2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
Results
Patient was positioned supine on the operating table. For
access we used a 6 cm-long midline supraumbilical incision
for the hand port, 5 mm ports in the epigastrum, left upper
quadrant on the mid clavicular line and left flank on the axillary
line. An additional 12 mm port was placed on the left mid
clavicular line just above the umbilicus. An extended right
hemicolectomy was performed. A distal pancreatectomy was
performed with an attempt at splenic preservation. However,
at the end of the procedure, the spleen was found to be nonviable
and a splenectomy was performed as well. There were no
complications. Patient was discharged home after 6 days. The
postoperative recovery was unremarkable. Her pathology
demonstrated a T3N0M0 adenocarcinoma of the colon with
negative margins and a mucinous cystadenoma of the pancreas
with negative margins and no invasive malignancy.
Conclusions
A combined hand?assisted laparoscopic right hemicolectomy
and distal pancreatectomy is technically possible and requires
an optimal placement of the trocars and the hand port. This
technique allowed us to treat both conditions concomitantly,
using a minimally invasive approach, with important benefits
for the patient. We are not aware of any description of this
combined approach in the surgical literature.
P356–Minimally Invasive Other
OUTCOME OF LAPAROSCOPIC SPLENECTOMY FOR THE
TREATMENT OF HEMATOLOGICAL DISEASES, Jacques
Matone MD, Gaspar Lopes Filho PhD,Wagner Marcondes
MD,Elesiário Caetano MD,Ramiro Colleoni MD,Milton
Scalabrini MD, Federal University of Sao Paulo - Brazil
Objective: The aim of this study was to review our experience
with laparoscopic splenectomy, to determine its overall success
and applicability.
Introduction: Splenectomy is considered to be the best available
treatment for severe forms of hematological diseases,
such as hereditary spherocytosis, idiopathic thrombocytopenic
purpura (ITP) and other hematological conditions, refractory to
conservative management. With the advancement of laparoscopic
skills and technology, the minimally invasive approach
was applied to many open procedures, including splenectomy.
Over a short span of time laparoscopic splenectomy has largely
replaced open splenectomy regardless of operative indication
and has also resulted in an overall increase in the number
of splenectomies performed. However, several aspects of this
procedure remains as yet undefined and thus, several
attempts have been made to modify the standard technique to
try to optimize the procedure.
Methods: A retrospective analysis of 20 laparoscopic splenectomies
performed due to hematological diseases at our institution,
between February 2001 and January 2004, was carried
out. Patients were followed in the surgical and hematology
outpatient clinics and data was reviewed.
Results: The indications for the procedures were ITP (80%),
non-Hodgkin lymphoma (10%), hereditary spherocytosis (5%)
and hypersplenism due to erytematous lupus (5%). Mean age
was 31-year old (range 19 to 55) and 80% were female. Mean
operating time was 155 minutes. Concerning acessory spleen,
we performed routine search preoperatively. It was detected in
three patients before surgical approach. Conversion rate was
10%, due to an injury during hilar dissection in one case and
to multiple adhesions from previous surgery in another. Two
patients required blood transfusion and postsurgical complications
occurred in four patients (20%), including hematoma,
diaphragm perforation, pulmonary embolism and infection of
the port site. A small transverse incision in the lower abdomen
was made for an intact removal of the spleen. In all cases,
splenectomy improved patient?s hematological profiles.
Conclusion: The laparoscopic approach should be considered
the first option in cases of hematological conditions that
require splenectomy, whenever contraindications are absent.
The procedure requires extensive laparoscopic experience and
meticulous dissection of the spleen to lower the complication
rate.
220 http://www.sages.org/
P357–Minimally Invasive Other
LAPAROSCOPIC SPLENECTOMY IN SEVERE THROMBOCY-
TOPENIA, Roger D Moccia MD, Tejinder P Singh MD, Albany
Medical Center
Introduction: The purpose of this study was to determine if
severe thrombocytopenia (platelets < 35,000) affects morbidity,
mortality, or the need for transfusions in patients who have
undergone laparoscopic splenectomy.
