Introduction: As minimally invasive surgery migrates to a single port operative platform, the need for innovative retracting systems is becoming ever apparent. We evaluated an internal, adjustable retraction device for laparoendoscopic surgery, Versa lifter. Methods: Having received IRB approval we conducted a study using a porcine model. We performed 10 cholecystectomies and 10 gastric retraction procedures assessing multiple factors for the retraction device including ease of use, timing & damage to organs. Results: The VERSA LIFTER was very easy to deploy and retrieve with negligible peritoneal damage and overall a very intuitive system to use. Application and retrieval were completed in 3 minutes on average. Conclusion: The VERSA LIFTER is a very effective, efficient and intuitive system for adjustable internal organ retraction for Laparoendoscopic Single site surgery.

Divertikelerkrankungen sind in westlichen Gesellschaften sehr häufig. Allerdings gibt es eine Tendenz dazu, die Indikation für eine chirurgische Therapie der Divertikulitis seltener zu stellen. Minimal-invasive Operationen bieten viele potenzielle Vorteile für Patienten bei der Divertikulitisbehandlung und können zur Optimierung chirurgischer Indikationen führen.

Our aim was to assess the long-term survival advantage associated with the laparoscopic approach for colon cancer resection in an Irish minimally invasive unit. Between January 2005 and December 2006, 154 patients underwent resection for colon cancer. 108 underwent a laparoscopic resection, with a conversion rate of 11%. The overall 5 year survival was 71.4%. The overall 5 year survival rate for laparoscopic resections was 80.6% where as the overall survival for open resection was 50%. Laparoscopic surgery had a significant 5 year overall survival advantage compared to open in both non metastatic disease (Stage I and II) (92.2% vs. 69.6%, p = 0.0288) and metastatic disease (Stage III and IV), (68.4% vs. 30.4%, p = 0.0026). Laparoscopic surgery in a dedicated minimally invasive unit with verifiable low conversion rates is feasible and in our experience associated with a long-term survival advantage for colon cancer.

INTRODUCTION: Lymphangioma is an uncommon malformation of lymphatic system. Multiple colonic lymphangioma named as lymphangiomatosis is considered an extremely rare disease.PRESENTATION OF CASE: We report a case of colonic lymphangiomatosis presenting as recurrent right iliac fossa pain in a young female treated surgically.DISCUSSION: Lymphangiomatosis is a rare but benign disease with a variety of presentations. There are few reported cases in the literature at present and no guidelines regarding the diagnosis or treatment of the same.CONCLUSION: Our case demonstrates an unusual presentation of lymphangiomatosis treated surgically. Debate will remain on this rare condition. (C) 2012 Surgical Associates Ltd. Published by Elsevier Ltd.

Introduction Diverticular disease is very common in Western societies. However, there is a trend towards reducing indications for the surgical management of diverticulitis. Minimally invasive surgery offers many potential advantages to patients in the treatment of diverticulitis and may optimise surgical indications. Methods A systematic literature review of minimally invasive techniques was carried out for the treatment of diverticulitis. The following techniques were reviewed: laparoscopic, single-port, natural orifice specimen extraction, natural orifice transluminal endoscopic surgery and laparoscopic lavage for the treatment of diverticulitis. Results In total, 2,050 minimally invasive cases were reviewed. Of all the different minimally invasive techniques published regarding the management of diverticular disease, laparoscopic surgery is the only technique that has undergone the rigours of randomised controlled trials. The documented benefits are less blood loss, less pain and analgesic requirements, a reduction in major complications, a reduction in the frequency of drain usage, a reduction in the duration of postoperative ileus and shorter hospital stay. However, operative time does appear to be longer. It has also been demonstrated that elective laparoscopic surgery results in improved quality of life and social functioning. Conclusion Minimally invasive surgery for the treatment of diverticular disease appears feasible and safe. The result of future randomised trials will more clearly define the role each minimally invasive technique will play in the future.

