Severe hemobilia from hepatic artery pseudoaneurysm.

Background. Hemobilia is a rare, jeopardizing complication of laparoscopic cholecystectomy coming upon usually within 4 weeks after surgery. The first-line management is angiographic coil embolization of hepatic arteries, which is successful in the majority of bleedings: in a minority of cases, a second embolization or even laparotomy is needed.

Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival.

Background: The purpose of this study is to assess outcomes and 5-year survival after subtotal gastrectomy (SG) for early and advanced distal adenocarcinoma with D2 dissection performed by minimally invasive surgery (MIS).

Methods: From June 2000 to October 2009 a total of 70 patients with adenocarcinoma of the lower third of the stomach underwent SG with D2 nodal clearance by MIS. This series enrolled 37 patients with early gastric cancer (EGC) and 33 with advanced gastric cancer (AGC).

Laparoscopic repair of incisional hernias located on the abdominal borders: a retrospective critical review.

Background: The aim of this study was to assess feasibility and results of laparoscopic approach to repair incisional hernias of the abdominal borders, the weakest points of abdominal wall.

Methods: Since 2002 through 2008 a total of 39 patients with fascial defects of the abdominal borders underwent laparoscopic repair. The defects were suprapubic (n=18), subxiphoidal (n=15), and lateral sided (n=6).

Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases.

Purpose: Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that aims at reducing or abolishing skin incisions and potentially also postoperative pain. The purpose of this study was to analyse operative and long-term results of a series of hybrid transvaginal cholecystectomy.

Materials And Methods: Between July 2007 and May 2009, transvaginal NOTES cholecystectomy for symptomatic cholelithiasis was performed by a hybrid technique in 18 women (mean age 54 years), including four women with a body mass index >30 kg/m(2).

Laparoscopic resection for rectal adenocarcinoma.

Aims: Laparoscopic surgery for rectal cancer is still under discussion, but there is evidence that minimal access surgery can be feasible and safe also in this field. The aim of this study was to confirm that laparoscopic resection for rectal cancer can afford good results in terms of recurrence rate and survival.

Patients And Methods: Since June 1998 through December 2007 as many as 252 patients underwent laparoscopic resection for rectal cancer.

[The model of the Niguarda Hospital Trauma Team in Milan].

The aim of this work was to describe the model and clinical results obtained by the Niguarda Trauma Team referral center for major trauma, in Milan. The Trauma Team is organized as a trauma service, where general surgeons, anesthesiologists, orthopedic surgeons and neurosurgeons work on a 24 hour rotation. When not in duty in the rotations, specialists work in their specific elective activities.

Robot-assisted laparoscopic gastrectomy with D2 dissection for adenocarcinoma: initial experience with 17 patients.

Robot-assisted gastrectomy has been practised so far in very few centres in the world. The aims of this study were to assess the feasibility of robot-assisted gastrectomy for adenocarcinoma with D2 lymph nodal dissection and to analyze our preliminary results. Between January 2006 and August 2008, as many as 17 patients (11 females, 6 males) underwent laparoscopic robot-assisted surgery for non-metastatic adenocarcinoma of the stomach by a 3-armed da Vinci(®) Robotic Surgical System.

Laparoscopic management of incisional hernias > or = 15 cm in diameter.

Background: Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial.

Methods: Between 2002 and 2008 as many as 36 patients with abdominal wall defects > or = 15 cm were managed laparoscopically in our institution. The wall defects were > or = 20 cm in eight cases.

Laparoscopic distal pancreatectomy: a retrospective review of 14 cases.

Although the role of minimally invasive techniques in pancreatic surgery remains controversial, resection of the left pancreas for benign or endocrine lesions has been universally adopted as a routine technique over the last few years. This study was undertaken to assess feasibility and safety of minimal access resections of distal pancreas in benign, endocrine, and malignant diseases. Operative time, conversion rate, adequacy of dissection, respect for oncologic principles, morbidity rate, and short-term outcomes were analyzed.

Transvaginal endoscopic cholecystectomy in human beings: preliminary results.

Introduction: The exciting concept of performing surgery in the peritoneal cavity without abdominal incisions by means of flexible endoscopes introduced through natural orifices-natural orifice transluminal endoscopic surgery (NOTES) has been widely investigated in recent years in experimental settings. However, experience with this procedure in human beings is still lacking. In this paper, we report the preliminary results of a small consecutive series of transvaginal endoscopic cholecystectomies.

[Video-laparoscopic excision of pancreatic insulinoma. Experience with 3 cases].

Laparoscopic treatment of lesions of the distal pancreas has gained favour worldwide in the last decade. The objective of this study was to analyze 3 cases of insulinoma successfully treated with the laparoscopic approach. From 2000 to 2007 in our institution 3 patients with insulinoma of the left pancreas were treated with a laparoscopic approach.

Outcomes and survival after laparoscopic gastrectomy for adenocarcinoma. Analysis on 65 patients operated on by conventional or robot-assisted minimal access procedures.

