Laparoscopy and Minimally Invasive Surgery

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Laparoscopic Appendectomy

 Laparoscopic Colectomy

Right Laparoscopic Colectomy Surgery.
Source: Scott and White, Dr Harry T PapaconstantinouJanuary 2011

Dr Jesus Esquivel: Laparoscopic CRS & HIPEC

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Minimally CRS and HIPEC in Patients with Limited Disease



Dr Jesus Esquivel, and his colleagues at St. Agnes Hospital in Baltimore, MD, is reporting on their initial evaluation of the feasibility and safety of laparoscopic (minimally invasive) cytoreductive surgery (CRS) and HIPEC.The majority of patients who participated in this study were initially diagnosed with appendiceal malignancies, with low-tumor volume and no small bowel involvement mainly from. Ann Surg. 2011 Jan 6.

Abstract

INTRODUCTION: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being widely used in the treatment of patients with peritoneal surface malignancies. The open procedure has been associated with high grade III and IV morbidity and prolonged hospitalization.

METHODS: Patients with peritoneal surface malignancies and no gross evidence of carcinomatosis on the computed tomographic scan were enrolled to undergo laparoscopic CRS and HIPEC. We aimed to assess the feasibility, safety, and outcome of this procedure. Postoperative complications were reported according to the National Cancer Institute Common Toxicity Criteria.

RESULTS: From October 2008 to January 2010, 14 patients were enrolled into the protocol. Amongst these 14 patients, one patient was found with extensive carcinomatosis at the time of laparoscopy and had no surgical procedure. Thirteen patients had a complete cytoreduction and HIPEC, 10 (77%) laparoscopically and 3 (23%) were converted to an open procedure. There was one grade 3 morbidity (10%) and one patient (10%) in the laparoscopy group experienced a grade 4 complication, needing a reoperation for an internal hernia. Mean length of hospital stay was 6 days for those completed laparoscopically, 8 days for those converted to an open procedure and 8 days for a matched cohort of patients with an upfront open procedure.

CONCLUSIONS: This initial investigative stage demonstrates the feasibility and safety of cytoreductive surgery and HIPEC via the laparoscopic route in selected patients with low-tumor volume and no small bowel involvement mainly from appendiceal malignancies. Longer follow-up and additional studies are required to evaluate its long-term efficacy.

Laparoscopic Removal of Giant Abdominal Cyst

Mesenteric cyst
(graphic, full color video)

Laparoscopy Minimally Invasive Appendectomy

Source: Dr Naveen Alexander, Aug 2010
(graphic full color video)