Robotic splenectomy for mesothelial cyst: a case report.

Cystic lesions of the spleen represent a rare entity with an overall incidence of 0.5% among splenectomies. They can remain asymptomatic in 30% to 60% of patients or may cause symptoms for secondary compression of adjacent structures. Peripheral cysts may be suitable for conservative treatment whereas splenectomy is the accepted procedure for bulky and/or central lesions. Laparoscopy is the standard approach for elective splenic surgery, but in the last decade, introduction of the da Vinci robotic system has represented a further improvement in minimally invasive surgery, thanks to 3-dimensional vision and more accurate motion control. Herein, we report a case of a mesothelial splenic cysts successfully treated by robotic splenectomy; some anatomical considerations and technical aspects of robotic procedures have been discussed: it is a feasible and safe approach, particularly indicated in the presence of anatomic features such as an enlarged pancreatic tail and a type II vascular pattern of splenic pedicle. In such patients, the choice of a robotic approach may decrease the risk of intraoperative bleeding, thereby representing a further improvement in laparoscopic techniques.

Prognostic significance of 18q LOH in sporadic colorectal carcinoma.

Identification of molecular alterations with implication for prognosis and sensibility to chemotherapeutic agents represents a great challenge in colorectal carcinoma treatment. Controversial results have been reported on prognostic value of chromosome 18q loss. Ninety-seven unselected patients with sporadic colorectal carcinoma Stage II and III were investigated for loss of heterozygosity at 18q D18S58 and D18S61 loci. Molecular alterations were correlated with clinicopathological data and survival. 18q loss of heterozygosity (LOH) was present in 56 per cent cases of carcinoma and was not related either to the clinicopathological characteristics of the patients or to prognosis. However, patients with LOH at locus D18S61 showed a more favorable prognosis. This finding was especially true for Stage II and untreated carcinoma. Survival was not influenced by the status of D18S58 locus. In our series, LOH at chromosome 18q does not seem to predict an unfavorable outcome. It seems of special interest the benefit that D18S61 loss of heterozygosity confers to untreated patients and patients with Stage II colon carcinoma.

Laparoscopic treatment of a carcinoma of the cecum incarcerated in a right groin hernia: report of a case.

A carcinoma in a groin hernia is uncommon. We herein report a case of an intrasaccular carcinoma of the cecum in a right inguinoscrotal hernia with a simultaneous left inguinal hernia treated by a laparoscopic approach. A 70-year-old man presented with a painful, not completely reducible bilateral hernia. Blood examinations showed severe anemia. A computed tomography scan of the abdomen confirmed the presence of the cecum in the hernia sac, showing a round wall thickening of the herniated portion of the colon. A standard laparoscopic right colectomy with radical oncological purpose was performed. An incarcerated inguinal hernia is a relatively common surgical problem. In the case of anemia or other signs suggestive of malignancy, a specific preoperative work-up should be assessed. This case demonstrates that it is possible to perform an oncologically correct laparoscopic resection when the presence of malignancy is confirmed while performing an open traditional hernioplasty to avoid any possible contamination of the mesh.

Minimally invasive adrenalectomy for incidentally discovered cavernous hemangioma.

Cavernous hemangiomas are rare, benign, non-functioning neoplastic lesions that often involve liver and skin. Hemangiomas of the adrenal gland are very uncommon, and usually found accidentally in otherwise asymptomatic patients. This paper reports the only case of a large cavernous hemangioma removed with transperitoneal laparoscopic adrenalectomy and reviews the literature.

Large periampullary villous tumor of the duodenum.

A 67-year-old woman, who had symptoms of epigastric pain and abdominal distension, was found, on endoscopy, to have a large sessile villous adenoma of the periampullary duodenum. Despite the lack of evidence of malignancy, a pancreaticoduodenectomy procedure was performed, mainly because of the tumor size and site, involving the ampulla of Vater. The presence of the carcinoma was diagnosed only in the resected specimen by definitive histology. Because there is no general consensus on the optimal surgical procedure for the treatment of villous tumors of the duodenum, especially for the early stages, the indications for the operative procedure are discussed, based on a review of the literature.