Abstracts - Chirurgie Kongress

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was reoperated on pod 4 due to persisting thoracic discharge but no chyle leak or injury to the thoracic duct was found. Oral feeding was stopped and total parenteral nutrition and sandostatin were intitiated. Following this regimen, the thoracic drainages were removed on pod 9 and oral intake of food was started again. The patient was discharged on pod 11. Conclusion: Bilateral chylothorax is a very rare complication. The pathophysiology is not completely understood. Therapy is mostly conservative. Operative treatment is recommended for chyle leaks of more than 1l/day or occurrence of severe metabolic complications. The primary goal is to drain the bilateral effusions by chest tubes to treat respiratory and circulatory distress. Diet with middle chain fatty acids or even TPN without oral intake is recommended. Positive effects of sandostatin are controversially discussed. 68.46 Laser Doppler Flowmetrie der hepatischen Mikrozirkulation: Verteilungsmuster der örtlichen und zeitlichen Heterogenität der Leberperfusion S. Engelberger, S. Richter, O. Kollmar, J. Sperling, M. D. Menger, M. K. Schilling (Homburg/DE) Objective: Laser Doppler Flowmetrie (LDF) stellt intraoperativ einfach anzuwendende Methode zur Erfassung der Leberperfusion dar. Inwieweit jedoch die Messergebnisse durch eine zeitliche oder örtliche Heterogenität der Leberperfusion beeinflusst werden, wurde bisher noch nicht untersucht. Ziel der Studie war daher die Analyse der hepatischen Mikrozirkulation bei aufrechterhaltender Perfusion und während Pringle-Manöver mittels verschiedener LDF-Geräte. Methods: Bei fünf Schwäbisch-Halle’schen Landschweinen wurden in Intubationsnarkose und nach Laparotomie die systemische (PiCCo, Pulsion Medical) und die hepatische Makrohämodynamik erfasst (Transonic) sowie die hepatische Mikrozirkulation mittels zwei unterschiedlicher LDF-Geräte analysiert (O2C, LEA bzw. Periflux, Perimed), wobei mikrovaskulärer Blutfluss und Fließgeschwindigkeit vor, während und nach Pringle-Manöver an verschiedenen Stellen der Leberoberfläche erfasst wurden. Die Datenauswertung differenzierte zwischen den beiden unterschiedlichen LDF-Geräten und erlaubte die Berechnung der zeitlichen und örtlichen Heterogenität der Leberperfusion. Results: Pringle-Manöver führte zu kompletter Okklusion von Vena portae und Arteria hepatica, wie durch die Flußmessungen der Makrohämodynamik bestätigt. Die entsprechenden LDF-Werte zeigten dabei eine signifikante Reduktion, jedoch nicht auf Null. Beide LDF-Geräte zeigten einen ähnlichen signifikanten Anstieg der zeitlichen Heterogenität der Leberperfusion während des Pringle-Manövers. Der Anstieg der örtlichen Heterogenität war dabei noch stärker ausgeprägt als der der zeitlichen Heterogenität. Nach Beendigung des Pringle-Manövers kam es wieder in allen Fällen zu einer Rückkehr der LDF-Werte auf Ausgangsbedingungen. Conclusion: Beide LDF-Geräte zeigten sich hinreichend zur Erfassung der hepatischen Mikrozirkulation bei normalen Flussbedingungen und während eines Pringle-Manövers geeignet. Eingeschränkte mikrovaskuläre Perfusion geht mit einer signifikant gesteigerten zeitlichen und örtlichen Heterogenität der LDF-Signale einher. Insbesondere aufgrund der hohen örtlichen Variabilität der Messwerte empfiehlt es sich, eher mehrere kurze Messungen an verschiedenen Orten der Leberoberfläche durchzuführen als eine lange Messung an einem Ort. 68.47 „Interdisziplinäre Steinextraktion“ bei Choledocholithiasispersistenz nach Choledochusrevision B. Boldog, A. Steiner, F. Weigert, W. Schweizer, S. Soyka (Schaffhausen) Objective: Fallbeschreibung Methods and Results: Ein 42-jähriger Mann trat notfallmässig mit kolikartigen Oberbauch-schmerzen in unser Spital ein. Klinisch, laborchemisch und sonographisch zeigte sich eine Cholecysto- und Choledocholithiasis. Primär erfolgte der Versuch einer ERCP. Die Papillotomie und Steinextraktion war aber technisch nicht durchführbar. Somit war die Indikation zur chirurgische Steinextraktion gegeben. Primär wurde ein laparoskopischer Choledochusrevisionsversuch vorgenommen. Aufgrund der mangelhaften Übersicht entschloss man sich schliesslich zur offenen Choledochusrevisi-on. Nachdem mit einem vorgeschobenen Fogarty-Katheter ein Konkrement transpa-pillär entfernt worden war, war die