Use Of Laparoscopic Approach Research Articles

Influence of Certification Program on Treatment Quality and Survival for Rectal Cancer Patients in Germany: Results of 13 Certified Centers in Collaboration with AN Institute.

The certification of oncological units as colorectal cancer centers (CrCCs) has been proposed to standardize oncological treatment and improve the outcomes for patients with colorectal cancer (CRC). The proportion of patients with CRC in Germany that are treated by a certified center is around 53%. Lately, the effect of certification on the treatment outcomes has been critically discussed. Our aim was to investigate the treatment outcomes in patients with rectal carcinoma at certified CrCCs, in German hospitals of different medical care levels. We performed a retrospective analysis of a prospective, multicentric database (AN Institute) of adult patients who underwent surgery for rectal carcinoma between 2002 and 2016. We included 563 patients from 13 hospitals of different medical care levels (basic, priority, and maximal care) over periods of 5 years before and after certification. The certified CrCCs showed a significant increase in the use of laparoscopic approach for rectal cancer surgery (5% vs. 55%, p < 0.001). However, we observed a significantly prolonged mean duration of surgery in certified CrCCs (161 Min. vs. 192 Min., p < 0.001). The overall morbidity did not improve (32% vs. 38%, p = 0.174), but the appearance of postoperative stool fistulas decreased significantly in certified CrCCs (2% vs. 0%, p = 0.036). Concerning the overall in-hospital mortality, we registered a positive trend in certified centers during the five-year period after the certification (5% vs. 3%, p = 0.190). The length of preoperative hospitalization (preop. LOS) was shortened significantly (4.71 vs. 4.13 days, p < 0.001), while the overall length of in-hospital stays was also shorter in certified CrCCs (20.32 vs. 19.54 days, p = 0.065). We registered a clear advantage in detailed, high-quality histopathological examinations regarding the N, L, V, and M.E.R.C.U.R.Y. statuses. In the performed subgroup analysis, a significantly longer overall survival after certification was registered for maximal medical care units (p = 0.029) and in patients with UICC stage IV disease (p = 0.041). In patients with UICC stage III disease, we registered a slightly non-significant improvement in the disease-free survival (UICC III: p = 0.050). The results of the present study indicate an improvement in terms of the treatment quality and outcomes in certified CrCCs, which is enforced by certification-specific aspects such as a more differentiated surgical approach, a lower rate of certain postoperative complications, and a multidisciplinary approach. Further prospective clinical trials are necessary to investigate the influence of certification in the treatment of CRC patients.

Laparoscopic surgery for advanced peritonitis

To determine the criteria for choosing surgical access in patients with advanced peritonitis considering its local and general manifestations. We analyzed treatment outcomes in 588 patients with advanced peritonitis. The most common causes of peritonitis were destructive forms of acute appendicitis (273 cases), perforated gastroduodenal ulcers (165 cases), acute cholecystitis (59 cases). To determine the criteria for choosing surgical access in advanced peritonitis, we analyzed treatment outcomes considering MPI, SPP and WSES SSS score. The choice of surgical access in advanced peritonitis can only symbolically be standardized according to modern scoring systems (MPI, SPP, WSES SSS). Laparotomy is necessary for MPI score ≥30 and SPP score > 10 (WSES SSS score > 8). Regardless of MPI, SPP, WSES SSS scores, the absolute contraindications for laparoscopic surgery are dense non-removable fibrin deposits, interintestinal abscesses, purulent recesses, intra-abdominal pressure > 20 mm Hg or small intestine dilation> 3 cm, sepsis or septic shock (qSOFA score 2-3), previous open abdominal surgery, unstable hemodynamics, technical difficulties. Conversion should be used at any doubt. Careful patient selection, surgical experience and training in laparoscopic technique are decisive factors for wider use of laparoscopic approach in patients undergoing emergency abdominal surgery.

