Although we need to evaluate the long-term outcomes, our procedure is considered technically feasible, safe, and useful for the resection of gastric submucosal tumors located near the esophagogastric junction.

After considerable experience with laparoscopic cholecystectomy (LC) using four ports, we began using three-port LC in October 1993 and have performed 130 LCs with this procedure up to May 1996. The procedure was successful in 119 patients. In 6 patients fourth port was used, and in another 5, the procedure was converted to open laparo-tomy. Cooperative manipulation of the surgical instruments between the operator and assistant is very important for this procedure, for exposing Calot's triangle and dissecting the gallbladder from the gallbladder bed. The use of an ultrasonic aspiration system (Sumisonic ME 2400; Sumitomo Bakelite, Tokyo, Japan) made it easier to identify the cystic duct and artery, especially in patients with chronic inflammation or dense adhesions. We encountered no problems with cannulation into the cystic duct for intraoperative cholangiography, and there were no intra- and postoperative complications in this series. We achieved good results, similar to those achieved with the four-port technique. This technique is technically feasible and safe, and it has esthetic and cost advantages compared with the four-port technique. However, the operator who performs three-port LC should not hesitate to add another port, or to convert to open laparotomy, whenever any difficulties occur during this procedure, to prevent critical complications.

No abstract

After experience in laparoscopic cholecystectomy and improvement of laparoscopic instruments, we attempted laparoscopic resection of benign nonepithelial gastric tumors using Endo-GIA. We achieved successful results with this procedure in 2 cases. There were no intra- and postoperative complications. For both patients there was no recurrence during the follow-up period (3.3 and 1.5 years). The important points of this approach are confirmation of the location of the tumor by both gastroendoscopy and laparoscopy, proper selection of the trocar site for insertion of the Endo-GIA, and secure grasping and lifting of the gastric wall, including of the tumor. We conclude that this procedure is technically feasible, safe and useful for benign nonepithelial gastric tumors.

An improved technique for performing laparoscopic repair of an abdominal hernia is described herein. To ensure a successful repair, it is most important that adequate tension of the expanded-polytetrafluoroethylene (e-PTFE) patch be achieved, and that the defect be completely covered and securely stapled. Our technique involves tacking the four corners of the patch to the abdominal wall with a 2-0 nylon suture using a straight needle, then stapling it to the anterior abdominal wall over the defect with a laparoscopic stapler. We believe that this technique is a safe and reliable method which will prove useful for laparoscopic surgery.