Mini-laparoscopy in the endoscopy unit:Safety and outcomes in over one thousand patients

AIM:To investigate the safety of consecutive mini-lapar oscopy guided liver biopsies for the diagnosis and staging of liver diseases. METHODS: In this study we retrospectively analyzed the safety of mini-laparoscopic liver biopsy performed in an endoscopy unit in 1071 patients. We measured the incidence of bleeding and evaluated the management and outcome of bleeding interventions.were viral hepatitis and autoimmune liver disease. 250 patients had macroscopically and histologically proven cirrhosis. 13 patients had no pathological f indings. 33% of all patients had bleeding that required argon plasma coagulation of the puncture site during laparoscopy. Signif icant bleeding occurred more often in patients with liver cirrhosis compared to non-cirrhotic liver dise ases but was effectively treated with laparoscopic coag ulation. CONCLUSION: In conclusion, mini-laparoscopy liver biopsy can be performed safely and effectively in high risk patients with advanced liver disease; mini-lapar osc opy with liver biopsy can be done safely in an endos copy unit.

Retroperitoneal laparoscopic nondismembered pyeloplasty for uretero-pelvic junction obstruction due to crossing vessels: A matched-paired analysis and review of literature

Objective:To compare laparoscopic Anderson-Hynes pyeloplasty(LAHP)and retroperitoneal laparoscopic YV-pyeloplasty(LRYVP)in ureteropelvic junction obstruction(UPJ)in presence of a crossing vessels(CV).Methods:Our database showed 380 UPJO-cases,who underwent laparoscopic retroperitoneal surgery during the last 2 decades including 206 non-dismembered LRYVP,157 dismembered pyeloplasties LAHP,and 17 cases of laparoscopic ureterolysis.Among them 198 cases were suitable for a matched-pair(2:1)analysis comparing laparoscopic retroperitoneal non-dismembered LRYVP(Group 1,n Z 131)and dismembered LAHP(Group 2,n Z 67)in presence of a crossing vessel.Patients were matched according to age,gender,kidney functions,and obstruction grade.Complications were graded according to modified Clavien-classification.Results:Comparative data were similar between both groups(LRYVP vs.LAHP)including mean operating time(112 min vs.114 min),complication rates(4.2%vs.7.3%)mainly Grade 1e2 according to Clavien classification,and success rates(90%vs.89%).These results reflected in the reviewed literature indicate that LRYVP provides the advantage of minimal dissection in case of CV with similar outcome.However,redundant pelvis and anteriorly crossing vessels still require a dismembered pyeloplasty LAHP.Conclusion:LRYVP has achieved similar results compared with the previous golden standard of open surgery,especially in case of crossing vessels apart from presence of a redundant pelvis or anteriorly crossing vessel.This can be further improved when using the small access retroperitoneoscopic technique respectively mini-laparoscopy.