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Background: The conversion from open to laparoscopic simple nephrectomy was considered as an initial and most dramatic step toward progression, the second step is trying to miniaturization of the endoscope and instruments, in this study we aimed to evaluate miniaturization of laparoscopic simple nephrectomy looking for reduction perioperative morbidity and enhance cosmoses without significant operative disability. Patient and Methods: We prospectively reviewed 120 patients (60 in each group) who underwent trans-peritoneal conventional laparoscopy (CL) or mini laparoscopy (ML) simple nephrectomy between April 2015 and May 2018. The CL was done using 3 to 4 ports ranged from 5 to12 mm in diamond manner distribution. ML was done using same ports number and distribution ranged from 3- 5 mm except umbilical one was 10 mm. All operations were performed by same surgeon Results: However, ML experienced a significant longer operative time, significant more blood loss and insignificant increased conversion rate. The Post-operative data in the interest of ML were as follows; significantly lower pain scores, lower hospital stay, earlier return to activities and significant increase of cosmoses score of patients, Lastly, port site hernia was 6.7% in CL group and none in ML group (p = 0.042) Conclusion: ML trans-peritoneal simple nephrectomy is associated with lower post-operative pain, hospital stay, early return to normal activity, better cosmoses and less port site hernia. However operative time, blood loss and conversion rate are potentially more than CL.

INTRODUCTION: The aim of the study was to compare 3 mm mini-laparoscopy (mini LP), standard 5 mm laparoscopy (LP) and open surgery for pediatric pyeloplasty in a single center. METHODS: Patients who underwent pyeloplasty from 1997 to 2017 at Hospital Sant Joan de Déu were prospectively collected. Demographic data, clinical, surgical and radiological variables were assessed. A multivariate logistic regression analysis was performed in order to identify risks for surgical complications, urinary leak and need for redo-surgery. RESULTS: 340 pyeloplasties were performed in this period: 197 open, 30 LP and 113 mini LP. Independent risk factors for surgical complications in a multivariate logistic regression model were: LP (vs mini LP, OR = 3.95; 95% CI: 1.13-13.8), higher differential renal function (each point more increases the risk 6%; 95% CI: 1-11%), older children (every year increases the risk 1.11 times; 95% CI: 1.002-1.225). Open surgery, pelvis diameter or the use of different stents were not risk factors. This model had an 80% PPV and a 92% NPV. LP (OR = 4.65; 95% CI: 1.08-19.96) and longer surgical time (OR = 1.014; 95% CI: 1.003-1.025) were independent risk factors for urinary leak. Higher pelvis diameter (OR = 0.93; 95% CI: 0.87-0.99) and the use of external stents were independent protective risk factors for urinary leak (OR = 0.09; 95% CI: 0.01-0.72). We have not found independent risk factors for redo-surgery in a multivariate logistic regression model. CONCLUSION: mini LP can be safely and effectively used to perform pyeloplasty in pediatric patients of all ages.

To date, the advancement of available technologies has led to the effective implementation of minimally invasive approaches in gynecology, with significant improvement of surgical as well as esthet...

Background In recent years, mini-laparoscopic procedures are gaining the preference of most surgeons due to their potentially better surgical outcomes. The Mini Lap Percutaneous Surgical System with MiniGrip® Handle is currently the less invasive instrument and can be applied to a wide range of operations. The current paper presents its application on percutaneous laparoscopic cholecystectomy. Materials and methods From January 2017 to June 2017, 32 patients underwent percutaneous laparoscopic cholecystectomy with the MiniLap® system. All operations were performed by the same surgical team. Results No conversions and no overall complications were reported. Drainage were not necessary. Mean surgical time was 35 minutes, while patients were released in

The mini-laparoscopic cholecystectomy (MLC) was first performed in 1996, as the logical advancement of the conventional laparoscopic cholecystectomy. In Brazil, mini-laparoscopy was first performed in 1998, by Professors Peter Goh and Go Wakabaiashi, who performed a cholecystectomy using 3-mm instruments. The first study, with a considerable number of patients, was performed in Recife by Dr. Carvalho, and he reported that 719 patients were submitted to a MLC with a small rate of conversion for conventional laparoscopy. We discuss the development of mini-laparoscopy in Brazil for the past 20 years.

