nach oben

Erschienen in:

01.07.2007 | Review

Laparoscopic resection of curable colon and rectal cancer: an evidence-based review

verfasst von: T. M. Young-Fadok, MD, MS, FACS, FASCRS Chair, R. D. Fanelli, MD, FACS, R. R. Price, MD, FACS, D. B. Earle, MD, FACS

Erschienen in: Surgical Endoscopy | Ausgabe 7/2007

Einloggen, um Zugang zu erhalten

Abstract

The initial enthusiastic application of laparoscopic techniques to colorectal surgical procedures was tempered in the early 1990s by reports of tumor implants in the laparoscopic incisions. Substantial evidence has accumulated, including evidence from randomized controlled trials, to support that laparoscopic resection results in oncologic outcomes similar to open resection, when performed by well-trained, experienced surgeons. This review was developed in conjunction with guidelines published by the Society of American Gastrointestinal and Endoscopic Surgeons. Data from the surgical literature concerning laparoscopic resection of curable colorectal cancer was evaluated regarding diagnostic evaluation, preoperative preparation, operative techniques, prevention of tumor implants, and training and experience. Recommendations are accompanied by an assessment of the level of supporting evidence available at the time of the development of the guidelines.

Guidelines for laparoscopic resection of curable colon and rectal cancer. SAGES publication #32, July 2005. http://sages.org/publications.html#guide

Simmang CL, Senatore P, Lowry A, Hicks T, Burnstein M, Dentsman F, Fazio V, Glennon E, Hyman N, Kerner B, Kilkenny J, Moore R, Peters W, Ross T, Savoca P, Vernava A, Wong WD (1999) Practice parameters for detection of colorectal neoplasms. Dis Colon Rectum 42: 1123–1129PubMedCrossRef

Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C, Gastrointestinal Consortium Panel (2005) Colorectal cancer screening and surveillance: clinical guidelines and rationale: update based on new evidence. Gastroenterol 124: 544–560CrossRef

Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW III, Ko C, Moore R, Orsay C, Place R, Rafferty J, Rakinic J, Savoca P, Tjandra J, Whiteford M, Standards Practice Task force (2004) Practice parameters for colon cancer. Dis Colon Rectum 47: 1269–1284PubMedCrossRef

Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS (1997) Complications of laparoscopic colorectal surgery: analysis and comparison of early vs latter experience. Dis Colon Rectum 40: 592–596PubMedCrossRef

Piscatelli N, Hyman N, Osler T (2005) Localizing colorectal cancer by colonoscopy. Arch Surg 140: 932–935PubMedCrossRef

Feingold DL, Addona T, Forde KA, Arnell TD, Carter JJ, Huang EH, Whelan RL (2004) Safety and reliability of tattooing colorectal neoplasms prior to laparoscopic resection. J Gastrointest Surg 8: 543–546PubMedCrossRef

Ashar BH, Hughes MT, Marinopoulos SS, Prokopowicz GP, Berkenblit GV, Sisson SD, Simonson LA, Miller RG (2005) Current evidence for the use of emerging radiologic technologies for disease screening. Am J Manag Care 11: 385–392PubMed

Banarjee S, Van Dam J (2006) CT colongraphy for colon cancer screening. Gastrointest Endosc 63: 121–133CrossRef

10.

Ward J, Naik KS, Guthrie JA, Wilson D, Robinson PJ (1999) Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis. Radiology 210: 459–466PubMed

11.

Nelson H, The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350: 2050–2059CrossRef

12.

Abel ME, Rosen L, Kodner IJ, et al. (1993) Practice parameters for the treatment of rectal carcinoma. Dis Colon Rectum 36: 989–1006CrossRef

13.

Platell C, Hall J (1998) What is the role of mechanical bowel preparation in patients undergoing colorectal surgery? Dis Colon Rectum 41: 875–882PubMedCrossRef

14.

Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H, Verwaest C, Verhoef L, de Waard JW, Swank D, D'Hoore A, Croiset van Uchelen F (2005) Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 48:1509–1516PubMedCrossRef

15.

Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hayland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:580–581CrossRef

16.

Santos JC Jr, Batista J, Sirimarco MT, Guimaraes AS, Levy CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. Br J Surg 81: 1673–1676PubMedCrossRef

17.

Miettinen RP, Laitinen ST, Makela JT, Paakkonen ME (2000) Bowel preparation with oral polyethylene glycol electrolyte solution vs no preparation in elective open colorectal surgery: prospective, randomized study. Dis Colon Rectum 43: 669–677PubMedCrossRef

18.

Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, Krausz MM, Ayalon A (2003) Colon and rectal surgery without mechanical bowel preparation: randomized prospective trial. Ann Surg 237: 363–367PubMedCrossRef

19.

Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 39: S35–S46PubMedCrossRef

20.

Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D, National Cancer Institute Expert Panel (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93: 583–596PubMedCrossRef

21.

Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359: 2224–2229PubMedCrossRef

22.

Stocchi L, Nelson H (1998) Laparoscopic colectomy for colon cancer: trial update. J Surg Oncol 68: 255–267PubMedCrossRef

23.

Tjandra JJ, Kilkenny JW, Buie WD, Hyman N, Simmang C, Anthony T, Orsay C, Church J, Otchy D, Cohen J, Place R, Denstman F, Rakinic J, Moore R, Whiteford M, The Standards Practice Task Force, The American Society of Colon and Rectal Surgeons (2005) Practice parameters for the management of rectal cancer. Dis Colon Rectum 48: 411–423PubMedCrossRef

24.

Wu WX, Sun YM, Hua YB, Shen LZ (2004) Laparoscopic versus conventional open resection of rectal carcinoma: a clinical comparative study. World J Gastroenterol 10: 1167–1170PubMed

25.

Tsang WW, Chung CC, Li MK (2003) Prospective evaluation of laparoscopic total mesorectal excision with colonic J-pouch reconstruction for mid and low rectal cancers. Br J Surg 90: 867–871PubMedCrossRef

26.

Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18: 281–289PubMedCrossRef

27.

Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46: 1047–1053PubMedCrossRef

28.

Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL, European Association of Endoscopic Surgery (EAES) (2004) Laparoscopic resection of colon cancer. Consensus of the European Association of Endoscopic Surgery. Surg Endosc 18: 1163–1185PubMedCrossRef

29.

Slanetz CA Jr (1984) The effect of inadvertent perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 27: 792–797PubMedCrossRef

30.

Turnbull RB Jr, Kyle K, Watson FR, Spratt J (1967) Cancer of the colon: the influence of the no-touch isolation technique on survival rates. Ann Surg 166: 420–427PubMedCrossRef

31.

Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, Munting JD, Povel JA, Rutten AP, Volovics A, et al. (1988) No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg 75: 409–415PubMedCrossRef

32.

Berends FJ, Kazemier G, Bonjer HJ, Lange JF (1994) Subcutaneous metastases after laparoscopic colectomy. Lancet 344: 58PubMedCrossRef

33.

Johnstone PAS, Rohde DC, Swartz SE, Fetter JE, Wexner SD (1996) Port-site recurrences after laparoscopic and thoracoscopic procedures in malignancy. J Clin Oncol 14: 1950–1956PubMed

34.

Cirocco WC, Schwartzman A, Golub RW (1994) Abdominal wall recurrence after laparoscopic colectomy for colon cancer. Surgery 116: 842–846PubMed

35.

Kirman I, Poltaratskaia N, Cekic V, Forde KA, Ansari P, Boulay C, Whelan RL (2004) Depletion of circulating insulin-like growth factor binding protein 3 after open surgery is associated with high interleukin-6 levels. Dis Colon Rectum 47: 911–917; discussion 917–918PubMedCrossRef

36.

Lee SW, Feingold DL, Carter JJ, Zhai C, Stapleton G, Gleason N, Whelan RL (2003) Peritoneal macrophage and blood monocyte functions after open and laparoscopic-assisted cecectomy in rats. Surg Endosc 17: 1996–2002PubMedCrossRef

37.

Carter JJ, Feingold DL, Kirman I, Oh A, Wildbrett P, Asi Z, Fowler R, Huang E, Whelan RL (2003) Laparoscopic-assisted cecectomy is associated with decreased formation of postoperative pulmonary metastases compared with open cecectomy in a murine model. Surgery 134: 432–436PubMedCrossRef

38.

Whelan RL, Franklin M, Holubar SD, Donahue J, Fowler R, Munger C, Doorman J, Balli JE, Glass J, Gonzalez JJ, Bessler M, Xie H, Treat M (2003) Postoperative cell-mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc 17: 972–978PubMedCrossRef

39.

Lee SW, Gleason N, Blanco I, Asi ZK, Whelan RL (2002) Higher colon cancer tumor proliferative index and lower tumor cell death rate in mice undergoing laparotomy versus insufflation. Surg Endosc 16: 36–39PubMedCrossRef

40.

Carter JJ, Whelan RL (2001) The immunologic consequences of laparoscopy in oncology. Surg Oncol Clin North Am 10: 655–677

41.

