Three millimeter needlescopic splenectomy using three-port technique: report of three cases.

We report our experience with needlescopic splenectomy (NS) for the surgical treatment of idiopathic thrombocytopenic purpura using a 3-mm needlescope with three ports. One patient was male and two were females, and their mean age was 58 years. The patient was placed in the right lateral decubitus position. The first 12-mm port was introduced through the lateral margin of the left rectus abdominis muscle, and the other two 3-mm ports were inserted in the left upper quadrant. NS was performed by a standard technique under the observation of 3.3-mm needlescope. The surgical procedure was successfully completed in all the patients. The mean duration of surgery, intra-operative bleeding volume and post-operative hospital stay were 176 min, 70 ml and 4.7 days, respectively. There were no particular peri-operative complications in spite of dense adhesions or simultaneous laparoscopic procedures. Our method is safe and feasible with low morbidity and without impairing cosmetic benefits.

[A treatment for pulmonary metastases from colorectal cancer by pre-operative CPT-11/5'-DFUR combination therapy].

There is no standardized consensus at each institution about a treatment for pulmonary metastases from colorectal cancer. A case of pulmonary radical resection can expect a good result. However, a result of a nonoperative case is extremely poor. A focal control until the time of operation to a metastatic lesion is very important. We want to have a safe and effective chemotherapy. We experienced a resectable case by CPT-11/5'-DFUR combination therapy.

Feasibility of dividing the main vessels for enhancement of dynamic graciloplasty.

PURPOSE: The technique of dynamic graciloplasty is not yet-completely satisfactory. Its function could be improved by ensuring total wrapping of the neoanus with the muscular part of the gracilis, but this can only be achieved by dividing the main blood vessels, which are considered essential for blood supply to the flap. We devised a vascular delay technique to preserve the flap without these vessels, which we performed first experimentally, then clinically, with promising results. METHODS: Seventeen Japanese white rabbits were given graciloplasty after electrical stimulation, vascular ligation, or no preparation. The neoanus was assessed manometrically and histologically 5 days later. The good results seen in the animals encouraged us to start performing enhanced dynamic graciloplasty clinically. Five patients were given electrical stimulation and the vascular delay technique was carried out before dynamic graciloplasty. RESULTS: Vascular delay in the rabbits preserved the muscle flap, but electrical stimulation had a limited effect. In all five patients, the neoanus was successfully wrapped with the muscular part of the flap. There were no ischemic symptoms or perioperative complications. Furthermore, the neoanal pressure increased significantly with electrical stimulation from 23.8 cmH(2)O to 89.2 cmH(2)O. Satisfactory continence was achieved in three of the four patients whom we were able to evaluate. CONCLUSION: Dissection of the main vessels of the gracilis muscle with vascular delay and long-term electrical stimulation may optimize the gracilis flap in patients requiring dynamic graciloplasty.