Laparoscopic cholecystectomy with three trocars: 10 years experience.

Since 1992 we have performed laparoscopic cholecystectomy with 3 trocars (10, 10 and 5 mm) while most surgeons use 4. In our 10 years of experience a total of 1,243 cholecystectomies have been performed with the 3-trocar technique. The overall conversion rate is 0.75%. In 5.7% of cases we used a fourth trocar in order to avoid anatomical difficulties or to perform intraoperative cholangiography. All interventions are technically feasible, even in sclerotic cholecystitis and in emergency operations. We describe this technique which can be considered an economic and cosmetically satisfying alternative, that is safe and effective for the patient and easy to perform for the surgeon.

[The learning curve in laparoscopic resections of the colon and rectum: results and considerations]. / La curva di apprendimento nelle resezioni laparoscopiche del colon-retto: risultati e considerazioni.

A well-designed learning curve is essential for the success of laparoscopic colorectal surgery for cancer. The aim of this study was to evaluate the results and characteristics of the learning curve in laparoscopic colorectal surgery beginning with benign diseases and eventually going on to include colonic resections for cancer. A total of 60 laparoscopic resections were performed. In the first 33 cases only benign diseases (diverticular disease and polyps) were treated. The next 27 cases included resections for cancer, initially with the following exclusion criteria: obesity, previous abdominal surgery, emergency surgery for occlusion, voluminous tumours or infiltration of surrounding organs. Since January 2002 the only applicable exclusion criteria for laparoscopic resection have been emergency surgery for occlusion and invasion of adjacent organs. The following procedures were performed: 29 left hemicolectomies, 19 sigmoid resections, 7 segmentary resections, 3 abdomino-perineal resections and 2 right hemicolectomies. The conversion rate was 11.6%. The mean length of the segment removed was 21.5 cm. The mean number of lymph nodes harvested (for cancer) was 22.3. Major complications were observed in 3.3% and minor complications in 13.3%. The operative time decreased from a mean of 207 minutes to a mean of 170 minutes in the last group of 20 patients. Laparoscopic resections are safe and give the patient the opportunity to make a rapid recovery with less pain and a better outcome. We suggest performing laparoscopic colorectal resections initially for benign diseases (diverticular disease and polyps). This is needed in order to hone the technique. Resections for cancer can be undertaken only when the surgical team can guarantee an oncologically correct procedure in terms of lymphadenectomy, intraabdominal manipulation and extraction of the diseased segment from the abdomen.