Advancement in liver laparoscopic resection - development of a new surgical device.

Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

Advancement in liver laparoscopic resection - development of a new surgical device

Liver resection is the standard treatment for any liver lesion. Laparoscopic liver resection is associated with lower intra-operative blood loss and fewer complications than open resection. Access to the posterior part of the right liver lobe is very uncomfortable and difficult for surgeons due the anatomic position, especially when employing laparoscopic surgery. Based on these experiences, a new laparoscopic device was developed that is capable of bending its long axis and allowing the application of radiofrequency energy in areas that were not technically accessible. The device is equipped with four telescopic needle electrodes that cause tissue coagulation after the delivery of radiofrequency energy. Ex vivo testing was performed in 2012 and 2014 at the University Hospital, Ostrava, on a porcine liver tissue. The main goal of this testing was to verify if the newly proposed electrode layout was suitable for sufficient tissue coagulation and creating a safety zone around lesions. During the ex vivo testing, the material of needle electrodes was improved to achieve the lowest possibility of adhesion. The power supply was adjusted from 20 to 120 W and the ablation time, which varied from 10 to 110 s, was monitored. Subsequently, optimal power delivery and time for coagulation was determined. This experimental study demonstrated the feasibility and safety of the newly developed device. Based on the ex vivo testing, LARA-K1 can create a safety zone of coagulation. For further assessment of the new device, an in vivo study should be performed.

[Laparoscopic diverting ileostomy in rectal cancer surgery]. / Laparoskopická protektivní ileostomie v chirurgii karcinomu rekta.

INTRODUCTION: Low anterior resection (LAR) with total mesorectal excision (TME) represents the gold standard for patients with low rectal carcinoma. Protective ileostomy (PI) is commonly performed during LAR in an effort to protect low rectal anastomosis. The aim of this study is to analyse outcomes in our own patient population, focusing on morbidity associated with PI. METHOD: A retrospective clinical study of patients operated on between 2013 and 2015 was conducted in University Hospital Ostrava. All patients after LAR with PI due to low rectal cancer were included. The study design did not require randomisation. RESULTS: A total of 52 patients who underwent LAR with PI were included. Mean tumour height was 9.1±2.3 cm. 15.4% of the patients were classified as ASA I, 53.8% were classified as ASA II and 32.7% of the patients as ASA III. 30-day postoperative morbidity was 38.5%, and complications associated with PI (within 30 days after LAR) occurred in 7 (13.5%) patients. Three of these patients underwent urgent surgical revision due to small bowel obstruction (PI semirotation around its longitudinal axis in two patients and volvulus of the small bowel around PI in one patient). Mean time interval between PI creation and reversal was 252 days. During this period, complications associated with PI were detected in 25 (48.1%) patients; seven patients had more than one complication. Minor complications (such as peristomal dermatitis, stoma herniation or bleeding, wound infection after stoma reversal) were observed in 17 (32.7%) patients. Major complications (small bowel obstruction at the site of PI, dehydration due to high stoma output, intraabdominal abscess after stoma reversal) occurred in 8 (15.4%) patients. CONCLUSIONS: PI offers protection to low colorectal or coloanal anastomosis in rectal cancer surgery. However, this benefit is counterbalanced by a high risk of various complications which may occur during the whole period when PI is present. The decision for diversion should therefore be made only after careful consideration.Key words: rectal cancer - low anterior resection - laparoscopy - protective ileostomy - stoma complications.

[Left hepatic vein injury during laparoscopic fundoplication for giant paraoesophageal hiatal hernia]. / Poranení levé hepatické vény v prubehu laparoskopické fundoplikace pro velkou paraezofageální hiátovou kýlu.

INTRODUCTION: After laparoscopic cholecystectomy, laparoscopic fundoplication has become another gold standard of minimal invasive surgery. The level of satisfaction of patients undergoing endoscopic surgery is almost 90%. Laparoscopic fundoplication, like other surgery methods, can also be burdened with grave complications, which could result in a fatal outcome even if the surgery is performed by a skilled surgeon. Even the authors themselves encounter complications despite their rich experience (more than 3,500 laparoscopic operations in the diaphragmatic hiatus area in more than 20 years). CASE REPORT: The authors report on a rare left hepatic vein injury during laparoscopic hiatoplasty and fundoplication according to Toupet for giant paraoesophageal hiatal hernia. CONCLUSION: For its low percentage of complications, laparoscopic fundoplication is considered as a safe operative method for gastroesophageal reflux disease and hiatal hernias. However, severe complications may still arise during the surgery and the surgeon should be familiar with them, be prepared for them and be able to manage such complications.Key words: gastroesophageal reflux disease hiatal hernia laparoscopic fundoplication left hepatic vein.

Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum - toxicity and complications of the treatment.

AIMS: The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. METHODS: We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12 cm from the anocutaneous verge. The average follow-up time was 23.9 months. RESULTS: All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4-8 weeks following the concomitant chemoradiotherapy - in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases. CONCLUSIONS: We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine.

[Modern radiotherapy in the complex management of soft tissue and bone sarcomas in adults--current overview and the author's experience]. / Moderní radioterapie v komplexní lécbe sarkomu mekkých tkání a kostí u dospelých--aktuální prehled a vlastní zkusenosti.

Soft tissue sarcomas and primary bone tumours constitute very heterogenic group. Gold treatment standard is surgery in most of them. Nowadays the combination surgery with radiotherapy is preferred, because thanks new radiotherapeutic technology is possible to apply very high dose of radiation which necessary for local control of these tumours. The goal of our article is to describe new possibilities of radiotherapy, including neoadjuvant and adjuvant setting, intraoperative radiotherapy, interstitial brachytherapy and the combination with surgery. But very important is multidisciplinary cooperation to until recently in prognostic bad group of patients, concentration these patients to centers with modern technique and clinical experience with treatment of soft tissue sarcomas and bone tumours.

Intra-operative liver ultrasound--a contribution to colorectal carcinoma staging.

BACKGROUND: Laparoscopic resection of colorectal carcinoma is now a well-established surgical technique with oncology treatment outcome similar to open surgery, yet performing better in some short-term variables. The technique, however, does not allow palpation of intra-abdominal organs and the liver in particular. This prospective study aims to assess the performance of laparoscopic intra-operative ulrasonography of the liver (L-IOUS) and compare its findings with pre-operative staging data. METHODS: In total 70 patients, 53 men and 17 women, who were recruited into the study, were indicated for primary laparoscopic resection for colorectal carcinoma, with laparoscopic intra-operative ulrasonographic examination of the liver (L-IOUS) being used during the initial part of the operation. Before surgery, all patients underwent abdominal and pelvic contrast CT examinations. Ultrasonographic examination of the liver was included. RESULTS: In 14 patients L-IOUS detected a synchronous metastatic lesion of the liver as opposed to only six patients with pre-operative CT-positive findings. Furthermore, CT-positive metastases in three patients were not confirmed by L-IOUS. Several patients were diagnosed with benign lesions not disclosed during pre-operative assessment, e.g. haemangioma in 5 vs 2 patients, focal nodular hyperplasia in 3 vs 1 patient and liver cysts in 7 vs 5 patients. CONCLUSION: Results of the presented prospective study substantiate the use of laparoscopic intra-operative ultrasound of the liver (L-IOUS) within the standard staging protocol, as this seems to appropriately supplement the results of the pre-operative staging. In cases of colorectal carcinoma the method allows highly sensitive detection of occult synchronous liver metastases that could finally alter a therapeutic strategy.

[Laparoscopic resection of rectal cancer: evaluation of perioperative results of the primary resection and resection after preoperative chemoradiotherapy]. / Laparoskopická resekcia karcinómu rekta: zhodnotenie perioperacných výsledkov primárnej resekcie a resekcie po neoadjuvantnej chemorádioterapii.

AIMS: To evaluate and compare perioperative results of laparoscopic resection for low and middle third rectal cancer subgroup of patients intended for primary resection (PR) with those operated after chemoradiotherapy (CHRT). METHODS: 291 patients were operated for rectal cancer during the years 2005-2007 in Department of Surgery, J. G. Mendel Oncological Centre Nový Jicín. 155 patients (49 women and 106 men, mean age 65 +/- 9.7, range 27-87) having laparoscopic resection for low and middle rectal cancer were included in the present prospective single centre study. Primary surgical approach was adopted in 74 patients and 81 patients had a preoperative chemoradiotherapy. RESULTS: Both groups were comparable regarding intraoperative (p = 0.632) and postoperative surgical complications (p = 0.179) and nonsurgical complications (p = 0.654) too. Operative time and postoperative stay were similar in both groups. Number of harvested lymphnodes was higher for PR group (p < 0.001). CONCLUSION: In summary, after short term results evaluation, there is no significant difference for PR and CHRT groups in laparoscopic rectal resection. Neoadjuvant chemoradiotherapy did not lead to worsening of the perioperative results of our patients.

