Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?

Abstract

Background and Purpose:Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results.Materials and Methods:We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015.Results:A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period.Conclusions:Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

Combined Retroperitoneal and Transperitoneal Laparoscopic Procedures by a Single Surgeon: Boon to Economically and Medically Backward Areas

“…Meininger et al opined that prolonged laparoscopic surgeries therefore be avoided in patients with cardiopulmonary morbidities [17]. None of our patients had any intraoperative hemodynamic instability Many authors were concerned of combining two or more procedures in a single surgery as it may prolong the operating time, increase the chance of blood loss and complications, and increased hospital stay [2][3][4]8,15,19]. Tsivian A and his colleagues, in 2009, described 19 patients who underwent concomitant laparoscopic kidney surgery and cholecystectomy and reported an acceptable duration of surgery in addition to efficacy and safety of the procedure [7].…”

“…They presented 12 cases of endoscopic pelvic lymphadenectomy in the Journal of Urology in the year 1991. Since then, gradually, laparoscopy has become an important part in the management of urological diseases [ 2 , 3 ]. Due to the availability of other minimally invasive procedures like laser lithotripsy, extracorporeal shock wave lithotripsy (ESWL), and retrograde intrarenal surgery (RIRS), the use of laparoscopic surgery in the management of urolithiasis is still negligible.…”

“…Simultaneous laparoscopic procedures for general surgical diseases have received good acceptance [3][4][5][6]. Many isolated case reports and case series of concomitant urological procedures or with other laparoscopic operations also had been documented [2,3,[6][7][8][9][10]. Though some authors have described a few cases, not much literature is available on the combination of retroperitoneal laparoscopic procedure with another transperitoneal laparoscopic procedure [3,9,10].…”

“…The first laparoscopic urological procedure was reported by Dr William Schuessler and his colleagues [ 1 ]. Since then, laparoscopic surgery in urology has gradually become a standard, safe, and effective armamentarium [ 2 ]. It has emerged as an advanced tool for the newer generation of urologists to treat various urological diseases [ 3 ].…”

“…There are multiple advantages of concomitant surgeries that include operation under single anesthesia, single and shorter hospital stay, decreased amount of medication and cost of two interventions, and, very importantly, reduced psychological stress for the patients [ 2 - 4 , 6 , 11 ].…”