Preoperative planning of surgery for deeply infiltrating endometriosis using the ENZIAN classification.

Objective: To use the ENZIAN classification for preoperative estimation of laparoscopic operating time in patients with deeply infiltrating endometriosis (DIE).

Study Design: Retrospective study of women with DIE (n=151) who underwent laparoscopic surgery.

Results: 151 of 470 patients had DIE (n=205 lesions) exclusively in compartments A (rectovaginal septum, vagina), B (sacrouterine ligament to the pelvic wall) and C (rectum, sigmoid colon).

Conversion in laparoscopic cholecystectomy in low versus high-volume hospitals: is there a difference?

Background: Contraindications to laparoscopic cholecystectomy (LC) have diminished over the last decade but still conversion rate is about 5% to 6% in elective cases and higher in acute cholecystitis.

Aim: The aim of this study was to analyze whether the conversion rate is related to low (100 LC/y) versus high-volume hospitals (HVHs; >300 LC/y).

Methods: From 1999 to 2004, operations were performed in a low-volume hospital (LVH) and a HVH, divided into 3 groups: primary open cholecystectomy (OC), LC, and conversion (CC).

EAES recommendations on methodology of innovation management in endoscopic surgery.

Background: Under the mandate of the European Association for Endoscopic Surgery (EAES) a guideline on methodology of innovation management in endoscopic surgery has been developed. The primary focus of this guideline is patient safety, efficacy, and effectiveness.

Methods: An international expert panel was invited to develop recommendations for the assessment and introduction of surgical innovations.

Lessons learned from the analysis of 200 laparoscopic sigmoid resections for diverticulitis.

Introduction: Since the beginning of laparoscopic surgery indications for laparoscopic colon resections are still discussed controversively. In the latest studies benefit for laparoscopic approach is reported. The aim of this study was to evaluate the feasibility of laparoscopic sigmoid resections for diverticulitis regarding conversion rate, operation time and intraoperative and postoperative complications, and defining strategies to prevent complications.

Sentinel node mapping performed before preoperative chemotherapy may avoid axillary dissection in breast cancer patients with negative or micrometastatic sentinel nodes.

Background: Sentinel node (SN) biopsy after preoperative chemotherapy (PC) in breast cancer patients is associated with a lower identification rate (IR) and an increased false-negative rate (FNR) compared with SN biopsy in untreated patients. Our aims were to examine the feasibility of SN mapping before PC and the possibility to assess the lymph node status after chemotherapy through a follow-up lymphatic mapping.

Methods: SN biopsy was performed in 45 clinically node-negative breast cancer patients before PC.

NOTES--A new era?

Background/aims: After the first reports from the United States and India of accessing the peritoneal cavity via a transgastric route and performing operations without any abdominal incision, surgeons, as well as gastroenterologists worldwide, became interested in developing research projects in this topic. We evaluated the first papers and reports about the research and new techniques to focus on the possible advantages of NOTES (Natural Orifice Translumenal Endoscopic Surgery).

Methodology: The literature was screened in the time period January 2000 to June 2007 for research and development in NOTES and several reports and abstracts from the year 2007 (January to June) were reviewed.

Lifting of the umbilicus for the installation of pneumoperitoneum with the Veress needle increases the distance to the retroperitoneal and intraperitoneal structures.

Background: In laparoscopy, 50% of all complications occur during establishment of the pneumoperitoneum. Elevation of the fascia is recommended for the Veress needle approach, although the benefit has not been proved to date. This study aimed to evaluate the intraabdominal changes during lifting of the fascia with regard to the distance from the fascia to the retroperitoneal vessels and the intestine for access in laparoscopy.

Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer.

Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36).

A 14-year analysis of laparoscopic cholecystectomy: conversion--when and why?

Background: Contraindications to laparoscopic cholecystectomy diminished over the last decade but still conversion is about 5% to 6% in elective cases and higher in acute cholecystitis. The aim of this study was to analyze the reason for conversion in all patients operated on in our department and to create strategies for critical moments, which may need conversion.

Methods: From 1990 to 2004, operations have been divided in 3 groups: primary open cholecystectomy (OC), laparoscopic cholecystectomy, and conversion.

Oncoplastic techniques allow breast-conserving treatment in centrally located breast cancers.

