Advantages Of Minimal Invasive Surgery Research Articles

Outcomes and complications of cerebral aneurysms operated on by eyebrow incision according to aneurysm type and location

ObjectiveTrans-eyebrow supraorbital aneurysmal neck clipping, also known as keyhole surgery, have many advantages of minimal invasive surgery. However, there are few studies on whether there is a difference in keyhole surgery according to the location of the aneurysm, and how the complications after keyhole approach differ from the conventional approach. The authors investigated the surgical outcome of keyhole aneurysmal surgery for clarify the characteristics of keyhole surgery.MethodsA retrospective study was performed with review of medical records and images of patients with anterior circulation aneurysm undergoing aneurysmal clipping with keyhole surgery. The patient's clinical condition, imaging, surgical condition, and outcome were investigated.ResultsAs a result of analysis about the location of the aneurysm, middle cerebral artery (MCA) aneurysm group had a longer operation time than internal carotid artery and anterior cerebral artery aneurysm groups, but there was no significant difference in complication rate. The olfactory dysfunction occurred more than that of conventional surgery and occurred less in MCA aneurysm group than others. Scalp sensory change in the surgical site was more common in patients with unruptured aneurysms.ConclusionBy accurately investigating the frequency and severity of complications associated with trans-eyebrow aneurysmal neck clipping surgery, it can help to select a surgical approach considering risk versus benefit. In addition, patient’s satisfaction can be increased by providing information to patients and caregivers in advance about the outcome of this approach and the anticipated complications.

COMPARISON OF LAPAROSCOPIC VERSUS OPEN RIGHT HEMICOLECTOMY IN PATIENTS OF ASCENDING COLON TUMOR

Background: In addition to rectum, ascending colon and caecum can also develop cancer. Right hemicolectomy is the operation of choice for later two. Laparoscopic right hemicolectomy is reported to have advantages of minimal invasive surgery, but some contradictory results were found. So the purpose of this study is the quest of truth.
 Objective: To compare the outcome of Laparoscopic and Open Right Hemicolectomy in patients of ascending colon tumors.
 Methods: This randomized Controlled Trial was conducted at Surgical Unit II, LGH, Lahore for 12 months from 2020-2021. Then 90 patients (45 in each group) were enrolled based on inclusion criteria. In group A, laparoscopic and in group B, open method was performed. Duration of surgery, hospital stay, wound complications and anastomotic leakage were noted. Data was recorded on proforma and analyzed in SPSS Vr. 25.0. Both groups were compared for duration of surgery and hospital stay by using independent samples t-test and for wound complication and anastomotic leakage by using chi-square test. P-value<0.05 was taken as significant.
 Results: The mean age of patients was 52.31±13.30 yrs in laparoscopic and 51.18±10.74 years in open surgery. In laparoscopy group, male:female ratio was 1:1 and in open surgery group it was 1:2. In laparoscopy mean duration of surgery was 125.18±19.66 minutes while in open group it was 134.20±25.07 minutes. (p-value >0.05). In laparoscopy mean duration of hospital stay was 6.47±1.24 days and in open surgery it was 7.96±1.35 days (p-value <0.05). In laparoscopy group, wound complication occurred in 4 (8.9%) patients and in open surgery group, wound complication occurred in 7 (15.6%) patients (p-value >0.05). In laparoscopy group no anastomotic leak occurred i.e. 0 (0.0%) patients, but in open surgery group, anastomotic leak occurred in 3 (6.7%) patients (p-value >0.05). In laparoscopy group, pain was mild in 41 (91.1%) cases while moderate in 4 (8.9%) cases and no patients had severe or excruciating pain. In open surgery group, pain was mild in 32 (71.1%) cases while moderate in 10 (22.2%) cases and 3 (6.7%) patients had severe pain but no patient had excruciating pain. The difference was significant (p-value <0.05).
 Conclusion: Thus laparoscopic method has advantages in terms of reduced hospital stay, less postoperative pain, wound complications and anastomotic leakage after surgery as compared to open surgical method.
 Key words: Laparoscopic surgery, Open surgery, Right Hemicolectomy, ascending colon tumor, anastomotic leak, wound complication, stapling device.
 

