[The advantages of implementing an e-learning platform for laparoscopic liver surgery]. / Avantajele implementarii unei platforme de e-learning pentru chirurgia laparoscopica hepatica.

The rapid expansion of laparoscopic surgery has led to the development of training methods for acquiring technical skills. The importance and complexity of laparoscopic liver surgery are arguments for developing a new integrated system of teaching, learning and evaluation, based on modern educational principles, on flexibility allowing wide accessibility among surgeons. This paper presents the development of e-learning platform designed for training in laparoscopic liver surgery and pre-planning of the operation in a virtual environment. E-learning platform makes it possible to simulate laparoscopic liver surgery remotely via internet connection. The addressability of this e-learning platform is large, being represented by young surgeons who are mainly preoccupied by laparoscopic liver surgery, as well as experienced surgeons interested in obtaining a competence in the hepatic minimally invasive surgery.

[Left laparoscopic lobectomy]. / Lobectomie stânga pe cale laparoscopica pentru hepatocarcinom dezvoltat pe ficat non-cirotic--prezentare de caz.

The authors present a case of a 61-year-old patient diagnosed with a hepatic tumor located in the second segment with expression on the anterior (diaphragmatic) side. The diagnosis and treatment applied in this case are presented. The specific feature was the surgical intervention because it was performed a left laparoscopic lobectomy using the LigaSure Atlas sealer. The short hospitalization period and quick recovery make this method an efficient one, with a wide application. Laparoscopic surgery started with a cholecystectomy which was performed by Mouret in 1987. Since then it knew a continuous development with progressive extension of this type of approach to almost all of the digestive tract organs, cavitary as well as parenchymal organs like liver or spleen. Second and third bisegmentectomy was made for the first time in 1996 by Azagra. The segments II, III, IVb, V and VI are the most frequently resected in hepatic laparoscopic surgery. Surgeons are more interested in left hepatic lobe diseases because of the anatomy which makes the approach of the biliary and blood vessels easier. Lately we assist to an increase of hepatic cancer incidence, primary or secondary; therefore we consider necessary the development of hepatic laparoscopic surgical techniques.

[Intrabiliary rupture of hepatic hydatid cysts: results of 17 years' experience]. / Chisturile hidatice hepatice rupte în arborele biliar: experienta a 17 ani.

UNLABELLED: Between 1990 and 2006 in the III-rd Surgical Clinic Cluj-Napoca, 366 pacients with hepatic hydatid cyst were admitted and underwent surgery; 81 (22.13%) of them, who had a cyst-biliary comunication, were retrospectively reviewed: 52 (64.2%) had an occult communications and 29 (35.8%) had a frank intrabiliary rupture. The sex ratio was M/F=46/35 with a mean age of 44.5 years and with ages between 17 and 73 years. Choledochotomy, evacuation of parasitic material and lavage of the CBP were performed in all patients with frank intrabiliary rupture. In 25 patients, partial pericystectomy and choledochoduodenostomy/T-tube drainage of CBP was performed. Internal drainage by a Roux-en-Y pericystectojejunostomy and biliodigestive anastomosis was carried out in 2 patients, while other two patients underwent external drainage of cystic cavity and T-tube drainage of CBP. 15 patients (51.7%) had postoperative external bile leaks (fistulas). Occult communications were managed by partial pericystectomy +/- narrowing of the residual cavity (capitonage with an omentum flap or invagination of the fibrosis capsule margins into the cavity) in 35 patients (67.3%) while in 10 patients (19.2%) internal drainage by a Roux-en-Y pericystectojejunostomy was carried out. Regional resection of the liver was performed in 4 cases (7.7%) and external drainage of residual cavity in 3 patients (5.7%). 13 patients (25%) had postoperative external bile leaks (fistulas). The mean postoperative hospitalisation was 20 days with the range 5-85 days. The mortality rate was 2.4% (2 patients): one died due to septicemia and MOFS and the other due to pulmonary thromboembolism. CONCLUSION: Postoperative bile leaks (fistulas) fallowing conservative surgery of ruptured hydatid hepatic cyst into the biliary tract are not rare regardless of the type of rupture (frank or occult). Although the opening of the biliary duct is sutured, the risk of biliary fistulas is not clearly corelated with this approach; in such cases internal drainage provides a good alternative with low morbidity.

[Liver resection for benign hepatic lesion: mortality, morbidity and risk factors for postoperative complications]. / Hepatectomiile pentru leziuni focale hepatice benigne: mortalitate, morbiditate si factorii de risc corelati cu complicatiile postoperatorii.

UNLABELLED: The aim of this study was to evaluate the result of liver resection for benign hepatic lesion and to determine the risk factors for postoperative complication. Between January 2001 and December 2006 (6 years), a total of 50 patients with benign hepatic lesion underwent hepatic resection and were retrospectively reviewed. The sex ratio was M/F=31/19 with a mean age of 44 years (range 2-74). The diagnosis was: hydatid cyst in 24 patients (48%); hemangioma in 14 patients (28%), focal nodular hyperplasia (FNH) in 6 (12%), hepatic adenoma in 3 cases (6%), and hepatoblastoma in 3 patients (6%). Fourty patients (80%) had symptoms prior to surgery (mainly abdominal pain). The abnormalities were located in 34 cases on the left liver (II-IV Couinaud segments) and in 16 cases on the right liver (V-VIII Couinaud segments). Twenty-nine patients (58%) underwent atypical resections, 4 underwent left hemihepatectomy (8%), 16 underwent left lobectomy (32%) and 1 patient was treated by segmentectomy (2%). Median operating time was 108 minutes (range 60-220) and the median blood lost was 310 ml range (30- 1500). The morbidity rate was 18% (9 patients). Independent risk factors associated with the development of postoperative complication were intraoperative blood lost more than 1200 ml (p=0,015; OR=1,7) and the operating time more than 150 minutes (p=0,048; OR=1,09). There was no mortality. The mean postoperative hospitalization was 7,86 days with the range 3-23 days. CONCLUSION: 1. Liver resections for benign hepatic lesion performed in specialized centers are safe and efficient, with low morbidity and mortality. 2. Postoperative morbidity was related to the intraoperative blood lost more than 1200 ml and to the operating time more than 150 minutes.

[Laparoscopic antireflux surgery--long-term results]. / Montaje antireflux efectuate pe cale laparoscopica--rezultate pe termen lung.

METHOD AND MATERIAL: Between 1995 and 2005 a number of 98 antireflux laparoscopic procedures have been performed. The patients have answered to a 7 point questionnaire regarding the disappearance of specific gastro-esophageal symptoms, the necessity of medical adjuvant treatment as well as regarding the measure in which surgery brought a real subjective improvement. The average follow-up was 57 months (4.7 years). RESULTS: 43 laparoscopic patients have answered the questions. 10 patients had dysphagia, most of which had a spontaneous remission. Only 3 of those patients needed an endoscopic dilatation. Bloating was still possible for 33 of the patients. Retrosternal pain remained present for 14 patients. Intestinal transit disorders have showed up in 11 cases. Reflux persisted at a variable degree in 12 patients. Only 7 patients continue to follow a systematic drug treatment. 35 patients consider that the surgery has brought an improvement of their disease.