Abstract:

The success of laparoscopic cholecystectomy has resulted in the broad application of minimally invasive techniques in many surgery specialties. The theoretical advantages of laparoscopy over conventional open operations, including less postoperative pain, faster overall recovery, and better cosmetic results have been achieved leading to its acceptance by surgeons and the public alike. Numerous abdominal procedures have been adapted to minimally invasive approaches including bowel resection, inguinal and ventral hernia repair, anti-reflux techniques, and solid organ removal such as splenectomy.

Authors:

Charles L. Backus, D.O., R. Matthew Walsh, M.D., Brent D. Matthews, M.D., Ronald F. Sing, D.O., R. Todd Heniford, M.D., Carolinas Medical Center, Charlotte, NC

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Abstract:

In comparison to medical treatment, antireflux surgery is recognized as an effective, efficient and longlasting therapy, as well as the only treatment that is able to modify the natural history of gastroesophageal reflux disease (GERD). The 360° fundoplication is the most widely used surgical procedure for GERD. Although performed in the era of H2-blockers and open surgery, comparison of the so-called Nissen repair to both symptomatic and continuous medical therapies concluded that surgery was superior to medical therapy in every outcome measure used.

Authors:

Abe Fingerhut, M.D., F.A.C.S., F.R.C.S., Elie Yahchouchy, M.D., Centre Hospitalier Intercommunal de Poissy, Poissy, France, Bertrand Millat, M.D., Hopital Saint Eloi, Montpelier, France, Chadli Dziri, M.D., F.A.C.S., Hopital Charles Nicolle, Tunis, Tunisia, Jean-Charles Etienne, M.D., Ahmed Al Hadrani Centre Hospitalier Intercommunal De Poissy, Poissy, France, Jean-Christopher Paquet, M.D. Centre Hopitalier de Longjumeau, Jean-Marie Hay, M.D. Hopital Louis Mourier, Pierre Louis Fagniez, M.D. Hopital Henri Mondor, Simon Msika, M.D. Hopital Louis Mourier, Colombes, France

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Abstract:

Endoscopy has significantly improved the evaluation of hollow organs such as the gastrointestinal tract and bronchial system. It enables detailed visualization of the endoluminal surfaces and provides high diagnostic accuracy. Furthermore, interventional techniques, such as biopsy or therapeutic procedures, can be performed under direct vision. Miniaturization and improvements in optical quality of endoscopes have been accomplished through the development of smaller fiber optic pixels and wideangle optical lenses. We present a new system for microendoscopy and describe our early experience with various applications of this technique.

Authors:

Michael Hunerbein, M.D. Robert-Rossle Hospital Susan Totkas, M.D., Cyrus Khodadadyan, M.D., Campus Virchow Hospital, Peter M. Schlag, M.D., Ph.D., F.S.S.O., Robert-Rossre Hospital, Berlin, Germany

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Abstract:

Laparoscopic surgery has undergone a rapid evolution since the first laparoscopic cholecystectomy of Erich Mühe in 1985. Many surgeons felt that further technological success would be related not only to increasing experience and skill of surgeons, but also technological advances which would enable surgeons to perform increasingly more difficult and complex tasks. Progress has been rapid for some, but broad acceptance by surgeons has been slow.

Authors:

Demetrius E. Litwin, M.D., Yuri Novitsky, M.D., Kent W. Kercher, M.D., Andras Sandor, M.D., Steven M. Yood, M.D., M.P.H.; John J. Kelly, M.D.; Richard M. Beane; Steven Ek; William C. Meyers, M.D.; Karen A. Gallagher, R.N., B.S; University of Massachusetts Medical School and University of Massachusetts Memorial Healthcare, Worcester, MA

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Abstract:

Morbid obesity is a serious disease that is responsible for several co-morbid conditions. Patients with a body mass index of over 40 kg/m2 will require surgical intervention if a dietary program fails. In the US, patients who are morbidly obese number approximately 8 million. At present, three conventional operations, with acceptable early and late complication rates, are performed most frequently worldwide: vertical gastroplasty (VRG), vertical banded gastroplasty (VBG), and gastric bypass (GB). In this article, we describe our experience with the LAP-BAND® technique, and in particular with the new LAPBAND ® adjustable gastric banding system (LAGB®), which further reduces postoperative complications and reoperations.

Authors:

Rudolf Weiner, M.D.; Hermann Bockhorn, M.D.; Davorin Wagner, M.D.; Hospital Nordwest, Frankfurt, Germany

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Abstract:

Endoscopic adrenalectomy, since its initial description in 1992 by Gagner et al. in Canada and by Higashaihara in Japan has emerged as the standard of care in the treatment of patients with benign adrenal neoplasms. It has been shown to be as effective as open surgery in treating adrenal pathology, with improvements in pain, cosmesis and duration of hospitalization.

Authors:

G. Dean Roye, M.D.; Jack Monchik, M.D.; Joseph F. Amaral, M.D.; Brown University, Providence, Rl

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Abstract:

There is a need for secure and easy methods for suturing in laparoscopic surgery, no matter whether vessels are to be ligated, two structures sutured together, or the cystic duct is to be occluded in cholecystectomy. Laparoscopic suturing can be done with a suture, using automatic sewing devices or clips. Improper ligation of a vessel for example can result in bleeding, which is more difficult to treat in a laparoscopic procedure than in an open procedure. By using a Roeder knot in laparoscopic suturing, tying of the knot requires some expertise and makes the procedure more complicated and time-consuming.

Authors:

Sabine Cecile Fischer, M.D.; Klaus Roth Alberto Arezzo, M.D.; Heike Raestrup, M.D.; Marc Olivier Schurr, M.D.; Gerhard Fritz Buess, M.D., Ph.D., F.R.C.S. (Ed); Eberhabd-Karls-University of Tubingen, Tubingen, Germany

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Abstract:

Gastric endo-organ surgery is a minimally invasive procedure combining the use of gastroesophageal endoscopy and laparoscopy to approach intragastric problems that require surgical intervention. The advantages include: less scarring; shorter hospital stays; and less postoperative discomfort than conventional laparotomy. The technique requires placement of two or three percutaneous endoscopic gastrostomies in various positions on the gastric wall. Filipi et al. developed a percutaneous endoscopic gastrostomy (PEG) that is large enough to allow the use of 5 and 10mm laparoscopic instruments for intragastric surgery. In this article we review the complications related to the introduction of this access port.

Authors:

Glenn C. Gardner, M.D.; Charles J. Filipi, M.D., F.A.C.S.; Creighton University, Omaha, NE

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