Accessible laparoscopic liver resection performed in low volume centers: Is it time for democratization?

INTRODUCTION: Laparoscopic liver resection (LLR) has been developed and is daily practiced by many expert teams. However, very few data are available on the experience of low volume centres. The aim of our study was to report and discuss the operative results of LLR performed in three low volume centres. METHODS: Records of patients who underwent a LLR in three low volume centres in France between May 2014 and November 2017 were collected. Endpoints studied were indications, intra and postoperative outcomes as well as short-term outcomes. RESULTS: A total of 46 patients (57 specimen resected) underwent a LLR during this period, representing 29.6% of total liver resections. Indications of LLR were benign lesions in 26%, primitive malignant lesions in 32.6% and metastatic tumours in 41.3%. Median size of lesions was 22mm (range 11-100). Most liver resections were non-anatomic (64.7%), while left lateral sectionectomies represented 19.2%. Five patients required conversion and there were at the end 3 specimen with margins inferior to 1mm resected laparoscopically. Postoperative mortality was nil and morbidity rate was 17.3%. Median hospital stay was 6 days (3-15). CONCLUSION: Although LLR have gained acceptance in surgeons' arsenal, it remains concentrated in referral centres. Our results suggest the feasibility of LLR in non-academic centres when it comes to small accessible lesions. Further studies would provide data about the long-term safety of this procedure in those centres.

[Birth of a child with Down syndrome: parental choice or failure of screening policy?]. / Naissance d'un enfant porteur de trisomie 21: choix parental ou défaut de la politique de dépistage ?

OBJECTIVES: Birth of a child with Down syndrome (DS) can follow parental choice or failure of screening. The objective of this work is to describe the circumstances of births of children with DS in a French perinatal health network. METHODS: Retrospective multicentric study, with prospective trial registration of all children born alive with DS, between 2010 and 2013. RESULTS: Sixty-three children were born with DS. Complete screening was performed by 61 % of patients, incomplete screening by 29 % of patients and no screening test by 10 %. Among these births, 50 % occurred following parental choice, 40 % following failure of screening and for 10 %, parental choice concerning screening was unknown. False negative had often calculating risk close to 1/1000. CONCLUSION: In this study, the birth of a child with DS occurred following parental choice in half of cases. It's necessary, to optimize the follow-up, to document in medical records the medical information and parental choice concerning DS screening and data of screening when this was done.