Laparoscopic Catheter Research Articles

Novel method for laparoscopic rectus sheath tunneling with Lin's tube in peritoneal dialysis catheter implantation.

Laparoscopic implantation of a catheter through rectus sheath tunnel minimizes the risks of catheter failure and reduces some complications like catheter migration, hernias, and leaks. We described a novel method for laparoscopic catheter rectus sheath tunneling using an aspiration tube and a silk tie (Lin's tube). This material is easilyavailable and yields a small fascial defect with an equivalent cannula size to minimize tissue disruption. The technique is feasible, reproducible and it may reduce the risks of postoperative leakage and hemorrhage.

Two plus one port laparoscopic assisted continuous ambulatory peritoneal dialysis insertion modified technique: a case series.

A retrospective case series from the medical records at Semarang Tertiary Hospital was identified between 2017 and 2021. Demographic, clinical, intraoperative, and postoperative complication data were collected with a 1-year follow-up after the CAPD procedure. This study included 49 patients with a mean age of 43.2±13.6 years, and diabetes was the main cause (51.02%). This modified technique showed no complications intraoperatively. The postoperative complications were found to include one case of hematoma (2.04%), eight cases of omental adhesion (16.3%), seven cases of exit-site infection (14.28%), and two cases of peritonitis (4.08%). Malposition of the Tenckhoff catheter was not found 1-year after the procedure. The two plus one port modified laparoscopic assisted CAPD technique could prevent malposition of the Teckhoff catheter because it is already fixated in the pelvic. A long-term follow-up of 5 years is necessary to know the long-term survival of the Tenckhoff catheter in the next study.

Jejunal perforation secondary to blind insertion of peritoneal dialysis catheter: a case report and review of literature

BackgroundPeritoneal dialysis (PD) depends upon a functioning and durable access to the peritoneal cavity. Many techniques exist to insert a peritoneal catheter, showing similar outcomes and benefits. Blind percutaneous insertion represents a bedside intervention predominantly performed by nephrologists requiring only local anesthesia, sedation and minimal transcutaneous access. Although current guidelines recommend insertion techniques allowing visualization of the peritoneal cavity, the blind percutaneous approach is still widely used and has been proven safe and effective to bring durable peritoneal dialysis access. Herein, we described a rare case of jejunal perforation secondary to blind PD catheter placement, and conduct a review of the current medical literature describing early bowel perforations secondary to PD catheter placement, gathering descriptions of symptomatology and outcomes and their relations to the insertion technique.Clinical presentationWe herein describe the case of a 48 year-old patient with a history of appendectomy who suffered from triple jejunal perforation after blind percutaneous insertion and subsequent embedment of his peritoneal catheter. Accurate diagnosis was made 1 month after insertion due to atypical clinical presentation and because physicians had no access to the peritoneal cavity after catheter embedment. After surgical repair and broad-spectrum antibiotics, the patient was switched to HD.ConclusionEarly catheter-related visceral injury is a rare, yet threatening condition that is almost always causing a switch to hemodialysis or death. Our review highlights that laparoscopic catheter placement might bring better outcomes if perforation occurs, as it allows immediate diagnosis and treatment. On the contrary, catheter embedment may delay clinical diagnosis and therefore bring worse outcomes.

Evaluation of the effectiveness of prophylactic omentopexy during laparoscopic insertion of peritoneal dialysis catheter: a case-control clinical trial.

The laparoscopic omentopexy has been described for the prevention of peritoneal dialysis catheter obstruction due to omental wrapping of the catheter. As there are some controversies and limited data regarding the outcomes of prophylactic omentopexy, we designed a study to evaluate the efficacy of prophylactic omentopexy in preventing catheter dysfunction in patients undergoing laparoscopic catheter placement. In this randomized clinical trial, patients with end-stage renal disease during 3 months were divided into two groups of peritoneal dialysis catheter implants with and without omentopexy and subsequently evaluated regarding postoperative features. A total of 43 patients were evaluated, including 22 undergoing prophylactic omentopexies. There was no significant difference among the baseline features of the patients. There was also no significant difference regarding postoperative features, including peritonitis, leakage, reoperation, need for catheter removal, and mortality. Prophylactic omentopexy did not cause any significant differences in complications. In addition, there was no benefit for decreasing postoperative outflow obstruction due to omental wrapping following peritoneal dialysis catheter insertion.

