Laparoscopic Surgical Approach Research Articles

Application of a New Approach for Laparoscopic Resection of Bismuth IIIa Hilar Cholangiocarcinoma.

Background: Hilar cholangiocarcinoma (HCCA) has a high degree of malignancy and poor prognosis, and the best long-term prognosis can only be achieved by radical resection. However, the surgical steps are complicated, and the operating space is limited, making it hard to complete laparoscopically. So our team proposes a new surgical approach for laparoscopic left-liver-first anterior radical modular orthotopic right hemihepatectomy (Lap-Larmorh). In this way, we can simplify the operation steps and reduce the difficulty. Materials and Methods: We recorded and analyzed the clinical data of 26 patients with type IIIa HCCA, who underwent laparoscopic radical resection in our department from December 2018 to January 2023. According to the laparoscopic surgical approach, we divided the patients into the new approach (NA) group (n = 14) using the Lap-Lamorh and the traditional approach (TA) group (n = 12) not using the Lap-Lamorh. Results: All surgeries in this study were completed laparoscopically with no conversion to open surgery. The operation time in the NA group and TA group had statistically significant differences, which was 372.5 (332.8, 420.0) minutes versus 423.5 (385.8, 498.8) minutes (P = .019). The two groups showed no significant difference in other characteristics (P > .05). Only 1 patient suffered from transient liver failure due to portal vein thrombosis. Patients with pleural effusion or ascites were cured by catheter drainage and enhanced nutrition. Conclusion: Lap-Larmorh reduces the difficulty of serving the vessels at the second and third hepatic hilum by splitting the right and left livers early intraoperatively. The new approach is more suitable for the narrow space of laparoscopic surgery and reflects the no-touch principle of oncology.

Evaluation of the Effect of Surgical Access on the Innate Immune Response During Liver Resections of Various Volume, Experimental Study

Introduction. The major components of the immune system are affected in almost all surgical operations, including those related to the tumor removal. The volume of the operation correlates with the level of the immune system suppression and frequency of complications. The issue of the effect of surgical access for liver resection with different volumes on surgical trauma and severity of the innate immune response are still challenging nowadays. The aim of the study is to evaluate the effect of open and laparoscopic surgical approaches on the severity of the innate immune response in small and large liver resections in laboratory animals.Methods. The study included 4 groups of rabbits, 10 animals each, formed depending on the surgical approach and the volume of liver resection: laparoscopic small and large liver resections, open small and large liver resections. The following parameters of the innate immune response were studied: phagocytic, cytotoxic and proliferative activity in dynamics. The experimental data were processed using the STATISTICA 6.0 software package (StatSoft, 2001). The results were considered statistically significant at p0.05.Results. Open extensive liver resections are characterized by a more significantly decreased phagocytic activity of neutrophils - from 95.7% to 32.05% - than similar interventions using laparoscopic access - from 96.4% to 52.4%, respectively. Cytotoxic activity in the group of animals exposed to surgery with laparotomy access decreased by 40% compared to 23% in animals exposed to laparoscopy surgery. There was registered a more than twice increased spontaneous and decreased induced proliferation in the postoperative period. Conclusion. The study results allow concluding on a positive effect manifested as a reduced surgical injury for liver resections of various volumes due to laparoscopic access; this is evidenced by the parameters of immune reactivity.

Surgical outcomes and cost analysis of a multi-specialty robotic-assisted surgery caseload in the Australian public health system.

