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Introduction: The gastric and duodenal perforations are a life-threatening complication of peptic ulcer disease with the indication for immediate surgical intervention. To which extent laparoscopy is a suitable method in an acute situation was examined in the present investigation., Materials and Methods: The data of all patients within a period of 15 years (01/1996-12/2010) who were operated laparoscopically because of a perforated gastric or duodenal ulcer, were collected prospectively in terms of age, gender, localisation of perforation, diagnostics, symptoms, surgical procedures, intraoperative and postoperative complications and postoperative course, and were analysed retrospectively., Results: During the observation period 45 patients were operated laparoscopically due to gastric or duodenal perforation. The median age at operation was 58 (18-91) years. An NSAID medication was present in 11 (24.4 %) patients. The perforation was juxtapyloric in 12 (26.7 %) patients, postpyloric in 10 (22.2 %) patients, one (2.2 %) patient in each small and greater curvature, in 18 (40.0 %) at the front and in three (6.7 %) patients on the rear wall. In two cases, previous surgical treatment in the upper abdomen was performed. After primary diagnostic laparoscopy, an indication for conversion was seen in 20 (44.4 %) patients. During laparoscopically completed operations simple suturing was done in 18/25 (72.0 %) patients and excision and suturing was performed in 7/25 (37.8 %) patients. After conversion simple suturing was observed in 7/20 (35.0 %) patients, whereas in 10/20 (50.0 %) patients excision and suturing was performed. 3/20 (15.0 %) patients underwent a resective operation. The median operative time was 105 (40-306) minutes and mean hospitalisation 11 (4-66) days. The ICU stay was in median 2 (0-37) days. Major complications were seen in 11 (24.4 %) patients, namely re-laparotomy (n = 7; 15.6 %) and haemorrhage (n = 4; 8.9 %). Minor complications were observed in 8 (17.8 %) of cases. The mortality rate was 11.1 % (n = 5)., Conclusion: The laparoscopic treatment of gastric and duodenal perforations is a minimally invasive therapeutic option for the definitive treatment of this life-threatening disease. The indication for a laparoscopic approach has to be considered individually and depends to a decisive extent on the experience of the laparoscopic surgeon., (Georg Thieme Verlag KG Stuttgart · New York.)

Anorectal outlet obstruction constitutes one form of chronic constipation. Combinations of morphological alterations of the pelvis, the pelvic floor and the colorectum are nearly always evident. The goal of the diagnostic work-up is to identify those patients who will profit from a surgical intervention. Resection rectopexy aims at restoring the physiological anatomy thereby ameliorating the functional interaction of structures effected with the laparoscopic approach entailing all advantages of minimally invasive surgery. Besides a detailed description of the surgical technique used and an algorithm for indications to operate we present our results after 19 years of experience. Throughout this period, 264 laparoscopic resection rectopexies for outlet obstruction were performed. With a mean follow-up of 58.2 months the rate of improvement of obstructive symptoms was 79.5 % (n = 128 of 161 available for follow-up). Present studies suggest that (laparoscopic) resection rectopexy entails better results in comparison to non-resecting procedures and procedures with the implantation of allogenic material. Certainly, in order to achieve these results a correct patient selection and an expertise in laparoscopic surgery are essential. Both the perioperative and the functional results of our own collective fortify the advantages of laparoscopic resection rectopexy in patients with an outlet obstruction., (Georg Thieme Verlag KG Stuttgart · New York.)

Background/aims: Laparoscopic Radiofrequency-ablation is a safe and effective method for tumor destruction in patients with unresectable liver tumors. However, accurate probe placement using laparoscopic ultrasound guidance is required to achieve complete tumor ablation. After development and evaluation of laparoscopic navigation tools for radiofrequency ablation, we are now presenting a prototype of a navigation- and documentation-system for laparoscopic RFA., Methodology: An image-guided surgery system for laparoscopic liver treatments (LapAssistent) based on a 3D-navigation scene was developed. A laparoscopic ultrasound probe and a RFA needle could be navigated using an electromagnetic tracking system. The system was studied using a perfused tumour-mimic-model of a porcine liver., Results: The study showed that laparoscopic ultrasound-guided navigation is technically feasible. The system enables the surgeon to intraoperatively update the three-dimensional planning data in case of new findings. The RFA needle could be placed accurately in a targeted tumour with a targeting error ranging from 5 - 7 mm, even out of the ultrasound plane. In case of multiple tumours lying in close spatial relationship, the documentation module helps to keep track of the already ablated tumours and those that still need to be treated., Discussion: Laparoscopic radiofrequency ablation requires advanced laparoscopic ultrasound skills for accurate placement of the RFA probe. The system adds benefit to laparoscopic RFA enabling the surgeon to place the needle accurately inside the targeted tumours using the navigation scene. The possibility to update the three-dimensional model with new intraoperative findings enables the surgeon to adapt to a new intraoperative situation.

Background: The swallowing function can be restored after large oncologic resections in the upper aerodigestive tract with microvascular anastomosed transplants., Patients and Methods: With the help of the perfusion manometry we would like to demonstrate the functional advantages of this reconstruction method. We examined three reconstructed regions: tongue with 15 patients, soft palate with 11 patients, and the laryngeal and pharyngeal complex after total laryngopharyngectomy with 17 patients., Results: Patients with reconstructed tongue or soft palate reached 69% or 74% of their pressure compared to normal values., Conclusions: We demonstrated that although normal pressure values were not reached after reconstruction of large defects with microvascular anastomosed transplants; these reconstruction methods restored the pressure gradient essential for swallowing, with a higher pressure of the soft palate and a lower pressure of the base of tongue.