The DSS is useful to indicate VATS after the first episode. For routine application, assigning patients to low- and high-grade groups seems most practical. We recommend CT-evaluation for every PSP patient and early surgery for those with lesions exceeding one bleb. After VATS, the preoperative DSS is not beneficial in predicting recurrence.

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Objective: Video-assisted thoracic surgery (VATS) is recognized to be as effective as open thoracic surgery for a variety of diagnostic and therapeutic conditions, but with significantly less morbidity. Chronic postoperative pain (CPP) is defined as persisting more than 2 months after the procedure. CPP and other neurological sensations like dysesthesia or numbness are found frequently, but little is known about the outcome of those patients many years after the primary procedure. Methods: In 1999 we retrospectively investigated a group of 46 (31.9%) out of 144 patients who were identified with sequels at a mean of 32 months after a VATS procedure. Now at 123 months postoperation we reinvestigated those patients for ongoing sequels. Results: Out of 46 patients, 36 were still alive and could be reached for an interview. Eighteen patients (50%) were now free from symptoms while 18 patients (50%) still suffered from sequels. From the group of 144 patients operated on, sequels were now present in 18 patients (12.5% at 123 months vs 31.4% at 32 months, p = 0.0002). Pain was present in 17 patients (11.8% vs 20.1%, p = 0.11), in 3 patients (2.1% vs 18.1%, p < 0.000001) even at rest, and in 4 patients (2.7% vs 12.5%, p = 0.0002) only at exercise. Ten patients (6.9% vs 28.5%, p = 0.096) suffered from pain occasionally, e.g. because of changing weather. Painkillers were taken only by one patient (0.7% vs 16.6%, p < 0.0001) occasionally, and the sequels impacted the life of one female patient (0.7% vs 13.2%, p < 0.0001) badly. Numbness was present in 16.9% versus 1.3% ( p = 0.0013) of patients. Conclusion: Early postoperative sequels are frequently found in VATS procedures, but patients with pain even after years have a nearly 50% chance to eliminate their problems. In addition, numbness and dysesthesia seem to disappear almost completely several years after the procedure. #

Background: Single incision laparoscopic surgery (SILS) is a modified laparoscopic technique with only one access through the umbilicus to avoid visible scars. One crucial step of a cholecystectomy is a good insight to the triangle of Calot. We present our technique to retract the gallbladder with a PDS-Endoloop fixed to the fundus and which is passed through the abdominal wall with the Endo Close TM Trocar Site Closure Device.Methods: Prospective study. Results: Cholecystectomy was performed in 29 patients with the SILS-technique between 7/2009 and 3/ 2010. Twenty-four patients were female (82.8%), the median age was 50 years (range, 17-74) and the median body mass index was 25.9 kg/m 2 (range, 20.5-34.0). Cholecystitis was present in 13 out of 29 patients (6 acute, 7 chronic), all others (55.2%) had no inflammatory signs. In the majority of the cases (69.0%) the PDS-Endoloop technique was feasible; in 4 cases there was no need for additional retraction with the PDS-Endoloop. In 5 cases the application of the PDS-Endoloop was not possible due to advanced inflammation of the gallbladder. No complications occurred.Conclusions: This technique is simple, safe and feasible and can be carried out in selected cases of cholecystitis. The main advantage is the prevention of bile leakage.

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