Fundus first as the standard technique for laparoscopic cholecystectomy

In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.

P157 GIANT PEDUNCULATED OESOPHAGEAL LIPOSARCOMAS: A CASE AND REVIEW OF RESECTION TECHNIQUES

Aim Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of giant oesophageal liposarcoma with a discussion focusing on resection techniques. Background & Methods A 54-year-old gentleman presented to the hospital with symptoms of anaemia and weight loss for 3 months. A CT scan and oesophagogastroduodenoscopy (OGD) showed a giant, pedunculated polyp extending from the cervical oesophagus to cardioesophageal junction (CEJ) with mucosal ulceration at its distal aspect. Endoscopic ultrasound (EUS) revealed a 24 x 6 cm submucosal pedunculated mass with lipomatous regions and core biopsy only showed rare groups of spindle cells with no malignancy. Resection was advised in view of occult bleeding from polyp and endoscopic resection was deemed unsuitable in view of a highly vascular stalk and large size of polyp. He underwent surgical resection via a left cervical oesophagostomy with gastrostomy for polyp retrieval. Final histology showed a dedifferentiated liposarcoma arising within a giant fibrovascular polyp. Results Open surgery has classically been standard of treatment, but endoscopic resection is less morbid and invasive. Endoscopic techniques described include using a retraction suture followed by division of the polyp stalk using ultrasonic shears, using a snare, endoscopic submucosal dissection (ESD), and application of hemoclips following diathermy. In cases where endoscopic resection is not feasible, surgery such as oesophagostomy, oesophagectomy and laparotomy for resection and retrieval of the tumour have been described. Main reason for oesophagectomy was the presence of a submucosal (rather than polypoid, pedunculated) large tumour. For resection via oesophagostomy, stalk transection can be performed via stapling devices or suture ligation. Conclusion Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle in the proximal oesophagus. Resection techniques have shifted from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.

New generation cut-and-seal devices in oral and oropharyngeal cancer resection: clinical and cost-effectiveness study

Objectives:To evaluate the clinical efficacy and cost-effectiveness of ultrasonic shears and the electrothermal bipolar vessel sealing system, in comparison to the traditional cold knife and bipolar forceps, in oral and oropharyngeal cancer surgery.Methods:Patients who underwent oral or oropharyngeal cancer resection and neck dissection with either ultrasonic shears (n= 36) or electrothermal bipolar vessel sealing (n= 32) were enrolled. Surgical time, intra-operative bleeding, blood drainage, post-operative pain, neck oedema, complications and hospitalisation duration were compared to those of an historical cohort of 36 patients treated using a cold knife and bipolar forceps. Additionally, a cost-effectiveness evaluation was performed.Results:Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, were advantageous compared to the traditional techniques. The cost of ultrasonic shears and electrothermal bipolar vessel sealing was completely offset by declining time-driven costs for the surgical team and operating theatre.Conclusion:Ultrasonic shears and, in particular, electrothermal bipolar vessel sealing, are more advantageous compared to the traditional techniques, from both a clinical and economic point of view.