E-TEP in Ventral and Incisional Hernia Repair – Our Experiences

Background: Rives-Stoppa repair has become the standard for repairing ventral and incisional hernias. The endoscopic retromuscular approach has the same benefits and offers the advantages of minimal invasive surgery. Method: The technique is based on the retromuscular approach to the linea semilunaris (longitudinal technique) or the linea semicircularis (transverse technique). The incision is made on the anterior rectus sheath, and the trocar is placed below the muscle. A retromuscular space is created and the neck of the hernia sac can be reached. Upon release of the hernia, the sheath of the opposite rectus muscle opens up entirely up to the semilunar line, allowing the creation of enough space for placing the mesh. The mesh can be fixed using transcutaneous sutures, glue or be non-fixed. It is not always necessary to close the defect. Results: Between 2003 and 2017 we performed 108 operations. We had 35 umbilical, 17 epigastric, one Spigelian and 55 incisional hernias. There were no intraoperative complications with ventral hernias, and one bowel injury in the incisional hernia group. There were five conversions and four recurrences. All of them were caused by a small mesh, after insufficient dissection. There were no infections. Conclusion: Unlike LVRH, e-TEP will probably achieve the results and benefits of the retromuscular open technique.

Robotically assisted enhanced-view totally extraperitoneal repair (eTEP) of a recurrent umbilical hernia in a patient with peritoneal dialysis.

Background: Abdominal wall hernias are frequent in patients with peritoneal dialysis. Guidelines recommend an open hernia repair with extraperitoneal mesh placement to avoid access to the abdominal cavity. Method: We performed a lateral docking robotically assisted enhanced-view totally extraperitoneal repair (eTEP) of a recurrent umbilical hernia with diastasis recti in a patient with peritoneal dialysis due to polycystic kidney disease. After suturing of the midline a 20 x 28 cm mesh was placed in the retrorectus space, covering the whole area of preparation while also overlapping all trocar sites. A drainage was left in the retrorectus space until the first session of PD did not sample any form of leakage.Result: Robotically assisted totally extraperitoneal hernia repair was feasible. The patient was able to continue peritoneal dialysis without intermittent hemodialysis. There was no leakage of the dialysate to the retrorectus space. Postoperative recovery was uneventful. 6 months after surgery the patient was free from pain and showed no signs of recurrence. Conclusion: Robotically assisted totally extraperitoneal hernia repair in patients with umbilical hernia and peritoneal dialysis could be a promising surgical technique to combine the advantages of minimally-invasive surgery with totally extraperitoneal mesh placement without access to the abdominal cavity.

Total laparoscopic pancreaticoduodenectomy in 26 patients: single surgeon experience

Background: Total laparoscopic pancreaticoduodenectomy (TLPD) has become more feasible and preferred surgery for periampullary tumour. With the innovation of latest equipment and continuous learning curve, this has become more sophisticated and rampant, along the advantages of minimal invasive surgery. Methods: We analysed data of all the 26 patients who underwent TLPD from October 2015 to November 2019. Preoperative haematological, liver function test, tumour marker, MRCP, triphasic CT, scan with pancreatic protocol, endoscopic ultrasound guided fine needle aspiration or brush cytology done for confirmation of diagnosis, nodal status and operability. Meticulously selected patients with periampullary carcinoma of tumour size≤2.5 cm included. Demographic data, operative time, length of hospital stay, post-operative complication and pathological analyses of resected specimen (en bloc) observed. Results: TLPD for periampullary tumours attempted in twenty-six patients among them six converted to open surgery. Patients were of both genders and mean age was 45 (27-60, SD7.4) years. The mean operative time was 353 SD 28.77 (306-420) minutes. Postoperatively, there were few complications and mean length of hospital stay was 11 (9-13 days) days. The histopathology revealed maximum no. of cholangiocarcinoma with negative margins and positive nodes in all the patients.Conclusions: TLPD is feasible, safe and promising alternative to the standard open surgery with expert hands. This has benefits of short hospital stay, less blood loss, cosmetic, early recovery with few complications. Short-term surgical outcomes are superior or comparable to open surgery.

