Rationale and surgical technique of laparoscopic left lateral sectionectomy using endoscopic staples

PURPOSE: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples. METHODS: We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14). RESULTS: Mean operation time was 265.3 +/- 21.3 minutes (mean +/- standard deviation) in the individual group and 170 +/- 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 +/- 1.6 and 2.6 +/- 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 +/- 1.1 and 9.4 +/- 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups. CONCLUSION: LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.

Suturas: lo usual y lo nuevo / Sutures: the usual and the new

En la actualidad, existen numerosas estrategias para enfrentar el cierre de una herida quirúrgica. Éstas son suturas, corchetes y adhesivos, teniendo cada una de ellas indicaciones precisas. Las suturas constituyen la estrategia más antigua, existiendo en la actualidad una gran variedad de suturas absorbibles y no absorbibles con distintas características. El presente documento hará una breve revisión de las suturas existentes y abordar algunas líneas de desarrollo nuevos métodos de cierre de heridas, orientadas principalmente a reducir la incidencia de complicaciones.

Nowadays, there are numerous strategies to close a surgical wound. These are sutures, staples and adhesive materials. Each one has precise indications. Sutures are the most antique strategy and there are multiple absorbable and non-absorbable sutures with different characteristics. This document will review actual sutures and will discuss some new advances in wound closures in order to reduce complications.