Long-term outcomes of peritoneal dialysis catheters inserted by laparoscopic and percutaneous techniques in a single regional dialysis centre.

BackgroundMinimally invasive insertion of catheters for peritoneal dialysis can be performed laparoscopically or percutaneously under image guidance. In Geelong (Victoria, Australia) both methods are used. Our aim was to analyse the outcomes of all catheters inserted by both laparoscopic and percutaneous techniques and compare them against published studies from tertiary referral centres.MethodsData were collected retrospectively on all patients who had their catheter inserted (since 2006) within the Geelong regional service. We compared the outcomes of percutaneous catheter insertion under image guidance (percutaneous group, n = 29) with the laparoscopic catheter placement technique (laparoscopic group, n = 61). Perioperative, follow‐up and catheter outcome data were collected. There were no exclusion criteria. Analysis was performed using the unpaired student t‐test and chi‐squared test.ResultsNinety catheters were inserted between 2006 and 2017 in mostly male patients (63%) with a mean age of 60 ± 0.4 years. The most common aetiology of chronic kidney disease was diabetic nephropathy (34%). Percutaneous insertion required less operative time, shorter hospital stay and earlier initiation of peritoneal dialysis. In the longer term, percutaneous catheters were more likely to migrate and laparoscopic catheters were more durable but more often associated with peritonitis. Thirty‐day complication rates did not differ between both groups. No Clavien‐Dindo grade 3 or 4 complication was reported.ConclusionsLaparoscopic insertion of peritoneal dialysis catheters at our centre is performed safely and with patient outcomes comparable to published literature. Percutaneous insertion represents a safe and effective alternative based on the study findings.

Laparoscopic peritoneal catheter revisions reduce the rate of subsequent revisions in pediatric patients operated for hydrocephalus

Laparoscopic peritoneal catheter revisions reduce the rate of subsequent revisions in pediatric patients operated for hydrocephalus

Introduction of advanced laparoscopy for peritoneal dialysis catheter placement and the outcome in a University Hospital

BackgroundPeritoneal dialysis (PD) catheters can be obstructed by omental wrapping or migration, leading to catheter malfunction. Multiple catheter placement techniques have been described. Advanced laparoscopy with fixation of the catheter and omentum has been reported to improve functional outcome compared to basic laparoscopy without fixation. This feasibility study describes surgical technique, complications, and comparison of the functional outcome of advanced versus basic laparoscopic catheter placement.MethodsBetween July 2016 and April 2019, the advanced laparoscopy technique was applied in all eligible patients. Two experienced surgeons placed the catheters in a standardized procedure. Peri-operative complications and functional outcome of the catheter were scored. Results were compared to a historical cohort retrieved from our RCT performed earlier using basic laparoscopy.FindingsThe basic laparoscopic group (BLG) consisted of 46 patients and the advanced laparoscopic group (ALG) of 32. Complication rate in both groups was similar and low with 7% in the BLG and 6% in the ALG (p = 1.0). There was a trend toward better functional catheter outcome in the ALG (88%) compared to the BLG (70%) (p = 0.1). Part of the catheter failures in the ALG could be related to the learning curve. After revision surgery, 94% of patients in the ALG had a functional catheter. These findings lead to the set-up of a multi-center randomized-controlled trial, currently running, comparing basic to advanced laparoscopic techniques.

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.

Different techniques for peritoneal dialysis catheter implantation: A systematic review and network meta-analysis.

The current consensus recommended the peritoneal dialysis catheter (PDC) techniques based on the patients' anesthesia situation and previous abdominal surgery. However, the research comparing of all the existing PDC techniques is lacking. The objective was to compare the efficacy and safety of PDC techniques by network meta-analysis (NMA). A systematic review of databases was conducted to identify eligible studies. NMA was used to estimate the ranking for endpoints. Our NMA included 41 studies (9 randomized controlled trials (RCTs) and 32 observational trials) and enrolled 3902 patients, comparing three techniques: the laparoscopic catheterization (LC), open surgery catheterization (OSC), and percutaneous catheterization (PC). NMA in RCTs showed OSC had the highest incidence of catheter mechanical dysfunction, PC and LC were very similar, but this result had no statistical difference. NMA in observational studies showed that LC had the highest 1-year catheter survival but without statistical difference (LC vs. OSC: odds ratio (OR) 1.75, 95% credible intervals (CrIs) 0.90-3.40; PC vs. OSC: OR 1.55, 95% CrIs 0.80-2.97; PC vs. LC: OR 0.88, 95% CrIs 0.54-1.44). OSC had the lowest incidence for bleeding. The complications of leakage, peritonitis, and exit/tunnel infection were inconclusive due to the inconsistent results between RCTs and observational studies. Our NMA revealed LC may have the best 1-year catheter survival. PC and LC might be efficacious in lowering the mechanical dysfunction. OSC had the lowest incidence for bleeding. More RCTs with larger scale and higher quality are needed in order to obtain more credible evidence.