This study aims to compare surgical outcomes and in-hospital cost between robotic-assisted surgery (RAS), laparoscopic and open approaches for benign gynaecology, colorectal and urological patients and to explore the association between cost and surgical complexity. This retrospective cohort study included consecutive patients undergoing RAS, laparoscopic or open surgery for benign gynaecology, colorectal or urological conditions between July 2018 and June 2021 at a major public hospital in Sydney. Patients' characteristics, surgical outcomes and in-hospital cost variables were extracted from the hospital medical records using routinely collected diagnosis-related groups (DRG) codes. Comparison of the outcomes within each surgical discipline and according to surgical complexity were performed using non-parametric statistics. Of the 1,271 patients included, 756 underwent benign gynaecology (54 robotic, 652 laparoscopic, 50 open), 233 colorectal (49 robotic, 123 laparoscopic, 61 open) and 282 urological surgeries (184 robotic, 12 laparoscopic, 86 open). Patients undergoing minimally invasive surgery (robotic or laparoscopic) presented with a significantly shorter length of hospital stay when compared to open surgical approach (P < 0.001). Rates of postoperative morbidity were significantly lower in robotic colorectal and urological procedures when compared to laparoscopic and open approaches. The total in-hospital cost of robotic benign gynaecology, colorectal and urological surgeries were significantly higher than other surgical approaches, independent of the surgical complexity. RAS resulted in better surgical outcomes, especially when compared to open surgery in patients presenting with benign gynaecology, colorectal and urological diseases. However, the total cost of RAS was higher than laparoscopic and open surgical approaches.

Laparoscopic Radical Nephrectomy with Transperitoneal Approach for Large Renal Tumors: Standardized Surgical Technique and Outcomes.

Background: Minimally invasive surgery is used only in selected cases of renal masses greater than 7 cm, and few studies exist in this setting. This study aimed to evaluate the safety and effectiveness of a laparoscopic surgical approach for the treatment of large renal tumors using a standardized technique. Materials and Methods: Data of patients who underwent laparoscopic nephrectomy (LN) using the transperitoneal approach were retrospectively evaluated from December 2019 to September 2022. The study population was divided into two groups: patients with renal masses <7 cm (Group A) and those with renal masses ≥7 cm in diameter (Group B). The intraoperative and postoperative outcomes were compared. Results: Forty patients were enrolled (16 in Group A and 24 in Group B) in this study. Although significant difference in terms of age and American Society of Anesthesiologists score were detected, the two groups did not differ in mean operative time (130 minutes standard deviation [SD] ± 64 versus 148 minutes DS ± 56; P = .376), intraoperative complications (0% versus 8.3%; P = .508), need for postoperative transfusion (12% versus 12%; P > .999), and length of stay (3.38 DS ± 0.62 days versus 3.92 DS ± 2.47; P = .313). One patient had a local recurrence and died ∼13 months after surgery. Furthermore, 2 patients developed trocar-site incisional hernia in Group B. Conclusion: In this cohort of patients, LN for large renal tumors appeared to be safe and feasible. Larger mass dimension does not appear to influence the outcomes when the surgery is performed using a standardized technique by experienced surgeons.

Laparoscopic excision of inflammatory pseudotumors: A case report

Inflammatory pseudotumors (IPs) are rare incidental benign lesions which can occur in any anatomical site. They have been reported by a variety of names, including inflammatory myofibroblastic tumor, histiocytoma, xanthoma, and plasma cell granuloma. Their knowledge is important because of the differential diagnosis with others true malignancies. Only 30 case reports are reported in the literature. Surgical resection is the mainstay of treatment with excellent outcomes and low recurrence rates. When anatomical site is suitable, a laparoscopic approach should be performed to minimize morbidity and expedite recovery. Here, we present a case report of IPs of antimesenteric bowel treated with a laparoscopic surgical approach.

Interstitial pregnancy.

A case report of a patient with interstitial pregnancy and a history of hyperprolactinemia. A 30-year-old woman was hospitalized for a suspicion of ectopic pregnancy and referred for laparoscopy. During the laparoscopic surgery, interstitial pregnancy was dia-gnosed and solved with cornuostomy. Ectopic interstitial pregnancy represents a serious worldwide issue because unrecognized, it can endanger a womans life, despite advances in ultrasound examination, the dia-gnosis often remains inaccurate. Laparoscopic surgical approach with evacuation of pregnancy with subsequent uterus suture represents one of the possible approaches. This method is minimally invasive and safe.

