Department of General Surgery, University of Pernambuco (UPE), Faculty of Medical Sciences, Recife, Brazil (Dr. Carvalho, and Mr. GÓES) and Clinica Cirurgica Videolaparoscopica, Recife, Brazil (Dr. Carvalho).
State Servers Hospital, Recife, Brazil (Dr. Lima).
Minimally Invasive Surgery Program, Getulio Vargas Hospital, Recife, Brazil (Dr. Silva).

ABSTRACT

Introduction: Nonparasitic splenic cyst (NPSC) is a rare disease of the spleen and is categorized as a true or pseudocyst. Traditionally, the management of NPSC is partial or total splenectomy by laparotomy; however, minimally invasive surgery has shown efficacy in the treatment of this disease and is currently considered the gold standard treatment.

Case Description: This study reports an 11-year-old female patient who was diagnosed with a splenic cyst 10 cm in diameter. A sonographic scan showed a giant splenic cyst (10 8.8 7.6 cm). After diagnosis, the patient was completely asymptomatic and underwent periodic sonograms, which showed the lesion to be of constant size. This finding was confirmed by a computed tomographic scan of the abdomen. Then, the patient developed recurrent episodes of pain in the left upper quadrant. Three low-friction 3-mm minilaparoscopic trocars and an 11-mm port in the umbilical region for the insertion of the optics were used in this procedure. The cyst was punctured and its contents completely aspirated. It was then resected carefully by electrocautery in its margins, preserving as much splenic tissue as possible.

Conclusion: The minilaparoscopic approach is a safe and effective technique for this procedure.

Key Words: Minilaparoscopy, Splenic cyst.

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Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York (all authors).

ABSTRACT

Introduction: Abdominal mesenteric cystic lymphangiomas are congenital lymphatic malformations found most commonly within the small bowel mesentery, omentum, and mesocolon. These lesions may be detected incidentally on imaging studies or may present with bowel obstruction. Treatment of choice is surgical enucleation with possible segmental intestinal resection.

Case Description: This report describes the use of minilaparoscopy in the treatment of abdominal mesenteric cystic lymphangioma (MCL) in a child, along with a review of the current literature on laparoscopic treatment. Our patient, who had a prenatal diagnosis of an intra-abdominal mass, had developed postprandial emesis. Imaging work-up with ultrasonography and CT scan revealed an intra-abdominal mass suspicious for lipomatous tumor. The patient underwent minilaparoscopy-assisted resection of the intra-abdominal mass, along with the resection of small bowel that was adherent to the tumor. The final pathology showed that the mass was an MCL.

Discussion: The traditional treatment for MCL has been open surgical resection. Recently, laparoscopic surgical excision of mesenteric cysts in children has been reported in the literature.

Key Words: Abdominal mesenteric cystic lymphangioma, Minilaparoscopy

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Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal (all authors). ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, Portugal (all authors). Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal (Dr Ferreira). Department of Obstetrics and Gynecology, Hospital de Braga, Braga, Portugal (Dr Nogueira-Silva). Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal (Dr Correia-Pinto).

ABSTRACT

Background: The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in gynecological oncology, namely in cervical and endometrial malignancies. Therefore, we assessed the feasibility of SLN identification, dissection, and harvesting by using minilaparoscopic surgical instruments in an animal model. We compared the minilaparoscopic approach, which is known to bring important advantages, with the use of conventional laparoscopic instruments.

Methods: Two groups of 7 female pigs were enrolled in this experiment that was performed by the same surgical team. In group A, all animals were approached by a similar minilaparoscopic surgical instrumentation, namely a 5-mm 30° endoscope (supraumbilical port) and 3 ancillary 3.5-mm trocars. In group B, a 5-mm conventional laparoscopic instrument set was used. The patent blue (4.0 mL) was injected on the paracervical region. The time for SLN coloring, identification, localization, dissection, and excision, as well as complications were recorded. The sealing of the lymphatic vessels was observed in the 2 groups. During this experiment, and for the both groups, the Trendelenburg position was kept the same, as well as the carbon dioxide–pneumoperitoneum pressure. Finally, a laparotomy was then performed to evaluate whether any stained SLN still remained.

Results: All endoscopic procedures were performed without major complications. SLN were identified and excised in all animals in both groups. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times, from skin incision to SLN removal, was 28.4 ± 5.6 minutes for minilaparoscopy and 25.3 ± 6.8 minutes for conventional laparoscopy (P=.36). In group B, 1 stained SLN remained and was only detected by laparotomy.

Conclusions: We confirmed the feasibility of the minilaparoscopic surgical approach for identification, dissection, and excision of SLN, as well as for sealing the lymphatic vessels that supply the nodes. This procedure might be considered a potentially better alternative to reduce morbidity during staging procedures for gynecological malignancies.

Key Words: Gynecology, Instrumentation, Malignancy, Minilaparoscopy, Sentinel lymph node, Surgery

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