Methods: Retrospective case review of all patients who have
undergone laparoscopic splenectomy (LS) by one surgeon in
one institution between 1/1995 and 4/2004. Charts were
reviewed to determine indication for procedure, pre-operative
platelet count, post operative transfusions, morbidity, mortality,
length of hospital stay (LOS) and conversion to open operation.
Results: Thirty five laparoscopic splenectomies were performed
by one surgeon at Albany Medical Center over a 9 year
period. Twelve patients (34%) had preoperative platelet counts
of less than 35,000. There were 6 men and 6 women with a
mean age of 35 years (13 ? 62). Ten of the patients had a diagnosis
of ITP, one had TTP and one had CLL. Mean operative
time was 130 minutes (range 103 ? 166). Mean EBL was 61 ml
(range 5 ? 300ml). Median post op LOS was 2 days (range 1 to
24). Three patients required post operative blood transfusions
(1unit, 2units and 14 units). One patient (TTP) continued to
have ongoing bleeding after operation requiring transfusion of
14 units of packed red blood cells. There were no post operative
deaths and none of the patients required conversion to
open operation.
Conclusions: Laparoscopic splenectomy can be performed
safely in patients who have severe thrombocytopenia.
Bleeding risk is not increased in this patient population and
there does not appear to be a need for pre-operative transfusion
of platelets in patients who are not actively bleeding.
P358–Minimally Invasive Other
A SIMULTANEOUS LAPAROSCOPY-ASSISTED HEPATECTOMY
AND SIGMOID COLECTOMY FOR A PATIENT WITH COLON
CANCER AND LIVER METASTASIS : A CASE REPORT,
masanori nishioka MD, tetsuya ikemoto MD,tsutomu ando
MD,takashi iwata MD,nobuhiro kurita MD,mitsuo shimada PhD,
Department of Digestive Surgery, Tokushima university
[Introduction] The rate of recurrent cancer was recently reported
similar after laparoscopically assisted colectomy and open
colectomy for colon cancer. Laparoscopic approach is an
acceptable alternative to open surgery for colon cancer recently
because of its radicality, safety and minimal invasiveness
(The Clinical Outcomes of Surgical Therapy Study Group.
NEJM 2004). Laparoscopic hepatectomy has been reported a
feasible option for liver malignancy (Shimada M, et al. Surg
Endosc 2002). Laparoscopic hepatectomy, as well as laparoscopic
colectomy, allows for radical local treatment of liver
cancer, while causing minimal stress to the patient. Herein, we
report a case who underwent a laparoscopy-assisted hepatectomy
and colectomy for colon cancer with liver metastasis.
[Case] A 69-year old women, who was indicated high CEA, was
found having a 20mm tumor in the sigmoid colon by colonal
endoscopy. On abdominal CT scan, abdominal magnetic resonance
imagingscan and angiography, a 40mm metastatic liver
tumor in the lateral segment from colon cancer was diagnosed.
Laparoscopy assisted hepatectomy of lateral segment
and sigmoid colectomy were performed. Hepatectomy with a
small abdominal incision was performed by abdominal wall
lifting method. Sigmoid colectomy was performed by pneumoperitoneal
method, and the bowel was exteriorized through
a small incision for resection and anastomosis. The operation
time was 480 minute and the blood loss was 250 ml. The postoperative
course was uneventful.
[Conclusion] In case of colon cancer with resectable liver
metastases, a simultaneous laparoscopic procedures of hepatectomy
and colectomy is useful option because of the less
invasiveness and the cosmetic.
P359–Minimally Invasive Other
LAPAROSCOPIC ARTICULATED GRASPER, Dmitry Oleynikov
MD, Tim Judkins MS,Katherine Done MS,Allison DiMartino