[The role of interstitial brachytherapy in multimodality management of solid tumors]. / Role intersticiální brachyterapie v multimodalitní lécbe solidních tumoru.

Although being used for several decades, interstitial brachytherapy remains a modern radiotherapeutic method. Over the time, it has been highly improved, including the latest technologies. Its broad use has been facilitaed by the use of high dose rate (HDR) afterloadings. The method is fast and fairly inexpensive. Its prons include, in particular, a possibility to apply a dose, in addition to external radiotherapy, directly into the tumor region or its focus, which may improve treatment success rates in patients with localized tumors. The commonest diagnoses, where interstitial brachytherapy is employed, include the following: breast carcinomas, soft tissue sarcomas, head and neck tumors, gynaecological tumors, penile and anal tumors and prostate tumors. In the article, the authors aimed to highlight potential and benefits of intersitital brachytherapy in individaual diagnoses. Only multidisciplinary management of these patients may improve their prognosis or quality of life.

[Laparoscopic cholecystectomy in outpatient surgery clinic]. / Laparoskopická cholecystektómia v ambulantnej chirurgii.

AIM: Based on literature data and their own experience, the authors present a view that, in a selected group of patients, ambulatory laparoscopic cholecystectomy may be performed with no increased risks and with good outcomes. MATERIAL AND METHODS: The retrospective study presents a group of 93 patients, 72 females and 21 males, who underwent ambulatory laparoscopic procedures for symptomatic cholecystolithiasis in the Podlesí Hospital Centre of Miniinvasive Surgery, from January 2003 to the end of June 2006. 61.3% of the patients were in their forties and fifties, 69.9% of the patients were classified as ASA II, according to the surgical risk. Half of the patients had an ideal body weight, according to their body mass index (BMI) assessment. RESULTS: No peroperative or postoperative complications were recorded in the above, closely selected group of patients. 84 patients (90.3%) were discharged to homecare on the day of the procedure. Nine patients (9.7% required hospitalization for the first postoperative night and they were discharged the following morning, i.e. within 24 hours after the procedure. None of the subjects, discharged after the ambulatory procedure, required rehospitalization. CONCLUSION: Similarly to studies presented in the literature worldwide, the authors concluded that laparoscopic cholecystcctomy performed in the outpatient regime appears an appropriate surgical method in closely selected patient groups. In our setting, out of the total of 618 operated patients, who underwent laparoscopic cholecystectomy during the studied period, 15.4% could be managed using the above method.

[Appendectomy--comparison of results of laparoscopy versus open surgery]. / Apendektómia - porovnanie výsledkov laparoskopickej a otvorenej techniky operácie.

AIM: The authors present results of laparoscopy versus open appendectomy in patients indicated for urgent procedures. MATERIALS AND METHODS: 214 patients, who underwent urgent appendectomy during a 18-month period (November 2004 - April 2006) were included in the retrospective study. The subjects were assigned to two main study groups according to the chosen abdominal approach - laparoscopic versus classical method. Within the respective study groups, duration of the procedure, histopathological findings, peroperative and postoperative complications, duration of postoperative hospitalization were assessed. Furthermore, in the laparoscopic subgroup, requirement for conversion to open surgery is assessed. RESULTS: The results proved that the laparoscoic approach reduced hospitalization period in patients with histopathologicaly advanced findings. The positive effect of miniinvasive methods on hospitalization duration is diminished in subjects with less advanced findings. CONCLUSION: Considering overall benefits of the laparoscopic procedures, the authors themselves prefer the laparoscopic method as the method of choice in management of acute appendicitis.

[The Peutz-Jeghers syndrome--a case review]. / Peutz-Jeghersov syndróm - kazuistika.