Clinical Effect and Safety of Endoscopic Ultrasound-Guided Laparoscopic Catheter Drainage for Severe Acute Pancreatitis

In order to study the clinical effect and safety of endoscopic ultrasound-guided laparoscopic catheter drainage for severe acute pancreatitis, the patients with severe acute pancreatitis were selected as the research objects, the laparoscopic catheter drainage under the guidance of endoscopic ultrasound was carried out, and the efficacy and safety of the operation were evaluated. The results showed that after endoscopic ultrasound-guided laparoscopic catheterization and drainage, the number of C-reactive protein, procalcitonin and white blood cells was decreased, and the inflammation was improved after treatment; the body temperature of 45% patients returned to normal on the first day after operation, and 55% patients returned to normal on the third day after operation; only 1 case of patients followed up had infectious necrosis of pancreas. In summary, endoscopic ultrasound-guided laparoscopic catheter drainage is a safe and effective treatment for severe acute pancreatitis.

Comparison of the effects of laparoscopic catheterization and surgical incision catheterization on catheter-related complications and microinflammation in uremic peritoneal dialysis patients

Objective To compare the effects of laparoscopic and surgical catheterization on catheter-related complications and microinflammation in uremic peritoneal dialysis (PD) patients. Methods According to different catheterization methods, 98 uremic patients who were scheduled to undergo peritoneal dialysis in the First People's Hospital of Jiande from January 2014 to March 2019 were divided into group A (38 cases), group B (60 cases). Laparoscopic catheterization was used in group A, and incision catheterization was used in group B. Surgical parameters, catheter complications, microinflammation and survival rate of early catheterization were observed in the two groups. Results The operation time of group A was (35.00±3.14)min, which was shorter than that of group B [(50.00±5.17)min], and the operation cost of group A was (5 800.0±318.9)CNY, which was higher than that of group B [(3 400.0±297.4)CNY], and the visual analogue score (VAS) of group A was (2.33±0.31)points, which was lower than that of group B [(3.25±0.49)points], there were statistically significant differences between the two groups (t=11.540, 9.317, 10.328, 36.578, all P 0.05). After catheterization, the levels of hs-CRP, IL-6 and TNF-alpha in group B were (12.52±3.75)mg/L, (12.02±3.76)ng/L, (15.92±5.72)ng/L, respectively, which were higher than those in group A [(9.63±2.36)mg/L, (9.11±3.54)ng/L, (13.41±5.61)ng/L] (t=4.244, 4.081, 4.510, all P<0.05). After 2 months of follow-up, the survival rate of dialysis tube technique was 89.47%(34/38) in group A and 71.67%(43/60) in group B, there was statistically significant difference between the two groups (χ2=4.382, P<0.05). Conclusion Application of laparoscopic catheterization in uremic PD patients has satisfactory effect, light pain, fewer complications, mild inflammation and high survival rate of early catheterization technology, which is worthy of clinical promotion. Key words: Uremia; Peritoneal dialysis; Laparoscopy; Catheterization; Postoperative complications; C-reactive protein; Interleukin-6; Tumor necrosis factor-alpha

Randomized controlled trials for comparison of laparoscopic versus conventional open catheter placement in peritoneal dialysis patients: a meta-analysis