Evaluation of laparoscopic versus open sacrocolpopexy for vaginal vault prolapse – A study from a tertiary care center

Background: Post hysterectomy vault prolapse is a progressive herniation of the vaginal vault through the urogenital diaphragm and commonly leads to per vaginal bulge. Surgically, vault prolapse is corrected by sacrocolpopexy which can be done both as an open abdominal surgery and as a laparoscopic repair. Aims and Objectives: This study was performed to compare the therapeutic efficacies of laparoscopic and abdominal sacrocolpopexy. Materials and Methods: This study includes 50 cases of vault prolapsed who underwent hysterectomy previously, admitted in our institution and operated during January 2021–June 2022 for a period of 18 months with both open abdominal and laparoscopic sacrocolpopexy. We compared the basic characteristics, duration of surgery, post-operative stay, post-operative complications, and patient satisfaction between open and laparoscopic groups. Results: No significant difference was observed between the characteristics of the patients in the abdominal-approach group and the laparoscopic-approach group. The laparoscopic-approach group had a lower intraoperative estimated blood loss (187.8 vs. 90.3 mL, P&lt;0.001) and a shorter operative time (148.0 vs. 115.3 min, P&lt;0.001) than the abdominal-approach group. The complication rates of the two groups were not significantly different. Conclusion: Our Study is favorable for the use of laparoscopic approach over open abdominal surgery for treating cases of vault prolapse for sacrocolpopexy. The less invasive method leads to less blood loss and a shorter operative time than an open approach.

A Systemic Review and Meta-analysis of Laparoscopic Surgery Versus Open Surgery for Gallbladder Cancer.

Laparoscopy in gallbladder cancer (GBC) has a possible role in staging, radical cure, and palliation in gallbladder cancer. However, a few studies have advocated the use of laparoscopic approach and concluded the safety of this approach. This present study was undertaken to determine the safety and feasibility between open and laparoscopic cholecystectomy in patients with the non-metastatic GBC. A systematic database search was performed in MEDLINE, Embase, and Google Scholar for relevant articles. As a result, a list of such studies, clinical trials, published in English up to May 2021, was obtained,14 studies were included and statistical analysis was conducted using RevMan software 5.3 (The Nordic Cochrane Centre). The 5-year survival rate was reported in 13 out of 14 studies (1388 patients), and all compared laparoscopic and open approach. There was no significant heterogeneity in between the studies (chi-square, 10.66; df, 12; I2, 0%). There was significant higher overall survival in open group (389/850 vs 194/538 or 1.45, 95% CI (1.12-1.88), P value, 0.005). There was no significant difference in recurrence rate, operative time, blood loss, lymph node yield, and postoperative complication in between open and laparoscopic groups. Our present study demonstrates that overall survival is significantly increased with open approach when compared with laparoscopic approach. There is no difference in recurrence rate, operative time, blood loss, lymph node yield, and postoperative complications between the open and laparoscopic cholecystectomy groups.

Abstracts from Hydrocephalus 2021: The Thirteenth Meeting of the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders

Abstracts from Hydrocephalus 2021: The Thirteenth Meeting of the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders

Transmission Possibility of COVID-19 via Surgical Smoke Generated by the Use of Laparoscopic Approaches: A Subject of Debate During the Pandemic.