Outcomes of laparoscopic versus open resection of pediatric choledochal cyst

BackgroundUntreated pediatric choledochal cyst (CC) is associated with complications including cholangitis, pancreatitis, and risk of malignancy. Therefore, CC is typically treated by surgical excision with biliary reconstruction. Both open and laparoscopic (lap) surgical approaches are regularly used, but outcomes have not been compared on a national level. MethodsThe Nationwide Readmissions Database was used to identify pediatric patients (age 0–21 years, excluding newborns) with choledochal cyst from 2016 to 2018 based on ICD-10 codes. Patients were stratified by operative approach (open vs. lap). Demographics, operative management, and complications were compared using standard statistical tests. Results were weighted for national estimates. ResultsCholedochal cyst excision was performed in 577 children (75% female) via lap (28%) and open (72%) surgical approaches. Patients undergoing an open resection experienced longer index hospital length of stay (LOS), higher total cost, and more complications. Anastomotic technique differed by approach, with Roux-en-Y hepaticojejunostomy (RYHJ) more often utilized with open cases (86% vs. 29%) and hepaticoduodenostomy (HD) more common with laparoscopic procedures (71% vs. 15%), both p < 0.001. There was no significant difference in post-operative cholangitis or mortality. ConclusionsAlthough utilized less frequently than an open approach, laparoscopic choledochal cyst resection is safe in pediatric patients and is associated with shorter LOS, lower costs, and fewer complications. HD anastomosis is more commonly performed during laparoscopic procedures, whereas RYHJ more commonly used with the open approach. While HD is associated with more short-term gastrointestinal dysfunction than RYHJ, the latter is more commonly associated with sepsis, wound infection, and respiratory dysfunction. Level of evidenceLevel III: Retrospective Comparative Study.

Impact of type 2 diabetes mellitus on the prognosis of patients with hepatocellular carcinoma after laparoscopic liver resection: A multicenter retrospective study.

The effect of type 2 diabetes mellitus (T2DM) on survival of patients with hepatocellular carcinoma (HCC) after laparoscopic liver resection (LLR) has not been reported. This study aimed to explore the relationship between preoperative T2DM and long-term prognosis in HCC patients undergoing LLR. HCC patients receiving LLR as initial treatment at four cancer centers were retrospectively included in this study. Clinicopathological factors associated with the prognosis of HCC patients were identified using univariate and multivariate Cox regression analysis. Recurrence-free survival (RFS) and overall survival (OS) curves between different cohorts of patients were generated using the Kaplan-Meier method and compared using the log-rank test. Of 402 HCC patients included, 62 patients had T2DM and 340 patients did not have T2DM. The OS and RFS of patients with T2DM were significantly worse compared to those without T2DM (P = 0.001 and 0.032, respectively). In Cox multivariate analysis, T2DM was identified as an independent risk factors for OS (HR = 2.31, 95% CI = 1.38-3.85, P = 0.001) and RFS (HR = 1.66, 95% CI = 1.08-2.55, P = 0.020). Following laparoscopic surgical approach, HCC patients with T2DM had poorer prognoses than those without T2DM. Preoperative T2DM was an independent risk factor for HCC patients. Thus, patients with concurrent HCC and T2DM should be closely monitored after LLR.

8811 Diaphragmatic Endometriosis: Anatomopathology and Correlation with Surgical Technique in 230 Patients Treated in a Referral Center

<h3>Study Objective</h3> To define a decision-making algorithm for Diaphragmatic Endometriosis (DE) surgical treatment correlating laparoscopic appearance of endometriotic implants with their histopatological counterpart. <h3>Design</h3> All the cases of DE surgically treated in Our Department, from January 2004 to January 2021, were analyzed in a retrospective chart review. <h3>Setting</h3> DE lesions were correlated to intraoperative findings (morphology, localization, side of the diaphragm, diameter, depth of infiltration and number) and classified according to their histopathological features as: •"Foci": bidimensional superficial peritoneal lesions, generally ≤ 1 cm diameter. •"Plaques": thin fibrotic lesions, thickening the diaphragmatic peritoneum with no muscular infiltration, > 1cm diameter. •"Nodules": solid, tridimensional implants, associated with partial or full-thickness infiltration of underneath muscle layers and generally > 1cm diameter. <h3>Patients or Participants</h3> Two hundred -thirty patients were collected. <h3>Interventions</h3> The histopathologic revision of all the specimens enabled us to select a different laparoscopic surgical approach, for each lesion, as the following: <h3>Measurements and Main Results</h3> •Argon Beam Coagulator (ABC) and/or Diathermocoagulation (DTC) for diaphragmatic foci; •Diaphragmatic stripping is indicated for endometriotic plaques •Nodulectomy is the right choice for endometriotic nodules, with the need of partial or full-thickness diaphragmatic resection according to the entity of muscular involvement. <h3>Conclusion</h3> A safe eradication of the implants requires a standardization of the surgical technique based on the knowledge of laparoscopic and histopathologic characteristics of lesions, thus avoiding intra- and post-operative morbidities.