intraoperativ durchgeführte T-Drain-Cholangiographie unauffällig. Das postoperative Kontroll-Cholangiogramm zeigte jedoch eine Persistenz der Choledocholithiasis. Therapie: Es folgte eine ERCP-Untersuchung, bei der über den T-Drain ein langer Führungsdraht vorgeschoben, mit dem Endoskop gefasst und herausgezogen wur-de. Ueber diesen Führungsdraht konnte das Papillotom gut plaziert werden. Nach der Papillotomie gelang die Steinextraktion problemlos. Conclusion: Zeigen sich nach Choledochusrevision persistierende Konkremente im Ductus choledochus, bietet sich bei liegender T-Drainage mit dem „Ren-dez-vous“ ERCP-Verfahren eine einfache und für den Patienten komfortable Möglichkeit zur Steinextraktion. 68.48 Intestinal pneumatosis and pneumoperitoneum not requiring surgery A. Andres, N. Desbaillets, A. Meyer, J.-M. Michel, M. Menth, B. Marty, D. Hayoz, B. Egger (Fribourg) Objective: In the context of abdominal pain, intestinal pneumatosis and pneumoperitoneum are often associated with an ischemic disaster which requires immediate surgery. We report here the case of a patient with abdominal pain, pneumatosis and pneumoperitoneum whose underlying disease, a rheumatologic disorder, did not require surgery Methods: A 77 years-old woman presented with diffuse abdominal pain, significant weight lose and diarrhea for several month. She underwent coloscopy and gastroscopy that revealed diverticulosis and hiatal hernia with signs of reflux esophagitis. A recent CT scan did not show any pathology. Because of exacerbation of abdominal pain, she was hospitalized, and a new CT scan revealed the presence of intestinal pneumatosis associated with peritoneal free air and liquid. An emergent laparatomy confirmed the presence of air in the wall of the ileum but no perforation or other macroscopic lesion was 54 swiss knife 2009; special edition found. A segmental ileal resection containing the pathology was performed. Pathological analysis showed cystic pneumatosis and a non-specific slight fibrosis. Post-operative recovery was uneventful. A follow-up CT scan did not show any further pathology. Two months later, the patient was re-hospitalized for recurrent abdominal pain, diarrhea and weight lose. Another CT scan showed re-apparition of peritoneal free air and intestinal wall thickening. The angiographic phase excluded ischemic arterial or venous involvement. We decided an expectant attitude and the patient did stabilize without any signs of peritonitis. A careful general examination revealed the presence of calcified cold fingers and a capillaroscopy confirmed the suspected Reynaud syndrome. Furthermore, serological analysis showed presence of anti-centromere antibodies. Results and conclusion: Retrospectively, intestinal pneumatosis was certainly related with a scleroderma disorder, a rare association that does not require surgical approach. Connective tissue disorders are reported to be associated with intestinal pneumatosis, a condition normally related with an abdominal ischemic disaster. Although laparotomy or laparoscopy has to be performed when diagnosis remains doubtful, connective tissue disorders should be searched in cases of unusual clinical presentation of intestinal pneumatosis and pneumoperitoneum. 68.49 Quality of life after laparoscopic Toupet antireflux surgery L. Muller, B. Kern, M. O. Guenin, R. Peterli, C. Ackermann, M. von Flüe (Basel) Objective: To evaluate the outcome of antireflux surgery, we assessed quality of life of all patients treated by laparoscopic fundoplication with the Toupet technique between 2003 and 2008. Methods: Disease-specific symptoms and quality of life were evaluated for 24 laparoscopic Toupet operations using the standardized quality of life questionnaire according to Eypasch. Results were compared with a previous analysed group of patients after laparoscopic Nissen fundoplication. Results: 86% returned the questionnaire. The questionnaire revealed that in 87% preoperative heartburn and in 91% preoperative regurgitation was gone. The average gastrointestinal quality of life index was 120.4 points (normal healthy population 120.8 points). Quality of life index of the laparoscopic Nissen group was 115 points. 94% of all patients were satisfied with the result and would undergo surgery again Conclusion: Laparoscopic Toupet antireflux surgery results in high patient satisfaction. Quality of life index is very good, comparable to a healthy population and better than after laparoscopic Nissen fundoplication. 