Laparoscopic radical subtotal gastrectomy for distal gastric cancer is a feasible and safe oncologic procedure with short- and long-term results similar to those obtained with an open approach. Additional benefits for the LG were reduced blood loss, shorter time to resumption of oral intake, and earlier discharge from hospital.
No significant difference was found in both patient groups regarding postoperative mortality and complications, biliary complications, and especially cystic duct leaks. A retrospective comparison of literature data showed that use of ultrasonic dissection during LC seems to reduce the risk of BDI. Nevertheless, a learning curve in the use of ultrasonic-activated devices is required: a significant differences in postoperative major complications and biliary complications between the expert and the surgeon-in-training subgroups was shown. Furthermore, ultrasonic scissors misuse may cause bowel injuries in patients with severe adhesions, and this could represent a possible limitation for surgical safety.
Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.
The authors present the rationale of the laparoscopic approach to liver surgery, showing the technique of fully endoscopic and endoscopic-assisted formal and wedge hepatic resections and the early results of their experience. From 1993 to 1997, 38 liver resections have been attempted through the laparoscopic or the laparoscopic assisted approach. Out of these 38 resections, 5 were wedge resections, 11 were segmentectomies, 10 were left formal hepatectomies, 1 was an extended left hepatectomy, 5 were bisegmentectomies, 5 were right formal hepatectomies, and 1 was an extended right hepatectomy. In two cases, one segmentectomy and one bisegmentectomy, the procedures were converted to open surgery. Wedge, segmental, and left liver resections were usually performed through a fully endoscopic approach, whereas right liver resections were accomplished by a video-assisted approach. In all but six cases, the resections were attempted for malignancy. There were no intra-operative deaths. One patient died on postoperative day-1 because of liver failure and severe coagulopathy. The early results are comparable to those of conventional surgery, with the benefits derived from minimal access surgery. Laparoscopic liver resections are technically feasible with an acceptable morbidity and mortality rate, but extensive experience in conventional liver surgery, advanced laparoscopic surgery, and the availability of all requested technology are indispensable prerequisites.
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