Operative performance in laparoscopic cholecystectomy using the Procedural-Based Assessment tool.

Aims: The Intercollegiate Surgical Curriculum Project (ISCP) has devised assessment tools for index operations to assess trainee technical skills. In this study we used the Procedural-Based Assessment (PBA) tool to evaluate operations performed by trainees.

Methods: Live and simulated laparoscopic cholecystectomies were performed by trainees.

Stapled transanal rectal resection in solitary rectal ulcer associated with prolapse of the rectum: a prospective study.

Purpose: At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal prolapse seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demonstrated to successfully cure patients with internal rectal prolapse associated with rectocele, or prolapsed hemorrhoids. This prospective study was designed to evaluate the short-term and long-term results of stapled transanal rectal resection in patients affected by solitary rectal ulcer associated with internal rectal prolapse and nonresponders to biofeedback therapy.

Videolaparoscopic appendectomy: the current outlook.

Background: Mini-invasive techniques have revolutionized surgery, but the superiority of laparoscopic access for appendectomy is widely debated. The authors analyze their monocentric experience with 1,347 laparoscopic appendectomies.

Methods: Between October 1991 and December 2002, all the patients with an indication for appendectomy underwent surgery (301 emergency and 1,046 interval appendectomies) using the laparoscopic approach.

Tracheal sleeve pneumonectomy: long-term outcome.

Selected primary lung cancers less than 2cm from the carina or invading the tracheo-bronchial angle, formerly considered inoperable, can be amenable to tracheal sleeve pneumonectomy (TSP). Such a delicate technique, can entail remarkable post-operative morbidity and mortality, and only few clinical series are reported. Purpose of this paper is to examine complications and long-term survival of our personal series and those reported in literature.

Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature.

Background: Although more than 10 years have passed since the first video-assisted thoracoscopic lobectomies, these procedures have not gained widespread acceptance. We discuss the technical aspects and major problems associated with these operations, focusing on their present status and future perspectives. The results of our clinical series are presented and the relevant literature is reviewed.

Multimedia article. Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature, part 2.

Background: Although more than 10 years have passed since the first video-assisted thoracoscopic lobectomies, these procedures have not gained widespread acceptance. We discuss the technical aspects and major problems associated with these operations, focusing on their present status and future perspectives. The results of our clinical series are presented and the relevant literature is reviewed.

Long-term survival after videothoracoscopic lobectomy for stage I lung cancer.

Study Objectives: The aim of this study was to evaluate our personal experience and survival curves after video-assisted thoracic surgery (VATS) lobectomies for stage I lung cancer, in comparison with the results reported in existing literature.

Design: Retrospective analysis of our experience and an overview of literature.

Setting: Department of Surgery, San Giuseppe Hospital, University of Milan.

Non-small cell lung cancer with chest wall invasion: evolution of surgical treatment and prognosis in the last 3 decades.

Study Objectives: The treatment of patients with non-small cell lung cancer (NSCLC) that is invading the chest wall is still debated. We aim to illustrate the improvements in treatment results that have occurred over last decade.

Design: Retrospective analysis of our experience and an overview of the literature.

State of the art in thoracospic surgery: a personal experience of 2000 videothoracoscopic procedures and an overview of the literature.

Background: Herein we compare our personal experience with a series of > 2000 videothoracoscopic procedures with those reported in the literature to identify the procedures now accepted as the gold standard, those still regarded as investigational, and those considered unacceptable.

Methods: Between June 1991 and December 2000, we performed 2068 videothoracoscopic procedures, including lung cancer staging (n = 910), wedge resections (n = 261), lobectomies (n = 221), pneumonectomies (n = 6), the diagnosis and treatment of pleural diseases (n = 200), the treatment of pneumothorax (n = 170), giant bullae (n = 57), lung volume reduction surgery (LVRS) for emphysema (n = 41), the diagnosis and treatment of mediastinal diseases (n = 133), the treatment of esophageal diseases (n = 39), and 30 other miscellaneous procedures.

Results: A review of the literature indicates that videothoracoscopy is usually considered the preferred approach for the treatment of spontaneous pneumothorax, the diagnosis of indeterminate pleural effusions, the treatment of malignant pleural effusions, sympathectomy, and the diagnosis and treatment of benign esophageal or mediastinal diseases.

Major vascular injuries in laparoscopic surgery.

Background: Major vascular injuries (MVI) still occur in laparoscopic surgery.

Methods: We report our institution's experience of two MVI (aortic lesions) in a series of 3545 laparoscopies (July 1991-December 2000). We compared this experience with other series reporting MVI from Medline, Embase, Current Contents, and Best Evidence.

Thoracoscopy and transplantation: a new attractive tool.

Background: Transplanted patients on immunosuppressive treatment have an increased risk of infections or neoplasms. Transplantation candidates with infection or a suspected malignancy are excluded from transplantation. In patients already transplanted, thoracoscopy can resolve complications or treat the pulmonary pathology without compromising the precarious existing reactive equilibrium.

Complications of tracheal sleeve pneumonectomy: personal experience and overview of the literature.

Objectives: Tracheal sleeve pneumonectomy, although technically demanding, is considered the choice for tracheobronchial angle cancers. Complications in our 49 tracheal sleeve pneumonectomies are reviewed. Results, complications, and technical aspects are critically discussed.