Aims: Despite laparoscopic surgery for gastric cancer has gained worldwide acceptance, long term results and survival are seldom reported. This study was designed to assess long term outcomes after laparoscopic gastrectomy with D2 dissection. The short term results of conventional and robot-assisted minimally invasive procedures were also examined.

Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases.

The role of laparoscopic techniques in pancreatic surgery is still controversial especially regarding to exocrine malignancies. Operative time, conversion rate, adequacy of dissection, and morbidity do represent factors of major concern. Whereas laparoscopic resection of left sided pancreatic lesions requires no anastomosis and therefore has gained worldwide acceptance over the last years, excision of cephalic lesions by mimimal access has little place in surgeons' practice because of its technical complexity and duration of surgery.

Laparoscopic repair of incisional hernia: Outcomes of 100 consecutive cases comprising 25 wall defects larger than 15 cm.

Background: Minimal access surgery for incisional hernia repair is still debated, especially for large and giant wall defects. This study was undertaken to analyze the results of the use of the laparoscopic technique in incisional hernias smaller and larger than 15 cm of diameter.

Method: From 2002 to 2007 a total of 100 patients with incisional hernia were operated on by laparoscopy and were included in this study.

Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases.

Background: Laparoscopic excision of rectal tumors has gained favor in the last decade and several issues have reported encouraging results: still, the use of laparoscopy remains open to debate. The aim of the current study is to assess the reliability of laparoscopic anterior resection (LAR) for rectal cancer analyzing short-term outcomes and long-term survival.

Methods: The charts of 157 patients were reviewed retrospectively after anterior resection for rectal adenocarcinoma performed by minimal access.

Outcomes of laparoscopic adrenalectomy. Clinical experience with 68 patients.

The aim of this study was to analyze feasibility and outcomes of laparoscopic adrenalectomy (LA). Pathology, size and bilateral site of lesions were considered. Between December 1998 and May 2007 in our institution a total of 68 patients of mean age of 53 years underwent unilateral (n=57) or bilateral (n=11) LA.

Outcomes of laparoscopic Miles' operation in very low rectal adenocarcinoma. Analysis of 32 cases.

Aims: Minivasive techniques for excision of low rectal tumours have spread worldwide with good results, but their employment is still under discussion. The purpose of this study is to assess short term results and survival of laparoscopic abdominoperineal resection (LAPR) in very low rectal cancers.

Methods: The charts of 32 patients undergoing LAPR for very low rectal adenocarcinoma (0-2cm from dentata line) were reviewed retrospectively.

Total and subtotal laparoscopic gastrectomy for adenocarcinoma.

Background: Laparoscopic gastrectomies are currently performed in many centers, but compliance with oncologic requirements still represents a subject open to debate. The aim of this work was to compare the short-term and oncologic outcomes after laparoscopic and open surgery in gastric adenocarcinoma.

Methods: From June 2000 through June 2005, 147 patients in our institution underwent gastrectomy by open or mininvasive approach for adenocarcinoma.

Traumatic right atrial disruption with hepatic and splenic injuries: treatment by CPB-assisted laparotomy and sternotomy.

The Authors present a case of thoracoabdominal trauma from a road accident in a young woman who received care initially in a level II hospital. She was then transferred to a level I Trauma Centre with the onset of haemorrhagic shock due to haemopericardium and haemoperitoneum from liver injuries. A chest CT scan led to the suspicion of aortic dissection, hence a cardiopulmonary bypass (CPB) for life support was instituted just before laparotomy through the femoral vessels.

Laparoscopic splenectomy: A retrospective review of 75 cases.

Laparoscopic splenectomy (LS) is considered a safe procedure for spleens of normal size as well as for larger spleens. Seventy-five consecutive patients underwent LS. Splenomegaly was defined by diameter >15 cm and by weight >400 g.

[Liver trauma: experience in the management of 252 cases].

The treatment of liver traumas has evolved considerably over recent decades with the possibility of non-operative management and arteriographic embolisation for selected patients in haemodynamically stable conditions. The aim of the study was to compare two periods with different approaches to the management of blunt or penetrating liver injuries. From January 1989 to October 2004, 252 patients were admitted to the emergency surgery department of Niguarda Hospital in Milan for liver traumas.

[Nonoperative management of traumatic liver injuries].

Background: Nonoperative management (TNO) of traumatic liver injury is the choice in hemodinamically stable patients without other abdominal injuries requiring celiotomy, apart from liver injury grading and amount of free peritoneal blood. CT-scan and angiographic embolization availability increase TNO feasibility.

Aims: To investigate feasibility of TNO in 16-months period consecutive liver injuries.

[Splenectomy in haematologic diseases. Clinical indications and surgical technique].

After the introduction of corticosteroids fifty years ago the indications for splenectomy in benign haematological diseases became more controversial, also due to the morbidity and mortality associated at that time with open splenectomy. The advent of minimally invasive techniques has provided safe procedures for removal of the spleen in cases of benign as well as malignant haematological disease. Laparoscopic splenectomy has been performed for spleens of normal size or larger size or weight.