Total extraperitoneal (TEP) hernioplasty with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia.

We describe the first clinical case of a total extraperitoneal hernioplasty combined with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia. The patient was a 94-year-old woman admitted to the emergency room with signs and symptoms of acute small bowel obstruction. Diagnosis of a strangulated left Richter femoral hernia was only possible during the initial exploratory laparoscopy.

Single-incision laparoscopic cholecystectomy for day surgery procedure: are we prepared?

Single-incision laparoscopic surgery (SILS) for cholecystectomy is a well-established procedure and represents the next step in developing the concept of fast track surgery. This report describes our experience with SILS cholecystectomy in patients that stay overnight. Between February 2009 and July 2010, patients referred for cholecystectomy to the day surgery unit who agreed to undergo SILS were included in a prospective study.

Single-incision versus standard laparoscopic cholecystectomy: comparison of surgical outcomes from a single institution.

Background: Laparoscopic cholecystectomy via the three-trocar technique is widely used for symptomatic gallbladder stones. Single-incision laparoscopic surgery (SILS) for cholecystectomy is a well-established procedure and represents the next step in developing the concept of mini-invasive surgery. We here described our 24-month experience SILS cholecystectomy.

Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option.

Background: At the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or purulent or gangrenous acute appendicitis requiring intra-abdominal drainage is avoided.

Laparoendoscopic single-site cholecystectomy: a safe and reproducible alternative.

Background: Laparoscopic cholecystectomy via the three-trocar technique is widely used for symptomatic gallbladder stones. In this article, we describe the initial experience with laparoendoscopic single-site surgery (LESS) cholecystectomy.

Patients And Methods: Between February and April 2009, patients referred for cholecystectomy to the General Surgery Unit of our institution who agreed to undergo LESS were included in a prospective study.

Laparoendoscopic single-site surgery appendectomy.

Background: Laparoscopic appendectomy via the three-trocar technique is widely used for appendectomy. This report describes the initial experience with laparoendoscopic single-site surgery (LESS) appendectomy.

Methods: Between December 2008 and March 2009, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors' institution who agreed to undergo LESS appendectomy were included in a prospective study.

[Factors associated with patient satisfaction and care of over 65 year olds in emergency departments].

Introduction: The population over 65 years old represents 40-50% of the all visits made to an emergency department (ED). Some situations of stress and dehumanization can occur due to user overflow. Our target is to identify factors influencing overall satisfaction of patients older than 65 attended in the ED, in order to identify points of conflict and improve the deficiencies in our care.

Retroperitoneal approach in laparoscopic adrenalectomy: is it advantageous?

Recently, the retroperitoneal laparoscopic approach has been described as advantageous in avoiding the respiratory and hemodynamic effects of CO2 pneumoperitoneum and giving direct access without the need to move abdominal organs. Forty-two laparoscopic adrenalectomies (LpA) were performed in 36 patients with a variety of adrenal disorders, including 9 patients with nonfunctioning tumors, 11 patients with aldosterone adenoma, 10 patients with Cushing's adenoma, and 6 patients with Cushing's disease. Twenty-two adrenalectomies were performed using the transperitoneal approach (TLpA), and 20 via the retroperitoneoscopic approach (RLpA).

Laparoscopic surgery for treatment of splenic disorders: an update.

Laparoscopic splenectomy is a feasible and safe technique in the hands of skilled laparoscopic surgeons. The special characteristics of the spleen, a fragile solid organ with a rich vascularization, pose a number of technical questions (patient position, organ mobilization and retrieval) which have been successfully resolved during the last few years and permit the advantages of laparoscopic surgery to become available to patients that need splenectomy.

Total bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome and multiple endocrine neoplasia (IIa).

Background: The benefit of simultaneous bilateral laparoscopic adrenalectomy in patients with Cushing's syndrome and pheochromocytoma associated with multiple endocrine neoplasia (MEN) is unknown.

