Hand-assisted laparoscopic surgery for liver tumors.

BACKGROUND: The surgical treatment for liver tumors, whether metastatic or hepatic in origin, traditionally used the open approach through large incisions. In recent years the laparoscopic approach became popular but few centers use this method routinely. OBJECTIVES: To assess the results of our initial experience with liver resection using the laparoscopic approach, in terms of patient safety and oncologic surgical outcome. METHODS: Between August 2007 and April 2008 we performed 10 liver resections in 9 patients using the hand-assisted laparoscopic surgery technique. RESULTS: The main indication for surgery was metastatic colorectal carcinoma in seven patients and hepatocellular carcinoma in two. The mean age was 67 +/- 11 years. The tumor was solitary in seven patients. Five patients had neoadjuvant chemotherapy. Altogether, 12 lesions with an average size of 17 +/- 9 mm were resected. The mean operative time was 180 +/- 52 minutes. Average postoperative stay was 6.5 +/- 3.5 days. There was no perioperative mortality. There was one conversion to open surgery due to bleeding from the left hepatic vein. No major perioperative complications were encountered. All resected margins were free of malignancy. CONCLUSIONS: Liver resection using HALS is safe and feasible and should be considered in selected patients.

[Urgent splenectomy after traumatic colonoscopy].

Traumatic rupture of the spleen during the performance of a colonoscopy is a very rare complication. The more common complications after such procedures, diagnostic or therapeutic, include bleeding from and perforation of the bowel at the resected or biopsy site. However, the rate of these complications merely reaches one percent. In this case report the authors present and discuss the condition of a patient who underwent an urgent operation due to rupture of the spleen during a colonoscopy.