Double incision laparoscopic cholecystectomy (DILC) with routinary intra-operative cholangiography (IOC) : less trauma, same safety. Report on 30 consecutive non-selected cases.

Laparoscopic approach for cholecystectomy is, actually, the gold standard for gallbladder surgical benign diseases. Single transumbilical incision can further reduce abdominal wall trauma. Two main related issues are still to be enlighten: difficulty in obtaining a clear exposure of the Calot's triangle and routinely use of intra-operative cholangiography (IOC). A standardized technique of double incision laparoscopic cholecystectomy (DILC) with routine IOC is described. Between January and May 2012, 30 consecutive patients scheduled for elective cholecystectomy underwent DILC with IOC. Exclusion criteria were: clinical and/or radiological suspect of gallbladder malignancy/acute cholecystitis (AC)/common duct stones; ASA > 3; previous extensive abdominal surgery. Follow-up was performed at 7, 30 and 60 days postoperatively. Three 5-mm trocars through the umbilicus and one 3-mm subcostally on the right are used, along with a 30° laparoscopic camera. IOC is performed through the 3-mm channel. Median age was 49.5 years (range 24-78); female/male was 21/9. Median BMI was 27.4 (range 16.2-38.9). AC was encountered in five cases (17 %). Synchronous AC and choledocolithiasis occurred in one case (3 %), requiring conversion to laparoscopic choledocolithotomy. Additional ports were required in these latter five patients (17 %). IOC was routinely attempted in all patients, succeeding in 26 (86 %). Median operative 'skin to skin' time was 47.8 min (range 25-75). In the subgroup not receiving IOC, median operative time was 35 min (range 25-45); 51.5 min as median time (range 25-75) was reported for the subgroup undergone the entire planned procedure. No intraoperative complications occurred. Median length of stay was 1.51 days (range 1-5). Postoperative minor complications occurred in three patients (10 %) and wound umbilical infection occurred in one (3.4 %). DILC with the routine use of IOC seems to be repeatable and safe. Even if DILC seems more easily learnt, further studies are needed to address this issue.

Leiomyosarcoma of the inferior vena cava: a case report and review of the literature.

Leiomyosarcoma of the inferior vena cava is a particularly rare tumour, originating from the smooth muscle of the vessel wall. The authors describe the case of a female patient admitted with a picture of anorexia and weight loss, accompanied by epi- and mesogastric pain. Preoperative examinations revealed the presence of a mass of considerable size originating from the inferior vena cava. The patient was submitted to surgery consisting in removal of the mass and of part of the wall of the vena cava. A review of the literature confirms the rarity of this tumour and demonstrates that optimal anatomical knowledge is absolutely indispensable for the management of this pathology.