Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina (all authors).

ABSTRACT

Introduction: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has recently been introduced as a feasible strategy that allows complete resection with curative intention in selected patients with otherwise locally unresectable disease due to an insufficient future liver remnant. Minimally invasive surgery has shown several benefits over the open approach in different surgical areas, including liver resections, over the past 2 decades. We report a case of a pure laparoscopic ALPPS.

Case Description: A 73-year-old woman with a single hepatic metastasis from breast cancer was referred to our unit. She had been treated with radical left and right mastectomy 30 and 15 years before referral. Magnetic resonance imaging and positron emission tomographic computed tomography demonstrated a single hypermetabolic 68-mm tumor mass located in the right liver lobe without other systemic tumor dissemination. A laparoscopic right hepatectomy was scheduled, but due to unexpected tumor extension during surgical exploration and the need for a larger than planned liver resection, a pure laparoscopic ALPPS approach was performed. After a 41% future liver remnant hypertrophy, the patient underwent a laparoscopic completion surgery without any complications. She had a favorable recovery and was discharged on postoperative day 3. The histopathological analysis indicated multiple metastatic breast cancer with negative resection margins.

Discussion and Conclusions: Pure laparoscopic ALPPS is feasible and may be performed safely in experienced hands. Minimally invasive access may represent a good alternative to reduce the surgical impact of the ALPPS approach in terms of postoperative recovery in selected patients.

Key Words: ALPPS, Laparoscopic liver surgery, Laparoscopy, Liver malignancy, Minimally invasive surgery.

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ABSTRACT

Introduction: Using a commercially available multichannel port for single incision laparoscopic surgery (SILS) can be cost prohibitive to the development of this novel surgical technique. The use of a glove and Alexis wound protector allows laparoscopic surgeons to perform glove single incision laparoscopic surgery (G-SILS) at lower cost.

The post Gloved Appendectomy Performed With a Gloved Single Incision Laparoscopic Surgery Technique Versus Conventional Multiport Laparoscopic Technique first appeared on JSLS.

ABSTRACT

We herein report a rare case of gastric and regional lymph node metastasis of cutaneous malignant melanoma that underwent curative resection. The patient, a 68-year-old man, was first diagnosed as having cutaneous malignant melanoma of the right forearm in 2005. He had extensive skin excision and axillary lymph node dissection and had undergone adjuvant chemotherapy. Six years after the primary surgery, gastrointestinal endoscopy revealed gastric metastasis of a malignant melanoma. As there was no other metastasis found, laparoscopic-assisted distal gastrectomy with lymph node dissection was performed. Microscopic findings showed diffuse melanin granule growth invading the muscularis propria of the stomach. Micrometastases of the lymph nodes were observed that were not detected by preoperative examination. Seventeen months have passed without recurrence. We conclude that regional lymph node dissection should be performed with gastrectomy whenever distant metastases are not observed, because there is a possibility of micrometastases, which cannot be detected preoperativ

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Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway (Drs. Haugvik, Røsok, Edwin). Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Drs. Haugvik, Edwin). Department of Radiology and Nuclear Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway (Dr. Andersen). Interventional Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway (Dr. Edwin).

ABSTRACT

Introduction: Laparoscopic spleen-preserving distal pancreatectomy for tumors of the pancreatic body and tail is becoming increasingly established at hepato-pancreato-biliary surgical departments worldwide. Spleen preservation is only recommended in benign or borderline lesions of the pancreas. We present a rare complication after laparoscopic spleen-preserving distal pancreatectomy.

Case Description: A 43-year-old woman with multiple endocrine neoplasia type 1 syndrome was referred to our department for surgical removal of a tumor in the pancreatic tail. A laparoscopic spleen-preserving distal pancreatectomy, including preservation of the splenic vessels, was performed. The patient was discharged on the tenth postoperative day after percutaneous drainage of peripancreatic fluid and transient fever. About 4 months postoperatively, she was admitted to her local hospital with recurrent anemia. Gastroscopy and abdominal computed tomography did not show any signs of bleeding, but prominent gastric varices and occlusion of the splenic vein were observed. The patient was referred back to our department, where an embolization of the splenic artery was performed with a percutaneous endovascular technique. She was discharged after 2 days with no recurrent anemia thereafter.