Laparoscopic Treatment of Hydatid Cyst of Liver: Outcome at Tertiary Care Hospital

Objective: To determine the outcome of laparoscopic treatment of hydatid cyst of liver at tertiary care Hospital.
 Methodology: This cross sectional, study was conducted at public and private sector Hospitals of Jamshoro/Hyderabad from June 2017 to Sept 2019. It includes all diagnosed patients of Hydatid cyst of liver with either of gender and age range from 15 to 65 years who were operated laparoscopically. Patient’s demographic information, postoperative complications, operative time and hospital stay were recorded via self-made proforma and data was analyzed by using SPSS version 20.
 Results: Total 29 patients were admitted with hydatid disease of liver and out of them 21 patients underwent laparoscopic treatment during study period; their mean age was 46.7±13 years. Males were commonest 71.42% and 28.57% were female. Mean operative time was 98.3±18 minutes. According to postoperative pain, the average of visual analog score was 07.85±1.38 at 24 hours and 3.42±1.50 at 72 hours. VAS mean was 07.8 and 3.4 respectively. Cavity related infection was noticed in 3 cases; port site infection in two cases, bile leak in two and residual cyst was also found in two patients. Mean postoperative Hospital stay was 6.6 days.
 Conclusion: Laparoscopic surgery for hepatic hydatid disease can be conducted safely as it provides advantages of minimal invasive surgery. Careful selection of the patient is utmost important to achieve good results especially in initial phases.

How I do it? Uniportal full endoscopic contralateral approach for lumbar foraminal stenosis with double crush syndrome

BackgroundEvolution of endoscopic surgery provides equivalent results to open surgery with advantages of minimal invasive surgery. The literature on technique Uniportal Full endoscopic contralateral approach is scarce.MethodsThe endoscopic contralateral approach technique applies for patients presenting with double crush syndrome with foraminal and extraforminal stenosis. The key steps focus on contralateral ventral overriding superior articular process decompression, foraminal and extraforaminal discectomy, and lateral vertebral syndesmophyte decompression leading to enlargement of the contralateral foramen and extraforamen size.ConclusionThe Uniportal Full endoscopic contralateral approach is a good alternative to open surgery or minimally invasive microscopic surgery through direct endoscopic visualization of the entire route of exiting nerve with no neural retraction allowing both lateral recess and foraminal and extraforaminal decompression all in one approach.

VATS anatomical resection (lobectomy or segmentectomy) for pulmonary metastasis

Metastasectomy is steadily gaining place in the arsenal of treatments of patients suffering from lung metastasis of colorectal carcinoma (CRC). Meanwhile thoracotomy has been the gold standard approach during years for lung metastasectomy of CRC, the use of video-assisted thoracic surgery (VATS) in this field is currently thriving. Indeed, in addition of known advantages of minimally-invasive surgery, VATS has shown equivalent oncologic outcomes in comparison to open techniques. Otherwise, several questions in the management of these particular patients remained unsolved. In particular, only few studies have explored the role of anatomical resections (i.e., segmentectomy/lobectomy/pneumonectomy) compared to wedge resections. Despite their low level of evidence, these studies highlight interesting preliminary results, in particular a survival advantage of anatomical resections over non-anatomical. Most recent works have even suggested a potential role of molecular markers to select candidates who would benefit from an anatomical resection.

67. Lateral lumbar interbody fusion with percutaneous pedicle screw fixation (LLIF-PPS): are we getting the sagittal alignment right?

