Single access laparoscopic colorectal surgery: lights and shadows.

INTRODUCTION: To minimize the complications related to conventional multiport laparoscopic surgery, the single access laparoscopic surgery has been developed. Some results of case series and case-controlled studies are supporting the feasibility and safety of Single Access Laparoscopic Colectomy (SALC). MATERIALS AND METHODS: Since January 2009 we performed all kind of colorectal procedure by a single access laparoscopic approach. We began with right colectomy that represent the only procedure in which we did not reproduce the same surgical steps of multiport laparoscopic surgery. In contrast, we reproduce the same surgical technique of multiport colorectal resection during a left or rectal single access laparoscopic procedure as well as total colectomy. CONCLUSION: About the transferability of SALC, programs of training need to focus on safety and techniques. We believe that only high laparoscopic skills surgeon can perform SALC. It's mandatory to evaluate outcomes and cost-effectiveness of SALC respect to multiport laparoscopic colectomy using randomized trials.

[Traditional esophagectomy and esophago-gastrectomy vs. laparoscopic surgery. Evaluation and results]. / Esofagectomia ed esogastrectomia tradizionale vs la chirurgia laparoscopica. Valutazione e risultati.

The therapeutical choice in patients affected with esophagus disease depends on patients' conditions, as well as on the benign or malignant nature of the lesion. Actually, the surgical option is strongly conditioned by the state of health, particularly, the surgical therapy of resection, that is a mayor kind of surgery, has to value the heavy engagement to which the patient is submitted, meant as a clinical stress, caused by the clinical situation in which the patient can frequently feel: malnutrition, immunological and hematological conditions. It is in this field that the mininvasive surgery can be considered the most important surgical choice. The target of the treatment of the traditional and mininvasive surgery, to cure the intestinal transit, by means of other internal organs, is the same: that is curative or palliative. In this study we analyzed and compared 8 patients, from July 1999 to March 2003; all of them undergone a therapy of resection in order to cure esophageal lesions (we applicated the same technique of esophagectomy according to Orringer): 5 of them underwent a mininvasive surgery, while the other 3 patients underwent a traditional surgery. As a result we saw the same mortality in both groups, with a minor morbidity in the second one (mininvasive surgery); this fact is very important because we can suppose an increase in the number of patients threatened with a curative or a palliative surgery, thanks to a minor load of the mininvasive surgery compared to the same surgical operation performed with the traditional methodology.