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In recent years scarless surgery (axillo-bilateral-breast aproach [ABBA], natural orifice transluminal endoscopic surgery [NOTES], single-port surgery) has gained importance in order to improve postoperative outcome in laparoscopic surgery. As part of this effort minilaparoscopic surgery might be a suitable alternative concerning cosmetic outcome without implementing a completely new technique. Due to the definition minilaparoscopic surgery is based on instruments which reduce the total length of trocar incisions to less than 2.5 cm. Nevertheless the total number of incisions is similar to conventional laparoscopic techniques. Most recent indications for minilaparoscopic surgery are cholecystectomy, appendectomy, hernia and colorectal surgery. This article describes the technical aspects and feasibility of minilaparoscopic cholecystectomy and transabdominal preperitoneal hernia repair (TAPP). While the trocar positions remain in the original setting the laparoscopic surgeon benefits from experience gained in conventional laparoscopic surgery. Although the cosmetic outcome is not comparable to single-port surgery, in the author's opinion minilaparoscopic surgery is a useful alternative in scarless surgery due to the fact that it is easy to adapt without establishing a completely new technique. [ABSTRACT FROM AUTHOR]

Background: Recent data indicate that pneumoperitoneal carbondioxide (CO2) insufflation impairs hepatic macro- and microcirculation. Whether dopamine and endothelin-1 (ET-1) antagonists might restore liver blood during laparoscopic surgery has not yet been investigated.Methods: For this study, 30 male WAG/Rij rats were randomized into two groups to obtain pneumoperitoneum with CO2 (n=15) or helium (n = 15). All the animals were implanted with a polyethylene-50 cannula into the right vena jugularis and a Doppler ultrasound flow probe around the portal vein. In each group, the rats were administered dopamine (n = 5); JKC-10, JKC-301, which is a selective endothelin-1 (ET-1) antagonist (n = 5), or sodium chloride as a control (n = 5). Portal blood flow was measured during intraabdominal pressures 2 to 12 mmHg. Data were analyzed using the Kruskal-Wallis h-test.Results: The application of dopamine and ET-1 antagonists significantly improved portal blood flow over that of the control animals (p <0.05). No significant differences were found between CO2 and helium insufflation (P > 0.05).Conclusions: Dopamine and ET-1 antagonism restore portal blood flow during laparoscopic surgery independently of the insufflation gas. Whether improved hepatic perfusion might have beneficial effects on liver function needs further investigation. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery using a robotic system (Da Vinci) was recently introduced into surgical practice for adult patients. To investigate the feasibility of this system in pediatric surgery, laparoscopic fundoplication (Thal and Nissen), cholecystectomy, and bilateral salpingo-oophorectomy were performed. Methods: Eleven children with a mean age of 12 years (range, 7–16 years) underwent either laparoscopic anterior partial fundoplication (Thal, n = 8) or Nissen fundoplication (n = 3) for correction of gastroesophageal reflux disease in the presence of uncontrolled symptoms of regurgitation and pulmonary infection. Two children underwent laparoscopic cholecystectomy due to symptomatic cholecystolithiasis. One child underwent bilateral salpingo-oophorectomy due to a gonadoblastoma. Results: Mean operating time for fundoplication was 146 min (range, l05–180 min), the operating times for cholecystectomy were 150 and 105 min, and that for salpingo-oophorectomy was 95 min. No complications were registered during either the robotic procedures or the postoperative courses. Conclusions: Compared to conventional laparoscopy, the three-dimensional high-quality vision, advanced instrument movement, and improved ergonomic position of the surgeon appear to enhance surgical precision. Robotic surgery in children using the Da Vinci system seems to be feasible and safe. However, the technique is limited due to the fact that instruments adapted to the size of small children are not available. Furthermore, the high costs and prolonged system setup are disadvantages. [ABSTRACT FROM AUTHOR]

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