Can AAGL 2021 Endometriosis Classification be Adopted at Preoperative Ultrasound for Reliably Predicting Surgical Complexity?

<h3>Study Objective</h3> to evaluate the use of new AAGL2021 Endometriosis classification (AAGL2021-EC) for staging at ultrasound (ULS) women undergoing surgical approach for deep endometriosis (DE). <h3>Design</h3> single-center retrospective analysis of a prospectively collected database (NCT05291624). <h3>Setting</h3> referral center for endometriosis. <h3>Patients or Participants</h3> consecutive women undergoing surgical approach for DE. <h3>Interventions</h3> at preoperative ULS, the presence of endometriosis was staged by using the AAGL2021-EC (ULS score). Laparoscopic surgical approach was performed within 15 days from the ultrasonographic evaluation. During surgery, the presence of endometriosis was staged by using the AAGL2021-EC (surgical score); the surgeons were blinded to the results of the preoperative ULS staging. All the women were treated by full radical resection of all visible endometriotic lesions. <h3>Measurements and Main Results</h3> 198 patients were enrolled. The mean ULS score was significantly lower than the surgical score (24.6 ± 12.3 vs 35.9 ± 19.6; p<0.001). In 53.5% (n=106) of patients, the severity stage predicted by ULS score coincided exactly with that described at surgery; in 32.8% (n=65) cases, ULS predicted a higher surgical severity stage; in 13.7% (n=27) cases, ULS predicted a lower severity stage. There was a moderate agreement between ULS severity stage and surgical procedures performed according to the distinguished severity stages expected by the AAGL2021-EC (V=0.520; p=0.0003); in particular, the agreement was worse when predicting surgical procedures related to lower (V=0.172; p=0.327) than higher (V=0.412; p=0.005) severity stages (p<0.001). The maximum percentages of exact concordances between ULS and surgical specific localization scores were observed for bladder (83.1%) and vagina (77.2%); the minimum percentage for peritoneum (41.2%). The most relevant underestimation and overestimation in specific localization scores were reported, respectively, for left ureter (46.5%) and right ovary (31.5%). <h3>Conclusion</h3> the ultrasonographic use of AAGL2021-EC moderately predicts surgical complexity; in particular, it tends to be worse when predicting easier surgical procedures expected by AAGL2021-EC severity stages.

LB1148: An Enteral Protease Inhibitor Significantly Accelerated the Return of Bowel Function after Bowel Resection

Introduction: Return of bowel function is a clinically accepted determinant of recovery after gastrointestinal (GI) surgery. Postoperative ileus presents significant clinical challenges that may prolong hospital stay, contribute to readmission, and increase morbidity and expense. The aim of this study was to determine if a novel enteral formulation of tranexamic acid, LB1148, could accelerate return of GI function in patients undergoing bowel resection surgery. Methods: We conducted a phase II multicenter, randomized, double-blind, placebo-controlled study of LB1148 for the restoration of postoperative bowel function in patients undergoing elective bowel resection. The study included both open and laparoscopic surgical approaches with anastomosis and or stoma creation. Primary outcome was recovery of bowel function as measured by time from end of surgery to oral food tolerance and passage of stool. Results: A total of 120 patients completed the study. Treatment groups were well balanced for patient demographics and included a broad range of baseline surgery characteristics, approaches, and methodologies. Median time to return of bowel function was 2.77 days vs 3.83 days in patients receiving LB1148 and placebo, respectively (hazard ratio=1.8; p = 0.0008). Key GI functional data will be presented based on laparoscopy and laparotomy with surgical characteristics including, right hemicolectomy, left hemicolectomy, and rectosigmoid surgery. The most common drug-related adverse events were GI disorders (LB1148 4.7% vs placebo 3.2%). No drug-related serious adverse events occurred in the trial. Conclusion: For patients undergoing elective bowel resection surgery, LB1148 was safe and well-tolerated and significantly accelerated the return of bowel function.