Whelan RL, Lee SW (1999) Review of investigations regarding the etiology of port-site tumor recurrence. J Laparoendosc Adv Surg Techniques Part A 9: 1–16CrossRef

42.

Allendorf JD, Bessler M, Horvath KD, Marvin MR, Laird DA, Whelan RL (1999) Increased tumor establishment and growth after open vs laparoscopic surgery in mice may be related to differences in postoperative T-cell function. Surg Endosc 13: 233–235PubMedCrossRef

43.

Whelan RL, Allendorf JD, Gutt CN, Jacobi CA, Mutter D, Dorrance HR, Bessler M, Bonjer HJ (1998) General oncologic effects of the laparoscopic surgical approach. 1997 Frankfurt international meeting of animal laparoscopic researchers. Surg Endosc 12: 1092–1095PubMedCrossRef

44.

Southall JC, Lee SW, Allendorf JD, Bessler M, Whelan RL (1998) Colon adenocarcinoma and B-16 melanoma grow larger following laparotomy vs pneumoperitoneum in a murine model. Dis Colon Rectum 41: 564–569PubMedCrossRef

45.

Bouvy ND, Marquet RL, Jeekel H, Bonjer HJ (1996) Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases. Ann Surg 224: 694–700PubMedCrossRef

46.

Watson DI, Mathew G, Ellis T, Baigrie CF, Rofe AM, Jamieson GG (1997) Gasless laparoscopy may reduce the risk of port-site metastases following laparoscopic tumor surgery. Arch Surg 132: 166–168PubMed

47.

Gutt CN, Riemer V, Kim ZG, Jacobi CA, Paolucci V, Lorenz M (1999) Impact of laparoscopic colonic resection on tumour growth and spread in an experimental model. Br J Surg 86: 1180–1184PubMedCrossRef

48.

Iwanaka T, Arya G, Ziegler MM (1998) Mechanism and prevention of port-site tumor recurrence after laparoscopy in a murine model. J Pediatr Surg 33: 457–461PubMedCrossRef

49.

Wittich P, Steyerberg EW, Simons SH, Marquet RL, Bonjer HJ (2000) Intraperitoneal tumor growth is influenced by pressure of carbon dioxide pneumoperitoneum. Surg Endosc 14: 817–819PubMedCrossRef

50.

Jacobi CA, Sterzel A, Braumann C, Halle E, Stosslein R, Krahenbuhl L, Muller JM (2001) The impact of conventional and laparoscopic colon resection (CO2 or helium) on intraperitoneal adhesion formation in a rat peritonitis model. Surg Endosc 15: 380–386PubMedCrossRef

51.

Neuhaus SJ, Ellis T, Rofe AM, Pike GK, Jamieson GG, Watson DI (1998) Tumor implantation following laparoscopy using different insufflation gases. Surg Endosc 12: 1300–1302PubMedCrossRef

52.

Jacobi CA, Wildbrett P, Volk T, Muller JM (1999) Influence of different gases and intraperitoneal instillation of antiadherent or cytotoxic agents on peritoneal tumor cell growth and implantation with laparoscopic surgery in a rat model. Surg Endosc 13: 1021–1025PubMedCrossRef

53.

Bouvy ND, Giuffrida MC, Tseng LN, Steyerberg EW, Marquet RL, Jeekel H, Bonjer HJ (1998) Effects of carbon dioxide pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy on body weight and tumor growth. Arch Surg 133: 652–656PubMedCrossRef

54.

Wu JS, Guo LW, Ruiz MB, Pfister SM, Connett JM, Fleshman JW (1998) Excision of trocar sites reduces tumor implantation in an animal model. Dis Colon Rectum 41: 1107–1111PubMedCrossRef

55.

Watson DI, Ellis T, Leeder PC, Neuhaus SJ, Dodd T, Jamieson GG (2003) Excision of laparoscopic port sites increases the likelihood of wound metastases in an experimental model. Surg Endosc 17: 83–85PubMedCrossRef

56.

Wittich P, Marquet RL, Kazemier G, Bonjer HJ (2000) Port-site metastases after CO₂ laparoscopy: is aerosolization of tumor cells a pivotal factor? Surg Endosc 14: 189–192PubMedCrossRef

57.

Whelan RL, Sellers GJ, Allendorf JD, Laird D, Bessler MD, Nowygrod R, Treat MR (1996) Trocar-site recurrence is unlikely to result from aerosolization of tumor cells. Dis Colon Rectum 39: S7–S13PubMedCrossRef

58.