Videothoracoscopic approach to primary mediastinal pathology.

Study Objectives: Personal results and validity of videothoracoscopic (VTS) approach to primary mediastinal diseases are analyzed.

Design: Retrospective review of personal experience.

Setting: Department of Surgery, San Giuseppe Hospital, University of Milano, Italy.

Techniques of pneumonectomy. Video-assisted thoracic surgery pneumonectomy.

Thoracoscopic major pulmonary resections such as lobectomies or pneumonectomies are the most difficult operations that can be attempted thoracoscopically, and still have limited routine application in thoracic surgical practice. The precise indications for thoracoscopic pneumonectomy are very rare and have not yet been defined precisely; we limited the procedure only to double tumors, small tumors infiltrating the fissure, and small tumors at the secondary carina not amenable to a bronchoplasty procedure. Although the technique still has very limited applications, the advantages include reduced surgical trauma and consequent minimal postoperative pain, a shortened hospital stay, and a rapid resumption of normal activities which ultimately reduces costs.

Video-assisted thoracoscopic surgery (VATS) major pulmonary resections: the Italian experience.

Videoendoscopic lobectomies or pneumonectomies are infrequently performed, mostly because of technical difficulties, concern for intraoperative accidents, and radicality in case of malignancy. The work diffusely describes technical details and a personal experience of videothoracoscopic major pulmonary resections (MPRs). All patients are first explored thoracoscopically.

Videothoracoscopic treatment of oesophageal leiomyoma.

Background: Oesophageal leiomyomas are usually so easily removed that thoracotomy seems out of proportion and thoracoscopic removal is therefore highly desirable.

Methods: Out of a total of 1003 thoracoscopic operations undertaken between July 1991 and December 1996, seven patients underwent thoracoscopic removal of oesophageal leiomyoma. All of them had been preoperatively studied by oesophagogastroscopy and computed tomographic scanning of the chest which had confirmed the presence of a lesion with benign features.

Endoscopic treatment of bronchopleural fistulas.

Background: Bronchial fistula is one of the most serious complications of pulmonary resection.

Methods: We present an endoscopic treatment that consists of multiple submucosal injections of polidocanol-hydroxypoliethoxidodecane (Aethoxysklerol Kreussler) on the margins of the fistula using an endoscopic needle inserted through a flexible bronchoscope.

Results: From 1984 to 1995, 35 consecutive nonselected patients with a postresectional bronchopleural fistula were treated.

Complications following cholecystectomy.

Laparoscopic cholecystectomy is considered the gold standard for cholelithiasis. Nevertheless possible complications must not be underestimated. In this department, from 1 July 1991 to 30 November 1995, 1005 patients with cholelithiasis underwent videocholecystectomy.

Major thoracoscopic operations: pulmonary resection and mediastinal mass excision.

After the great success of laparoscopy in the field of abdominal surgery, the mini-invasive approach has opened interesting new possibilities in the field of thoracic surgery too. At present, in many centres, thoracoscopy is the surgical approach of choice for the treatment of recurrent pneumothorax, giant bullous lung disease, peripheral benign lesions. In very few centres a new phase is now starting, having the objective of verifying the validity of more complex thoracoscopic surgical operations.

Videothoracoscopic operative staging for lung cancer.

The authors describe their experience in performing Videothoracoscopy as the first step of the operation in patients affected by lung cancer: they refer to this procedure as Videothoracoscopic Operative Staging (VOS). In 286 patients, already proposed for curative surgical resection on the basis of conventional staging, VOS was carried out in order to reach a conclusive judgement of resectability. VOS discovered unsuspected causes of inoperability in 17 patients (5.

Videothoracoscopic staging and treatment of lung cancer.

Videothoracoscopy, routinely performed as the initial step of an operation, opens interesting opportunities for both the operative staging and treatment of lung cancer. Videosurgical maneuvers ensure thorough exploration of the cavity, thus avoiding unnecessary exploratory thoracotomies, confirming resectability of the lesion by open or, in selected cases, by a direct video-assisted approach. We report our experience of 155 patients submitted to videothoracoscopic operative staging between October 1991 and January 1994.

Videothoracoscopic excision of mediastinal masses: indications and technique.

Mediastinal masses are generally excised through wide thoracotomies or median sternotomies. These lesions are often benign, usually asymptomatic, discovered incidentally, and relatively easy to resect. For these reasons, a minimally invasive approach is appropriate.

Major videothoracoscopic pulmonary resections.

Major pulmonary resections are generally performed through long thoracotomies which cause important functional and cosmetic sequelae. The progress in videoendoscopic surgery has allowed the authors to perform 31 pulmonary resections (28 lobectomies, 1 segmentectomy and 2 pneumonectomies) by thoracoscopic approach. Seven patients had benign pulmonary disease, 3 patients had pulmonary metastases and 21 cases suffered from a primary lung cancer TNM stage I.

Major pulmonary resections: pneumonectomies and lobectomies.

We report on our experience in 20 patients who underwent major thoracoscopic pulmonary resections between October 1991 and November 1992. These consist of 2 left pneumonectomies, 17 lobectomies, and 1 segmentectomy. The indications were strictly limited to benign pulmonary diseases and stage I (TNM) primary lung cancer.