68.50 Die Zwerchfellruptur: auch Jahre danach lebensbedrohlich S. Azizi, V. Schreiber, R. Schlumpf (Aarau) Objective: Die Zwerchfellruptur stellt mit einer Inzidenz von 5-7% eine seltene Komplikation nach stumpfem oder penetrierendem thorako-abdominalem Trauma dar. Heutzutage betrifft sie vor allem junge Männer in der dritten Lebensdekade im Rahmen von Verkehrsunfällen und wird häufig durch die Ueberlagerung von Schock und assoziierten Verletzungen am kritischen Zeitpunkt verkannt. Methods: Wir berichten über einen 75-jährigen Patienten mit den klinischen und konventionell-radiologischen Zeichen eines Ileus. Bei der notfallmässig durchgeführten Laparotomie zeigte sich eine Inkarzertion von Dünndarmschlingen durch eine Zwerchfelllücke links, welche nach Darmreposition mit einer nicht-resorbierbaren Naht verschlossen wurde. Retrospektiv konnte man eruieren, dass der Patient vor 20 Jahren einen Verkehrsunfall mit schwerem thorako-abdominalem Trauma erlitten hatte. Results: Die Zwerchfellruptur wird nicht selten erst bei der Exploration anderer thorako-abdominalen Verletzungen bzw. zu einem viel späteren Zeitpunkt, wie in unserem Fall, bei der Inkarzeration von Abdominalorganen diagnostiziert. Die mit zirka 80% in der Literatur angegebene Bevorzugung des linken Zwerchfells, dürfte einerseits darauf beruhen, dass Rupturen rechts oft nicht diagnostiziert werden und anderseits, dass die Leber den Druck nach kranial breitflächiger verteilt. Im Roentgenbild kann sich eine Verlagerung der Magenblase bzw. von Darmschlingen in den Thorax zeigen. Allerdings ist eine Prolabierung abdominaler Organen nicht immer vorhanden. Die klinische Verdachtsdiagnose wird am besten mittels Spiral-CT mit koronarer und sagittaler Rekonstruktion bestätigt. Die frische Zwerchfellruptur wird in der Regel über einer medianen Laparotomie, welche die Beurteilung der Abdominalorganen ermöglicht, versorgt. Die ältere Zwerchfellruptur wird öfters über einem transthorakalem Zugang, welcher eine übersichtlichere Freipäparation prolabierter Organen ermöglicht, versorgt. Die Reparatur reicht von der direkten Naht bis zur Anwendung alloplastischen Materialen, wie PTFE oder Goretex. Conclusion: Obwohl die Zwerchfellruptur selten ist, sollte bei jedem thorako-abdominalen Trauma daran gedacht werden. Unabhängig von ihrer Ausdehnung stellt sie eine Operationsindikation dar, da eine Verlagerung abdominaler Organen in den Thorax mit der Gefahr einer Inkarzeration nicht zu vermeiden ist. 68.51 The impact of computed tomography in acute appendicitis and obese patients M. von der Groeben, V. Neuhaus, O. Schöb (Schlieren) Objective: Beside the clinical examination, the diagnosis of acute appendicitis is routinely based on ultrasound imaging of the abdomen and laboratory tests. However, ultrasonography may not be sufficient for a definite diagnosis in obese patients and in the case of meteorism. In the present study, the clinical relevance of computed tomography (CT) to diagnose acute appendicitis, especially in obese patients, was evaluated. Therefore, data from 204 patients suffering from acute appendicitis collected during a two-year period in our hospital were analyzed in a retrospective study. Methods: Patients suffering from acute pain in the right underbelly were examined for acute appendicitis by means of clinical examination as well as ultrasound imaging and laboratory tests. In the case
of definite diagnostic findings (n=160), appendectomy was accomplished by laparoscopy. In the case of negative ultrasonography findings (n=38), patients were reexamined by CT the same day (n=20) or by ultrasound imaging and laboratory tests the next day after admission (n=18). Moreover, highly increased inflammation parameters (leucocyte >16’000 G/l or CRP >100 mg/l) and peritonism were reasons to directly perform CT (n=6). Results: In patients with negative initial ultrasonography findings (n=38), duration of anamnesis ranged from 12 to 120 hours and 14 (36.8%) of these patients were considered as obese due to their body mass index (BMI >=30 kg/m 2 ). In comparison, only 7.3% of the patients with initial positive ultrasonography findings were obese. Among the 20 patients further examined by CT, 17 (85.0%) showed a BMI >=30 kg/m 2 . Duration of anamnesis thereby mainly ranged from 12 to 48 h. In contrast, among the 18 patients reexamined by ultrasound imaging, only two showed a BMI >=30 kg/m 2 . Conclusion: To enhance diagnosis of acute appendicitis in patients with increased BMI (>=30 kg/m 2 ) suffering from acute pain in the right underbelly and short duration of anamnesis, it is advisable to directly perform CT of the abdomen instead of ultrasound imaging. Compared to admission of patients and reexamination by ultrasound imaging and laboratory tests, the faster diagnosis by initial CT is additionally associated with cost savings in these patients. 