Experience and Limitations of Gynecological Laparoscopy for a Beginner in Private Practice

Introductions: Minimally invasive surgery is now the standard surgical procedure for benign gynecological diseases and plays an increasing role in their treatment. This study presents a personal series of an evaluation of the laparoscopic surgical approach. Its outcomes in the surgical treatment of patients with benign gynecological diseases. Aim: The study aimed to evaluate the outcome of gynecological laparoscopy in a low-resource setting. Method: This cross-sectional study was conducted in a private hospital in Rajshahi, Bangladesh. It is a retrospective surgical series of patients performed by the author, which analyzes (n=24) female patient treated from 2019 to December 2020. Results: A number of 24 female patients were included in this study; their mean age was 32.6 years. Among them diagnostic laparoscopy was done in 13 patients. This is mostly due to primary sub-fertility and therapeutic laparoscopy in 11 patients (2 salpingectomy for ectopic pregnancy, 3 laparoscopically assisted vaginal hysterectomy, 1 myomectomy, 1 TLH, 1 laparoscopic adhesiolysis, 2 Ovarian cystectomy, and 1 left sided salpingoophorectomy was done for ovarian cyst). 1 laparoscopic procedure for LAVH was converted to laparotomy due to excessive bleeding. 20 patients were released without incident, but post-Surgical site infection occurred in 1 patient. There was no significant difference in operative complications, blood loss, or length of hospital stay compared to conventional laparoscopic surgery reported in the literature. The perioperative complications are minimal in this personal series. In this study, laparoscopic myomectomy and laparoscopic adhesiolysis for pelvic endometriosis. It took longer to perform using this approach compared with other procedures. Conclusion: Despite having many benefits over conventional procedures, gynecological laparoscopy has several limitations, especially in a low resource-poor setting (Lack of knowledge, Popularity among patients, Higher cost, Long learning curve, Instrumental backup). This paper reported a feasible and safe surgical approach to laparoscopic surgery for gynecological diseases.

Analysis of bowel function, urogenital function, and long-term follow-up outcomes associated with robotic and laparoscopic sphincter-preserving surgical approaches to total mesorectal excision in low rectal cancer: a retrospective cohort study

ObjectiveThe present study comparatively analyzed short-term clinical effectiveness and long-term follow-up endpoints associated with robotic-assisted sphincter-preserving surgery (RAS) and laparoscopic-assisted sphincter-preserving surgery (LAS) when used to treat low rectal cancer.MethodWithin such a single-center retrospective cohort analysis, low rectal cancer patients that underwent RAS (n=200) or LAS (n=486) between January 2015 and beginning of July 2018 were enrolled.ResultsThe mean operative durations in the RAS and LAS cohorts were 249±64 min and 203±47 min, respectively (P<0.001). Temporary ileostomy rates in the RAS and LAS cohorts were 64.5% and 51.6% (P = 0.002). In addition, major variations across such cohorts regarding catheter removal timing, time to liquid intake, time to first leaving bed, and length of hospitalization (all P<0.001). This distal resection margin distance within the RAS cohort was diminished in comparison to LAS cohort (P=0.004). For patients within the LAS cohort, the time required to recover from reduced urinary/female sexual function was > 6 months post-surgery (P<0.0001), whereas within the RAS cohort this interval was 3 months (P<0.0001). At 6 months post-surgery, male sexual function within RAS cohort was improved in comparison to LAS cohort (P<0.001). At 6 months post-surgery, Wexner scores revealed similar results (P<0.001). No major variations within overall or disease-free survival were identified across these cohorts at 3 or 5 years post-surgery.ConclusionRobotic sphincter-preserving surgery is a safe and effective surgical technique in low rectal patients in terms of postoperative oncological safety and long-term endpoints. And the RAS strategy provides certain additional benefits with respect to short-term urogenital/anorectal functional recovery in treated patients compared to LAS.

Outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): Laparoscopic and open surgical approach

Ji Eun KWON, Sunghae PARK, Young Ju OH, Sang Oh YUN, Jaehun YANG, Manuel LIM, Eun Sung JEONG, Kyeong Deok KIM, Jinsoo RHU, Gyu-Seong CHOI, Jong Man KIM*, Jae-Won JOH. Ann Hepatobiliary Pancreat Surg 2022;26:S285. https://doi.org/10.14701/ahbps.2022S1.EP-3

Social media as a tool for surgical education: a qualitative systematic review.

BackgroundSocial media use has exploded, attaining a significant influence within medicine. Previous studies have denoted the use of social media in various surgical specialties as a means to exchange professional ideas and improve the conference experience and at the same time, some have assessed its feasibility as a method of education. This systematic review aims to characterize the use of social media as a tool for general surgery education.MethodsA systematic review of several databases from each database inception was conducted following the PRISMA guidelines. The JBI’s critical appraisal tools were used to assess quality of the studies.ResultsA total of 861 articles were identified of which 222 were duplicates removed. The titles and abstracts from the remaining 639 abstracts were screened and 589 were excluded. The remaining 51 full articles were analyzed for eligibility, of which 24 met inclusion criteria and were included in the systematic review. These studies covered the general surgery specialty, of which 11 (n = 46%) focused on the laparoscopic surgical approach, 1 (n = 4%) on robotic-assisted surgical procedures, 1 (n = 4%) on both surgical approaches previously mentioned and 11 (n = 46%) on the general surgery specialty regardless of the surgical approach or technique.ConclusionsAdvantages that SM offers should be considered, and content creators and institutions should help collectively to make sure that the content being published is evidence and guideline-based so its use it is taken to the maximum benefit.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09150-9.

Splenic cyst following trauma, the intraoperative decision on definitive management

Introduction. Posttraumatic splenic cysts are most commonly the result of blunt force trauma to the abdomen. They usually develop from subcapsular or intraparenchymal hematomas and are typically asymptomatic. Diagnostics includes clinical history and radiological imaging procedures. Surgical treatment is the only curative modality of treatment. Case outline. A 43-year-old female patient, without comorbidities, was admitted to the health institution for additional diagnostics and surgical treatment. Laboratory test results were within the reference ranges, while serological test results for hydatid disease were negative. An abdominal CT examination was subsequently performed confirming a splenic cyst positioned in the central part of the spleen. After a laparoscopic partial pericystectomy of the cyst, we identified another smaller cyst of the spleen. According to the estimation of the surgical team, the intraoperative appearance of the remaining tissue of the spleen was less than a third of the entire spleen. The decision was taken to perform a splenectomy in the best interests of the patient, bearing in mind the possibility of complications Conclusion. Accurate diagnosis of posttraumatic splenic cysts remains a challenge, despite state-of-the-art radiological imaging procedures that are applied. In addition to the well-known modalities of treatment, the laparoscopic surgical approach, i.e., minimally invasive treatment, should be the one of choice, if the situation allows it. The laparoscopic approach is a diagnostic and therapeutic method whose effect can especially be observed when the intraoperative finding differs from the preoperative radiological finding.

One-step laparoscopic pancreatic necrosectomy verse surgical step-up approach for infected pancreatic necrosis: a case-control study.

The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis (IPN) patients with various abscesses or no safe route for percutaneous catheter drainage (PCD). This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy (LPN) in treating IPN. This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020. The short-term and long-term complications after surgery, length of hospital stay, and postoperative ICU stays in both groups were analyzed. Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death. A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study. There was no significant difference in the incidence of death, major complications, new-onset diabetes, or new-onset pancreatic exocrine insufficiency between the two groups. However, the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group. Univariate regression analysis showed that the surgical approach (one-step/step-up) was not the risk factor for major complications or death. Multivariate logistic regression analysis indicated that computed tomography (CT) severity index, American Society of Anesthesiologists (ASA) class IV, and white blood cell (WBC) were the significant risk factors for major complications or death. One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients, and reduces total hospital stay.

