[Laparoscopy-assisted total vaginal hysterectomy with transperitoneal lymphadenectomy for early cervical cancer--surgical technique]. / Histerectomia totala vaginala asistata laparoscopic cu evidare ganglionara pentru cancer de col incipient--tehnica operatorie.

UNLABELLED: Cervical carcinoma remains an important health problem. The classical surgical approach for cervical cancer is radical hysterectomy (Wertheim's operation). Our paper presents the technique of laparoscopic assisted radical vaginal hysterectomy with transperitoneal lymphadenectomy, as well as the details for the dissection of obturator, paravesical, pararectal fossae, and parametrectomy. The major advantage of this techique is that the entire abdominal part of the procedure is performed under direct observation, therefore minimizing the visceral or vascular injury. CONCLUSION: Our experiences suggest that this type of approach is feasible and offers the possibility to remove a greather number of lymph-node as compared to the classical approach. An increased experince will prove helpful in performing the entire procedure laparoscopically.

[Gastric necrosis, rare complication after laparoscopic gastric banding--case report]. / Necroza gastrica, complicatie rara dupa gastric banding--prezentare de caz.

In the last years, laparoscopic gastric banding has become a popular surgical option for morbidly obese patients, because of the minimally invasive and easy surgical technique, its reversibility, and the possibility to calibrate the stoma. Gastric necrosis, as a complication of laparoscopic gastric banding, has been rarely reported. We present the case of a 34 -year-old pregnant patient (18 week pregnancy) with 5 days history of abdominal pain. She had undergone laparoscopic adjustable gastric banding 24 months earlier with a body mass index (BMI) of 43 kg/m2. Diagnostic workup was very difficult because the patient was pregnant and we can use only ultrasonography and clinically signs. After initial conservative management, the patient underwent urgent surgery and we found an anterior gastric prolapse through the band with necrosis of the herniated stomach. A longitudinal (sleeve) gastrectomy was performed. The postoperative evolution was god and the patient left our clinic after 9 day. Emergency sleeve gastrectomy could represent a good option to treat, in a safe way.

[Percutaneous treatment of the liver hydatid cysts under sonographic guidance]. / Punctia transcutanata ghidata ecografic în tratamentul chistului hidatic hepatic.

This paper is a retrospective study of the first 51 cases of liver hydatid cysts, which underwent a conservative treatment between April 1996-December 2000. There were 28 females and 23 males with a mean age of 40.1 years (7-65), which had 63 liver hydatid cysts. In the right liver lobe were located 46 cysts, in the left liver lobe were located 7 cysts and in 10 cases cysts were located in both liver lobes. In 4 cases a pulmonary hydatidosis was associated. Abdominal ultrasound and CT scan were routinely performed and the cysts were classified in type I and II after Gharbi's classification. All of these 63 cysts were treated by ultrasound guided fine-needle percutaneous puncture with aspiration and instillation of sterile alcohol 95 degrees. Pre and postoperative the patients were treated with mebendazol or albendazol. They were followed-up by ultrasound and CT scan examination in the second day postoperative and monthly. No new cysts were noted during an average follow-up of 14.7 months and maximal cyst diameter decreased with minimum 72%. Two episodes of reversible anaphylaxis were encountered. The mean hospital stay was 3.3 days. In this paper the indications for conservative treatment and preliminary results of this method are discussed.

[Difficult laparoscopic cholecystectomy]. / Colecistectomia laparoscopica dificila.

From 2505 cases operated between 1994-2000, the authors selected a lot of 889 cases of difficult cholecystectomy, which after classical criteria would have been classified as contraindications of laparoscopic procedure. This study analyzed of intraoperative incidents, the conversion rate and particularities of operative tactics and techniques. The lot of patients includes 889 cases of difficult laparoscopic cholecystectomy. The patients were selected according to classical contraindications of laparoscopic cholecystectomy: obesity, liver cirrhosis, previous operated abdomen, severe cardio-pulmonary diseases, ages over 70 years, acute cholecistitis. The rate of intraoperative incidents and accidents was 19.9% (177 cases), in comparison to intraoperative incidents and accidents rate in "easy" laparoscopic chole-cystectomy which was 15.5% (251 cases from 1616 patients). The conversion rate in case of difficult laparoscopic cholecystectomy was 6.1% (55 patients) and 3.2% in the lot of "easy" cholecystectomy. The postoperative morbidity was 6.4% (57 patients) and 5.5% (147 patients) in the lot of "easy cholecystectomy. The postoperative mortality was 0.6% (6 deaths) and 0.3% (5 deaths) in the lot of "easy" cholecystectomy. In this paper are discussed the modalities and the technical particularities of a difficult laparoscopic cholecystectomy, able to lowering the risk of operative incidents and postoperative complications. In conclusion, laparoscopic cholecystectomy can be safely performed to the majority of patients with lithiasic cholecistitis, by an experienced surgical team.