BACKGROUND CONTEXT Lateral lumbar interbody fusion with percutaneous pedicle screw fixation (LLIF-PPS) is a circumferential minimally-invasive surgery (MIS) that achieves indirect decompression, stabilization and interbody fusion for treatment of lumbar pathologies. Advantages of MIS include lower blood loss, less postoperative pain, and quicker recovery. Attaining proper sagittal alignment with spinal fusion has been shown to strongly correlate with surgical outcomes and is thus an important goal in spinal fusion. PURPOSE We evaluated the efficacy of LLIF-PPS in achieving optimal sagittal alignment. STUDY DESIGN/SETTING Retrospective radiographic analysis. PATIENT SAMPLE Eighty-four patients (115 levels) who underwent LLIF-PPS by 2 surgeons at 2 institutions (2009- 2018) were included in the study. Exclusion criteria were: concomitant ALIF/TLIF; corrective osteotomies; pre-psoas approach; planned anterior longitudinal ligament release; extension of fixation to the thoracic spine or pelvis; and fusion for discitis, osteomyelitis or acute trauma. OUTCOME MEASURES Pre- and postoperative radiographs were analyzed for mean number of alignment goals met using the following criteria: (1) PI-LL = 60% of PI. METHODS Preoperative and 6- to12-week postoperative standing lateral spine radiographs were evaluated for the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and L4-S1 lordosis. The frequency that each of 3 sagittal alignment criteria was met in pre- and postoperative radiographs was recorded. RESULTS There was no difference in rate of meeting specific alignment goals before and after LLIF-PPS (p > 0.05 for all three criteria). Average number of goals met was higher pre- than postoperative (1.68 vs 1.48, p = 0.03). Postoperative, 51% of patients met the same number of alignment goals, 17% met more and 31% met fewer, compared to their preoperative state. CONCLUSIONS There was no difference in frequency of meeting alignment goals before and after LLIF-PPS. Fewer cumulative alignments goals were met after LLIF-PPS. These findings suggest that LLIF-PPS generally is not able to correct sagittal malalignment, and that patients with preoperative sagittal malalignment should be considered for additional procedures (eg, osteotomies) that provide more significant correction of lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

When prospective randomised trials have unexpected results: where do we go from there?

With the modernisation of laparoscopy and subsequent rapid uptake of the robotic platform, minimally invasive surgery (MIS) became the widely accepted standard of care for gynaecological cancer. Virtually all data supporting improved patient outcomes and oncological safety for MIS in gynaecological cancer derive from retrospective studies. Nevertheless, the advantages of MIS have rapidly been accepted, not only because of the perceived benefits to patients. Surgeons appreciate improved optics, magnification, and the facility of performing complex, delicate surgery on an increasingly obese female population. A generation of gynaecological oncology fellows in the USA has been trained in MIS, with a trend towards minimally invasive hysterectomies becoming the norm. Dr Ramirez and colleagues’ strong belief in MIS for patients with cervical cancer led to the Laparoscopic Approach to Cervical Cancer (LACC) study, a well-designed, prospective (WDP) randomised controlled trial (RCT) with the primary hypothesis that MIS was not inferior to laparotomy with respect to overall survival (Ramirez et al. N Engl J Med 2018;20:1895–1904). Unexpectedly, this study required early closure and literally staggered the authors and the gynaecological oncology community. Patients undergoing MIS had a four-fold increased disease recurrence and a six-fold increased rate of death from disease compared with patients undergoing laparotomy. A database analysis published simultaneously in the New England Journal of Medicine supported the RCT results (Melamed et al., N Engl J Med 2018;379:1905–14). In anticipation of the publication of these data, sceptical gynaecological oncologists published retrospective data refuting the study's findings. The current paper is reassuring for patients in the UK, reporting oncological safety in 779 women treated at eight academic centres (Martin-Hirsch et al. BJOG 2019;126:956–9) Unfortunately, it is not rational to challenge results of a WDP RCT with retrospective data and their inherent biases. WDP RCTs are the ‘gold standard’ of medicine providing the most rigorous data upon which to base future clinical care. Why, then, are we so reluctant to accept the results? Even WDP RCTs sometimes fail to influence medical practice (Bothwell et al. N Engl J Med 2016;374:2175–81). WDP studies have been repeated multiple times for gynaecological cancer, including studies of neoadjuvant chemotherapy and intraperitoneal chemotherapy. It is important to note that the LACC study will never be repeated; there will never be the equipoise required for ethical randomisation. The clinical community is therefore left to decide how to interpret and manage the results. Patients with cervical cancer are vulnerable – often disadvantaged socially, economically and educationally – making a shared decision-making strategy challenging. I agree with the authors of the current paper that ‘applying the results of RCTs is not always entirely straightforward’ and applaud their thoughtful analysis of how best to approach the results of the LACC trial. Surgical RCTs have multiple challenges, including establishing appropriate inclusion criteria and standardising surgical interventions. Perhaps, as the authors suggest, there are certain patients (women with very small tumours or women who are very obese) for whom MIS would be appropriate. Unfortunately, the LACC trial cannot answer questions regarding specific groups of patients: the study was not powered to address the safety of MIS for women who had stage-IA or small (<2 cm) stage-IB tumours, nor did the study include a sufficient number of women with a body mass index (BMI) of >30 kg/m2. Exceptions to standards of care can and will always be made in best practice based upon individual, patient-specific factors. But, at this time, the best evidence supports open surgery for the treatment of early cervical cancer. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Laparoscopic nephrectomy: initial experience and 3 years follow-up with 68 cases

