2005 SAGES Abstracts

POSTER ABSTRACTS
All complications of previous open approaches were able to
be managed laparoscopically. The laparoscopic approach has
multiple advantages over open techniques including
decreased morbidity, ability to manage complications and
more rapid recovery. In patients with recurrent neurologic
symptoms or where concern exists for distal patency,
laparoscopy offers direct assessment of shunt position and
CSF drainage. Laparoscopy should be the standard of care for
peritoneal catheter placement, management of distal shunt
malfunction, diagnosis of abdominal pain etiologies and
assessment of shunt function. A detailed review of the current
literature is provided.
P367–Minimally Invasive Other
TOTALLY EXTRAPERITONEAL LAPAROSCOPIC LYMPH NODE
BIOPSY FOR LYMPHOMA, Robert J Wilmoth MD, Michael E
Harned MD,Craig S Swafford MD,Matthew L Mancini MD,
Department of General Surgery, University of Tennessee
Medical Center, Knoxville, TN.
Objective: The extraperitoneal space has become widely used
for many surgical procedures. We present a case in which
laparoscopy was used to obtain tissue diagnosis for pelvic
lymphadenopathy after CT guided biopsy failed adequate
specimen for diagnosis.
Case Report: Patient is a 27-year-old male who initially presented
with supraclavicular adenopathy in March, 2003.
Subsequent lymph node biopsy and PET staging revealed
Hodgkin?s disease with no evidence of disease below the
diaphragm. The patient underwent systemic treatment and follow
up imaging out to two years revealed no evidence of
recurrence. In November, 2003, the patient demonstrated left
pelvic adenopathy on CT scan. CT guided biopsy was obtained
on two separate occasions without tissue diagnosis. At this
time there was no evidence of adenopathy at any other location.
Results: Balloon expandable trocar was utilized to gain access
to the extraperitoneal space. Two additional 5mm ports were
placed in the midline in a similar fashion as utilized in the TEP
hernia approach. The left pelvis nodal chain was dissected and
lymph node samples were obtained with biopsy forceps. The
procedure was performed on an outpatient basis. Pathology
revealed recurrent Hodgkin?s lymphoma.
Conclusion: Advanced laparoscopic skills continue to expand
the clinical applications for the surgeon. We applied a facile
technique used for the TEP hernia repair to obtain tissue from
a deep location. We conclude that this is a safe and effective
means evaluation of nodal pathology which would otherwise
require a more extensive operation.
P368–Minimally Invasive Other
OUTCOME OF ELECTIVE LAPAROSCOPIC SPLENECTOMY IN
89 CONSECUTIVE PATIENTS., I Takemasa MD, M Sekimoto
MD,M Ikeda MD,T Shuji MD,M Yasui MD,T Hata MD,T Shingai
MD,M Ikenaga MD,M Ohue MD,H Yamamoto MD,M Monden
MD, Department of Surgery and Clinical Oncology, Graduate
School of Medicine, Osaka University
Background and purpose: Laparoscopic splenectomy (LS) is
the procedure of choice for elective splenectomy at our
Institution. Technical feasibility and safety of elective LS in 89
consecutive patients were examined.
Methods: We studied retrospectively reviewed a consecutive
series of LS from November 1995 to March 2004. Patient
demographics, operative indications, morbidity, mortality and
clinical outcome were evaluated.
Results: A total of 89 LS splenectomy including 12 hand-assisted
LS (HALS) were performed. Indications were idiopathic
thrombocytopenic purpura (ITP) 59, malignant lymphoma 9,
splenic tumor or cysts 4, hereditary spherocytosis 3, hypersplenism
3, autoimmune hemolytic anemia 2, and others 9.
There were no deaths. Two patients (2%) who underwent
HALS required conversion to open splenectomy, one for dense
intraabdominal adhesion, and the other for bleeding of splenic
vein. Complication occurred in 7 patients (8%), 4 patients in
HALS and 3 in LS. All complications were treated conservatively.
Patients who underwent LS had significantly shorter
operation time, decreased estimated blood loss, and small
spleen than those underwent HALS (141 vs 267 min, 132 vs
1050g, and 196 vs 1381g, respectively).
Conclusions: LS is feasible, and the incidence of severe complications
is rare.
P369–Minimally Invasive Other
IS THE LAPAROSCOPIC SURGERY AFFECT THYROID FUNC-
TIONS?, Ali Uzunkoy MD, Harran University, School of
Medicine, Department of Surgery, Sanliurfa, Turkey
It is known that laparoscopic operations cause less tissue
injury and systemic stress response. However, it has not been
researched yet the response of thyroid functions, which is a
stress organ, against trauma. Although there are a few studies
to evaluate open surgery, there is not available report about
the effect of laparoscopic surgery on thyroid function. The aim
of this study was to evaluate the effects of surgery trauma on
thyroid functions in subjects with laparoscopic cholecystectomy.
Methods: Forty subjects who underwent laparoscopic cholecystectomy
were included in this study. Venous blood samples
were taken before operation 30th min and 2nd and 24th hours
afterwards for measurement of the levels of TSH, free T3, total
T3, free T4, total T4, cortisole and albumin.
Results: Free T3 and total T3 levels were decreased significantly
at postoperative 2nd and 24th hours than preoperative time
(p