68.52 From NOTES to minimally invasive surgery: two ports sigmoidectomy F. Pugin, P. Bucher, N. Buchs, J. Fasel, P. Morel (Genève) Objective: NOTES is a rapidly evolving technique in visceral surgery; however some technical progress, especially in term of instrumentation, still limits its application in clinical practice. Study aim was to evaluate if the use of per-operative colonoscopy could be use as efficiently as laparoscopic retractors and decrease the number of trans-abdominal accesses Methods: For this preliminary study two ports sigmoidectomy were performed in male human cadavers. The two laparoscopic ports (10mm and 12mm) were placed in a small Mc Burney incision. A colonoscope was used per-operatively as a retractor to enable bowel mobilization. A laparoscopic camera and strait laparoscopic instruments and staplers were used for dissection. Colorectal side to end anastomosis was performed using circular stapler (photos). Results: Sigmoidectomy was performed successfully on the two occasions with an operative time of 90 and 60 min. Specimen length were 36 and 33cm and included colorectal junction. Anastomosis was checked through endoscopy and was satisfying. Specimen was extracted through the Mc Burney incision. Conclusion: Two ports sigmoidectomy through a single McBurney incision is easily feasible using a coloscope as a retractor. While NOTES made surgeons discover and use endoscopes for trans-gastric and trans-intestinal surgery, they could primarily help us to reduce the invasiveness of minimally invasive surgery. 68.53 Anastomotic leakage following laparoscopic sigmoidectomy F. C. Grafen, R. Fahrner, O. Schöb (Schlieren) Objective: Anastomotic leakage following colorectal surgery is among the most frightened complications because of high morbidity and mortality. It worsens prognosis of the patient and is associated with extended time to recovery. The aim was to determine the incidence of an anastomotic leak and risk factors. Methods: During 2006 to 2008 a retrospective database of laparoscopic sigmoidectomy in a single surgical unit were analyzed. Incidence of anastomotic leakage was registered and the effect of age, sex, ASA-classification, and type of disease was analyzed concerning the need for reintervention, ICU stay, hospital stay and 30-day-mortality. Results: A total of 134 patients undergoing laparoscopic sigmoidectomy and stapled colorectal anastomosis were analyzed. Mean age was 66.7 ± 11.5 years with 37% male. 12% of all patients were treated for cancer. All others suffered from recurring diverticulitis. The overall anastomotic leak rate was 6% (n=8) and 30-day-mortality rate was 1.5%. There were no statistical differences between the two groups concerning age, ASA-classification and previous procedures. One patient with anastomotic leak was placed on conservative treatment, all others followed a surgical procedure (stoma n=4, revision of the anastomosis n=3). 62.5% of all anastomotic leaks were operated due to cancer. Patients with anastomotic leakage were significantly longer in hospital (9.3 ± 4.9 days vs. 42.4 ± 25.7 days) and at ICU (0.4 ± 1.7 days vs. 5.5 ± 4.2 days). Conclusion: In literature we found anastomotic leakage rates from 2.7 to 7.4% which is consistent with our findings. Low anastomosis and resections due to cancer are postulated risk factors. In our collective the majority of anastomotic leaks was seen in patients with cancer. But anastomotic leakage is multi-causative which makes it difficult to make a predictive statement. As expected is the incidence of anastomotic leakage associated with a prolonged ICU and hospital stay due to further intervention and conservative therapy. 