Introduction : Partial nephrectomy is considered the gold standard procedure in managing small renal masses less than 4cm, even less than 7 cm in the last decade. Minimal invasive surgery is a preferred option in those cases. Laparoscopic partial nephrectomy has equivalent oncological results with open partial nephrectomy, offering in the same time all the advantages of minimal invasive surgery. The purpose of our study is to present our initial experience in laparoscopic partial nephrectomy. Material and Methods : Between May 2015 and December 2017, 68 selected patients with renal masses smaller than 7cm observed by CT scan, were submitted to laparoscopic partial nephrectomy. Patient demographics, preoperative tumor characteristics and detailed operative, postoperative and pathologic data were collected. Results : Mean age of patients is 56,1 years (44-71), mean diameter of renal tumor 5, 3 cm (3,3 - 7,4 cm).36 patients had a right partial nephrectomy and 32 a left one, with no intraoperative complications. In four patients a laparoscopic radical nephrectomy was done, there are no cases of conversion to open surgery. The operation time ranged from 90 to 211 min, estimated blood loss (EBL) ranged from 30 to 300 ml and warm ischemia time (WIT) ranged from 5 to 31 min. Overall, four cases of postoperative complications CDC ≥ 3 were observed. One patient presented with a ureteric stricture and 3 with bleeding which necessitate angiographic intervention. There was one patient with a microscopic positive surgical margin and all patients are disease free during follow up (3-20 months, mean 12,2 months). Mean serum creatinine level has increased 23 mcmol/L (0-114). Conclusion : Laparoscopic partial nephrectomy is a safe and feasible approach in small renal masses, offering all the advantages of minimal invasive surgery

Laparoscopic versus open splenectomy in children with benign hematological diseases in children

Introduction: Splenectomy whether open or laparoscopic addresses the role of the spleen in the hematology disorders, particularly that of the cellular sequestration and destruction and antibody production. Laparoscopic splenectomy (LS) has been increasingly used for the removal of spleen in children. However, there are still certain questions as regards the feasibility, economic reflections, appropriate splenic size suitable for LS, vascular control of that organ, and final outcomes related to either procedure. Patients and methods: In the period between May 2007 and March 2017, 70 children with benign hematological diseases underwent splenectomy, either laparoscopic or open. They were divided into group A and group B. Group A included cases who had LS, and group B included cases who had open splenectomy (OS). We performed LS while the child was in the right lateral position. In cases of normal splenic size, we used three ports and four ports in cases of splenomegaly. OS was performed in supine position. Results: A total of 70 children were subjected to splenectomy, of whom 20 were boys and 50 were girls. Thalassemia was present in 36 cases, idiopathic thrombocytopenic purpura in 24 cases, and spherocytosis in 10 cases. Five cases were converted to the traditional approach, and three of them were because of huge splenomegaly and two cases were because of accidental bleeding. In the LS group, small-sized spleens were extracted using retrieval bags, whereas large spleens were extracted through Pfannenstiel incision. OS procedure was performed through midline incision. Cholecystectomy was performed in five cases during the original procedure because of gall bladder stones: three cases in group A and two cases in group B. Conclusion: Although both LS and OS achieved the same goal for the children with benign hematological disease, the advantages of minimal invasive surgery made LS the standard approach for treatment of children with benign hematological diseases. However, the main concern is the high economic burden of LS when compared with OS. Keywords: children, laparoscopic, open, splenectomy

Role of minimal invasive surgeries in gastric neoplastic diseases; how far we have come: an experience at tertiary centre

