Luis Sarotto

Primary segmental infarction of the greater omentum: a rare cause of RLQ syndrome: laparoscopic resection.

The authors report a rare case of a patient with a primary segmental infarction of the greater omentum who reported acute abdominal pain. Despite preoperative clinical studies and imaging evaluation, an etiologic diagnosis could not be determined. The diagnosis of this uncommon disease was determined after initial laparoscopic exploration. A laparoscopic resection was performed. The patient had an uneventful recovery and was discharged within 12 hours. The differential diagnosis of the right lower quadrant syndrome includes several disorders, of which the primary segmental infarction of the greater omentum is not frequent. The authors emphasize the usefulness of routine laparoscopic exploration in patients with RLQ syndrome because it adds the possibility of mini-invasive treatment to the initial diagnosis.

Ureter Identification Using Methylene Blue and Fluorescein

The use of a multimodal optical system that expands the surgeon’s light spectrum of view can improve surgical performance making structures clearly visible during laparoscopic and open surgery. This allows for shorter procedural duration and improved prevention and incidence of ureteral injury associated with complex pelvic surgery. Optical imaging using invisible NIR fluorescent light has several advantages over currently available intraoperative techniques. First, visualization of the ureters does not require ionizing radiation, and uses only safe wavelengths of light for ample excitation. Secondly, because fluorescence emission is invisible to the human eye, the surgical field is not stained or changed in any way. The blue dyes that are currently used stain the surgical field and have relatively poor contrast. Thirdly, imaging can be performed in real-time (up to 15 frames per second) with the merged image from the color video and NIR fluorescent cameras providing anatomical landmarks that are easily identifiable. More work is needed to identify the optimal contrast agent and light wavelength with which it is most optimally visualized. Overall, this field of knowledge is of great interest and reports a great growing potential.

Fluorescence Cholangiography in Laparoscopic Cholecystectomy Experience in Argentina

The frequency of laparoscopic cholecystectomies in Argentina has increased in the last few years. The use of intraoperative methods for the detection of bile ducts such as intraoperative cholangiography (IOC) varies within the country although it is a routine procedure in our workplace. Surgical injuries in bile ducts remain a constant, amounting to about 0.4%. This is the reason why we have been looking for an easy alternative to IOC, with the aim to reduce those numbers. Sponsored by the company Karl Storz, in 2011 we started performing fluorescence cholangiography in our laparoscopic cholecystectomies; we have kept those records prospectively and now have a total of 65 cases. The use of this method seems promising with some clear advantages such as its low cost, real-time performance and the possibility to visualize structures before they are sectioned. We have been able to visualize the main bile duct without dissection in 89.5% of the cases. Areas that still need improvement include some technical issues such as the depth for visualization in obese patients or in those with severe or substantially chronic inflammatory stages where the light cannot penetrate tissues appropriately.