Role Of Laparoscopy In Oncological Surgery

Preoperative evaluation of gastric cancer is extremely difficult. Nodal enlargement is easily detected by preoperative CT however, more than 30 of nodal metastases occur in nodes smaller than 3 mm in diameter.39 The lower limit for detecting hepatic metastases is 5-10 mm in diameter by either CT scan or by ultrasound. Furthermore, peritoneal metastases are usually undetected by conventional CT or ultrasound. The efficacy of preoperative laparoscopic examination on the resectability of stomach...

Videoassisted Thoracic Surgery for Lung Cancer

In 1996, 170,000 new cases of lung carcinoma were diagnosed while 156,000 patients died from the disease. Patients diagnosed with localized pulmonary carcinoma are treated surgically. Surgical intervention for pulmonary carcinoma requires at a minimum a lobectomy with mediastinal lymph node dissection. Patients diagnosed with locally advanced disease are treated with either surgery and adjuvant therapy or exclusively with adjuvant therapy. Disseminated disease is treated with chemotherapy...

Laparoscopic Surgery in Kidney Cancer

Renal cell carcinoma is the most common primary renal malignancy, accounting for approximately 25,000 cases annually in the United States and resulting in over 10,000 deaths. It is the tenth most common cancer, constituting 3 of all adult malignancies, and generally occurs in adults between the ages of 50 and 70. Males are affected twice as frequently as females.1 It occurs bilaterally in 2 to 4 of individuals either synchronously or metachronously. The incidence of renal carcinoma has steadily...

Conclusion

We believe that currently the combination of contrast-enhanced dynamic CT imaging of the pancreas with videolaparoscopy is an effective, safe, and cost-efficient method of staging patients with pancreatic cancer. These investigations avoid unnecessary operation while not precluding exploration and resection for those who would potentially benefit. However, the true role of laparoscopic bypass remains to be defined. Early reports have demonstrated their feasibility, but their place in our...

Surgery Of Hepatobiliary Malignancies

Complete surgical resection holds the only realistic hope of long-term survival for patients with hepatobiliary malignancies. However, there are distinct criteria for determining resectability, and each type of tumor has specific problems concerning (preoperative) patient selection. There is ample evidence that resection of colorectal liver metastases has the potential to achieve long-term cure in selected patients.3-5 Even repeat resection may be feasible. Although the percentage of patients...

Laparoscopic Diagnosis and Treatment of Ascites and Peritoneal Malignancies

From its inception, the laparoscope has been an important tool in the assessment of causes of fluid collection in the abdomen as well as in the diagnosis and subsequent management of peritoneal malignancies.1 Although most cases of as-cites result from benign conditions worldwide, it is important to understand that benign and malignant conditions may occur concurrently and that a focused approach to the etiology of ascitic collection is mandatory for appropriate treatment strategies. Among the...

Resection Of Neurogenic Tumors

Neurogenic tumors, found in any mediastinal location, are most commonly located in the posterior compartment. They often arise from either the intercostal nerves (neurofibroma, neurolemma and neurofibroma), the sympathetic ganglia (ganglioma, ganglioblastoma and neuroblastoma), or paraganglia cells (paraganglioma).1 Of all neurogenic tumors, neurolemma is the most common. Preopera-tive staging with magnetic resonance imaging is required to exclude intraspinous involvement (dumbbell-tumor).18...

Laparoscopic Ultrasonography

Combining the advantages of diagnostic laparoscopy with those offered by intraoperative ultrasonography seems a logical development, particularly for the assessment of liver tumors.2 The first report of a technique combining LS with US dates back to 1963, when Yamakawa41 described A-mode US scanning of a gallbladder cancer under LS guidance. But it was not until 19812 that Ohta42 and Oda43 reported their pilot studies using laparoscopic real-time B-mode scanning techniques. In 1983 Frank et...

Introduction

Pancreatic cancer has the worst prognosis of all gastrointestinal malignancies. According to the National Cancer Institute, only 3 of all patients will be alive five years after diagnosis. Preoperative staging is therefore mandatory in order to carefully select those few patients who may be operated with a likelihood of cure1,2 and accurate staging will allow selection of patients for palliative treatment without the need for an exploratory laparotomy. Twenty years ago, Cuschieri3 demonstrated...

Immune Response

In 1997 Walker et al reported higher T lymphocyte counts, increased oxidative activity of leukocytes and lower concentrations of inflammatory mediators following VATS versus open thoracotomy for pulmonary lobectomies.32 Although open thoracotomy produced greater immune suppression, there was no difference in clinical outcome between the groups. However MaKinlay et al24 noted a trend toward greater disease-free survival rates in patients treated by VATS for pulmonary malignancies. The full...