Background: The smoke created by energy-based devices during surgery may have the potential to transmit viral components to operating room staff. The COVID-19 pandemic has changed staff safety regulations. However, it is not clearly understood whether it can be transmitted via surgical smoke. Laparoscopic approaches have become the standard surgical procedure in many cases, but some of previous investigations have advised to pretermit these approaches due to high risk of COVID-19 transmission. Materials and Methods: We reviewed the English literature that were indexed in the PubMed, Google Scholar, and Scopus databases by using key words including Virus, viral transmission, surgical smoke, surgical plum, laparoscopy, and COVID-19 both solely and in two-word combination. A total of 87 articles were found relevant, and after reviewing the abstract, 33 articles were shortlisted and summarized. Results: Previous studies have focused on different surgical instruments that generate smoke, methods to collect and analyze the smoke and to understand the implications of its exposure after an analysis. A total of 9 out of 11 studies on the potential transmission of human papilloma virus through surgical smoke found evidence in favor of transmission. There were studies on the possible transmission of HIV, hepatitis B virus, and Sabin poliomyelitis vaccine virus 2. Conclusion: We do not believe that laparoscopic procedures may have extra risk for COVID-19 transmission compared with the open procedures, but it is always advised that the operating room staff adhere to the safety instructions during the COVID-19 pandemic.

241 Have We Learnt Any Lessons from the 2018 NASBO Report?

Abstract Introduction Small Bowel Obstruction (SBO) is a common presentation requiring a multidisciplinary approach to its management. However, patient outcomes remain poor. Until the NASBO 2018 report1, there were no standard protocols. This study is an evaluation of our local service, assessing our compatibility to NASBO guidelines and identifying areas to improve patient outcomes. Method A retrospective cohort study was carried out on patients with SBO during 2018-19. In a busy emergency surgery unit in North West England, with the highest number of emergency laparotomies (NELA 2019)2. Clinical assessment, management, outcomes, and complications were compared to the national data reported in NASBO 2018. Results Of 200 patients (median age 73), 60% were treated conservatively and 40% surgically, of which &amp;lt;50% were initially treated conservatively. 59.5% had a nutritional assessment on admission, of which 33.5% were at nutritional risk and started on TPN. Complications during stay were within the target range (&amp;lt;5%). 16% were admitted in HDU. The 30-day mortality was 8%, with 3% requiring palliative care for malignancy and severe comorbidities. Conclusions When compared to the national average, our department had a similar performance in management. Use of laparoscopic approach, ERAS, nutritional assessment and elective HDU/ITU admissions were identified as areas for improvement.

Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life

BackgroundCOVID-19 pandemic has rapidly spread in Italy in late February 2020. Almost all surgical services have been reorganized, with the aim of maintaining an adequate therapeutic path, especially for surgical emergencies. The knowledge of how surgeons dealing with emergency surgery have reacted to the epidemic in the real life can be useful while drafting clinical recommendations.MethodsSurgeons from multiple Italian regions were invited answering to an online survey in order to make a snapshot of their current behaviors towards COVID-19-positive patients bearing urgent surgical diseases. Questions about institutional rules and personal approach for patient treatment and to limit epidemic spread were included in a 37-item questionnaire.ResultsSeventy-one questionnaires from institutions dealing with emergency surgery were accepted. Participating surgeons were equally subdivided from a geographical point of view, with a large proportion of public (97.2%) and non-academical (91.5%) centers. In 80.3% of cases, the hospitals treated COVID-19 patients; in 69.1% of centers, a change in work plan was necessary, and 33.8% of teams had almost a surgeon infected or in preventive quarantine. The vast majority of surgeons operated only on urgent cases (73.9%), but the number of interventions significantly dropped. Up to 40% of non-traumatic abdominal emergency cases had an unusual delayed treatment. The laparoscopic approach was used in 69.6% of interventions on COVID-19 patients. Strategies to protect health care workers against COVID-19 infection and to identify asymptomatic infected surgeons were suboptimal with respect to the WHO recommendations in 70.4% and 90.2% of centers, respectively. Advanced personal protective equipment for operating room workers was adopted for all surgeries in only 12.7% of centers.DiscussionThis survey confirms that the COVID-19 outbreak is dramatically changing the practice of emergency surgery centers in Italy. Despite the reduction in number, urgent cases were on average more challenging owing to diagnostic delay. Recommendations from the International Scientific Societies are frequently not complied concerning the use of laparoscopic approach, the availability of personal protective equipment in the operating rooms, and the testing of both asymptomatic physicians and patients scheduled for surgery. A further evaluation of the short-term results of these attitudes is warranted to modulate international recommendations.

