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Aim: Choledochal cyst is characterized by congenital dilatation of the biliary system. Patients with choledochal cyst tend to be symptomatic in their childhood. The aim of this study was to review the current practice in laparoscopic management of choledochal cyst in infants and children. Patients and Methods: A PubMed database search was performed for all the studies on children who underwent laparoscopic excision of choledochal cyst. Additional literature was cited second hand from the first‐tier literatures. Results: Studies on i) laparoscopic excision of choledochal cyst and hepaticojejunostomy in children; ii) laparoscopic management of choledochal cyst in antenatally detected choledochal cyst; iii) single incision laparoscopic surgery (SILS) in children with choledochal cyst; iv) robotic assisted laparoscopic surgery in children with choledochal cyst and v) hepaticoduodenostomy in children with choledochal cyst were reviewed. Conclusions: Laparoscopic excision of choledochal cyst and hepaticojejunostomy remains safe and feasible in children and infants. In centers experienced in MIS, SILS and robotic–assisted laparoscopy in the management of children with choledochal cyst were reported to be an alternative approach. The debate on hepaticoduodenostomy versus hepaticojejunostomy in biliary reconstruction will continue until a longterm outcome is available in the future. [ABSTRACT FROM AUTHOR]

Single port access procedure attempts to further enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. A 47-year-old woman underwent a single incision transumbilical laparoscopic nephrectomy for her non-functioning left kidney due to a full staghorn stone complicated by recurrent symptomatic urinary tract infection. The operation was successfully completed with three transumbilical ports (12 mm, 5 mm and 5 mm). Flexible grasper was used to facilitate dissection. Both 10 mm and 5 mm lens were used, the latter being required when instruments larger than 5 mm needed to be accommodated. The ureter was divided between Hem-O-Lok clips, whereas the renal vessels were controlled by vascular Endo-GIA staplers. Specimen retrieval was made possible by connecting the three transumbilical ports. No extra-umbilical incision was made. To my knowledge, this is the first case of single incision transumbilical laparoscopic nephrectomy ever carried out in Hong Kong. [ABSTRACT FROM AUTHOR]

Aim: In performing laparoscopic sphincter-preserving total mesorectal excision, one of the technical challenges is to obtain an adequate distal mural margin of 2 cm in the case of low rectal tumours. Herein we describe a technique, known as simultaneous laparoscopic abdominal and transanal excision, where an adequate distal margin can be safely achieved at the beginning of the operation. Methods and Results: As the specimen is delivered per anum, the patient can enjoy the full benefits of minimally invasive surgery. Additionally, the simultaneous approach helps to shorten the operating time. The technique was attempted in five patients with radiological T2 or T3 disease, with two patients having received neoadjuvant chemoirradiation. The outcomes of these five patients are presented. Conclusion: As treatment of rectal cancer is increasingly stage dependent, the simultaneous laparoscopic abdominal and transanal excision procedure offers a clear alternative for treating patients with low rectal tumours in this laparoscopic era. [ABSTRACT FROM AUTHOR]

To review the literature that addresses carrying out laparoscopic partial hepatectomy A review and analysis of the English-speaking literature addressing laparoscopic partial hepatectomy. Laparoscopic partial hepatectomy is carried out in limited numbers and mostly on small tumours requiring wedge or segmental resections. No prospective trials have been carried out comparing laparoscopic techniques to open surgery, but case control comparisons suggest that this technique is safe and associated with shortened hospital stay and decreased incisional pain. Major hepatectomies have been carried out laparoscopically, but in very limited numbers and published experience is not sufficient to formally address this operation. Laparoscopic minor partial hepatectomy appears to be safe and of some benefit to patients if carried out by surgeons experienced in both laparoscopic and hepatic surgery. The ultimate utility of this novel surgical technique will have to be determined by future randomized prospective trials. [ABSTRACT FROM AUTHOR]

Although laparoscopic incisional hernioplasty has been gaining in popularity, the best approach for the repair of incisional hernia remains controversial. The present study was undertaken to evaluate the medium-term outcomes of laparoscopic incisional hernioplasties utilizing onlay GORE-TEX DualMesh (GORE-TEX DualMesh Biomaterial; W.L. Gore and Associates, Flagstaff, Arizona, TX, USA).Between June 2000 and July 2004, 42 patients underwent laparoscopic incisional hernioplasties at our institution. Perioperative data and postoperative outcomes were collected prospectively and analyzed.Laparoscopic incisional hernioplasty was successfully performed on 39 (93%) patients. Conversion to open repair was required in three patients. The overall mean operative time was 108 min. Sixteen patients (37%) were found to have more than one hernial defect after reduction of the hernial contents. Postoperative morbidity included seroma (n = 8), urinary retention (n = 3), ileus (n = 1), pneumonia (n = 1), fever (n = 1), wound infection (n = 1), and prolonged suture site pain (n = 1) in 13 patients. All these morbidities resolved spontaneously without intervention. Two-thirds of the patients were discharged within 2 days after surgery. With a median follow up of 2 years, two clinical recurrences (4.8%) were detected.Laparoscopic approach was a safe and efficacious technique for the repair of incisional hernia. Medium-term outcomes were promising with low postoperative morbidity and recurrence rates. This technique allows clear identification of multiple hernial defects and confers the advantages of minimal access surgery. [ABSTRACT FROM AUTHOR]

The concept of natural orifices transluminal endoscopic surgery (NOTES) started in 2000 when transgastric peritoneoscopy was experimental. Although numerous surgical procedures had been performed successfully in animal models, the application of NOTES in humans was limited. The main obstacles to the performance of NOTES in humans included the security of closing the gastrointestinal (GI) access site, the lack of a stable multi-tasking platform and prospective clinical studies. The present article reviews the current developments in the field of NOTES with special focus on developments in the closure of GI access, a multi-tasking platform and the potential future applications of NOTES. [ABSTRACT FROM AUTHOR]

The article focuses on the technique of Laparoendoscopic Single-Site Surgery (LESS) cholecystectomy using a new retraction device, the Endograb. It informs that the LESS technique has been described for cholecystectomy, appendectomy and obesity surgery. One of the limitations of the technique is the lack of retraction. It is stated that the Endograb system provides a method to enhance retraction during LESS cholecystectomy.