Interstitial ectopic pregnancy (EP) is a life-threatening condition due to the risk of massive hemorrhage in the event of its disturbance. We present the case of a 27-year-old patient who was admitted with massive hemoperitoneum, caused by the rupture of an interstitial pregnancy in the area of the fallopian tube stump, which had been removed after a previous ectopic pregnancy. The condition was overcome using a mini-laparoscopic approach (2.6 mm, 30° optics), with one 3 mm port for micro-laparoscopic instruments and one 10 mm port. Such an approach has not yet been reported in the available literature, among the casuistically reported cases of pregnancy in the tubal stump. We consider that the technique is safe, completely in the interest of the patient, applicable by an experienced team, and in agreement with modern trends regarding the minimization of operative access.

Background/Aim: The assessment of advanced chronic liver disease (ACLD) is a prerequisite for therapy and surveillance in patients with chronic hepatitis C infection. Mini-laparoscopy-assisted liver biopsies facilitate both histological and macroscopical evaluation of liver fibrosis. This study is aimed at investigating the prognostic significance of the laparoscopic assessment for the cumulative incidence of ACLD-related events. Patients and Methods: We performed a single center, retrospective analysis of 94 patients with either macroscopically or/and microscopically assessed advanced fibrosis/cirrhosis caused by chronic hepatitis C infection. The patients' data, the respective laboratory results, and follow-up period were evaluated in the outpatient clinic. Results: The group with both macro- and microscopic diagnosed ACLD showed a significantly higher number of decompensating events (n = 7) compared with the other 2 groups (n = 0 in the group with only histological and n = 1 in the group with only laparoscopic diagnosis of advanced liver disease). The results were not affected by the successful treatment of the hepatitis C virus. In the Cox-regression analysis, the spleen size (>120 mm) was significantly associated with the incidence of ACLD-related events. Conclusions: Assessment of ACLD in chronic hepatitis C by mini-laparoscopy-assisted liver biopsies may facilitate the selection of patients with a poor prognosis, irrespective of achieving a sustained virological response following treatment. Follow-up of these patients should be intensified to treat decompensation early. �� In Copyright http://rightsstatements.org/vocab/InC/1.0/, publishedVersion

The authors appreciated the support and participation of the MIUSW course attendees for participating in this study and The Research Endoscopic Laboratory at the University of Minho, as well as, the support of Karl Storz, Germany for providing instrumentation used in the study.

Mini-laparoscopy represents an evolving and attractive field both in general and in pediatric surgery, with a pressing and increasing technical demand. Although the advantages of the mini-laparoscopic approach (reduced morbidity, less incisional pain and discomfort, better cosmetic results) are well recognized, its technical difficulties due to the lack of suitable and comfortable instruments brought to a limited use. Moreover, in the pediatric population, the need of ergonomic mini-invasive but efficient devices is the key of a widespread use of mini-laparoscopic surgery performed with an effective and safe technique. We aim to highlight the first case of pediatric laparoscopic cholecystectomy performed with 2.3 mm percutaneous instruments (MiniLap ® Percutaneous Surgical System, Teleflex Incorporated, USA) that represents a significant advance in minimally invasive surgery.