P.122 The prediction of outcome after shunting for idiopathic normal pressure hydrocephalus

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a triad of impaired gait, cognition and urinary control in the setting of normal pressure ventriculomegaly. Various options for shunt implantation exist, but there is limited ability to predict outcome. Methods: This study is a retrospective chart review of 82 shunted patients for iNPH between 2007 and 2018. Factors examined included age, sex, lumbar puncture results, use of laparoscopic approach, type of shunt used, Charlson Comorbidity Index and imaging (callosal angle and DESH). Patient outcome was assessed via modified Rankin Scale (mRS). Results: 52 patients were male and 30 were female. Average age at surgery was 71.4 years. 58/62 (94%) improved following lumbar puncture. 41% of patients had VP shunt, and 59% of patients had LP shunt. 30/79 (38%) had laparoscopic placement of the distal catheter. 23/75 (31%) and 30/81 (36%) had a complication and required reoperation, respectively. Callosal angle showed statistically significant increase post-shunting (76 to 94 degrees, p&amp;lt;0.005). Presence of DESH did not change post-shunting. Average Charlson Comorbidity Index was 4.4. The mRS decreased from 3.84 to 2.66 post-operatively (p&amp;lt;0.005). Conclusions: In our centre, iNPH patients had clinicoradiologic improvement following shunting. We will perform regressional statistics to elucidate the factors influencing outcomes.

Standardization of surgical procedures to reduce risk of anastomotic leakage, reoperation, and surgical site infection in colorectal cancer surgery: a retrospective cohort study of 1189 patients.

Anastomotic leakage (AL) and surgical site infection (SSI) are prevalent complications of colorectal surgery. To lower this risk, we standardized our surgical procedures in 2012, with a preferential use of laparoscopic approach (LS) for both colon and rectal surgery, combined with triangulating anastomosis (TA) for colon surgery and defunctioning ileostomy (DI) for low anterior resection. Our aim was to evaluate the outcomes of our standardized procedures. The incidence rate of AL (primary outcome) and of reoperation and SSI (secondary outcome) was compared before (early period, n = 648) and after (late period, n = 541) standardization, through a retrospective analysis. The incidence rate of AL (6.6 versus 1.8%; P = 0.001), reoperation (3.5 versus 0.7%; P = 0.0012), and SSI (7.7 versus 4.6%; P = 0.029) was lower in late than in the early period. For colon cancer, TA and LS reduced the risk of AL (2.1 versus 0.3%, P = 0.020, for TA, and 3.2 versus 0.4%, P = 0.0027, for LS) and reoperation (2.9 versus 0.3%, P = 0.003, for TA, and 2.5 versus 0.2%, P = 0.0040, for LS). For rectal cancer, the incidence of all adverse outcomes (AL, reoperation, and SSI) was lower in cases treated by LS. However, the incidence of AL was lower in the late than in early period (P = 0.002) and with LS (P = 0.002). On multivariate analysis, late period and LS were independent factors of a lower risk of adverse outcomes. Our surgical standardization seems to be effective in lowering the risks of AL, reoperation, and SSI after colorectal cancer surgery.

The role of laparoscopic myomectomy in the modern management of uterine fibroids – a literature review

Uterine fibroids are the most common benign tumors of the genital female tract and the leading indication for hysterectomies in the USA. The prevalence rates quoted in literature range from 20-50%, based on postmortem studies. The prevalence varies with age, with an increase in the late reproductive period. Since the beginning of 1990s laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from literature, the authors report on the situation today regarding the operative technique for LM and the risks and benefits of the technique as compared with myomectomy by laparotomy. The operative technique include four main stage: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. A consensus gradually emerges that the maximal size of myoma must be 8-10 cm and the total number of fibroids should not exceed four. When conducted by experienced surgeons, the risk of perioperative complications is no higher using this technique. The use of laparoscopic approach could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of postoperative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. Some studies showed that the risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy. Laparoscopic myomectomy cases may become difficult if bleeding problems occur. Extended operative times may be necessary for morcellation and extensive laparoscopic suturing. Gynecologists need to improve their laparoscopic skills, as minimally invasive surgery is becoming the sine qua non condition of a modern surgeon.