BackgroundThe application of laparoscopic catheterization technology in peritoneal dialysis (PD) patients has recently increased. However, the advantages and disadvantages of laparoscopic versus conventional open PD catheter placement are still controversial. The aim of this meta-analysis is to assess the complications of catheterization in PD patients and to provide a reference for choosing a PD-catheter placement technique in the clinic.MethodsWe searched numerous databases, including Embase, PubMed, CNKI and the Cochrane Library, for published randomized controlled trials (RCTs).ResultsEight relevant studies (n = 646) were included in the meta-analysis. The pooled results showed a lower incidence of catheter migration (OR: 0.42, 95% CI: 0.19 to 0.90, P: 0.03) and catheter removal (OR: 0.41, 95% CI: 0.21 to 0.79, P: 0.008) but a higher incidence of bleeding (OR: 3.25, 95% CI: 1.18 to 8.97, P: 0.02) with a laparoscopic approach than with a conventional approach. There was no significant difference in the incidence of omentum adhesion (OR: 0.32, 95% CI: 0.05 to 2.10, P: 0.24), hernia (OR: 0.38, 95% CI: 0.09 to 1.68, P: 0.20), leakage (OR: 0.69, 95% CI: 0.38 to 1.26, P: 0.23), intestinal obstruction (OR: 0.96, 95% CI: 0.48 to 1.91, P: 0.90) or perforation (OR: 0.95, 95% CI: 0.06 to 15.42, P: 0.97). The statistical analysis showed no significant difference in early (OR: 0.44, 95% CI: 0.15 to 1.33, P: 0.15), late (OR: 0.89, 95% CI: 0.41 to 1.90, P: 0.76) or total (OR: 0.68, 95% CI: 0.42 to 1.12, P: 0.13) peritonitis infections between the 2 groups, and there are no no significant difference in early (OR: 0.39, 95% CI: 0.06 to 2.36, P: 0.30), late (OR: 1.35, 95% CI: 0.78 to 2.33, P: 0.16) or total (OR: 1.20, 95% CI: 0.71 to 2.02, P: 0.17) tunnel or exit-site infections between the 2 groups.ConclusionLaparoscopic catheterization and conventional open catheter placement in PD patients have unique advantages, but laparoscopic PD catheterization may be superior to conventional open catheter placement. However, this conclusion needs to be confirmed with further large-sample-size, multi-centre, high-quality RCTs.

Laparoscopic Catheter Implantation for Targeted Therapy Delivery in the Treatment of Pudendal Neuralgia and Other Intrapelvic Causes Of Neuropathic Pain

Video Objective To describe the technique and propose a tentative care pathway for the use of the targeted delivery of ropivacaine via implanted catheter to alleviate post-decompression neuropathic pain in patients with intrapelvic nerve entrapments (INE) in four successful initial cases. Setting Tertiary care center: specialized Neuropelveology center; this video features an initial proof-of-concept case series. Interventions Despite the high success rate of laparoscopic neuronavigation (LANN) in the surgical treatment of INE, 52% of patients experience residual pain, likely resulting from axon demyelination and Schwann cell degeneration. During axonal injury, sodium channels are upregulated, resulting in a massive influx of sodium, causing neuralgia, mechanosensitivity, and hyperalgesia. Genetic/pharmacologic blockade of these channels has neuroprotective and analgesic effects. Building on these insights, we hypothesized that the inhibition of sodium channels with ropivacaine in the entrapped nerve may alleviate post-decompression pain in patients undergoing LANN. Four patients (one male, three female) diagnosed with INE in our Neuropelveology clinic in Sao Paulo and undergoing LANN detrapment were included. The first three cases had a catheter implanted at the site where the INE was relieved; the catheter was connected to a medication pump or a subcutaneous port. The fourth case was a salvage procedure, in which the patient had failed to experience pain relief following one prior hip replacement, one hip prosthesis revision, and one previous LANN detrapment of the intrapelvic portion of the sciatic nerve. Optimal pain control was obtained in all the four patients. A proposed care pathway for INE is presented and discussed. Conclusion Preliminary observations indicate that the targeted delivery of ropivacaine via implanted catheter and pump/port may effectively control post-decompression neuropathic pain and completely obviate the use of opioid analgesics without the risk of dependence or cognitive side effects.