INTRODUCTION: The authors present a case review of a localized Peutz-Jeghers syndrome of the caecum, emulating a carcinoma. METHODS: The patient who presented with insignificant family history with a diagnosed stenosing tumor of his appendix and histological findings of highly suspected adenocarcinoma, was indicated for surgical revision and right-sided hemicolectomy. RESULTS: The patient underwent laparoscopically assissted right-sided hemicolectomy and his postoperative course was adequate. The final histological finding diagnosed solitary hamartoma of the Peutz-Jeghers polyp. CONCLUSION: Differential diagnostic reasoning in patients with negative family history and unclear case history with findings of polypous tumorous lesions of the GIT, should also consider the Peutz-Jeghers syndrome. The syndrome is related to a high risk of malignancies in the elderly.

[Da vinci robotic surgery in gynaecological oncology: a critical interim appraisal]. / Da Vinci robotická chirurgie v gynekologické onkologii: kritické hodnocení úvodních zkuseností.

OBJECTIVE: Benefit evaluation of robot-assisted surgery in gynecological oncology. The parameters observed were feasibility, safety, overal surgery length and economic aspects. DESIGN: Prospective study analysing our experience in 10 patients operated due to gynaecological malignancy, adnexal tumors or planned for the procedure used as a part of extensive oncological surgery. SETTINGS: Department of Gynecology and Minimally Invasive Surgery Na Homolce Hospital, Prague. METHODS: The surgeries were performed with Da Vinci robotic system (Intuitive Surgical, inc., USA) including surgeon's console with stereoscopic viewer with hand and foot controls. The second component of the system was In Site vision system with 3D 12 mm endoscope. The third part comprised of 3 telerobotic arms with Endowrist instruments. From 2/2006 to 9/2006 10 patients were operated upon. 2 patients with early invasive cervical cancer, 2 patients with cervical cancer in situ (CIS), 3 patients with complex ovarian tumors, 2 patients with symptomatic atypical endometrial glandular hyperplasia and 1 patient underwent necessary gynecological surgery as a part of oncological treatment of breast cancer. The range of surgery included Total robotic hysterectomy, Robot-assisted vaginal hysterectomy with adnexectomy and frozen section, Robot-assisted radical vaginal trachelectomy with pelvic lymphadenectomy and unilateral adnexectomy with frozen section. The average age of patients was 52 years (range 32-58 years). 30% of patients had a previous laparotomy in their history. RESULTS: All procedures were finished with robot-assisted system. In 2 patients a temporary conversion to laparoscopy was made. In 3 patients a technical fault of the robotic system was noticed. This was corrected during the surgery. The overal surgery time was significantly longer (29 hours for robot-assisted versus 12 hours for laparoscopy). This represented operation time increase of 59% in comparison to identical laparoscopic procedures in our department in 2006. This was caused by lengthy assembly and disassembly time of the robotic system. No patients experienced any peroperative or postoperative comlications. The costs in our setting were approximately 10 times higher in comparison to laparoscopy. CONCLUSION: Our preliminary experience shows that Robot-assisted surgery is comparable to the standard laparoscopic procedure in terms of feasibility and outcome, but costs are considerably higher owing to longer operating time and the use of more expensive instruments. A major limitation is the lack of a large operation field. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of robotic surgery. The use of robotic system in gynecologic oncologic surgery and in abdominal surgery in general offers, at this stage, no relevant benefit and thus is not justified. Clinical data demonstrating improved outcomes are so far lacking for robotic surgical application within the abdomen.

[Colorectal cancer--short time results of laparoscopic resection in 350 patients]. / Kolorektální karcinom - zhodnocení kráitkodobých výsledku laparoskopické resekce u 350 pacientu.

BACKGROUND: Laparoscopic resection of the colon with its results is fully acceptable method of choice in patients with colorectal cancer. Authors present their own experiences. METHODS AND RESULTS: A retrospective study of 350 patients who undergone laparoscopic resection because of colorectal carcinoma (curative or palliative) from January 1, 2002 to December 31, 2005. From these patients 50.8 % were operated in the 1. and II. grade of the disease, it means without detectable metastases of the lymphatic nodes. Patients with the carcinoma localised in rectosigma and rectum - 61.1 % dominate in our study. The conversion of the laparoscopic operation was necessary in 9.1%, in 13.1% there were surgery postoperative complications and postoperative mortality was 1.4%. Normal eating was allowed to patients in average 4.1 days after the operation and the average hospitalisation time was 8.3 days. We mentioned also the time of operation in various types of resection, size of resection express by the number of detectable lymph nodes and necessity of the postoperative analgesic therapy. CONCLUSIONS: Laparoscopic resection of the colorectal cancer is today method of choice, which is safe for patient and with the same morbidity and mortality as in open surgery, provides advantages of mini-invasive approach.