68.54 Primary neuroendocrine carcinoma of the breast. Case Report and diagnostic criteria O. Burckhardt, M. Matter, M. Fiche, N. Demartines (Lausanne) Objective: Carcinoid tumors in the breast are rare. But differentiation between primary neuroendocrine breast carcinoma and metastatic disease to the breast is important because of differences in treatment. Aim: To report a case of primary neuroendocrine carcinoma of the breast and discuss the diagnostic criteria. Methods: We report a case of a neuroendocrine carcinoma of the breast in an 84 year-old woman who presented with a 3 cm lump in her left breast with free axilla. Results: Mammography revealed a spiculated nodule and ultrasonography showed no regionally enlarged lymph node. The pathological diagnosis on core needle biopsy was invasive ductal carcinoma. We performed a sentinel node biopsy procedure with per-operative cytological examination of appositions from the sentinel nodes. On the basis of a positive result, we performed a total mastectomy according to the Patey procedure (with axillary nodes dissection). Definitive histological examination of the specimen diagnosed showed a pure neuroendocrine carcinoma grade II according to Elston and Ellis, with a minimal intra-tumoral associated ductal carcinoma in situ. Estrogen and progesterone receptors were expressed in tumor cells (ER:100%, PR:20%) whereas the HER2 protein was not overexpressed . All tumor cells (100%) expressed chromogranin and synaptophysin. Recovery was uneventful. Despite our patient’s refusal for further investigations we admitted a primary breast origin in an otherwise asymptomatic woman. A systemic therapy using aromatase inhibitors was decided on the basis of usual current (Saint Gallen 2007) criteria for breast cancer patient management. Conclusion: The diagnosis of neuroendocrine carcinoma of the breast requires the expression of neuroendocrine markers in more than 50% of tumor cells, by immunohistochemistry (WHO Classification of Breast tumors, 2003). Histopathological demonstration of a component of ductal carcinoma in situ associated with the invasive carcinoma (which can also exhibit a neurodendocrine differenciation) provides a demonstration of the primary nature of the tumor. If absent, the possibility of a breast metastasis of an extramammary neuroendocrine carcinoma has to be considered and ruled out by an OctreoScan scintigraphy. 68.55 Surgical treatment of non-hydatid hepatic cyst, a single centre experience F. Ris, I. Inan, P. Morel, F. Schwenter, P. Majno, G. Mentha (Genève) Objective: Hepatic cysts are rarely symptomatic before 50 years and no treatment is necessary. When the cyst becomes symptomatic, the best therapy is a laparoscopic fenestration. We observed recently an increase of symptomatic patients and we have reviewed our experience. Methods: Retrospective study of all operative management of symptomatic hepatic cyst from 1996 to 2008. Results: During this period, 38 interventions in 35 patients for benign hepatic cyst were performed. Median age was 63 years (37-84), with a clear female predominance (4 men/34 women). Disease was known from one and a half year before surgery (0-25 years), but with symptoms aggravation starting 8 weeks before surgery (1-104). 50% of the patients presented with abdominal discomfort, 40% with acute abdominal pain and 10% with other symptoms. Laparoscopy was performed in 58% of the cases, with only one conversion due to a difficult diagnosis with this approach. A single cyst was present in 29% and 71% of the patients had multiple cysts (median of 2 (1-12)). We observed a morbidity of 21% for medical and surgical complication. No death was reported. Minor surgical complications included incisional haematomas (n=3), post-operative ileus, no major surgical complications were reported. Medical complications were more severe: respiratory problems (one pneumonia and one pleural effusion), three cardiac problems (one ischemic and two rhythmic problems), one acute renal failure, one cerebro-vascular accident due to an open cardiac foramen. Median hospital stay was 6 days (1-18). Histological analysis showed in 79% a simple hepatic cyst, in 13 % a polycystic hepatic disease and in 8% a cystadenoma. Median follow-up was 8 months (1-100). Recurrence occurred in 10% (four recurrences in three patients). A second surgery was required in two patients and one had a simple radiological aspiration. Complete relief of symptoms was seen in all cases. No other recurrence was observed. Conclusion: Fenestration of liver cyst is indicated for all symptomatic simple liver cyst. This technique allowed in 90% of patients a significant improvement of symptoms without long term recurrence. There is no mortality and an acceptable morbidity. Laparoscopic approach is feasible in most of the cases. 