistakes as others, we find it suitable to build an "experimental" operating room theater where we can try out and study new equipment, logistics, and communications, and operating forms and new technology that both benefit the establishment of our hospital, as well as the establishment of other hospitals and their laparoscopic operating rooms nationally and internationally. The main goals in the project are, through research and development, to reveal information and develop technology and methods to establish more efficient and prospective patient treatment that is focused on quality. The project is deeply rooted in the established research environment in Trondheim, Norway. We will develop new integrated solutions in the laparoscopic operating unit to create a possibility to rapidly implement the results in the form of practical improvements, increased quality, and renovation in patient treatment. The goal is also that this will result in the establishment of new industry nationally.

Laparoscopic splenectomy in cases of splenomegaly has been shown to be feasible in experienced hands, even though the size of the spleen increases the operative time and difficulty. Laparoscopic splenectomy for splenomegaly offers the same advantages as for patients with smaller spleens: a shorter hospital stay and a faster recovery. Recent experience has shown that hand-assisted laparoscopic surgery makes the surgical maneuvers during laparoscopic splenectomy in cases of splenomegaly considerably easier while preserving the advantages of a purely laparoscopic approach. This technique may facilitate and broaden the application of laparoscopy for splenectomy in patients with enlarged spleens.

This paper describes and discusses the surgical steps needed to perform a laparoscopic distal pancreatectomy. The current lack of standardization of the operative technique can account for the limited diffusion of this procedure. The issue of spleen preservation, which cannot be overemphasized, always demands an accurate surgical technique that results from proficiency both in open pancreatic surgery and advanced laparoscopy. The preservation of the splenic vessels or short gastric-vessel salvage is feasible, yet with different indications. Also, the splenic-vessels preservation procedure has two distinct technical options. The technique of occlusion of the pancreatic stump is crucial for reducing the risk of a postoperative fistula and should be tailored to the structural features of the gland at the transection line. Finally, the hand-assisted approach can provide distinctive advantages over the pure laparoscopic technique in selected circumstances.

The onset of cervicoscopy dates back to the first laparoscopic parathyroidectomy in 1996. This operation, with its several variants, has today become a valid option that is widespread in many centers. Endoscopic or video-assisted thyroidectomy was introduced later, despite the limits imposed by the mass of the gland to be removed. Even though it was indicated for a minority of patients for this reason, both parathyroidectomy and thyroidectomy showed some important advantages with respect to conventional surgery, advantages that were also demonstrated in prospective studies that include a better cosmetic outcome and a less distressful postoperative course. These approaches proved to be safe and feasible in any surgical background, and their complication rate is the same as traditional open neck surgery. The videoscopic access to neck lymph nodes (central and lateral compartments) seems to be very promising, whereas other fields of application such as carotid artery surgery and spine surgery are still being studied experimentally. Cervicoscopy by consequence has to be considered an important surgical tool that can be further improved but which also has an excellent potential.