A retrospective case review study was carried out on gastrointestinal injuries which occur during gynaecological laparoscopy. Fifty-six patients with 62 gastrointestinal injuries were identified. One-third of the complications (32.2%) occurred during the installation phase for laparoscopy. Four of the six complications attributed to electrosurgery were secondary to the use of monopolar coagulation. Diagnosis of these gastrointestinal injuries was made during surgery in only 20 patients (35.7%). The mean time before diagnosis was 4.0 +/- 5.4 (range 0-23) days. Treatment of these complications was performed by laparoscopic surgery in 16.1% of cases. Prevention relies on the surgeon's experience, strict observance of the safety rules, perfect familiarity with the physical properties of the instruments used, systematic use of bowel preparation for patients presenting a risk of bowel complications, systematic supervision of the route taken by the trocars, meticulous inspection on completion of surgery of all areas where bowel adhesiolysis has been used and, in case of any doubt, tests for leakage involving the rectosigmoid. For patients with a risk of bowel complications, the creation of a pneumoperitoneum and performing a mini laparoscopy in the left hypochondrium can be the judicious option.

Background/Aims: For diagnosis, prognosis, and treatment of acute liver failure (ALF), macroscopic evaluation and histological assessment of the liver are important. Due to impaired coagulation in ALF, the risk of bleeding is high after a percutaneous liver biopsy. Our aims were to assess (i) safety and benefit of mini laparoscopy (ML) in patients with ALF and (ii) the potential utility of histological markers in ALF prognosis. Methods: ML was performed in 39 patients with ALF to assess liver surface and to obtain a liver biopsy. Serological markers of liver injury and immunohistochemical detection of cell death and proliferation were compared to a non-ALF group (n = 10). Results: Liver biopsies were successfully performed in all patients with no significant complications. All patients had markedly elevated M30 and M65 levels in the serum. In the liver, M30 and Ki67 immune-reactive cells were more abundant in those with ALF. Importantly, there were significantly more Ki67-positive cells but fewer M30-positive cells in livers of ALF patients who recovered spontaneously. Conclusion: ML with liver biopsy in patients with ALF and severe coagulopathy is safe. Immunohistochemical detection of liver cell death and regeneration may identify individuals who would recover spontaneously or who would need a liver transplant.

Blood biochemistry, ascites tests, and imaging examinations have low sensitivities in abdominal neoplasm diagnoses. In addition, exploratory laparotomy is not suitable for final stage patients. Mini-laparoscopy has recently emerged as a new diagnostic technology for abdominal disease. The aim of this research was to evaluate the value of mini-laparoscopy in diagnosing abdominal neoplasms.Clinical and operational data were retrospectively analyzed in 20 cases with pathologically confirmed abdominal malignancies. Of these, 10 cases were each diagnosed by mini-laparoscopy and exploratory laparotomy. The surgical and anesthesia expenses, perioperative nursing, monitoring and treating charges, postoperative hospital stay and complications were compared between groups.The surgical and anesthesia costs were statistically lower in patients who received a mini-laparoscopy (P0.01). Perioperative drug expenses and nursing and monitoring charges were also significantly decreased (P0.05 and P0.01, respectively). Further, the gastrointestinal function recovery time and postoperative hospital stay were significantly reduced in the mini-laparoscopy group. There was no significant difference between the two groups regarding the preoperative hospital stay and postoperative complications.Mini-laparoscopy effectively reduces surgical injury and treatment costs, and is capable of safely diagnosing abdominal tumors. Moreover, the procedure is also easy to perform.

cholestasis in 21. Fibrotic changes exceeding aMetavir score of 1 were found in 30 specimens. The clinical course was favourable in the majority of cases, 3 patients died of progressive organ failure, 5 received orthotopic liver transplant and 27 showed clinical restitution following specific therapy guided by macroscopic and histological assessment. Conclusion: Mini laparoscopy is a technically simple examination with high diagnostic yield that can safely be combined with laparoscopically guided liver biopsy in patients with ALV and severe coagulopathy. The high proportion of liver samples with advanced fibrosis can not be regarded as evidence for preexisting liver disease and do not preclude clinical restitution.

DOI: 10.1007/s11670-011-0214-0 The spelling of the author’s department name in the original version of this article was incorrect. “Hepotology” should be corrected to “Hepatology”. The correct information is given below: Department of Gastroenterology and Hepatology The online version of the original article can be found at http://dx.doi.org/10.1007/s11670-011-0214-0