A5260 - Drains use for bariatric surgical procedures is associated with increased complications and prolonged length of stay: a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program analysis

Drain use for bariatric procedures with an anastomosis has been considered the standard of care for many years. With an increased use of laparoscopic approaches, the routine use of drains has been questioned. Our aim was to evaluate predictors of postoperative complications in patients who underwent laparoscopic bariatric procedures.

Comparative effectiveness of laparoscopic radical hysterectomy for cervical cancer.

e17015 Background: Despite the benefits of minimally invasive surgery for cervical cancer, population-level data describing the surgery’s effectiveness in unselected patients are lacking. We compared morbidity, cost, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Methods: We used the Korean Health Insurance Review and Assessment Service database to identify women with cervical cancer who underwent radical hysterectomy from 2011 to 2014. Patient who underwent abdominal radical hysterectomy were compared with those who had minimally invasive hysterectomy. Perioperative morbidity, use of adjuvant therapy, and survival were evaluated. Results: We identified 6,335 patients including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. Uptake of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger and treated at larger hospital were more likely to undergo laparoscopic procedure (P&lt;0.001). Laparoscopic radical hysterectomy had lower rates of complication, less transfusion requirement, shorter hospital stays, and reduced total medical costs (P&lt;0.001). There was no significant association between use of laparoscopic approach and recurrence-free survival (P=0.194). Conclusions: Laparoscopic radical hysterectomy was associated with lower risk of perioperative complication and have comparable outcomes with abdominal radical hysterectomy.

Laparoscopic Management of Gastrointestinal Stromal Tumors: Nine Patients with Different Locations and Presentations: Retrospective Study

Background: Laparoscopic management of gastrointestinal stromal tumors (GISTs) is safe and effective. It is considered to be the preferred technique offered to the patient. Laparoscopic wedge resection has been widely accepted for small- and medium-sized GISTs. The use of laparoscopic approach should be based on a variety of factors including: patient characteristics, tumor size, and presence of invasion, location of tumor, surgeon and laparoscopic expertise. Patients and methods: Total number of nine patients with GISTs who presented to our unit from January 2010 till May 2015 were retrospectively reviewed. Patients’ demographics, clinical data, intraoperative and postoperative complications, and histopathological data were analyzed. Most lesions were resected via a wedge technique with closure of defect either by an endoscopic linear stapling device or intracorporeal suturing technique. Results: Nine patients who presented with GISTs underwent laparoscopic resection according to its position and size. The median age at diagnosis was 48 years old, and average tumor size was 4.2 cm with the largest tumor measuring 7.5 cm. There was no episode of tumor rupture or spillage and no major intraoperative or postoperative complications. All margins were negative, mean follow up was 14.4 (range 8.5–15.2) months. Majority of lesions were resected via laparoscopic wedge resection except one case (female patient aged 48 years old) that presented with GIST located at the gastric fundus , this patient underwent proximal (partial gastrectomy) and another case (adult male 26 years old) that presented with upper rectal GIST was managed via laparoscopic anterior resection. There was no evidence of metastasis or recurrence except in the patient who had been presented with rectal GIST. Conclusion: Laparoscopic resection is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to be removed safely. Laparoscopic removal is currently the surgical treatment of choice for patients with primary localized GISTs, and open surgery is not even considered unless there are contraindications to the laparoscopic approach