Background: Minimal invasive surgery (MIS) is a means of performing major operations through small incision, often using miniaturized, high tech imaging systems, to minimize the trauma of surgical exposure without compromising the quality of the surgical procedure. Upper gastro intestinal (GI) diseases constitute majority of gastro intestinal pathologies. With improved diagnostic and screening modalities, even in fatal diseases like carcinoma stomach (Ca stomach), MIS offers not only complete treatment but also improved quality of life by decreasing morbidity and mortality. This study attempts to explain our experience with MIS being performed at our institute.Methods: This study is hospital based, non-randomized prospective study carried out in the Department of Surgery, Govt. Cancer Hospital, Aurangabad from August 2014 to December 2016. Total 30 patients were included in study. All gastric neoplastic diseases operated by minimal invasive surgeries in patients of all age groups were included. All patients were operated under general anaesthesia. Post-operative pain scoring was done according to VAS scale. All patients were kept in ICU in immediate post-operative period for 2-3 days. Then patients were shifted to general ward once patients were clinically stable. Patients were discharged according to recovery. Hospital stay was prolonged in cases having complications. Patients were followed up post operatively after 1, 3 and 6 months and assessed on basis of symptoms.Results: Maximum patients belonged to the age group of 41-60 years. Mean age of patients operated for Gastrointestinal stromal tumours (GIST) was 57.5 years and Ca Stomach was 56.6 years. Mean operative time for laparoscopic gastrojejunostomy in our study was 150 min, for laparoscopic gastrectomy with gastro jejunal anastomosis was 230 min and for benign gastric tumours including GIST was 112 min. Type of anastomosis: Among 16 anastomoses, 2 oesophago - jejunal, 7 gastro - jejunal and 7 cases of gastro - gastric anastomosis were done. Jejuno - jejunal anastomoses are not included in this series. Both the oesophago - jejunal anastomoses were done by stapler method.Conclusions: It can be concluded that, minimal invasive surgeries for gastric diseases are feasible to perform. Blood loss, post-operative analgesia and hospital stay are less in laparoscopic procedures so it decreases over all hospital cost. Early post-operative recovery, decreased post-operative morbidity and avoiding unnecessary laparotomies are some of the other advantages of MIS. So, MIS should be considered as an alternative for open procedures in gastric disorders, for betterment of patient care.

MINIMALLY INVASIVE SURGERY FOR CONGENITAL HYDRONEPHROSIS IN CHILDREN

Introduction. Minimal invasive treatment for congenital hydro nephrosis in children remains a controversial topic, both in defining the necessity and timing of operation using laparoscopic techniques in neonates and infants. Materials and methods. This study aims to analyze criteria used for surgery in a series of patients operated in a laparoscopic manner, for congenital hydro nephrosis, at the Emergency Clinical Hospital for Children “Marie Curie” Bucharest, Department of Pediatric Surgery, between 2007-2015. Results. In our series, the most frequent found criteria for surgery were anterior-posterior diameter over 3 cm, followed by 50% reduced parenchymal thickness, decreased renal function under 40% and finally symptomatic criteria – urinary tract infections and flank colicky pain. Both pelvic dilatation and parenchymal thickness correlates with renal function, though reduced parenchymal thickness has a stronger correlation. Infants under 1 year and under 10 kg represented a significant proportion (17.5% and 22.5% respectively). Conclusions. Young age (under 1 year old) and low-weight (under 10 kilos) in children are not reasons to delay classical or laparoscopic surgical treatment for PUJO (pyelo-ureteric junction obstruction). Pyelectasis is not specific to PUJO. It does not always mean obstruction and does not always show a strong correlation with impaired renal function. Best in establishing therapeutic conduct are the magnitude of renal parenchymal restructuring, the degree of renal function impairment and clinical symptomatology. Laparoscopic treatment is an effective surgical approach, that meets all the major advantages of minimal invasive surgery, applicable to infants and small children, regardless of age and weight.