Tseng LN, Berends FJ, Wittich P, Bouvy ND, Marquet RL, Kazemier G, Bonjer HJ (1998) Port-site metastases: impact of local tissue trauma and gas leakage. Surg Endosc 12: 1377–1380PubMedCrossRef

59.

Neuhaus SJ, Watson DI, Ellis T, Rofe AM, Jamieson GG (1999) Influence of cytotoxic agents on intraperitoneal tumor implantation after laparoscopy. Dis Colon Rectum 42: 10–15PubMedCrossRef

60.

Lee SW, Gleason NR, Bessler M, Whelan RL (1999) Peritoneal irrigation with povidone-iodine solution after laparoscopic-assisted splenectomy significantly decreases port-tumor recurrence in a murine model. Dis Colon Rectum 42: 319–326PubMedCrossRef

61.

Neuhaus SJ, Ellis T, Jamieson GG, Watson DI (1999) Experimental study of the effect of intraperitoneal heparin on tumour implantation following laparoscopy. Br J Surg 86: 400–404PubMedCrossRef

62.

Braumann C, Ordemann J, Wildbrett P, Jacobi CA (2000) Influence of intraperitoneal and systemic application of taurolidine and taurolidine/heparin during laparoscopy on intraperitoneal and subcutaneous tumour growth in rats. Clin J Exp Metastasis 18: 547–552CrossRef

63.

Jacobi CA, Peter FJ, Wenger FA, Ordemann J, Muller JM (1999) New therapeutic strategies to avoid intra- and extraperitoneal metastases during laparoscopy: results of a tumor model in the rat. Dig Surg 16: 393–399PubMedCrossRef

64.

Eshraghi N, Swanstrom LL, Bax T, Jobe B, Horvath K, Sheppard B, Deveney C (1999) Topical treatments of laparoscopic port sites can decrease the incidence of incision metastasis. Surg Endosc 13: 1121–1124PubMedCrossRef

65.

Fleshman JW, Nelson H, Peters WR, Kim HC, Larach S, Boorse RR, Ambroze W, Leggett P, Bleday R, Stryker S, Christenson B, Wexner S, Senagore A, Rattner D, Sutton J, Fine AP (1996) Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 39(Suppl): S53–S58PubMedCrossRef

66.

Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O’Connell MJ (1996) Wound recurrence following conventional treatment of colorectal cancer: a rare but perhaps underestimated problem. Dis Colon Rectum 39: 200–207PubMedCrossRef

67.

Nelson H, Weeks JC, Wieand HS (1995) Proposed phase II trial comparing laparoscopic-assisted colectomy versus open colectomy for colon cancer. In: Journal of the National Cancer Institute monographs. No. 19. Bethesda, MD: National Cancer Institute, 51-6 (NIH publication no. 94-03839)

68.

Wishner JD, Baker JW Jr, Hoffman GC, Hubbard GW II, Gould RJ, Wohlgemuth SD, Ruffin WK, Melick CF (1995) Laparoscopic-assisted colectomy: the learning curve. Surg Endosc 9: 1179–1183PubMedCrossRef

69.

Lumley JW, Fielding GA, Rhodes M, Nathanson LK, Siu S, Stitz RW (1996) Laparoscopic-assisted colorectal surgery: lessons learned from 240 consecutive patients. Dis Colon Rectum 39: 155–159PubMedCrossRef

70.

Kuhry E, Bonjer HJ, Haglind E, Hop WC, Veldkamp R, Cuesta MA, Jeekel J, Pahlman L, Morino M, Lacy A, Delgado S, COLOR Study Group (2005) Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc 19: 687–692PubMedCrossRef

Titel: Laparoscopic resection of curable colon and rectal cancer: an evidence-based review
verfasst von: T. M. Young-Fadok, MD, MS, FACS, FASCRS Chair
R. D. Fanelli, MD, FACS
R. R. Price, MD, FACS
D. B. Earle, MD, FACS
Publikationsdatum: 01.07.2007
Verlag: Springer-Verlag
Erschienen in: Surgical Endoscopy / Ausgabe 7/2007
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-006-9172-x

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2007

Technique for the insertion of large mesh during minimally invasive incisional herniorrhaphy

Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy

Influence of laparoscopic surgery on opioid requirement in patients with Crohn’s disease

Natural orifice surgery with an endoluminal mobile robot

Mirror glasses for minimally invasive surgery

Efficacy of percutaneous treatment of biliary tract calculi using the holmium:YAG laser

Update Chirurgie