Üçüncü basamak bir çocuk cerrahisi merkezinde çocuklarda palpe edilemeyen testislerin laparoskopik tedavisinin klinik sonuçları

Aim: Non-palpable testis is defined as the absence of the testis in the inguinal canal and scrotum in a male patient. It is important to define the condition and location of the non-palpable testis, to prevent the risks of infertility and malignant transformation of the testis in patients. We aimed to evaluate the results of the laparoscopic approach we applied in the treatment of pediatric patients with non-palpable testes.Methods: Patients with non-palpable testes, diagnosed and treated by the laparoscopic approach in a tertiary pediatric surgery center, were evaluated retrospectively. In the treatment protocol, laparoscopic abdominal exploration, two-stage Fowler-Stephens laparoscopic orchiopexy, primary laparoscopic orchiopexy and inguinal exploration surgical approaches were applied according to the case characteristics.Results: Data from 54 testes in 45 pediatric patients were evaluated. Intra-abdominal testis was detected in 46.2% of the cases, with 88% of them at the entrance of the internal inguinal ring. After laparoscopic abdominal exploration, two-stage Fowler-Stephens in 7 (28%), primary laparoscopic orchiopexy in 18 (72%) were applied of testes. Inguinal exploration was performed in 27 (50%) whom no testis could not found. Seventeen (73.9%) of 23 testes that were descended into the scrotum remained viable, while atrophy occurred in 6 (26%) of them. Viable testis cells were not detected in the histopathology of 27 excised nubbins.Conclusion: The laparoscopic approach is a reliable and effective method in the diagnosis and treatment of non-palpable testis. Localization of intra-abdominal testes may support consideration of the inguinal exploration approach as the primary surgical intervention.

Laparoscopic Resection of Retroperitoneal Schwannoma: Report of 3 cases

Background: Schwannoma is a neoplasm that arises from Schwann cells in the peripheral nerve sheath. They are mainly benign tumors, Ohigashi T et al. reported that only 0.7% is located in the retroperitoneum and these are associated with a higher rate of malignancy. The preoperative diagnosis is a challenge due to its low frequency and the low specificity of imaging studies. Treatment consists of its complete surgical resection, avoiding its rupture since it is associated with local recurrences. The laparoscopic approach presents technical limitations due to the usually large size of these tumors, and few cases of laparoscopic excision have been reported in the world literature to date. Methods: the results of 3 retroperitoneal schwannomas of different location, size and complexity are presented, all resolved laparoscopically by a highly complex laparoscopic surgery team. Results: all surgeries were performed completely laparoscopically, there were no complications associated with the mini-invasive procedure and all the benefits of it were obtained. The anatomopathological and immunohistochemical examination was compatible with schwannomas in all 3 cases. To date, the patients do not present recurrences. Conclusions: although the location, size and relationship with other anatomical structures make the laparoscopic surgical approach difficult, with a well-trained team in laparoscopic surgery, these procedures can be performed safely, without increased morbidity and with all the benefits that mini-invasive procedures provide

Laparoscopic Intervention to Pancreatic Pseudocyst Confers Short-Term Benefits: A Meta-Analysis.

Background Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical techniques, a laparoscopic surgical approach for PPs has been conducted increasingly with comparable outcomes. The present study was conducted to compare the efficacy and safety of surgical intervention for PPs between the laparoscopic approach and the open approach. Methods Databases including Cochrane Library, PubMed, and EMBASE were searched to identify studies that compared the safety and efficacy of surgical intervention for PPs between the laparoscopic approach and the open approach (until Aug 1st 2020). Results A total of 6 studies were eligible in qualitative synthesis. The laparoscopic approach was associated with less intraoperative blood loss (MD = −69.97; 95% CI: −95.14 to −44.70, P < 0.00001; P=0.86 for heterogeneity) and shorter operating time (MD = −33.12; 95% CI: −62.24 to −4.00, P=0.03; P < 0.00001 for heterogeneity). There was no significant difference found between the two approaches regarding the success rate and the recurrence rate. The postoperative complications and mortality rates were comparable between the two approaches. Conclusions The laparoscopic approach for the surgical intervention of PPs is safe and efficacious with shorter-term benefits.