Minimally invasive esophagectomy by video-assisted thoracoscopic approach for esophageal carcinoma. A case report.

Esophageal carcinoma represents a pathological entity with a bad prognosis even if adequate multimodal treatment is applied. Because of the high operative morbidity and mortality, due especially to respiratory and infectious complications, the tendency nowadays is to mobilize the thoracic esophagus and to perform esophagectomy and mediastinal lymphadenectomy by thoracoscopy instead of thoracotomy. We present the case of a 55-year-old male patient who was diagnosed with a mediothoracic esophageal spinocellular carcinoma, in whom we successfully performed subtotal esophagectomy by cervico-thoraco-abdominal approach, the dissection of the thoracic esophagus being performed entirely by thoracoscopy.

Incidents and postoperative complications of laparoscopic cholecystectomies for acute cholecystitis.

The purpose of this study was to analyze incidents and postoperative complications of the laparoscopic cholecystectomies performed for acute cholecystitis in 1453 patients in the 3rd Surgical Clinic, Cluj-Napoca. Hemorrhage occurred in 139 (9.5%) cases from which 75 (54%) lesions of the cystic artery, 63 (45.3%) cases of bleeding from the vesicular bed and 1 patient (0.72%) with section of the hepatic artery. Lesions of the bile ducts occurred in 13 (0.9%) patients from which 4 (3.07%) were on the right hepatic duct and 9 (6.93%) on the common bile duct. We encountered 152 (10.46%) early postoperative complications from which 92 (60.5%) were grade I, 56 (37%) grade II, 0 grade III and 4 (2.63%) grade IV, according to Clavien's classification. There were 35 (2.4%) nonspecific postoperative complications from which there where phlebitic reactions in 25 (71.4%) patients, phlebitis in 9 (25.7%) and upper digestive hemorrhage due to acutization of a duodenal ulcer in 1 patient (2.9%). We also registered a number of 20 (1.38%) later postoperative complications: 10 (50%) residual biliary lithiasis in the first postoperative year, and 10 (50%) hernias at the umbilical trocar insertion site.