Discussion: Splenic artery embolization can be an effective treatment option for gastric variceal bleeding caused by splenic vein occlusion after laparoscopic spleen-preserving distal pancreatectomy.

Key Words: Laparoscopic pancreatic surgery, Distal pancreatectomy, Splenic artery embolization, Left-sided portal hypertension, Gastric variceal bleeding.

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ABSTRACT

Powered laparoscopic staplers have entered the market in the last few years. We report the first case of a malfunction of a powered laparoscopic stapler during a laparoscopic nephrectomy for a nonfunctioning kidney. The complication was salvaged with further laparoscopic maneuvers by the surgeon without conversion or any further intraoperative complication. Powered laparoscopic staplers, like the nonpowered versions, are equally prone to device malfunction despite manual safety override mechanisms. Laparoscopic surgeons using these devices must be aware of this rare complication and possess the necessary skills to troubleshoot and overcome the problem without endangering the patient.

The post Powered Stapler Malfunction During Laparoscopic Nephrectomy first appeared on JSLS.

Introduction: We report a novel technique for the vaginal placement of a single-incision laparoscopic device to aid in the removal of pelvic and para-aortic lymph nodes in patients undergoing gynecologic cancer surgery.

Technique Description: Informed consent for laparoendoscopic single-site total hysterectomy and bilateral salpingooophorectomy with pelvic and para-aortic lymph node dissection was obtained. A single-incision laparoscopic device was placed through a 2.5-cm umbilical incision, and a total laparoscopic hysterectomy with removal of the ovaries and tubes was performed. Preoperative pathologic analysis showed a grade 2 endometrioid adenocarcinoma of the endometrium, and as a result, bilateral pelvic and para-aortic lymph node dissection was completed. To aid in the lymphadenectomy, an additional transvaginal single-incision laparoscopic device was placed. The procedure was completed in 221 minutes, with 125 minutes spent on the pelvic and para-aortic lymph node dissection. There were no intraoperative or postoperative complications. The amount of blood loss was 50 mL. There were 10 pelvic lymph nodes and 5 para-aortic lymph nodes removed, with no carcinoma detected. The patient tolerated the procedure well and was discharged home the next day.

Discussion: Placement of a second transvaginal port is a feasible technique that provides great flexibility and assistance for lymph node removal in gynecologic cancer surgery.

Key Words: Endometrial cancer, Laparoscopic surgery, Lymph node dissection, Laparoendoscopic single-site surgery.

The post Staging Endometrial Cancer first appeared on JSLS.

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The post Laparoscopic Diagnosis and Excision of a Giant Sigmoid Cystic Duplication first appeared on JSLS.

The post Laparoscopic Colectomy for Colon Cancer After Liver Transplantation first appeared on JSLS.

Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Beer Yaakov, Israel (Drs. Vaknin, Fuchs, Berger, Pansky; Smorgick). Department of General Surgery B, Assaf Harofe Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Beer Yaakov, Israel (Dr. Kais).

ABSTRACT

Introduction: Laparoscopic adjustable gastric banding (LAGB) is commonly used for the management of morbid obesity in women of reproductive age. This surgery was found to be safe and well tolerated during pregnancy, with a lower incidence of gestational diabetes and maternal hypertension than was found in control subjects. The most common complications of LABG include gastric perforation, band slippage, and port disconnection. We present an unusual complication of LABG during pregnancy.

Case Description: The patient is a 34-year-old pregnant woman who underwent LABG 3 years prior to her pregnancy and presented at 14 weeks’ gestation with acute left lower quadrant abdominal pain. Laparoscopy was performed for suspected adnexal torsion (based on clinical presentation and sonographic findings), revealing an entrapment of the left adnexum by the connecting tube of the LAGB device. The left adnexum was released with no residual complications.

Discussion: This complication, although rare, should be considered during early pregnancy.Key Words: Laparoscopic adjustable gastric banding, Pregnancy, adnexal torsion.

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