Minimally Invasive Surgery in Neonatal Patients: A Review

Laparoscopic and thoracoscopic surgery have gradually become accepted diagnostic and therapeutic modalities in the management of neonatal surgical conditions. In the hands of experienced surgeons, minimally invasive surgery (MIS) has reduced the need for open procedures. In children younger than 1 year, the advantages of MIS are evident in avoiding the sequelae of open surgery. MIS has shown outcomes comparable to those with open surgery. The recent literature in the PubMed database was reviewed, using the keywords “minimally invasive surgery,” “neonatology,” “pediatric surgery,” “laparoscopy,” and “thoracoscopy.” The review included retrospective and institutional reports of MIS published since January 2000.The results were used to develop a review of the current state of MIS in the neonatal population. The use of minimally invasive techniques in neonatal surgical conditions was successful in the hands of experienced surgeons. Some procedures currently performed include gastrostomy, pyloromyotomy for hypertrophic pyloric stenosis, gastroesophageal reflux surgery, the Ladd procedure for intestinal malrotation, colonic pull-through procedures for Hirschsprung disease and other anorectal malformations, repair of diaphragmatic eventration and congenital diaphragmatic hernia, duodenal atresia, esophageal atresia/tracheoesophageal fistula, pulmonary lobectomy, surgery for necrotizing enterocolitis, and ligation of patent ductus arteriosus. Further formal training of surgeons in these techniques and the development of new and improved instrumentation can reduce the rates of open surgery and its sequelae in the neonatal population.

Spectrum of laparoscopic surgery for gastric tumors

Minimally invasive operative procedures are increasingly being used for treating tumors of the upper gastrointestinal tract. While minimally invasive surgery (MIS) has become established as a standard procedure for benign tumors and gastrointestinal stromal tumors (GIST) based on current studies, the significance of MIS in the field of gastric cancer is the topic of heated debate. Until now the majority of studies and meta-analyses on gastric cancer have come from Asia and these indicate the advantages of MIS in terms of intraoperative blood loss, minor surgical complications and swifter convalescence although without any benefits in terms of long-term oncological results and quality of life. Unlike in Germany, gastric cancer in Asia with its unchanged high incidence rate, 50 % frequency of early carcinoma and predominantly distal tumor localization is treated at high-volume centres. Due to the proven marginal advantages of MIS over open resection described in the published studies no general recommendation for laparoscopic surgery of gastric cancer can currently be given.

Three-Year Results of Repaired Barlow Mitral Valves via Right Minithoracotomy versus Median Sternotomy in a Randomized Trial

Objectives: To clarify whether the results of repair of a complex mitral lesion (Barlow valve) at the intermediate-term follow-up are independent of the mode of surgical access [minithoracotomy vs. median sternotomy (MS)]. Methods: In a prospective randomized study of mitral repair for Barlow disease using either a minimally invasive (MI) approach or MS, we achieved an average follow-up of 3 years (echocardiography, physical examination and quality of life). Mitral repair was achieved with polytetrafluoroethylene chordal implantation for both leaflets. Results: Both groups included 80 patients. Mechanical ventilation time and intensive care unit and hospital stay were shorter in the MI group (p = 0.01, p = 0.013 and p = 0.02, respectively). During the follow-up, 5 patients in each group (6.25%) displayed mild mitral regurgitation, while 2 patients in each group (2.5%) developed recurrent regurgitation graded as at least moderate/severe. The rate of mitral reoperation was 2.5% in the MI group and 1.25% in the MS group (p = 0.9). The overall follow-up mortality was 3.75% in both the MI and the MS groups. Conclusions: The 3-year results of repair of Barlow valves were satisfactory irrespective of the approach used to repair the valve. The advantages of MI surgery can be achieved in patients with mitral Barlow disease without concerns over the durability of repair.