Methods: Ten patients underwent laparoscopic adrenalectomy (LpA) with CO2 pneumoperitoneum for Cushing's syndrome. One MEN patient underwent simultaneous bilateral laparoscopic adrenalectomy with helium pneumoperitoneum for bilateral pheochromocytoma.

Laparoscopic unilateral and bilateral adrenalectomy for Cushing's syndrome. Transperitoneal and retroperitoneal approaches.

Objective: This prospective randomized study compares the safety and efficacy of transperitoneal laparoscopic adrenalectomy (TLPA) and retroperitoneal approach (RLPA) in obese patients with Cushing's syndrome.

Summary Background Data: Recently, a retroperitoneal laparoscopic approach has been described with benefits of avoiding the respiratory and hemodynamic effects of carbon dioxide (CO2) pneumoperitoneum and giving direct access without the need to mobilize abdominal organs.

Methods: Twenty-one adrenalectomies were performed in 9 patients (2 men, 7 women; mean age, 46.

Does hormonal function of the tumor influence the outcome of laparoscopic adrenalectomy?

Background: Patients with hypertension, with catecholamine hypersecretion, and with cortisol excess may associate intraoperative cardiovascular instability and postoperative complications.

Methods: To compare the outcome of laparoscopic adrenalectomy (LpA) in patients with aldosterone adenoma (11), Cushing's adenoma (six), Cushing's disease (four), pheochromocytoma (Pheo) (11), and nonfunctioning tumor (five). Intra- and postoperative parameters were studied and in patients with Pheo intraoperative catecholamine plasma levels were correlated with cardiovascular derangements.

Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion.

This study compares the outcome of laparoscopic adrenalectomy (LpA) in 23 patients using CO2 insufflation with the outcome of this procedure in another 8 patients with pheochromocytoma (7 unilateral, 1 bilateral) using helium for pneumoperitoneum. The adrenal lesions in the first group included nonfunctional adenoma (n = 3), aldosterone adenoma (n = 11), Cushing's adenoma (n = 6), and Cushing's disease (n = 3). The latter patients were compared with a third group of 8 patients with pheochromocytoma undergoing conventional transabdominal adrenalectomy (CTA).

Pheochromocytoma: laparoscopic approach with CO2 and helium pneumoperitoneum.

A number of different surgical approaches have been devised for adrenalectomy in patients with pheochromocytoma. The anterior transabdominal approach was at one time considered a source of postoperative morbidity; the advent of laparoscopy however, may result in a resurgence in its use. The laparoscopic approach was used with a CO2 pneumoperitoneum in one patient with a left pheochromocytoma, and using a helium pneumoperitoneum in another with bilateral pheochromocytoma.

Technical aspects of adrenalectomy via operative laparoscopy.

Adrenalectomy is usually performed through a transabdominal or a posterior approach. These approaches are associated with a painful syndrome postoperatively and long hospital stay. We report a series of five successful laparoscopic adrenalectomies, performed on: a 35-year-old male with a 5-cm right nonfunctioning tumor; a 32-year-old female with a 1.

Immunocytochemical study of pancreatic islet revascularization in islet isograft. Effect of hyperglycemia of the recipient and of in vitro culture of islets.

We studied the revascularization process of isogeneic islets grafted into the kidney subcapsular space of streptozotocin-induced diabetic and nondiabetic rats by a double-labeling, indirect immunofluorescence technique using a rabbit antiserum to human factor VIII-related antigen (which identifies endothelial cells) and a guinea pig anti-insulin antiserum (which labels pancreatic beta cells). Freshly isolated islets contained a network of capillary endothelial cells, whereas 1-week-cultured islets at 37 degrees C have completely lost their intra-islet endothelial cells. Overnight cultured islets contained only occasional endothelial cells.

Laparoscopic approach to the adrenal tumors.

Over the years, a number of different surgical approaches to the adrenal glands have been devised. The anterior transabdominal approach is considered to be a source of postoperative morbidity. However, this conviction can be changed.