[Videolaparoscopic cholecystectomy in the obese patient].

The difficulties which arise when performing VLC in obese patients primarily concern the induction of pneumoperitoneum and the use of normal surgical instruments. This is due to the thickness of the abdominal wall and the scarce anchorage of the cutis and subcutis to the musculo-fascia level. Two technical variations of pneumoperitoneum are proposed in order to overcome the first problem, whereas with regard to the latter the authors suggest moving the trocar insertion points towards the site of the gallbladder.

[Retroperitoneal paragangliomas. Considerations on a internephro-caval case].

A case of paraganglioma situated between right renal vein, right renal artery and inferior vena cava is here with described. The report constitutes the rise to frame with precision the tumor according with WHO classification. Moreover criteria are to be discussed for nature and seat diagnosis, as well for the choice of the best way of access.

["Prophylactic" video-laparoscopic cholecystectomy].

The authors examine the prophylaxis of infections caused by cholelithiasis in kidney and heart transplant candidates as a new indication for videolaparoscopic cholecystectomy (VLC). The study included 6 patients in dialysis for chronic renal insufficiency and one patient suffering from cyanogenic congenital cardiopathy with asymptomatic gallbladder calculosis. The results obtained show that there are no substantial differences compared to patients without associated pathologies and justifies the inclusion of "prophylactic" VLC in preparatory treatment protocols for kidney and heart transplant in patients suffering from cholelithiasis.

[Transrectal polypectomy using a TEM (transanal endoscopic microsurgery) technique].

The paper describes the removal of a broad-based tubulo-villous adenoma from the middle rectum using a transanal endoscopic microsurgical technique. This procedure, which was introduced by Buess, Thess and Hutterer in 1983, represents an alternative to the classic transanal technique, compared to which it is more accurate, and to the trans-sacral and transperitoneal methods compared to which it is less invasive.

[Proctological surgery in the day-hospital regimen].

567 haemorrohoidectomies 83 of which total haemorrhoidectomies for piles with surgical indications, were performed with recourse to day-hospital admission. The authors examine the results of this experience and advise this therapy and this type of admission for pathologies with different cost/benefit ratio.