Urgent-start peritoneal dialysis after laparoscopic dialysis catheter implantation: a single-center experience

BackgroundAppropriate timing of peritoneal dialysis (PD) catheter implantation and PD initiation is important. Several guidelines suggest starting PD at least 2 weeks after PD catheter implantation. Recently, urgent-start PD is widespread throughout the world. However, the ideal time to start PD after laparoscopic catheter implantation is not known. We investigated the safety and feasibility of early initiation (within 7 days) PD following laparoscopic peritoneal catheter implantation.MethodsWe retrospectively analyzed patients who underwent laparoscopic PD catheter implantation at the Kyoto University Hospital from January 1, 2006, to December 31, 2016. Based on when PD was initiated, the patients were divided into two groups, namely, early group, ≤ 7 days and late group, > 7 days after catheter implantation. Catheter-related complications and catheter survival were analyzed.ResultsWe analyzed 29 and 26 patients in early and late groups, respectively. The age, sex, the incidence of diabetes and APD, and the follow-up period were not significantly different between the two groups. The interval from catheter implantation to the start of PD was 4.28 ± 1.83 and 162 ± 157.8 days in the early and late groups, respectively (P < 0.01). In a late group, 17 patients (65.4%) underwent catheter implantation using the Moncrief–Popovich technique. The use of bridge hemodialysis was higher in the early group (P < 0.01). No patients developed dialysate leakage in both groups, and no significant differences were observed for catheter malfunction (24.1% vs. 19.2%, P = 0.66), exit-site infection (ESI, 24.1% vs. 28%, P = 0.87), and peritonitis (7.14% vs. 8.0%, P = 0.91) within 6 months. Furthermore, early initiation of PD did not increase the risk of ESI, peritonitis, and PD withdrawal at 1, 2, and 5 years compared to that in the late group.ConclusionsUrgent-start of PD with laparoscopic catheter implantation did not increase infection-related complications and PD withdrawal. Laparoscopic PD catheter implantation may allow the initiation of PD earlier than 7 days after implantation.

Modification of laparoscopic catheter setting for peritoneal dialysis in patients with chronic kidney disease

Reducing the complications of the peritoneal dialysis (PD) procedure prolongs its use. The purpose of the work was to justify prolongation of peritoneal dialysis by modifying its setting. The study included 54 patients with chronic renal insufficiency, they carried out laparoscopic setting of PD; 14 patients were with omentopexy and 40 – with a classical statement. The operation was performed under general anesthesia. Surgical tactics were as follows: omentum folds were fixed to the parietal peritoneum; the control catheter was inserted through the window into the mesentery of the colon, and the dialysis portion at the bottom of the pelvis; sutured the window of the mesentery of the colon. Before insertion of the camera port, pneumoperitoneum was induced with a Veress needle, 10 mm below the navel. The pressure of abdominal gas was 12 mm Hg. Art. The point of entry into the abdominal cavity was established by the Hassan method: 5 cm lateral and 7 cm below the navel along the outer edge of the rectus abdominis muscle. A control catheter was inserted into the window under the transverse colon and inflated the balloon, the omentum was fixed to the parietal peritoneum 3 cm above the navel and the window in the colon mesentery was sutured. All early and late postoperative complications of the patients were recorded for 12 months (wound infections, including “tunnel infection”, dialysate leakage past the catheter, obturation of the catheter lumen, loss of tightness of omentoperitoneopexy). The study included 8 men and 6 women, aged from 43 to 76 years, of whom 2 patients had previously been operated on the abdominal organs. The operative intervention time averaged 54,6±15,4 min. No obstruction, catheter migration, or “tunnel infection” was established during the study. We have developed a laparoscopic technique of peritoneopexy of the upper half of the abdominal cavity, which will be used when the resource of the lower half of the abdominal cavity is exhausted and the effectiveness of preventing mechanical complications of the catheter PD has been proven.

Erratum: Outcomes of fluoroscopic and ultrasound-guided placement versus laparoscopic placement of peritoneal dialysis catheters.

[This corrects the article DOI: 10.1093/ckj/sfx132.].

