Laparoscopic surgery in the elderly: personal experience in 141 cases.

INTRODUCTION: As life expectancy increases, the number of elderly patients presenting with surgically correctable diseases will rise as well. For advantages, which are well recognized in young patients, laparoscopic surgery has been proposed also for older patients. Because of underlying chronic diseases, however, elderly patients have been considered at high risk for the laparoscopic approach. Several studies have pointed out the risks related to cardiac, respiratory, or general comorbidities when elderly patients are proposed for laparoscopic treatment of their surgical disease. PATIENTS AND METHODS: In this study, we reported our experience in 141 patients older than 65 years who were submitted to laparoscopic procedures for several indications. According to American Society of Anesthesiologists (ASA) score, patients were classified as ASA I in 70.9% of cases, ASA II in 27.6%, and ASA III in 1%. RESULTS: No mortality has been reported. Conversion rate was 5.3% for bleeding in 4 cases or intraoperative hypotension in 2 cases. Mean hospital stay was 5 days. Postoperative complication was reported in 1 case and consisted of a hearth attack. CONCLUSIONS: Laparoscopic surgery in the elderly is a safe procedure, if preoperative selection of the patients is accomplished. An experienced surgical team and multidisciplinary approach are mandatory.

Conservative laparoscopic treatment of a benign giant ovarian cyst in a young woman.

Giant ovarian cysts are very rare. Recently, laparoscopic treatment, with extirpation of the giant cyst and associated oophorectomy, has been reported. In this article, we describe the first case of complete laparoscopic enucleating of a giant serous cystoadenomyoma with preservation of residual ovarian parenchyma in an 18-year-old girl.

Incidental paracaval retroduodenal hemangiolymphangioma in adult patient: report of case removed laparoscopically.

INTRODUCTION: Retroperitoneal hemangiolymphangioma is a benign tumor, only occasionally reported in adult patients. Surgical removal of the tumor is the best treatment option. The laparoscopic surgical approach, however, have never been reported. The authors report a case of retroperitoneal hemangiolymphangioma removed by laparoscopic surgery and discuss the role of laparoscopic surgery in the treatment of this tumors. CASE REPORT: A 45-year-old man was referred to the surgical unit for a paracaval retroperitoneal mass, detected occasionally by an ultrasound examination. An abdominal computed tomography scan confirmed a primitive retroperitoneal solid enhancing mass, 3 cm in diameter. Surgical removal of the mass was planned by the laparoscopic approach. With the patient in semilateral position, 3 trocars were inserted in the right subcostal region. With an intraoperative ultrasound, the mass was located close to the left side of the inferior vena cava. Then it was dissected and completely removed by the laparoscopic approach, without any damage to the surrounding structures. Operative time was 45 minutes and length of hospital stay was 2 days. No complications were observed either intraoperatively or postoperatively. No recurrence has been observed in an 8-month follow-up. Pathology revealed hemangiolymphangioma. DISCUSSION: Laparoscopic surgical removal of retroperitoneal hemangiolymphangioma seems to be a safe approach. Besides the well-acknowledged advantages of laparoscopy, the mini-invasive approach allows a better exposure of the operative field. Intraoperative ultrasound and experienced surgical team are, however, recommended.