[Laparoscopy-assisted exenteration of the pelvis in a locally advanced rectal carcinoma]. / Laparoskopicky asistovaná totálna exenterácia panvy u lokálne pokrocilého karcinómu rekta.

INTRODUCTION: In this pilot study, based on three case-reviews, the authors report on their initial experience with the laparoscopy-assisted total exenteration of the pelvis, conducted in patients with locally advanced rectal carcinomas. METHODS: In two patients with histologically confirmed rectal carcinomas, the neoadjuvant radiochemotherapy was initiated, due to the locally advanced tumor finding, aiming to downstage and locally control the disorder. The pelvic exenteration was indicated, based on the control findings of the imagining methods. In one patient, due to repetitive enterorrhagies, the primary surgical management was indicated. RESULTS: The surgical procedures were multidisciplinary, assisted by urologists. In all three cases, the laparoscopic resections, followed by planned conversions and constructions of the ileouretheral conduit and the terminal sigmoidostomies (resp. with their maintenance), were completed. Prior to the procedures, in all the three patients, the presence of distant metastases was excluded. No peroperative complications were recorded in the case-reviews. In one case, postoperative re-suturing of the wound was inevitable, due to its dehiscence. In this patient, the enzymatic acute MI, without the ECG correlate, was diagnosed. CONCLUSION: The laparoscopy-assisted pelvic exenteration may be a suitable modification of the classical surgical procedure in selected patient groups with locally advanced colorectal carcinomas. Good visualisation and exact orientation in the region of the small pelvis, as well as other generally accepted advantages of miniinvasive procedures, are the pros of the method.

[Prevention of venous thromboembolism in surgery, in laparoscopic surgery, in venous surgery and in urology]. / Prevence zilní tromboembolické nemoci v chirurgii, v laparoskopické chirurgii, v cévní chirurgii a v urologii.

The article summarizes published data regarding the prophylaxis of venous thromboembolism in surgery, in laparoscopic surgery, in venous surgery and in urology. In surgical patients with low risk, no specific thromboprophylaxis is needed. Patients with moderate risk levels are the candidates for administration of subcutaneous low molecular weight heparin (LMWH) at doses under 3 400 anti-Xa units a day and patients with increased risk at doses higher than 3 400 anti-Xa units a day during the period of higher risk. In order to decrease the risk of bleeding, a half dose 2 hours prior or 4-6 hours after the operation can be administered. Under the highest risk conditions, there is a recommendation to combine LMWH over 3 400 anti-Xa units with elastic panty-hose or, alternatively, with intermittent pneumatic compression (IPC). At moderate risk levels, subcutaneous administration of unfractionated heparin at the doses of 5 000 units twice a day is also possible and at increased risk levels, a TID administration (LDUH) over the increased risk period. In patients with a significant bleeding risk, the physical method of thromboprophylaxis can be used and pharmacological prophylaxis can set in after the risk of bleeding has passed. Fondaparinux is the alternative to LMWH in people with a history of heparin induced thrombocytopenia over the past three months. The sole use of acetylsalycilic acid is not recommended. While undertaking epidural anaesthesia or analgesia, it is necessary to follow strictly the guidelines of the use of pharmacological thromboprophylaxis. Thromboprophylaxis with LMWH, LDUH, elastic panty-hose or IPC is indicated only in those patients who undergo laparoscopic surgeries and who moreover display the additional thrombosis factors. Patients with additional risk thrombosis factors undergoing major venous reconstructions require prophylaxis with LMWH (or LDUH). Uncomplicated patients undergoing transurethral or other low risk urologic surgery require no specific thromboprophylaxis. If they undergo a major intervention and/or they display additional risk thrombosis factors, they require the administration of LMWH or LDUH. Elastic panty-hose and/or intermittent pneumatic compression have the same indication as in abdominal surgeries.

[Surgical complications of laparoscopic colectomy in patients with colorectal carcinomas]. / Chirurgické komplikácie laparoskopickej kolektómie u pacientov s kolorektálnym karcinómom.

