Abstract:

Background: Mini-laparoscopy (Mini) was pioneered more than 20 years ago. Newer generation mini instruments have recently become available with improved effector tips, a choice of shaft diameters and lengths, better shaft insulation and electrosurgery capability, improved shaft strength and rotation, more ergonomic handles, low-friction trocar options, and improved instrument durability. Whether the use of mini instruments, particularly newer generation instruments, offers advantages for laparoscopic cholecystectomy is the subject of this review. Materials and Methods: The literature was searched for level I data comparing mini-laparoscopic cholecystectomy (Mini LC) to standard laparoscopic cholecystectomy (Std LC). Three systematic reviews and 19 randomized clinical trials were identified and these were studied to evaluate the science behind Mini LC. Results: Mini LC requires conversion to Std LC in 12.3% of patients. Mini LC and Std LC require conversion to open cholecystectomy at the same rate (2–3%). As compared to Std LC, Mini LC: (1) takes 3.4–4.9 minutes longer to perform; (2) has the same rate of intraoperative and postoperative complications; (3) may result in slightly less pain in the first 24 hours after surgery; (4) has the same duration of hospital stay, pain scores 1–28 days after surgery, time to return to activity, time to return to work, and postoperative quality of life 10 days after surgery; (5) provides a better early cosmetic result (as graded by patients and by blinded observers); and (6) provides no apparent difference in late cosmesis (as evaluated 6–12 months postop). There are minimal level I data published on the effects of newer mini instruments for laparoscopic cholecystectomy. Conclusion: When applied to elective laparoscopic cholecystectomy, the use of mini-laparoscopic instruments results in a slightly longer operative procedure (3–5 minutes), slightly less immediate postoperative pain (in the first 24 hours), and a better early cosmetic result, with no other apparent significant differences. Additional data are needed from large, well-conducted studies of Mini LC to resolve several unanswered questions, including the role of newer mini instruments.

Authors:

Gustavo L. Carvalho, MD, PhD, MSc, MBA, Associate Professor of Surgery, University of Pernambuco, Attending Surgeon, Department of Surgery, Hospital Universitário Oswaldo Cruz, Recife, Brazil, Eduardo Moreno Paquentin, MD, FACS, Associate Professor of Surgery, Centro Medico ABC Santa Fe, Mexico City, Mexico, Jay A. Redan, MD, FACS, Professor of Surgery, University of Central Florida College of Medicine, Orlando, Florida, Medical Director, Minimally Invasive General Surgery, Florida Hospital Celebration Health, Celebration, Florida, Phillip P. Shadduck, MD, FACS, Assistant Consulting Professor of Surgery, Duke University, Vice Chair of Surgery, Duke Regional Hospital, Chief of General Surgery, TOA Surgical Specialists, Chief of Staff Elect, North Carolina Specialty Hospital, Durham, North Carolina.

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Abstract:

Background: Liver resection is the curative treatment for patients with colorectal liver metastases (CRLMs), with five-year survival rates of 30–50%. Radiofrequency ablation (RFA) is a local and useful alternative for patients with non-resectable CRLMs to obtain complete tumor clearance. The aim of this study was to analyze survival rates with this local treatment. Materials and Methods: All patients who underwent RFA and resection or RFA alone for unresectable CRLMs between 2001 and 2012 were included in a retrospective study. Descriptive and survival statistics were calculated. Morbidity, mortality, and recurrence were also analyzed. Results: The study involved 72 patients and 179 lesions. RFA was performed in 109 procedures. Mortality was 2.7% and morbidity was 25.7%. Local recurrence concerned 25.7% of lesions. Independent risk factors for recurrence were more than one CRLM (p= 0.0427) and size of largest CRLM greater than 3 cm (p= 0.0139). The five-year overall survival rate was 45.5% and the five-year disease-free survival (DFS) was 9.9%. Conclusion: This study shows RFA has good oncological outcomes. The combination of RFA and resection is considered as a curative treatment for patients with unresectable CRLMs.

Authors:

Dr. Sandra Aissou, MD, Assistant Surgeon, Service de chirurgie viscérale et digestive, Dr. Victoire Cartier, MD, Assistant Radiologist, Service de radiologie interventionnelle, département d'imagerie médicale, Pr. Antoine Hamy, MD, Professor of Surgery, Service de chirurgie viscérale et digestive, Faculté de médecine d'Angers, Dr. Fleur Plumereau, MD, Assistant Surgeon, Service de chirurgie viscérale et digestive, Pr. Christophe Aube, MD, PhD, Professor of Radiology, Service de radiologie interventionnelle, département d'imagerie médicale, Faculté de médecine d'Angers, Pr. Emilie Lermite, MD, PhD, Professor of Surgery, Service de chirurgie viscérale et digestive, Centre Hospitalier Universitaire d'Angers, Faculté de médecine d'Angers, Angers, France

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