LAPAROSCOPIC ONCOLOGICAL PROCEDURES (1ST IRAQI EXPERIENCE)

Nezar A Almahfooz

ABSTRACT

Background: laparoscopy in minimally invasive surgery was a revolution in the history of surgery in the last decade of the 20th century. This new approach has changed the boundaries of the traditional clinical practice and philosophy of surgery. Surgical oncology is a fascinating field in laparoscopy and it can grow slowly and steadily step by step in order to obtain good results by carefully checking the "learning curve" in order to avoid complications.

Methods: data retired from the available references regarding the possibility of starting oncological laparoscopic procedures (diagnostic and therapeutic).  The oncological principles are almost the same in conventional surgery except some precautions like: lost tactile sensation, time factor, specimen retrieval and awareness of future port site metastases. Patients source were from four main hospitals, alsadir teaching hospital in basrah, sulaymania teaching hospital in sulaymania, ibn-albaytar private hospital and almoosawi private hospital.

Diagnostic laparoscopy group: including patients suspected to have tumor not proved by available investigations, and tumors for staging.

Therapeutic laparoscopy group: provisionally operable visceral tumors.

Results: in the diagnostic group: out of 142 patients with vague diagnosis, or for staging purpose, 110 found to be malignant, the rest were inflammatory. Malignancies were mainly gastric, colonic, ovarian, pancreatic, and lymphomas, in origin. In the therapeutic group: 11 cases of malignant tumors were subjected to surgery, 2 rectal cancer, colonic cancer, 4 ovarian teratoma and carcinoma, appedicular carcinoma, adrenal tumor, and spleen lymphoma. Surgical outcome was very good regarding the compliance with the oncological principles; no port metastesis recorded in 2-4 years follow up, time was significantly longer in laparoscopic surgeries, the specimen retrieval need special concern and attention.

Conclusion: laparoscopic oncology is a golden start in a hard way with promising future. Its initial difficulties worth's the final ambition. I recommend improving the surgical laparoscopic tools to broaden the spectrum of oncological operations which could be performed in our hospitals.

* MD, CABS, FICS, F.MAS, Consutant General & Laparoscopic Surgeon, Alsadir Teaching Hospital (Basrah)