Laparoscopic resection of the pancreas and review of the literature.

BACKGROUND: Laparoscopic pancreatic surgery still is not a common procedure worldwide. Postoperative complications such as a pancreatic leakage cause a serious condition. We report our consecutive laparoscopic pancreatic resections of islet cell tumors or benign diseases and their outcomes. METHOD: Laparoscopic pancreatic resections were attempted in three patients. Preoperative diagnoses were insulinoma in two patients and cystadenoma in one patient. The lesions were located in the pancreas body in two patients and the pancreas tail in one patient. Their sizes ranged from 1 to 6 cm in diameter (mean, 3 cm). RESULTS: We performed distal pancreatectomy using an endoscopic linear stapler with conservation of the spleen in two patients and enucleation in one patient. Of the distal pancreatectomies, the splenic artery and vein were preserved in one patient, whereas in the other they were divided. There were no perioperative complications in any of the cases. The mean postoperative hospital stay was 10 days (range, 7-14 days). There were no episodes of hypoglycemia or recurrence during the mean follow-up period of 25 months (range, 11-36 months). CONCLUSIONS: Although laparoscopic pancreatic resection of selected patients is a feasible and safe procedure in the hands of experienced laparoscopic surgeons, patients must be carefully observed after surgery to avoid serious conditions by pancreatic fistula.

Video-assisted bullectomy using needlescopic instruments for spontaneous pneumothorax.

Patients with spontaneous pneumothorax require immediate insertion of a chest drain to evacuate the intrathoracic air. During video-assisted bullectomy, we made use of an existing chest drain hole to insert a thoracoscope or an endoscopic linear stapler. Video-assisted bullectomy was performed through three ports-two 2-mm ports and the existing chest drain hole. Therefore, no new skin incisions were required for the insertion of the 2-mm ports. A chest drain was again inserted via the existing chest drain hole after bullectomy. This procedure was used on 8 of 10 patients with spontaneous pneumothorax. There were no postoperative complications or recurrences. Thoracoscopic bullectomy using needlescopic instruments is technically feasible, safe, and effective. Currently, the procedure is indicated only for simple cases and not for the lysis of adhesions.

[Antitumor effect of bacterial lipopolysaccharide (LPS) and a combination use of LPS and lentinan on C3H/He mice bearing MH-134 tumor].

Using C3H/He mice a series of experiments was carried to study the antitumor effect of lipopolysaccharide (LPS) in combined use with Lentinan extracted from Cortinellus shiitake and its influence on cellular immunity as well as antitumor effect of tumor necrosis factor (TNF) prepared from LPS, and the following results were obtained: 1) In the cases where LPS was administered when the tumor had grown to a certain extent after tumor transplantation, hemorrhagic necrosis of the tumor occurred within 48 hours, showing a high antitumor effect. 2) In the cases where LPS was used with Lentinan, i.e., 2 mg/kg/day of Lentinan was administered from the 1st to the 8th day after tumor transplantation, and 30 micrograms/kg of LPS given on the 12th day, the highest antitumor effect could be achieved. 3) By combined use of LPS and Lentinan delayed type hypersensitivity was intensified. 4) Upon application of rabbit serum containing TNF to cancer bearing mice, hemorrhagic necrosis of the tumor was observed within 48 hours, and a superior antitumor effect compared to LPS alone was noted in terms of tumor size and weight.