استكشف المجموعة الواسعة من العناوين المتاحة.

Introduction/BackgroundThis study is aimed to investigate the possibility of pre-operative oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy in gynecologic surgeries.MethodologyIn this retrospective study, 30 patients with gynecological malignancies who had indications for laparoscopic para-aortic lymphadenectomy up to the renal vessels were give pre-operative oral oil (oil administration group) (n=15) or not (control group) (n=15) at our hospital between September 2017 and June 2018. The chylous tubes displaying rate, incidence of chylous leakage and other perioperative datum of the two groups were compared.Results uccessful display of chylous tubes was observed in 93.3% (14/15) patients in the oil administration group. The chylous leakage was 0 in the oil administration group, and 33.3% (5/15) in the control group. The postoperative drainage duration (4.1±1.0d vs 7.6±1.4d, P=0.000), somatostatin application time (0d vs 5.9±0.8d), and post-operative hospital stay (6.0±2.3 d vs 9.1±2.1d, P=0.001) were significantly shorter in the oil administration group. The total cost is lower in the oil administration group (4972.52±80.54dollars vs 6260.80±484.47 dollars, P=0.000).ConclusionPre-operative oil administration is a feasible and effective method to display the chylous tubes and to prevent the chylous leakage in para-aortic lymphadenectomy.DisclosureNothing to disclose.Abstract P110 TablePerioperative datum of the oil administration group and control groupParameter, mean ±SD or n (%) oil administration group (n=15) control group (n=15) p value Para-aortic lymphadenectomy operating time (min) 73.14±13.22 68.53±11.65 0.327 Chylous tubes diaplaying rate (%) 93.3 (14/15) 0 (0/15) 0.000 Rate of chylous leakage (%) 0 (0/15) 33.3 (5/15) 0.042 Number of lymph nodes excised (n) 10±5 11±5 0.759 Postoperative drainage duration (d) 4.1±1.0 7.6±1.4 0.000 Somatostatin application time (d) 0 5.9±0.8 0.000 Hospital stay postsurgery (d) 6.0±2.3 9.1±2.1 0.001 Operation cost, US $ 1303.82±99.54 1363.53±98.57 0.120 Total cost, US $ 4972.52±80.54 6260.80±484.47 0.000 Abstract P110 Figure 1Recruitment and follow-up flow chartAbstract P110 Figure 2The left and the right lumbar trunk was displayed. Check the leakage and occlude the lesion

Introduction/BackgroundAsymptomatic lymphocele formation after lymphadenectomy is quite common but in some symptomatic cases surgical intervention is essential to relieve the symptoms.MethodologyVideo presentation of caseResults51 year old woman with postmenopausal bleeding was subjected to laparoscopic staging (laparoscopic hysterectomy + BSO + pelvic and paraaortic lymphadenectomy) who had grade III endometrioid adenocarcinoma of uterus in her endometrial biopsy. Intraoperatively in paraaortic lymphadenectomy an incidental injury to cisterna chyli occurred which was sealed and repaired immediately. She was discharged in post-op day 2. Three day after her discharge she referred to our clinic once again with complaints of right lower back-pain. Ultrasonographic evaluation revealed grade 2–3 hydroureteronephrosis (HUN). In CT scan a 5 cm lymphocele located in paraaortic area was observed which causes ureteral obstruction at that level. Because of the sympyoms and HUN re-laparoscopy was planned. Laparoscopically lymphocele located laterally in right low-paraaortic region was detected and aspirated. A window was created in the lymphocel sac in order to prevent recureence. In postoperative period the patient developed ileus which was handled conservatively. In P.O. day 4 she was discharged without any symptoms. One week after re-laparoscopy complete resolution of HUN was confirmed and she was referred to brachytherapy unit.ConclusionLaparoscopy is a useful and safe tool in the management of symptomatic lymphocele. With minimally invasive techniques recovery is fast and there is no delay in the planned adjuvant therapy.DisclosureNothing to disclose

