Surgical endoscopy
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Safety and efficiency are important topics in minimally invasive surgery. Apart from its advantages, laparoscopic surgery has the following drawbacks: two-dimensional imaging, challenging eye-hand coordination, and absence of tactile feedback. Enhanced imaging with earlier and clearer identification of essential tissue types can partly overcome these disadvantages. Research groups worldwide are investigating new technologies for image-guided surgery purposes. This review article gives an overview of current developments in surgical optical imaging for improved anatomic identification and physiologic tissue characterization during laparoscopic gastrointestinal surgery. ⋯ Implementation of new optical imaging methods during laparoscopic gastrointestinal surgery can improve intraoperative anatomy navigation. This may lead to increased patient safety (preventing iatrogenic functional tissue injury) and procedural efficiency (shorter operating time). Near-infrared fluorescence imaging seems to possess the greatest potential for implementation in clinical practice in the near future.
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Comparative Study
Totally laparoscopic liver resections for primary and metastatic cancer in the elderly: safety, feasibility and short-term outcomes.
Standard oncologic liver resections performed on elderly patients (≥70 years old) have been shown to be safe and effective. The aim of this study was to analyze operative and oncologic short-term outcomes of totally laparoscopic liver resections (TLLR) performed on elderly patients for malignancies. ⋯ This retrospective comparative study shows that TLLR performed on elderly for liver neoplasm are feasible and safe and lead to short-term outcomes similar to those of younger patients.
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Randomized Controlled Trial Comparative Study
Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes.
Laparoscopic colectomy for malignancy currently is the standard operative technique together with open colectomy. Single-incision laparoscopic surgery (SIL) is a recent advance in minimally invasive surgical techniques. This study aimed to compare SIL right colectomy with conventional laparoscopy (CL) used to treat patients with colon cancer. ⋯ The findings show that SIL right colectomy for colon cancer is safe and can provide resection and oncologic outcomes equal to those of conventional laparoscopic right colectomy.
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Laparoscopic pancreatic surgery has gradually expanded its applications to include pancreaticoduodenectomy. However, the benefits of the laparoscopic approach are still debated. This article aims to present data regarding the efficacy of laparoscopic pancreaticoduodenectomy in a single center. ⋯ The complexity of pancreaticoduodenectomy entails some issues, including patient selection and management of the pancreatic stump, that are not related to the approach used. Laparoscopic pancreaticoduodenectomy is feasible, safe, and oncologically adequate, but only if performed in selected cases by highly skilled laparoscopic surgeons. Laparoscopy does not provide any significant advantage over traditional surgery, but it may improve postoperative outcomes in the so-called excellence centers, once the learning curve has been overcome. Multicenter randomized trials are needed.
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Natural orifice transluminal endoscopic surgery (NOTES) has been the focus of several studies as a less invasive alternative to conventional laparoscopy to access and treat intracavitary organs. For the last 5 years, much has been accomplished with animal studies, yet the clinical utilization of this novel technique is still modest. After 2 years of experience in the laboratory, we started our clinical experience. We report our experience with clinical utilization of NOTES procedures from 2007 to 2010. ⋯ NOTES is safe, feasible, and reproducible with previous training in the laboratory and a consistent team at a high-volume center. Prospective randomized studies of a large patient population are necessary to assess long-term results.