INTRODUCTION: The authors present their experience with laparoscopic resections of the large intestine in patients with colorectal carcinomas. The aim is to discuss and assess peroperative and early postoperative surgical complications. METHODOLOGY: From 1st January to 30th June, the team of authors operated over 350 patients with colorectal carcinomas. In 264 patients the team completed laparoscopic resections (laparoscopy-assisted) of the colo-rectum. Patients who, following an initial laparoscopic exploration, underwent a classical procedure and patients who underwent derivation stomies, eventually by- pass procedures, were excluded from the study group. RESULTS: In 16 patients (out of the total 264 laparoscopic colectomies) the laparoscopic procedure was converted. The rate of peroperative complications was 3.4% and the rate of postoperative surgical complications was 14.4%. Five patients in our study group exited before the postoperative day 30. Two of these cases were directly related to surgical postoperative complications. CONCLUSION: Laparoscopic colectomy is a method of choice in patients with colorectal carcinomas. The more experienced the surgeon and the whole team, the lower the total lethality rate. The rate is similar to that of classical colectomies, however some indicators prefer the laparoscopic procedure.

[Laparoscopy in the colorectal carcinoma treatment]. / Laparoskopia v liecbe kolorektálneho karcinómu.

AIM: The authors present their experience and results with laparoscopic surgery in the colorectal carcinoma treatment in the Centre of Miniinvasive Surgery of the Podlesí-Trinec hospital. METHODOLOGY: In this retrospective study, the authors present a group of 148 patients with colorectal carcinomas operated by their team from 1st January, 2002 to 30th June, 2004. RESULTS: The authors completed resection procedures in 133 patients. In 15 patients, with respect to the extent of their disorder, the authors had to apply derivation colostomies, to construct by-pass ileotranversal anastomoses or to complete the procedures with exploration laparoscopies. CONCLUSION: Thank to miniinvasive techniques, laparoscopy has found its place also among the colorectal carcinoma treatment methods. The presented results, in accordance with other studies published in literature worldwide, present this method as a suitable one for a patient and fulfilling all criteria of the onco-surgical radicality.

[Laparoscopic therapy of inguinal hernia--transabdominal onlay mesh (TOM)]. / Laparoskopická liecba inguinálnej hernie--TOM (Transabdominal Onlay Mesh).

AIM: A presentation of the authors experience and results with the TOM (Transabdominal Onlay Mesh) when using the laparoscopic method for the inguinal hernia treatment. MATERIAL AND METHOD: The laparoscopic treatment method of the inguinal hernia has been used in the Centre of the miniinvasive surgery in Podlesí since October 1992. Until September 2003, we had operated 4910 patients, who were treated for 5399 inguinal hernias. From January 1999 to October 2003 we operated 3550 inguinal hernias in 3183 patients using the TOM method (367 hernia cases were bilateral). RESULTS: The average operation time in cases of uncomplicated hernias during unilateral surgical procedures is 21.4 minutes and during bilateral procedures is 31.5 minutes. Complications totaled 1.268% (peroperative 0.282% and postoperative 0.986%) The average patients age was 51.3 years (17-91). There were 87.8% males and 12.2% females. 96 patients were assigned to the one-day surgery programme. CONCLUSION: We believe that the use of the TOM method in the laparoscopic treatment of the inguinal hernia is grounded and that, with further development of new prosthetic materials, it will obtain a broader spectrum of applications.

[Methods of intraperitoneal placement of mesh in laparoscopic surgery of inguinal hernias (IPOM--Intraperitoneal Onlay Mesh)]. / Metoda intraperitoneálne polozené sít'ky u laparoskopické plastiky tríselné kýly (IPOM--Intraperitoneal Onlay Mesh).

BACKGROUND: Intraperitoneal onlay mesh is a new method of laparoscopic inguinal hernia repair shortening an operative time and reducing its cost, which is very safe and less burdening a patient. METHODS: 325 males and 37 females at the mean age of 47.3 years were operated on electively for symptomatic inguinal hernia by IPOM method. In all cases we used a polyester mesh impregnated with silicone. RESULTS: The mean operative time was 18 minutes for unilateral procedure and 28 minutes for bilateral one. There was no serious complication during the operation even the post-operative time and no recurrency following this type of the operation. CONCLUSION: IPOM hernioplasty can be a method of choice in the inguinal hernia repair because of this procedure is very simple, cheap and safe for a patient. We have to wait for a long-term results to validate the hitherto existing ones, even if they are very optimistic.