Background: Operative techniques for oncoplastic reconstruction combine oncologic extirpation of the tumor with immediate reconstruction of breast shape and symmetry. These techniques are increasingly being used for breast-conservation therapy of centrally located breast carcinomas. The goal of this study was to provide an overview of the various surgical options for oncoplastic treatment of central breast carcinomas.

Lost gallstones in laparoscopic cholecystectomy: all possible complications.

Background: Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones.

Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contralateral breast cancer.

Background And Objectives: Occult invasive cancer found in reduction mammaplasty specimen in the contralateral breast in breast cancer patients requires axillary lymph node dissection (ALND) to assess the lymph node status. Routine Sentinel node (SN) biopsy in these patients may avoid secondary ALND when an occult cancer is found and the SN is negative in the permanent histological examination.

Methods: One hundred sixty-nine breast cancer patients underwent contralateral reduction mammaplasty for symmetrization and with SN biopsy of the non-cancer breast.

Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein.

Endovenous laser treatment (EVLT) has become a valuable and safe option in the treatment of varicose veins. Although long-term results are lacking, most patients seem to benefit in the short-term from EVLT. Reported postoperative complications are limited, consisting usually of pain, ecchymosis, induration, phlebitis, or spot skin burn injuries.

Current status of laparoscopic therapy of cholecystolithiasis and common bile duct stones.

Background: Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out.

The use of sentinel node biopsy in breast cancer patients undergoing skin sparing mastectomy and immediate autologous reconstruction.

Background: Intraoperative frozen section examination of the sentinel node in breast cancer patients is associated with a high number of incorrect negative results with the sentinel node becoming positive in the permanent examination and necessitating a secondary axillary lymph node dissection. A reoperation of the axilla following skin-sparing mastectomy and immediate autologous tissue reconstruction may compromise the vascular pedicle of the flap and should be avoided.

Methods: Eighty breast cancer patients underwent skin-sparing mastectomy with immediate autologous reconstruction and sentinel node biopsy followed by axillary lymph node dissection irrespective of the result of the frozen section of the sentinel node.

Sentinel node biopsy performed before preoperative chemotherapy for axillary lymph node staging in breast cancer.

Sentinel node (SN) biopsy in breast cancer patients following preoperative chemotherapy is associated with a decreased identification rate and an increased false-negative rate when compared to SN biopsy performed in untreated patients. We performed SN biopsy in 21 breast cancer patients scheduled for preoperative chemotherapy using either vital blue dye alone (n = 11) or in combination with a radiocolloid (n = 10). Following a mean of four cycles of preoperative chemotherapy, surgery to the breast and complete axillary lymph node dissection was performed irrespective of the SN status.

Transilluminated powered phlebectomy: advantages and disadvantages of a new technique.

Background: Transilluminated powered phlebectomy is a new procedure for minimal invasive varicose vein surgery.

Objective: To evaluate this technique for its benefit and the technique-related risks and complications.

Methods: Thirty patients were prospectively operated with this new technique by the same surgeon (11 of them bilaterally [41 legs in all]).

Prospective trial comparing bilateral and unilateral varicose vein surgery.

Background: This study compared bilateral and unilateral varicose vein surgery in primary varicosis of the long or short saphenous vein with respect to blood loss.

Patients And Methods: The prospective trial assessed postoperative pain, analgesic consumption, blood loss, return to physical activity and work, cosmetic result, complications, hospitalization, patient satisfaction, and hospital cost in 73 consecutive patients undergoing unilateral ( n=40) or bilateral ( n=33) varicose vein surgery.

Results: There were no statistically significant differences between the two groups in postoperative pain, postoperative analgesic consumption immediately postoperatively and after 8 h, median postoperative stay, return to work and physical activity, or cosmetic result.

Sentinel node biopsy for breast cancer: does the number of sentinel nodes removed have an impact on the accuracy of finding a positive node?

Background And Objectives: The number of sentinel lymph nodes (SLNs) removed during biopsy may have an impact on the accuracy of finding a positive SLN. This study investigated various factors to determine if they had any significant correlation with the number of SLNs found during biopsy. In patients with positive SLNs, the nodes were then analyzed to determine which SLN contained metastasis.