[Laparoscopic resection of a bladder diverticulum]. / Résection laparoscopique d'un diverticule de vessie.

The authors report a case of laparoscopic resection of a bladder diverticulum performed at the same time as endoscopic treatment of its presumed cause. Dissection of the diverticulum, particularly its neck, and dissection of diverticula of the ureter and vas deferens are facilitated by magnification of the video image. This approach is only indicated in particular anatomical sites (posterior). The results of this technique must be compared with those of conventional treatments.

Cells are present in the smoke created during laparoscopic surgery.

BACKGROUND: The application of laparoscopy for malignancy has been halted in many centres because of a growing number of reports of metastases arising in port sites. The smoke created by coagulation during laparoscopic surgery appears to contain particles visible to the naked eye. This study tested the hypothesis that whole cells can be carried as an aerosol in the pneumoperitoneum during laparoscopy. METHODS: Nine patients undergoing laparoscopic surgery for benign and metastatic disease were studied. Throughout the procedure the gas of the pneumoperitoneum was allowed to escape through a filter. The filters and tubing were washed, and washing solution was centrifuged and stained immunohistochemically to identify the cells. Three of the filters were also examined with an electron microscope. RESULTS: Six of the nine samples contained cells. Clumps of whole cells were identified as mesothelial in origin; the electron micrographs showed many other cells stuck to the filter, which appeared to be blood and mesothelial cells but were not analysed further. CONCLUSION: The presence of whole identifiable cells carried in the pneumoperitoneum raises concerns for operating staff and could be a mechanism for tumour implantation. No malignant cells were found, but ethical considerations prevented intentional coagulation of malignant tissue.

[Inguinal hernia. Pre-peritoneal laparoscopic surgery vs. the Stoppa procedure. A prospective randomized trial: 100 cases]. / Hernies de l'aine. Traitement laparoscopique pré-péritonéal versus opération de Stoppa. Etude randomisée: 100 cas.

In a prospective randomized trial between totally pre peritoneal (TPP) laparoscopic surgery ant Stoppa procedure (open), 100 patients with groin hernia 'Nyhus IIIA, IIIB, IV) were included and followed during 3 years. Both groups were comparable. In the "laparoscopic" group, operating time was significatelly longer (p = 0.01) but hospital stay (3.2 vs 7.3 days) and delay to return to work (17 vs 35 days) were significantely reduced (p = 0.01 =. Post operative comfort (less pain) was better (p = 0.001) after laparoscopy. In this group, morbidity was also reduced (4% vs 20% p = 0.02). The mean follow up was 605 days and 93 per cent of the patients were reviewed at three years. There was 3 (6%) recurrence after TTP, specially in the beginning of the surgeon experience (learning curve) versus for the Stoppa (ns). In case of bilateral hernia, the authors suggest to use a large prosthesis than two little one to prevent recurrences. In these conditions, laparoscopics (TPP) approach of groin hernia treatment will have the same recurrence rate as open (Stoppa) procedure, but a real advantages in the early post operative period.