Effective Laparoscopic Catheter Insertion Technique for Peritoneal Dialysis Using Specially Designed Trocar: 22 Years Multi-Center Retrospective Study of 804 Patients

Introduction: Literature reveals several peritoneal dialysis laparoscopic catheter insertion techniques developed to improve long-term results for treatment chronic kidney failure with the technic of peritoneal dialysis. The purpose of the study is evaluation of developed and recommended minimally invasive laparoscopic technic for chronic peritoneal dialysis catheter placement using specially constructed trocar. Materials and Methods: Retrospective study included 804 patients in 10 departments of surgery. Surgical and non surgical complications related to PD catheter placement were analysed: bleeding, dialysate leak, early SSI, peritonitis, catheter tip migration, catheter obstruction, omental wrapping and visceral perforations. Available software (Microsoft® Excel for Windows 10, MedCalc, Mariakerke, Belgium) was used for statistical analysis (presented as percentages, mean ± SD or median). Conclusions: The presented technique with specially constructed trocar is a simple and effective procedure with fewer complications comparing to literature. The advantages of this method include long rectus sheath tunnel with the deep cuff placed pre-peritoneally, the small size of the entrance into the peritoneum and accurate position and control of catheter tip in the pelvis.

Outcomes of fluoroscopic and ultrasound-guided placement versus laparoscopic placement of peritoneal dialysis catheters.

BackgroundSeveral peritoneal dialysis catheter (PDC) placement techniques have been described. The objective of this study was to compare the fluoroscopy and ultrasound guidance technique with the laparoscopic technique.MethodsWe retrospectively reviewed the medical records of 260 patients who had their first PDC placed between January 2005 and June 2016. We compared the outcomes of the fluoroscopic and ultrasound-guided catheter placement technique (radiologic group, n = 50) with the laparoscopic catheter placement technique (laparoscopic group, n = 190). The primary endpoint was complication-free catheter survival at 365 days. Secondary endpoints were complication-free catheter survival at 90 days, overall catheter survival at 90 and 365 days, median days to first complication and median days to catheter removal.ResultsIn the radiologic group, the complication-free catheter survival at 90 and 365 days was 64% and 48%, respectively, while in the laparoscopic group it was 71% (P = 0.374) and 53% (P = 0.494), respectively. Catheter malfunction was significantly higher in the laparoscopic group (30%) compared with the radiologic group (16%, P = 0.048). The overall catheter survival at 90 and 365 days was 76% and 52%, respectively, in the radiologic group, while in the laparoscopic group it was 88% (P = 0.0514) an 48% (P = 0.652), respectively. There was no significant difference in the median days to first complication and the median days to catheter removal between the two groups (P = 0.71).ConclusionThe technique of fluoroscopic and ultrasound-guided PDC placement is a clinically effective and safe alternative to laparoscopic catheter placement with similar survival and complication rates.

Minimally-invasive catheterization of portal and mesenteric veins and abdominal aorta for quantitative determination of portal-drained viscera metabolism in pigs

A laparoscopic catheterization of portal and ileal veins as well as abdominal aorta was performed in eight pigs under general anesthesia for quantitative determination of portal-drained viscera metabolism. Three polyurethane catheters were introduced into the target vessels through an abdominal wall cannula using the guide catheter and wire. Surgery duration, length of incisions, and postoperative outcomes were recorded. On days 7 and 30, portal vein blood flow rates were measured by paraaminohippuric acid method. On day 35, a second laparoscopy was performed to monitor the setup of intraabdominal catheters. The laparoscopic procedures were completed with a mean operative time of 82 ± 9 min, and mean total incision size was 4.5 ± 0.5 cm. No major intraoperative or postoperative complications were encountered. The second laparoscopy showed that position and fixation of catheters remain stable 35 d after the surgical preparation. Portal vein blood flow remained similar (P > 0.05) from 7 to 30 d after the la...

MINIMALLY INVASIVE TECHNOLOGIES IN TREATMENT OF COLORECTAL CANCER WITH LIVER METASTASES

Purpose: to explore the results of application of minimally invasive technologies in treatment of colorectal cancer with liver metastases. Materials and methods: results of treatment of 55 patients with colorectal cancer with liver metastases (T2-3N0-1M1) were analyzed. 25 patients, who underwent laparoscopic procedures on the colon with atypical liver resection or radiofrequency thermal ablation of liver metastases with interstitial chemotherapy and laparoscopic catheterization umbilical vein, formed the study group. 30 patients, who underwent open surgery, formed the control group. Chemotherapy was performed for both groups of patients (drugs was injected through the umbilical vein in the study group and through a peripheral vein in the control group). Results: laparoscopic approach led to reliable decrease of postoperative complications and improvement in the life quality of patients during the postoperative period (p&lt;0,05). Summary: minimally invasive combination treatment reduced the rate of progression by 32% and increase the time to disease progression for 7 months (p &lt;0,05) in the study group.