Laparoscopic Transperitoneal Lateral Adrenalectomy for Large Adrenal Tumors

Background: Laparoscopic adrenalectomy is the gold standard for treatment of benign adrenal lesions. Tumor size is a factor that might influence decision-making concerning the use of laparoscopic approach. The aim of this study was to analyze the results of adrenalectomy for tumors ≥6 cm in diameter. Methods: Two groups of patients were analyzed: first group comprised 441 patients with tumors <6 cm in diameter and second group consisted of 89 patients with tumors ≥6 cm. Both groups were compared with regard to the duration of surgery, intraoperative blood loss, conversion and complications rate. Results: Median duration of surgery in groups 1 and 2 amounted to 86.6 and 111.9 min (p < 0.0001), respectively. Median intraoperative blood loss in groups 1 and 2 was 56.5 and 172.8 ml (p < 0.0001), respectively. There was a linear relationship between tumor size and the duration of surgery, and between tumor size and intraoperative blood loss (p < 0.0001). There were 2 (0.5%) and 6 (6.7%) conversions in groups 1 and 2, respectively. There were 41 (9.3%) and 14 (15.7%) complications in groups 1 and 2 (p = 0.0692), respectively. Conclusions: Laparoscopic adrenalectomy of tumors ≥6 cm is more difficult, but it can be regarded safe and beneficial for patients.

Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience.

Background:Minimally invasive surgery is the current approach to perform heminephroureterectomy (HN) in children. This can be obtained through a transperitoneal (TP) or a retroperitoneal approach. Here, we report our experience using a TP approach.Materials and Methods:From 2005 to 2014, 22 TP laparoscopic upper poles HN were performed at our institution. There were nine girls and 13 boys aged between 20 months and 6 years (mean age 3.9). Eight patients were diagnosed prenatally, 17 patients presented with urinary tract infection (UTI) and three with vomiting and failure to thrive. The indication for HN was reflux nephropathy and UTI in non-functioning upper pole in 19 patients and cystic dysplasia in 1 patient. The surgical technique involved the following steps: Cystoscopic recognition; positioning of 3-4 trocar (right HN); identification of the kidney (detachment of the colon); isolation and low ligation of the dilated ureter; decrossing from renal vessels; section of the parenchyma by LigaSure; haemostasis with clips and LigaSure; drain.Results:The mean operative time was 154 min (range: 81-220 min). All patients were discharged from the 2nd to 4th day. Neither major complication nor conversion was recorded. 1 patient presented leakage of urine for 7 days from the drainage which resolved spontaneously. At ultrasound follow-up, 5 patients showed a secondary perirenal cyst, 2-5 cm diameter that resolved spontaneously.Conclusion:The results indicate that laparoscopic upper pole heminephrectomy is the treatment of choice in cases of non-functioning dilated lower segments of duplicated kidneys. The use of laparoscopic approach offers a good working space, a good visual control of the vessels and allows a very low isolation of the ureteral stump which counterbalance the peritoneal violation.

Possibilities and limits of modern metods of diagnosis of distant metastases locallyadvanced cervical cancer

A retrospective study of 245 cases of recurrent cervical cancer, in every third case was detected metastases in paraaortic lymph nodes. Given these results, a prospective study aimed at optimizing the staging of cervical cancer Ib1–IIIb stages. Analyzed 48 clinical cases of patients with locally - common forms of cervical cancer, which before the combined treatment paraaortic lymphadenectomy was performed through laparoscopy with subsequent histological examination of surgical specimens. At the preoperative stage, to identify distant metastasis in para-aortic lymph nodes, patients were examined by various methods of radiation diagnosis. The sensitivity of MRI was 75 %, specificity 79 %, sensitivity and specificity of ultrasonography – 75 % and 93 %, respectively. The positive predictive value of the test was 25 % MRI, ultrasound – 50 %. Performing paraaortic lymphadenectomy with the greatest possible to individualize treatment policy and, as a consequence, to improve the results of combined treatment of patients with locally-common forms of cervical cancer. The use of laparoscopic approach, given the short period of rehabilitation, has not led to the postponement of chemoradiotherapy.