P-0274 - Short-Term Outcomes of Single-Port Low Anterior Resection for Colorectal Cancers: a Comparative Study

Background: Single-port laparoscopic surgery was designed to maximize the advantages of minimal invasive surgery. However, no comparative study has been reported on this concept. Methods: Prospectively collected data of patients who had undergone either conventional laparoscopic lower anterior resection (LAR) (n = 49) or single-port LAR (n = 31) for colorectal cancers between March 2006 and June 2011, were analyzed retrospectively. Results: In single-port LAR, comparable lymph nodes could be attained (23.9 ± 14.9), and sufficient proximal and distal cut margins were secured (proximal cut margin: 10.9 ± 5.5 cm, distal cut margin: 5.1 ± 2.6 cm). Clinically, single-port LAR resulted in shortening of operation time (256 min versus 310 min; P = 0.015), lesser requirement of intra-operative PRC transfusion (6.5 per cent versus 44.9 per cent, P = 0.000), shortened duration to first flatus (2.0 days versus 3.2 days; P = 0.001), earlier initiation of free oral fluids (2.8 days versus 5.1 days) and soft diet (4.6 days versus 7.1 day), and shorted hospital stay (10.7 days versus 15.4 days). Conclusion: This study shows that single-port LAR is both safe and feasible in colorectal cancers, if performed by a surgeon who is good at conventional laparoscopic surgery, with a requirement of a short-term learning period. Furthermore, if single-port is subsequently supported by favorable, at least not inferior, long-term oncologic results, it could be one of the standard procedures for colorectal cancers.

Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review

Due to the well-known advantages of minimal invasive surgery, the majority of procedures for benign gynaecological diseases are performed by laparoscopy. Although laparoscopic surgery results in improved patient satisfaction, a considerable portion of patients have complaints of post-operative shoulder pain. This review presents an overview of the currently evaluated techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted using Medline, Embase and Cochrane databases. Randomised clinical trials reporting techniques to reduce shoulder pain after laparoscopic gynaecologic procedures for benign diseases were included. Eighty-eight articles were screened for inclusion. A total of 15 articles were included in the final review. The following studies described the techniques used to reduce shoulder pain: six studies evaluated the effect of local anaesthetics, three studies evaluated the effect of pulmonary recruitment manoeuvre and three studies evaluated the effect of intraperitoneal drainage. The remaining three studies evaluated the effect of saline installation, minilaparoscopy and gasless laparoscopy by using the Laprolift®. Overall, the pulmonary recruitment manoeuvre and intraperitoneal drainage were found to reduce the incidence and severity of shoulder pain (SP). Based on the current evidence, safety and possibility to implement the technique in daily practice, pulmonary recruitment manoeuvre can be recommended to reduce both the incidence and severity of SP.

Minimally Invasive Surgery for AIS: An Early Prospective Comparison with Standard Open Posterior Surgery

Study design: Prospective matched-control comparison study. Objective: To prospectively compare deformity correction and measures of perioperative morbidity between minimally invasive posterior spinal fusion and conventional open posterior procedures in age- and curve classificationmatched individuals. Summary of background data: Minimally invasive surgery (MIS) has evolved in an effort to decrease the rate of approach-related morbidity associated with conventional open procedures for spinal disorders. Its widespread use in spinal trauma and degenerative disorders has yielded similar clinical results to open techniques with the added benefit of optimizing peri-operative morbidity. No report has been made comparing the clinical results of MIS to conventional open procedures in the setting of adolescent idiopathic scoliosis (AIS). Methods: Patients enrolled in a multi-center, longitudinal, prospective AIS study were included in this analysis. Pre-op, peri-op and first erect post-op data was evaluated. 16 MIS patients were matched for age, sex, Lenke classification, and curve size with 16 conventional open posterior procedures. All cases were also matched to a single surgeon to reduce potential surgeon-induced variability. Statistical analysis was done using SPSS v.18. Results: Age, gender, Lenke classification and curve magnitude were not statistically different between individuals treated with MIS or open surgery (Table 1). Post-op major Cobb was 20 degrees (curve correction 63%) in those treated with MIS and 18 degrees (curve correction 68%) in those treated with open surgery. Both estimated blood loss and length of stay (LOS) were significantly less in the MIS group (277 mL, 4.63 days) compared to the open group (388 mL, 6.19 days); however OR time was significantly longer in the MIS group (444 min) compared to the open group (350 min). Conclusions: MIS for AIS has similar results to standard open posterior techniques, specifically for curve correction. Although increase in operative time was noted in the MIS group, advantages of MIS over standard open procedures seem to include decreased LOS and blood loss. Further follow-up will be critical to evaluating the longerterm outcomes of the MIS approach to AIS treatment.