Critical Analysis

Video-assisted surgery must respect the principles of oncological resection. However, in the specific case of esophageal cancer, it is conceivable to palliate dysphagia. Esophageal resection with or without wide lymphadenectomy is controversial, regardless of surgical technique. Akiyama recommends wide lym-phadenectomy whereas its value is questioned by Western surgeons.22,23 It is widely recognized that lymphadenectomy improves pathological staging however it is much more traumatic. As...

Rationale For Laparoscopic Staging

The goal of clinical oncological staging is to accurately define the extent of disease, direct appropriate therapy and avoid unnecessary intervention. Minimal access surgery offers a new approach to this problem. In theory, decreased surgical morbidity, reduced hospital stay, shorter recovery, and potentially improved qual-ity-of-life would be of benefit to the patient expected not to live longer than a few months. Recent reports have suggested that laparoscopy can play an important role in the...

Endosurgery and Pediatric Oncology

Paulo Chapchap, Ricardo Frank Coelho da Rocha The Surgeon's Role in Pediatric Evaluation and THE SURGEON'S ROLE IN PEDIATRIC ONCOLOGY Although pediatric cancer is one of the most common serious diseases among children and adolescents under 16 years of age in developed countries,1 the most frequent pediatric malignant diseases, leukemias and central nervous system tumors are not in the therapeutic field of the pediatric surgeon. However, pediatric surgeons have always played a leading role in...

Laparoscopic Adrenal Surgery

Laproscopy Surgery Adrenalectomy

Litwin 140 149 Since the introduction of laparoscopic adrenalectomy in 19921 its use has become increasingly widespread. The advantages of removing adrenal glands laparoscopically are related to the small incisions used in this procedure, resulting in decreased length of stay, decreased utilization of parenteral pain medication, and earlier return to functional status. In this chapter, we will review the indications for laparoscopic adrenalectomy in surgical...

H

Hyperechoic with no mass-effect on surrounding tissue and no Fig. 8.9b. Typical hemangioma (H) acoustic shadow. hyperechoic with no mass-effect on surrounding tissue and no by their well-defined, hyperechoic, homogenous appearance. In cirrhosis regenerating nodules are difficult to differentiate from hepatoma. US-targeted biopsy is indispensable in obtaining a correct diagnosis. Fatty infiltration usually results in a uniformly increased acoustic impedance of the hepatic parenchyma....

Previous abil surgeryNo midline scars

Of midline scars, the umbilical position is usually favored for establishing pneumoperitoneum and laparoscope placement. LUS examination of the liver requires access from the right subcostal region when using a (semi-)rigid probe, introduced laterally, between the midclavicular and anterior axillary lines. A second port is needed for full examination, preferably in the left subcostal or infra-umbilical areas. For LUS of the hepatoduodenal ligament, the transducer needs to be placed...

Laparoscopic Biliary And Gastric Bypass

Distal Biliary Obstruction

The ideal palliative procedure for biliary obstruction should be effective in relieving jaundice, have minimal morbidity, be associated with a short hospital stay, have a low symptomatic recurrence and maintain quality-of-life. In patients with malignant distal biliary obstruction, there has been a trend recently towards Fig. 6.4. Ultrasound image of an hepatic metastasis. Aloka SSD-2000, 7.5 MHz linear array probe. nonoperative biliary drainage by either the endoscopic or transhepatic...

Diagnosis And Workup Of Malignant Ascites

The finding of ascitic fluid in patients with known abdominal malignancy is usually secondary to the tumor itself. Many times, however, patients present with increasing abdominal girth without other sequelae or prior diagnosis of malignancy. Non-neoplastic causes of ascites include congestive heart failure, cirrhosis, renal disease or pancreatic disease, hypoproteinemia, infectious processes such as spontaneous bacterial peritonitis or tuberculosis Fig. 3.2 . In addition, benign gynecologic...

Role of Laparoscopic Ultrasound

In Minimal Access Surgery Ramachandia Kolachalam, Maurice E. Arregui Indications for Laparoscopic Technique Role of LUS in Intra-abdominal Malignancy Results 184 Pancreatic-Biliary- Malignant Group Pancreas-Benign Liver Malignant Liver-Benign Colon Cancer Unknown Stomach, Spleen and 18. Biology of Port Site Pathophysiology of Tumor Implants Acute Chronic Immune 19. Video-Assisted Thoracic Surgery for Lung Cancer 199 20. VATS in Malignant Pleural Technique of VATS for Pleural 21. Laparoscopic...