Endocrine surgery is well defined by C. Proye: ''Attention à ce que vous enlevez, mais attention plus encore à ce que vous laissez'' [3]! Thus, in order to maximize the benefit from image magnification in the identification of the inferior laryngeal and parathyroid glands, we have successfully attempted a new endoscopic approach to thyroid surgery.A 30-year-old woman, operated 3 months previously for

Laparoscopy seems to offer the possibility of minimally invasive treatment, but long-term follow-up is needed to evaluate the efficacy of laparoscopic surgery in the treatment of colorectal cancer.

Laparoscopic and video-assisted colonic resection is under evaluation to determine its effectiveness, cost, morbidity and complication rate, and control of neoplastic disease'. The risk of tumour seeding at cannula sites has been reported after the incidental finding of carcinoma of the gallbladder at laparoscopic cholecystectomy for gallstones2. Direct contact between cancer cells and the abdominal wall has been suggested as the cause of such recurrence. Delivery of the specimen by means of a plastic bag to avoid this contact has been recommended' to prevent cancer seeding. Notwithstanding these precautions, a case of isolated parietal recurrence of carcinoma of the right colon after laparoscopic right colectomy has been observed. Case reportA 65-year-old man was admitted with the diagnosis of adenocarcinoma of the right colon without evidence of local or distant dissemination. At laparoscopic assessment no adhesion or infiltration to the surrounding structures was demonstrated and the tumour did not appear to involve the serosal layer. No macroscopic secondaries were evident. The patient was submitted to complete laparoscopic right hemicolectomy with intracorporeal mechanical ileocolic anastomosis. Owing to the dimension of the resected specimen, no commercially available laparoscopic plastic bag could be used. Therefore a large plastic bag was trimmed and a purse-string suture placed at its opening. It was inserted into the abdominal cavity through an 18-mm cannula. The specimen was placed in the bag using two graspers and the purse-string tied. The specimen was extracted through a muscle-splitting incision in the left lower quadrant, enlarging a cannula site. At the end of the procedure lavage of the peritoneal cavity was not performed. The postoperative course was uneventful and the patient was discharged 8 days after operation.The pathological diagnosis was tubular adenocarcinoma of the right colon infiltrating the subserosal layer. All 28 resected lymph nodes were free of metastases. The pathological stage was pT3NoM,,. No adjuvant treatment was given.The patient was seen 2months after operation with a moderately painful 7-cm mass in close proximity to the scar of the extraction incision. The carcinoembryonic antigen level was normal; no other site of neoplastic recurrence was found. Ultrasonography, computed tomography and fine-needle aspiration cytology were suggestive of local recurrence of adenocarcinoma (Fig.

Laparoscopy seems to offer the possibility of minimally invasive treatment, but long-term follow-up is needed to evaluate the efficacy of laparoscopic surgery in the treatment of colorectal cancer.

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