[Endoscopic parathyroidectomy. Surgical technique in primary hyperparathyroidism]. / Endoskopische Parathyreoidektomie. Operationstechnik bei primärem Hyperparathyreoidismus.

We report our experience and technique of endoscopic removal of parathyroid adenomas in case of primary hyperparathyroidism. Scintigraphy, MRI scan and cervical ultrasound enable exact diagnosis and therefore exact localisation and placement of the three 5 mm trocars for endoscopic operation. The placement of the optic and the function trocars depends on the localisation of the adenoma. The free room to work in is created between thyroid and neck muscles and supported by insufflated CO2 with a pressure of 12 mm Hg. After the adenoma is taken out through an incision above the jugulum. With this technique we operated upon 3 patients successfully. Benefits for the patients seem to be a less painful postoperative course with minimal blood loss because of the exact exploration of the adenoma with minimal invasion of the surrounding tissue.

Voice-controlled robotic arm in laparoscopic surgery.

AIM: To report on our experience with a voice-directed robotic arm for scope management in different procedures for "solo-surgery" and in complex laparoscopic operations. METHODS: A chip card with orders for the robotic arm is individually manufactured for every user. A surgeon gives order through a microphone and the optic field is thus under direct command of the surgeon. RESULTS: We analyzed 200 cases of laparoscopic procedures (gallbladder, stomach, colon, and hernia repair) done with the robotic arm. In each procedure the robotic arm worked precisely; voice understanding was exact and functioned flawlessly. A hundred "solo-surgery" operations were performed by a single surgeon. Another 96 complex videoscopic procedures were performed by a surgeon and one assistant. In comparison to other surgical procedures, operative time was not prolonged, and the number of used ports remained unchanged. CONCLUSION: Using the robotic arm in some procedures abolishes the need for assist ance. Further benefit accrued by the use of robotic assistance includes greater stability of view, less inadvertent smearing of the lens, and the absence of fatigue. The robotic arm can be used successfully in every operating theater by all surgeons using laparoscopy.

[Laparoscopy-assisted colorectal surgery. Early outcome in benign and malignant diseases--a prospective study of 120 patients]. / Laparoskopisch-assistierte kolorektale Chirurgie. Frühergebnisse bei gut- und bösartigen Erkrankungen--eine prospektive Untersuchung von 120 Patienten.

We present our results with laparoscopic-assisted colorectal surgery in 120 patients during the time from January 1993 to September 1996. The types of procedures cover almost the whole spectrum of colorectal surgery. They included hemicolectomies, signmoid resections, low anterior resections, Hartmann closures, proctocolectomies and rectopexies. 127 patients were subjected to laparoscopic operation, 7 needed conversion to open surgery (7% conversion rate). Average operation time was 145 +/- 58 min, length of postoperative stay 12 +/- 4 days. Oral food intake was started at the second day postoperatively without major problems. We observed perioperative complications in 21 cases (17%). There were 5 anastomotic leaks, 4 wound infections, 1 pneumothorax and 2 postoperative bleedings, 4 patients had clinical signs of prolonged bowel paralysis, 2 patients died as a consequence of anastomotic leaks, 2 of other reasons. In the postoperative period we saw a marked faster recovery and a lower complication rate compared to our conventionally operated patients and postoperative pain was less. In cases of malignant disease no rise in rate of recurrence was observed during follow-up (average 18 months) compared to open surgery. Until the results of long-term studies are published laparoscopic procedures should still be restricted to early tumor stages and palliative procedures.