[Laparoscopic appendectomy--considerations in about 1000 cases]. / Apendicectomia laparoscopica--consideratii pe baza a 1000 de cazuri.

Laparoscopic appendectomy (LA) is a well spread method today, but not as largely accepted as cholecystectomy, the cure of gastro-esophageal reflux and some other procedures (relatively small in number) for which the laparoscopic approach is the golden standard. Otherwise it is improbable that LA will gain such a status, at least in the near future. On the other hand it is obvious that LA offers important advantages for some special situations: the right iliac area syndrome, obesity, professional sportsmen, abnormal localization of the appendix, as well for the cases when localized and especially diffuse peritonitis is associated. Our paper analyses the experience of General Surgery Department at the "St.John" Emergency Hospital Bucharest on laparoscopic appendectomy. The retrospective study includes 996 cases that were treated laparoscopic between 1996-2004. Of these 745 cases were catarrhal, 166 cases were phlegmonous and 76 gangrenous appendicitis. In 93 cases localized or diffuse peritonitis was associated. There were recorded also 3 cases of each of the following: chronic appendicitis, appendicular mass and mucocele. The number of conversions was 28 (2.81%). There were also 10 reinterventions (1.004%), 7 because of intraperitoneal abscess and we also recorded one death.

[Transperitoneal laparoscopic right sympathectomy]. / Simpatectomia lombara dreapta laparoscopica pe cale transperitoneala.

Laparoscopic lumbar transperitoneal sympathectomy represents the miniinvasive approach of laterocolic procedure Adson-Diez. It is suitable to laparoscopic surgery, has a good reproducibility and it is more advantageous than total retroperitoneal approach because of a larger working space.

[Conversions and reinterventions in laparoscopic cholecystectomy]. / Conversii si reinterventii în colecistectomia laparoscopica.

From the introduction of the laparoscopy in our clinic, more and more of the cholecystectomies, reaching over 50% are done by this technique. Based upon the accumulation of an already important experience, the paper tries to analyze the situations in which, during or after laparoscopic cholecystectomy, intraoperative conversions (deliberate or of necessity) or reinterventions were necessary. We present a global view of the number of these cases and also (an in detail) analysis of the causes the imposed such decisions and of the solutions adopted. The percentages of 5.55 conversions and 1.49 reinterventions seem reasonable and acceptable in comparison with the initial results published by some experience surgeons in the field of laparoscopic surgery.

[A voluminous hepatic hydatid cyst of the right lobe in a patient with hypertrophic liver cirrhosis--comments on a case]. / Chist hidatic hepatic voluminos al lobului drept, la un pacient cu ciroza hepatica hipertrofica--discutii pe marginea unui caz.

There is presented the case of a patient with liver cirrhosis hepatomegalic form, echinococcosis and gallbladder stones. After the presentation of the clinical findings, there are discussed the problems of the surgical treatment. The remaining cavity was treated by pericysto-jejunostomy. The postoperative recovery was uneventful.

[Preliminary data on our laparoscopy experience in urinary pathology]. / Date preliminarii asupra experientei noastre laparoscopice în patologia urinara.

We studied laparoscopic urological procedures in 14 cases between July 1995 and October 1996. We applied retroperitoneal lomboscopic technique for 2 cases with symptomatic renal cyst (over 500 ml) and laparoscopic retroperitoneal lymphadenectomy in 12 cases (adenocarcinoma of the prostate-5 cases, pT2-3bMo, Gleason score between 3-9, PSA between 11-46 ng/ml and invasive bladder tumors-7 cases, pT2-3bMoG2-3). For the renal cyst we used extraperitoneal approach and for the pelvic lymph nodes we used in 8 cases intraperitoneal approach and in 4 cases extraperitoneal approach (patients with multiple prior abdominal surgeries). Lymph node tissue was present in 11 cases. For the bladder tumors we did first iliac lymph nodes dissection and for the prostate adenocarcinoma we did first obturator lymph nodes dissection. We didn't describe complications. For our patients it was 3 days long hospitalization. So, we consider that laparoscopic lymphadenectomy is essential for evaluation of the patients with prostate adenocarcinoma having markedly elevated prostate specific antigen, high Gleason grade, large clinical burden of tumor. For the invasive bladder tumors, radical cystectomy and especially bladder replacement surgery need absolutely evaluation of regional lymph nodes. For the symptomatic renal cysts (over 500 ml) laparoscopic surgery is with very good results, minimally invasive.

[The laparoscopic treatment of varicocele--a technical note]. / Cura laparoscopica a varicocelului--nota de tehnica.

After a short exposure of the main clinical and anatomical aspects of the varicocele, as arguments for a wider surgical indication, the authors present the technique of laparoscopic varicocelectomy. The operation implies general anesthesia and may be performed by transperitoneal or properitoneal approach--similar to laparoscopic hernia repair. The main step is the dissection, clipping or bipolar coagulation and section of the varicose spermatic veins.

[Laparoscopic treatment of transhiatal gastric hernia]. / Cura laparoscopica a herniei gastrice transhiatale.

The paper is referring to the laparoscopic cure of the gastric transhiatal hernia. The first part is a short comment on the way to establish the need for surgery and to choose the adequate procedure. Then the main tactical aspects of the laparoscopic Nissen fundoplication are discussed. Finally the technique of the operation is detailed. Six patients were operated on with good results.

[Therapeutic strategy in breast cancer]. / Strategia terapeutica în cancerul mamar.

The authors present the actual concepts of the therapeutic strategy for the breast cancer. The choice of the optimal protocol treatment is based on a complete and correct pretherapeutic evaluation. This implies the staging using TNM/ UICC/ 1987 system (explained in the text) and the definition of the prognostic factors: axillary lymph node involvement, other pathological patterns, the situation of the hormonal receptors and the cell proliferation index. For the stages I-II the strategy of the treatment include: modified radical mastectomy, postoperative irradiation in well defined cases and the adjuvant systemic treatment using chemotherapy and hormonal therapy. The laparoscopic ovariectomy is a safe and simple technique. For the local advanced cancer (IIIA and IIIB) the treatment begins with a systemic aggressive approach, the surgery being applied following the tumoral regression. In the stage IV the complex palliative treatment is indicated.