A new device for sentinel node detection in laparoscopic colon resection.

OBJECTIVE: To test the feasibility of using a newly developed device for laparoscopic lymphatic mapping of the colon by simultaneous and quantitative detection of both tissue coloration and radioactivity. METHODS: Four pigs were used in this study. In each animal, both blue dye and radioisotope injections were utilized. Lymphatic mapping was performed laparoscopically in the sigmoid mesocolon and in the right mesocolon. A solution containing a mix of 35 microcuries of Technetium Tc-99 sulfur Colloid and 1 mL of a vital blue dye was administered subserosally by percutaneous insertion of a 25 gauge needle under laparoscopic control. The new device for automated sentinel-node detection consists of a gamma-probe coupled with a laser device and can be passed through a regular 10-mm trocar. The device detects simultaneously both radioactivity and quantitative tissue coloration. Nodes showing a radioactivity at least 5 times higher than that of the background or that had a blue colorant concentration were considered our sentinel nodes. RESULTS: Laparoscopic simultaneous and quantitative detection of sentinel nodes was feasible in all pigs. One or more sentinel nodes were identified by either the blue dye or radioisotopic technique in both the sigmoid and right mesocolon. Quantitative tissue coloration detection led to the recognition of additional nodes that were not apparently colored to the naked eye. CONCLUSION: Laparoscopic sentinel node detection using a device combining gamma and color detection is feasible in the porcine model. The significance of nodes apparently clear but positive with the quantitative detection technique should be further evaluated.

[Total mesorectal excision by laparoscopy for rectal cancer]. / Resección total del mesorrecto por laparoscopia para el cáncer rectal.

The treatment of rectal cancer has improved mostly because of the emergence of total mesorectal excision (TME), first described by Heald, and the adjunct of adjuvant therapy in the form of radiotherapy and chemotherapy. Laparoscopy has now been performed for more than a decade with results showing faster return to activity and decreased postoperative pain for intra-abdominal surgery. Laparoscopy is now widely used and is well accepted for the treatment of most intra-abdominal benign pathologies. Furthermore, several authors now report excellent short and medium-term results for the treatment of colorectal cancer. These study tends to show that laparoscopy can be safely applied to digestive malignancies, when oncological principles specific to laparoscopy are respected. The laparoscopic approach is in our opinion a perfect approach for the performance of TME, because of the magnification of structures that it provides, and allows the surgeon to see important structures that need to be identified for the performance of the best oncological and functional procedure possible. This paper describes in a through manner our standardized technique. We also review our own experience with laparoscopic TME, the multimodal treatment of rectal cancer, and provide an analysis of the literature about TME when performed by laparotomy and laparoscopy.

Abordaje laparoscópico en el tratamiento de la colecistitis aguda: estudio retrospectivo en 609 casos / The laparoscopic approach in the treatment of acute cholecystitis. Retrospective study in 609 patients

La colecistectomía laparoscópica (CL) es actualmente bien aceptada como el tratamiento de elección en la colelitiasis sintomática no complicada. La aplicación de la técnica laparoscópica en pacientes con colecistitis aguda (CA) es más controvertida. El exacto papel y los beneficios potenciales de la CL en el tratamiento de la CA no se han establecido claramente, ni existen amplias series clínicas. El objetivo del estudio fue valorar la aplicabilidad, seguridad, beneficios y complicaciones específicas del abordaje laparoscópico en pacientes con CA. Se realizó un análisis retrospectivo de los pacientes admitidos en dos unidades de cirugía digestiva de urgencia entre octubre de 1990 y diciembre de 1997. Se identificaron y evaluaron 609 pacientes que cumplieron los criterios de CA. La tasa de complicaciones fue del 15 por ciento, con 12 fístulas biliares postoperatorias (1,97 por ciento) y 4 lesiones de la vía biliar (LVB) (0,66 por ciento). La mortalidad global fue del 0,66 por ciento. Las complicaciones locales y globales se correlacionaron significativamente con el retraso entre el inicio de los síntomas agudos y la cirugía, pero no así la tasa de complicaciones generales ni la de fallecimientos. Nuestros resultados demuestran la seguridad y la factibilidad de la CL en la CA. La colecistectomía temprana dentro de los primeros 4 días se recomienda ampliamente para minimizar las complicaciones e incrementar las posibilidades de un abordaje laparoscópico con éxito (AU)