68.56 Prospective analysis of 54 robotic-assisted gastric bypass F. Pugin, P. Bucher, M. Hagen, N. Buchs, P. Morel (Genève) Objective: The Roux-en-Y gastric bypass is routinely performed by laparoscopy. The morbidity and mortality of anastomotic complications remains non-negligible. Aim of this preliminary study is to assess if robotically hand-sewn anastomosis has a lower leak and/or stricture rate. Methods: Fifty-four patients with a mean age of 41 years underwent a robotic Roux-en-Y gastric bypass from may 2006 to December 2008. Mean BMI was 45.5 kg/m 2 . Mean follow-up was 12 months. Results: The operation was performed robotically in 52 cases with hand-sewn anatomosis (video). Two cases were converted to open surgery due to severe adhesions. Mean length of stay was 6 days. No anastomotic leak or stricture were recorded. One bleeding occurred at the jejunal staples row and stopped spontaneously. No other complication was noted. Mortality rate was 0% Conclusion: Robotic-assisted Roux-en-Y gastric bypass is feasible, safe, and potentially superior to standard laparoscopic approach. Robotically hand-sewn anatomosis may have a lower rate of leak and stricture than stapled anastomosis performed by conventional laparoscopy. Randomised trial with larger patients number and longer follow-up are needed to confirm these preliminary results. 68.57 Laparoscopic sleeve gastrectomy: indications and early results J.-M. Heinicke, Y. M. Borbély, P. Renzulli, D. Candinas (Bern) Objective: We present early results of a pilot study using laparoscopic sleeve gastrectomy (SG) in 25 selected patients suffering from morbid obesity. Methods: Patients with a very high BMI (VH), morbid obese patients with excessive comorbidities (EC) not suitable for gastric bypass surgery, and patients with pseudoachalasia after gastric banding (PA) swiss knife 2009; special edition 55
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Abstracts 96. Jahreskongress der Sc
Page 3 and 4: Der Jahreskongress der Chirurgische
Page 5 and 6: High Definition - Wenn das Detail e
Page 7 and 8: Visceral Surgery - Transplantation
Page 9 and 10: 5.6 What is the best transperitonea
Page 11 and 12: 3 tasks (T1-3) in an open, LAP and
Page 13 and 14: General Surgery - Trauma 07 7.1 PHI
Page 15 and 16: 7.6 Treatment of supra- and intraar
Page 17 and 18: Results: EMD clearly induced typica
Page 19 and 20: Abklärung zugeführt. Peri- und po
Page 21 and 22: ection of the rectal prolapse, mean
Page 23 and 24: 23.6 A20 promotes hepatocyte prolif
Page 25 and 26: General Surgery - Trauma Management
Page 27 and 28: Conclusion: This study indicates fo
Page 29 and 30: 47.4 Management of minimally sympto
Page 31 and 32: interested whether AM donor pretrea
Page 33 and 34: ehavior on slopes (p
Page 35 and 36: 57.20 Einfluss der Computertomograp
Page 37 and 38: 57.31 Big heterogenic cystic tumors
Page 39 and 40: ist sehr genau. Die geplanten Impla
Page 41 and 42: Results: Approximately 6 to 8 weeks
Page 43 and 44: n’a pu être observée en postop
Page 45 and 46: Results: Fifty-seven patients (34.3
Page 47 and 48: Results: PVT is an uncommon cause o
Page 49 and 50: 68.17 Was hat das Kompartmentsyndro
Page 51 and 52: 2-34.3 weeks), respectively. Use of
Page 53: abdominal pain, vomiting and diarrh
Page 57 and 58: (150mg/d) administered to 10 health
Page 59 and 60: of life is detected between TME and
Page 61 and 62: Visceral Surgery - Nouvel Technolog
Page 63 and 64: Visceral Surgery - General Surgery
Page 65 and 66: all cases with an SSI rate of 17.1%
Page 67 and 68: in the patients who died was larger
Page 69 and 70: migration of the helical blade into
Page 71 and 72: Video I 9 9.1 Laparoskopisch transv
Page 73 and 74: metically superior surgical access
Page 75 and 76: Most of these tumors can therefore
Page 77 and 78: Hofmann, A., Zürich 57.4 Holfeld,
Page 79: Dank V.A.C. ® U N T E R D R U C K
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