Laparoscopic liver resection: initial experience in Puerto Rico.

BACKGROUND: Laparoscopy has been changing in general and particularly upper gastrointestinal surgery for the last three decades. Hepatic surgery is one of the most hallenging fields in surgery and requires a prolonged surgical education and knowledge. This series describes our initial experience in laparoscopic resection of liver lesions. ME THODS: This was a retrospective analysis of a single institution. Sixteen patients undergoing laparoscopic hepatectomy between January 2008 and August 2009 were included. The data gathered included: lesion length, site of lesion, surgical time, conversion to open, operation rates, length of hospital stay, complications, mortality, and histology of lesions. RESULTS: Mean patient age: 63, which were comprised by 5 males and 11 females. Thirteen patients had liver cysts; 2 patients had metastatic liver cancer. One patient had End Stage Liver disease and cirrhosis. The average size of the lesions was 10 cm. The mean surgical time was 143.3 min. Conversion to laparotomy was required in two patients. There were no perioperative or thirty day mortality, and no postoperative liver failure. Mean postoperative stay was 3.5 days. CONCLUSION: Laparoscopic liver resection appears safe and viable procedure. Experienced hepatobiliary surgeons with adequate laparoscopic skills should perform this procedure. The technique has a low morbidity and a short hospital stay, and can be used for the treatment of patients with different liver conditions.

Incidental adreno-cortical adenoma, why surgery? a case report.

INTRODUCTION: Incidental adrenal tumors are commonly benign, but reports demonstrate that if the characteristics of the tumor are not clear, on images surgery is the procedure of choice. Our objective through this case is to show that laparoscopic adrenalectomy is a safe approach for adrenal incidental tumor regardless of radiological findings. CASE REPORT: A 52 year-old female with arterial hypertension (HBP), cramps, and back pain at right side, probably related to her chronic back pain history. She went for check up and a left adrenal mass on MRI described as myelolipoma was found incidentally. Laboratories were unremarkable except aldosterone and cortisol levels were slightly elevated. She was treated for hypertension for about a year. The patient underwent to a successful laparoscopic left adrenalectomy, after which the patient blood pressure was stable with out any medications, and the aldosterone and cortisol levels decreased. The pathological report was adrenal cortical adenoma with central hemorrhage and not a myelolipoma as described in images on magnetic resonance imaging (MRI). CONCLUSION: The use of imaging for diagnosis, clinical management and decision making is very controversial. Laparoscopic surgery for adrenal masses is a safe procedure for tumors of 6 cm regardless of the radiological description.