Hybrid transvaginal cholecystectomy is a good surgical model for minimally invasive surgery, a combination of NOTES and minilaparoscopy. It can be performed in surgical settings where laparoscopy is practised regularly, using the instruments normally used for endoscopy and laparoscopic surgery. Owing to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.
NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.
BACKGROUND: Lynch syndrome (LS) is characterized by mismatch repair (MMR) deficiency. However, there is a group of patients where LS is suspected because of MMR deficiency but there is no germinal mutation in MMR genes.These patients are known as Lynch-like syndrome (LLS) and there is no consensus about their management. The aim of this study is to describe a large series of LLS patients and to analyze if there are clinical, pathology or molecular differences in patients with suspected hereditary or sporadic origin.METHODS: Patients with colorectal cancer (CRC) were included in a national registry when their tumors show immunochemical loss of MSH2, MSH6, PMS2 or loss of MLH1 with BRAF-wild type and/or no MLH1 methylation and absence of pathogenic mutation in these genes. Demographic, clinical and pathological variables, as well as family history of neoplasms were registered. RESULTS: We included 160 patients with LLS. Mean age at diagnosis of CRC was 55 years. A total of 66 patients were female (41%). Amsterdam I and II criteria were fulfilled by 11%, revised Bethesda guidelines by 65% of cases and 24% were diagnosed because of universal screening. There were no differences in sex, indication for colonoscopy, immunochemistry, pathology findings or personal history of CRC or other LS related tumors between patients fulfilling Amsterdam or Bethesda guidelines and patients diagnosed because of universal screening of LS without family history.
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