Cervical scarless endoscopic thyroidectomy: Axillo-bilateral-breast approach (ABBA).

BACKGROUND: Neck surgery is one of the latest applications of minimally invasive surgery. We applied a new technique for totally endoscopic thyroidectomy, the axillo-bilateral-breast approach (ABBA). This approach does not leave a scar on the neck. METHODS: Between February 2005 and October 2005, 13 patients were treated by ABBA for uni- or multinodular goitres. Surgery is performed under general anaesthesia and in supine position. 5 mm bilateral skin incisions are made on the margin of the areola of nipple. They are used to insert and subcutaneously push forward a 20 cm long, 5 mm trocar to the jugular fossa. A further 5 mm incision is performed in the right axilla. The right breast trocar is the optical trocar. A Maryland clamp in axillary position and 5 mm harmonic scalpel via the left breast trocar permit a clear view of the further subfascial preparation. The caudal hyoidal muscles are longitudinally split along the linea alba. Using delicate blunt dissection, both thyroid lobes are exposed. After isthmus transection is performed, the upper thyroid pole is being mobilized. The upper pole vessels are isolated and divided close to the thyroid capsule. Preparation of the retrothyroidal area includes visualization of the recurrent laryngeal nerve. The resection is performed without bleeding with a harmonic scalpel. Via the axillary approach, with the incision being widened, a 20 mm trocar is inserted and advanced up to the thyroid lodge to remove the specimen. RESULTS: The average operation time was 132 minutes. No patient had to be converted to a conventional approach. Hypocalcaemia or recurrent laryngeal nerve palsy were not observed postoperatively. CONCLUSION: Our preliminary results show that the ABBA technique is a feasible, safe procedure with excellent cosmetic benefits. The small scars in the right axilla and bilateral nipple areola are almost invisible.

Laparoscopic surgery for colon and rectal cancer.

Use of laparoscopic resection for colorectal malignancy has raised concerns regarding local cancer control and the lack of long-term results. Most reported data are preliminary and medium-term results, at best. The aim of this study is to analyse all patients who underwent a laparoscopic resection for colorectal cancer at our department between November 1992 and July 2003. The cohort comprised a total of 394 patients (194 rectal cancer and 200 colon carcinoma). The most common procedures were high and low anterior resection with total mesorectum excision (TME) (176), followed by sigmoidectomy (89), right hemicolectomy (57), and left hemicolectomy (42). Mean operating time was 176 minutes. Conversion was necessary in 4 of the patients. Mean number of lymph nodes removed was 27. The postoperative complication rate was 20.1% (rectum) and 12.5% (colon). One patient died of myocardial infarction. Mean follow up was 45 (0.3-135) months. Port site metastasis occurred in 2 patients. The local recurrence rate was 4.1% after curative rectum resection and 0.5% in the colon group. After curative resection, the overall 5-year survival rate was 76.9% (rectum), and 81.4% (colon). Cancer-related survival rate after 5 years was 87.7% (rectum), and 91.3% (colon). Our results demonstrate that laparoscopic resection for colorectal cancer is not associated with higher morbidity and mortality rates. Established oncological principles are respected and long-term results are at least as good as those after open surgery.

Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients.

BACKGROUND: The aim of the present study was to analyze changes regarding the indications for and results of laparoscopic treatment of sigmoid diverticulitis. METHODS: The data were collected within the framework of an ongoing prospective multicenter study carried out by the Lapa roscopic Colorectal Surgery Study Group and were submitted to a statistical subgroup analysis. The institutions participating in the study were divided into three groups by experience (Group I, >100 procedures; Group II, 30-100 procedures; Group III, < 30 procedures). RESULTS: Among the 3,868 recruited patients, sigmoid diverticulitis (n = 1,545, 40 percent) was by far the most common indication for surgery, and sigmoid resection (n = 2,160, 55.9 percent) was by far the most common laparoscopic procedure. A total of 1,353 patients (87.6 percent) had uncomplicated diverticulitis, whereas 192 (12.4 percent) had a complicated form of diverticular disease (Hinchey I-IV, diverticular bleeding, fistula formation). Cases of complicated diverticulitis were significantly more frequently operated on at institutions with greater experience (Group I, 20.8 percent; Group II, 8.7 percent; Group III, 7.9 percent). Despite this fact, these institutions still had better intraoperative complication rates (Group I, 5.0 percent; Group II, 5.8 percent; Group III, 6.9 percent), conversion rates (Group I, 4.4 percent; Group II, 6.7 percent; Group III, 7.7 percent), and postoperative morbidity (Group I, 15.9 percent; Group II, 16.6 percent; Group III, 18.6 percent) and mortality (Group I, 0.2 percent; Group II, 0.5 percent; Group III, 0.4 percent) rates. CONCLUSION: An increase in experience is associated with an expansion of laparoscopic indications to include complicated forms of diverticulitis, with comparable ntraoperative and postoperative complication rates, operating time, and mortality rates.