Objectives: Since the introduction of laparoscopic nephrectomies, laparoscopic surgeries in the field of urology have become increasingly popular. Laparoscopic surgery has its advantages but carries the risk of complications like all interventions. In our study, we aimed to discuss our complication rates according to difficulty level by presenting our experiences with urological laparoscopic procedures for the upper urinary system. Methods: This retrospective study includes 942 laparoscopic urological procedures performed by a single surgeon. The procedures divided into three groups according to the European Scoring System (ESS) Classification. The complication rate of each group was calculated separately. Results: A total of 127 (13.4%) complications were observed. Partial nephrectomy, nephroureterectomy and ureterolithotomy had the highest complication rates. Renal cyst excision, simple nephrectomy and radical nephrectomy had the lowest complication rates. According to the Clavien Complication Classification, the distributions of Grade 1, 2 and 3 complications were 29.1% (n =37), 57.4% (n = 73) and 13.3% (n = 17); respectively. The open conversion rate was 0.84%. When procedures were classified as “easy”, “difficult” and “very difficult” according to the ESS classification; complication rates were found 7.3% in the easy group, 13.3% in the difficult group and 16.6% in the very difficult group. There was no significant difference between the three groups in terms of complication rates (p = 0.329). Conclusions: Performing easier operations according to ESS in the first years of the learning curve is beneficial in preventing complications. With increasing experience, more complicated procedures can be performed with similar complication rates.

HintergrundBei einem Großteil der Patienten mit Rektumkarzinom wird der Tumor minimal-invasiv reseziert, in der chirurgischen Therapie des Kolonkarzinoms überwiegt aber noch die offene Resektionstechnik.ZielEs wird ein Überblick über die aktuelle Datenlage zur minimal-invasiven Resektion des Kolonkarzinoms im Vergleich zur offen Resektion gegeben.Material und MethodeDiese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Kolonkarzinom“, „offene, laparoskopische oder robotische Resektion“.ErgebnisseBedenken gegenüber der laparoskopischen Technik bezüglich schlechterer onkologischer Ergebnisse haben sich in großen multizentrischen und randomisierten kontrollierten Studien nicht bestätigt. Die laparoskopische Kolonresektion ist sicher und der offenen Resektion unter Studienbedingungen mindestens onkologisch gleichwertig. Das reduzierte Zugangstrauma führt zu niedrigerer Gesamtmorbidität, kürzerem stationären Aufenthalt und schnellerer Rekonvaleszenz sowie zu weniger Folgeeingriffen aufgrund von Narbenhernien oder Adhäsionen. Weitere Vorteile bieten Abwandlungen wie die „hand-assisted laparoscopic surgery“ (HALS) oder die „single incision laparoscopic surgery“ (SILS), sind aber technisch anspruchsvoll und müssen auch von erfahrenen laparoskopischen Operateuren trainiert werden. Die roboterassistierte Kolonresektion ist einfacher zu erlernen und zeigt Vorteile bei der zentralen Gefäß- und Lymphknotendissektion sowie bei der Anlage intrakorporaler Anastomosen, ist aber teurer und technisch aufwendiger.SchlussfolgerungDurch gezielte Patientenselektion und spezielle Schulung der Operateure könnte die Rate an minimal-invasiven Resektionen zur Therapie des Kolonkarzinoms deutlich gesteigert werden.