Tumour stroma gene expression in biopsy specimens may obscure the expression of tumour parenchyma, hampering the predictive power of microarrays. We aimed to assess the utility of fluorescence-activated cell sorting (FACS) for generating cell populations for gene expression analysis and to compare the gene expression of FACS-purified tumour parenchyma to that of whole tumour biopsies. Single cell suspensions were generated from colorectal tumour biopsies and tumour parenchyma was separated using FACS. Fluorescence-activated cell sorting allowed reliable estimation and purification of cell populations, generating parenchymal purity above 90%. RNA from FACS-purified and corresponding whole tumour biopsies was hybridised to Affymetrix oligonucleotide microarrays. Whole tumour and parenchymal samples demonstrated differential gene expression, with 289 genes significantly overexpressed in the whole tumour, many of which were consistent with stromal gene expression (e.g., COL6A3, COL1A2, POSTN, TIMP2). Genes characteristic of colorectal carcinoma were overexpressed in the FACS-purified cells (e.g., HOX2D and RHOB). We found FACS to be a robust method for generating samples for gene expression analysis, allowing simultaneous assessment of parenchymal and stromal compartments. Gross stromal contamination may affect the interpretation of cancer gene expression microarray experiments, with implications for hypotheses generation and the stability of expression signatures used for predicting clinical outcomes.

Endothelial progenitor cells (EPCs) derived from bone marrow incorporate into foci of neovascularization to propogate tumor growth. These cells are mobilized in response to surgical injury. Laparoscopic surgery may protect against the oncologic adverse effects of open surgical tumor excision, and this may be related to attenuated mobilization of EPCs.

Accelerated perioperative tumour growth resulted in increased vasculogenesis. This effect may be independent of VEGF. Further studies into the precise biology of accelerated perioperative tumour growth are needed.

Introduction: Endothelial progenitor cells (EPC’s) andvasculogenesis are intricately involved in the initial neovascularisation of tumours. EPC’s are characterised by the expression of VEGFR-2 and AC133. Vasculogenesis offers a novel possibility for the targeting of anti-cancer therapies. Methods: Ex-vivo expanded EPC’s were cultured from peripheral blood samples from healthy male volunteers. To endocytose VEFGR-2 on EPC’s, cells were treated with incremental doses of dopamine and VEGFR-2 expression was analysed using anti-VEGFR-2 mAb on flow cytometry. Dil-labelled ex-vivo expanded EPC’s were transplanted into tumour bearing (3LL tumour cell line) MF1-nude mice (n=12). The mice received a daily i.p. injection of PBS or Dopamine (50 mg/kg). Tumour volume was assessed on alternate days. Vasculogenesis and angiogenesis were assessed using fluorescent microscopy and CD31 staining. To determine if Dopamine has a direct effect on 3LL cells, cells were cultured with incremental doses of dopamine for 48 h and cell apoptosis (PI-staining), proliferation (BrdU-Assay) and Cytotoxicity (LDH-Assay) were analysed. Statistical analysis was performed on SigmaStat using ANOVA. Results: Ex-vivo expanded EPC cultures were 80–85% pure. Dopamine caused an endocytosis of VEGFR-2 on EPC’s with the maximal effect seen at 1μM (p < 0.05). Dopamine had no effect on 3LL cell apoptosis, proliferation or cytotoxicity in all doses performed. Dopamine, by endocytosing VEGFR-2 on EPC’s, attenuated tumour growth by decreasing both tumour volume (p < 0.05; 241.8 +/- 106.8 v’s 59.7 +/- 20.5 at day 10) and tumour weight (p < 0.05). Absolute and relative levels of vasculogenesis were decreased in the dopamine group as compared to controls (p < 0.05). Conclusion: Induction of VEGFR-2 endocytosis on EPC’s decreases tumour growth and vasculogenesis. This data suggests that VEGFR-2 is a target for attenuating tumour vasculogenesis.

While SLNB accurately predicts nodal basin status, the incidence of nodal metastases in patients with early stage Tl cancers at ALND following a positive SLNB is 8%. The data suggest that patients with early stage breast cancer may not require completion lymphadenectomy, regardless of SLN positivity.

The early pattern of first recurrence for patients with negative results is characterised by a preponderance of locoregional sites, similar to that reported in previous studies of elective lymph node dissection. This data underscores the need for careful pathological analysis of the sentinel node as well as a careful, well-directed locoregional examination in the follow up of these patients.