Rafael Torres Peña

Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial

Background and study aims: Overall, 5 % to 15 % of patients undergoing cholecystectomy for cholelithiasis have concomitant bile duct stones, and the incidence of choledocholithiasis increases with age. There is no clear consensus on the best therapeutic approach (endoscopic versus surgical). Patients and methods: A prospective randomized controlled clinical trial was performed to compare three treatment options for patients with choledocholithiasis at the National Center for Minimally Invasive Surgery in Havana, Cuba from November 2007 to November 2011. The patients were randomized in three groups. Group I: patients who underwent intraoperative cholangiography (IOC) to confirm the choledocholithiasis followed by laparoscopic cholecystectomy (LC) associated with intraoperative endoscopic retrograde cholangiopancreatography (ERCP), group II: patients who underwent preoperative ERCP followed by LC during the same hospital admission and group III: patients who underwent IOC to confirm the choledocholithiasis followed by LC associated with laparoscopic common bile duct exploration (LCBDE). Results: A total of 300 patients with suspected choledocholithiasis were included in the trial and were randomized. As a result, a total of 134 patients were diagnosed with the presence of choledocholithiasis and treated during the study period. There were no significant differences in success rates of ductal stone clearance, but retained stone, postoperative complications and length of hospital stay were better in group I. Conclusions: Intraoperative ERCP/ES shows a higher rate of common bile duct stones clearance, a shorter hospital stay, and lower morbidity, but further research with a larger study population is necessary to determine the additional benefits of this procedure. The results to date suggests that in appropriate patients, single-stage treatments are the best options.

Laparoendoscopic Single-Site Hysterectomy: A Novel Method with New Medical Instruments

Objective: The aim of this research was to demonstrate the feasibility and safety of laparoendoscopic single-site surgery (LESS) for total laparoscopic hysterectomy (TLH). A laparoscope was used with a work channel and modified conventional laparoscopic instruments. Design: This was a prospective study. Materials and Methods: Between April 2010 and December 2014 LESS-TLH was performed in 80 patients with benign gynecologic conditions at the department of laparoscopic and endoscopic surgery at the National Center for Minimal Access Surgery in Havana Cuba. Results: The mean age of the patients was 45 years (range 30-76 years) mean uterus weight was 225 g (100-482 g) mean operative time was 82 minutes (50-200 minutes) and mean blood loss 54 mL (10-400 mL). The postoperative hospital stay was <1 day. One patient experienced an intraoperative complication (bladder injury). There were two postoperative complications: 1 patient with a vault abscess 2 weeks after surgery and 1 patient with endometriosis had a ureter injury. No patients required transfusion during or after the laparoscopic procedure and there were two conversions to conventional TLH. Conclusions: This LESS-TLH technique proposed in this article seems to be a feasible and safe approach with similar operative time and without the disadvantages of loss of triangulation and clashing of instruments compared with other LESS hysterectomy techniques.Abstract Objective: The aim of this research was to demonstrate the feasibility and safety of laparoendoscopic single-site surgery (LESS) for total laparoscopic hysterectomy (TLH). A laparoscope was used with a work channel and modified conventional laparoscopic instruments. Design: This was a prospective study. Materials and Methods: Between April 2010 and December 2014, LESS-TLH was performed in 80 patients with benign gynecologic conditions at the department of laparoscopic and endoscopic surgery, at the National Center for Minimal Access Surgery, in Havana, Cuba. Results: The mean age of the patients was 45 years (range 30–76 years), mean uterus weight was 225 g (100–482 g), mean operative time was 82 minutes (50–200 minutes), and mean blood loss 54 mL (10–400 mL). The postoperative hospital stay was <1 day. One patient experienced an intraoperative complication (bladder injury). There were two postoperative complications: 1 patient with a vault abscess 2 weeks after surgery and 1 patient with endomet...