977P - Prognostic Factors after Conservative Treatment of a Large Series of "Stage I" Serous Borderline Ovarian Tumors

ABSTRACT Objectives The aim of this study was to evaluate the prognostic factors of recurrence after conservative treatment of a large series of “apparent” stage I serous borderline ovarian tumors (SBOT). Methods A review of 119 patients treated conservatively between 2000 and 2010 with data on the follow-up. All pathological slides were reviewed by the same expert pathologist. Prognostic factors of recurrences were studied (age, histologic subtypes, surgical procedures used … ). Results Conservative procedures were: unilateral cystectomy/UC (n = 43; 36%); unilateral salpingo-oophorectomy/USO (n = 50; 42%); bilateral cystectomy (n = 11; 9%) and USO + CC (n = 15; 13%). Fourteen patients underwent complete peritoneal staging. Stages distributions were: IA (n = 80; 67%); IB (n = 18; 15%) & IC (n = 21; 18%). Twenty-six patients had bilateral tumors. Respectively 21 (18%) & 13 (11%) had stromal microinvasion and/or micropapillary pattern. With a median follow-up of 45 months, 40 (33%) patients recurred (in whom 10 had peritoneal recurrence under the form of non invasive implants during the 1st recurrence). Two of these 40 recurrent patients had evolution in the form of invasive recurrence (during the 2nd or 3rd recurrence): 1 in remaining ovary & 1 in the peritoneum. None patient died from disease. Only 2 prognostic factors of recurrence were identified in multivariate analysis: the young age of the patients ( Conclusions In this series (representing the largest series reported of conservative management of stage I SBOT), the risk of recurrence is not related to the histologic patterns of the tumor (micropapillary, stromal microinvasion) nor to the surgical procedures used (type of conservative approach, the use of staging surgery, the use of laparoscopic approach). The rate of invasive recurrence is very rare in stage I SBOT (2 cases in this series). Young age ( Disclosure All authors have declared no conflicts of interest.

Évolution de la prise en charge chirurgicale des pathologies prostatiques : analyse nationale du codage

Prostatic diseases are very important in urologist's practice. We wanted to study evolution of prostatic procedures using French national coding database. We searched the Agence Technique d'Information sur l'Hospitalisation (ATIH) web server for prostatic procedures between 1997and 2011for both private and public sectors. The procedures were more often performed in private sector (up to 70%). There was a sustained increase (+332%) of the number of prostatectomies between 1997and 2007 (more than 27,000procedures), followed by a slight decrease. There is a rising use of laparoscopic approach from 35% in 2006up to 58% in 2011. The use of brachytherapy and HIFU was marginal. Transurethral resection of the prostate number was stable between 56,000and 60,000procedures a year (for cancer for less than 7%). Adenomectomies number decreased from 9832to 7963procedures a year. The most noticeable data were upon prostatectomies number, with a peak effect in 2007. Laparoscopic procedures were more and more frequent. TURP number was stable, whereas adenomectomies number decreased.

Laparoscopy in the public health system in Ecuador: an evaluation of the status quo and the education in minimally invasive surgery

The following study describes the use of laparoscopic surgery in the public hospitals of the Ecuadorian ministry of public health in Quito, Ecuador in the year 2008. The aim of the present study was the description of the recent situation of laparoscopic surgery in the public sector of the Ecuadorian capital, the level of training and education of laparoscopists, and the determination of missing factors in the educational programs in minimally invasive surgery in Ecuador. We analyzed the use of laparoscopic approach in correlation to the specialty and the diagnosis. The results revealed that in many diagnoses, the standard surgical approach still is the laparotomy. The discrepancy between general surgery, gynecology, and urology in the use of minimally invasive surgery in the public health system shows the different educational levels and the need of training programs at university level and in the hospitals especially in gynecology.