Objective: With the increasing popularity of minimally-invasive surgery, laparoscopic pyeloplasty has become a staple in the armamentarium of urologists. However, the surgery has a steep learning curve and longer operative time. In this study, we aimed to evaluate the results of initial 53 cases of laparoscopic dismembered pyeloplasty in our institute. Materials and Methods: A total 52 of patients with pelvi-ureteric junction (PUJ) obstruction, 30 male and 22 female, with the mean age of 23.5 years were managed by transperitoneal laparoscopic dismembered pyeloplasty. The patients were placed in full lateral position and surgery was done using a minimum of three ports, retrograde pyelography was done in all; initial access was done by using a Veress needle. The ureter was spatulated first, first suture taken and then the PUJ was dismembered to avoid rotation of the ureter. Antegrade DJ stenting was done in all patients and one drain was left in the retroperitoneum after surgery. DJ stent was removed six weeks after surgery. Results: Fifty two patients were managed by dismembered pyeloplasty. Six patients required preoperative urinary diversion. Intrarenal pelvis was seen in seven, crossing vessel in ten, high insertion of ureter in six and associated calculus in five patients. Conversion to open surgery was required in six patients. Initially, the operative time was more than three hours but after sufficient experience of 25 cases, it reduced drastically and in last 28 cases, the mean operative time was 123 minutes, with shortest time reported 97 minutes. Reintervention was required in eight patients and overall success rate was 87%. Conclusion: Laparoscopic pyeloplasty is a safe, minimally-invasive and viable alternative to open pyeloplasty for the management of PUJ obstruction. Keywords: Laparoscopy, Pyeloplasty, PUJ, Obstruction, Dismembered Amac: Minimal invaziv cerrahinin artan popularitesiyle birlikte, Laparoskopik Piyeloplasti urologlarin temel araci haline gelmistir. Buna karsin cerrahi, dik bir ogrenme egrisine ve daha uzun operasyon surelerine sahiptir. Bu calismada, klinigimizde laparoskopik parcalanmis piyeloplasti gerceklestirilen ilk 52 olguya ait sonuclarin degerlendirilmesi amaclanmistir. Gerec ve Yontem: Pelvi-ureterik bileske (PUE) darligina sahip, 30 erkek ve 22 kadin olmak uzere yas ortalamasi 23,5 olan toplam 52 hastaya transperitoneal laparoskopik parcalanmis pyeloplasti uygulandi. Hastalar tam lateral pozisyona yerlestirildi ve en az uc port kullanilarak ameliyat yapildi, hepsinde retrograd piyelografi yapildi; ilk erisimde Veress ignesi kullanildi. Ureter ilk olarak spatule edildi; once sutur alindi ve daha sonra ureterin donusunu onlemek icin PUJ parcalandi. Antegrad DJ stentleme butun hastalara uygulandi ve operasyon sonrasi retroperitonda bir diren birakildi. Operasyondan 6 hafta sonra DJ stent cikarildi. Bulgular: Elli iki hasta parcalanmis piyeloplasti ile tedavi edildi. Alti hastaya ameliyat oncesi uriner diversiyon gerekti. Yedi hastada Intrarenal pelvis, 10 hastada damar gecisi, 6 hastada yuksek yerlesimli ureter ve 5 hastada iliskili kalkul gorulmustur. Alti hastada acik cerrahiye donulmesi gerekmistir. Baslangicta operasyon suresi 3 saatten daha uzunken, 25 olguda olusan yeterli deneyim sonrasi buyuk olcude azalmistir. Son 28 olgunun ortalama operasyon suresi 123 dakika olup bunlar icinde en kisa sure ise 97 dakikadir. Sekiz hastada tekrar mudahale gerekirken, genel basari orani %87'dir. Sonuc: Laparoskopik piyeloplasti; guvenilir, minimal invaziv ve PUE darlik yonetiminde acik piyeloplasti yerine uygulanabilir alternatif bir yontemdir. Anahtar Kelimeler: Laparoskopi, Piyeloplasti, PUE, Darlik, Parcalanmis

6th Asian Congress of Endometriosis and 6th International Congress of Minimally Invasive Surgery

Dès la fin des années 1980, la révolution laparoscopique gagnait la chirurgie digestive, et dans son prolongement les techniques bariatriques, ce qui a apporté une profonde amélioration de la prise en charge postopératoire. Pour d'évidentes raisons d'instrumentation et d'abord chirurgical, les premiers pas ont nécessité des efforts importants, mais l'engouement a été très rapidement présent chez les patients obèses, avec la pose des anneaux modulables, initiée par Mitiku Belachew, puis le bypass gastrique avec Alan Wittgrove, enfin la totalité de l'arsenal bariatrique. At the end of the eighties, the laparoscopic revolution reached digestive surgery, and from there bariatric techniques, which made it possible to improve considerably post-operative cares. For obvious reasons pertaining to instruments and surgical approach, the initial steps required important efforts, while the momentum came fast, owing to the enthusiasm of bariatric surgeons and morbidly obese patients. The laparoscopic gastric banding was initiated by Mitiku Belachew, then laparoscopic gastric bypass by Alan Wittgrove, then the whole bariatric armamentarium.

It has been well-established that a large portion of the lumbosacral plexus is located intra-abdominally, in the retroperitoneal space. However, most of the literature descriptions of lesions on this plexus refer to its extra-abdominal parts whereas its intra-abdominal portions are often neglected.The objective of this review paper is to describe the laparoscopic anatomy of intrapelvic nerve bundles, as well as the findings and advances already achieved by Neuropelveology practitioners.