Introduction: Nowadays, bariatric surgery is considered to be the most effective technique in the treatment of morbid obesity. In the current study, the effect of LAPAROSCOPIC Gastric Plication (LGP), a new technique, on the serum protein profile of obese patients has been investigated following surgery. Materials and Methods: Serum of 16 obese subjects with mean body mass index (BMI) of 41. 2± 5. 3 kg/m2, who underwent LGP was investigated before surgery and at two timepoints post-surgery (T1-1 to 2 months after surgery and T2-4 to 5 months after surgery). Peptide mixtures prepared using Polyvinylidene Fluoride (PVDF) membrane and trypsin enzyme were analyzed by Liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: In the present study 157 proteins were quantified, and twenty-four proteins showed statistically significant different levels at T1 post-surgery, using paired two-sample t-test (adjusted pvalue< 0. 05); of these, levels of 12 increased, while those of 12 decreased. At T2 post-surgery, 16 proteins were differentially regulated (adjusted p-value<0. 05), 10 upregulated proteins and 6 downregulated proteins. Conclusion: Due to the significant effect of bariatric surgery on the protein profile of patients, it is possible to study the impact of effective factors on the identified biomarkers and find a new strategy for obesity treatment in the future.

Introduction: LAPAROSCOPIC Hysterectomy (L.H) is a relatively new procedure and an alternative to abdominal hysterectomy (TAH), and can be run in different techniques more over; adhesionolysis, removal of myoma and other pelvic masses can be performed by new techniques and instruments. Materials and Methods: Since Feb.2007 till Dec.2010 we scheduled 81 patients for LH, one of them refused for LH and she preferred TAH. 72 patients (42 to 53 years old) were operated. Eight patients had big myoma and one of them had a huge pare ovarian cyst. All of them suffered from A.U.B.Surgical techniques: By four puncture technique, uterine pedicles were coagulated and cut by bipolar and ligasure. After dissection of bladder and ureters, uterine vessels and vaginal vault were sutured intra corporeally or cut and coagulated with ligasure. In four cases we had to use morcelltor to decrease size of uterus so that it could be delivered vaginally.Results: There was one case of bladder perforation (0.013%), which repaired LAPAROSCOPICally and cystoscopy carried out to check ureteral orifices and bladder integrity. Five cases (0.06%) had post op fever which subsided with medications. There was no blood transfusion or other complications. Mean blood loss was 300±200 ml. and mean duration of operation was 1.30±20 minutes.Pathologic findings:· Adenomyosis: 27 cases (33%)· Myoma 41 case (50%)· Myoma and Adenomyosis 13 cases (17%) Conclusion: LAPAROSCOPIC Hysterectomy is a safe and appropriate route of surgery with good outcomes, if there is no limitation or contraindication, and it encompasses variety of procedures that can be performed by an expert team and good and perfect instruments.

Purpose: To present the safety and surgical outcomes of the initial series of mini-LAPAROSCOPIC live donor nephrectomy and graft outcomes in related recipients. Materials and Methods: From January 2012 through July 2012, fifty patients underwent miniLAPAROSCOPIC live donor nephrectomy. Two 3. 5 mm trocars were inserted above and lateral to the umbilicus for grasping and scissoring. One 5 mm trocar with a camera was inserted in the umbilicus and an 11 mm trocar was inserted through fascia from a 6-8 cm Pfannenstiel incision for bipolar coagulation, kidney extraction, and vascular clip applier. Results: Mean age of donors was 28 ± 4. 2 (range, 21-39) years. Mean operative time from trocar insertion was 145. 8 (range, 85-210) minutes. No major perioperative or postoperative complications occurred. The average decrease in hemoglobin level was 1. 14 (range, 0. 32-1. 8) mg/dL and no one required blood transfusion. Mean warm ischemia time was 4. 41 (range, 2. 35-9) minutes. Mean hospital stay was 2. 2 (range, 2-5) days. Mean follow-up time of the recipients was 215 (range, 130-270) days. The mean serum creatinine level of the recipients at discharge time and the last follow-up visit was 1. 38 mg/dL and 1. 22 mg/dL, respectively. Conclusions: While the primary purpose of this technique is to make donor nephrectomy less invasive and more cosmetic, it is also comfortable for the laparoscopist surgeons because it is nearly similar to standard laparoscopy. A randomized controlled trial with a large sample size, long-term follow-up, and comparison with standard laparoscopy are necessary to present more definitive data about this technique.

Background: LAPAROSCOPIC ureterolithotomy is indicated in some large, Impacted stones In this study we evaluate the place of LAPAROSCOPIC surgery in ureterolithotomy and present LAPAROSCOPIC assisted transperitoneal TUL to aid this technique.Materials & Methods: In this case - series study we attempted LAPAROSCOPIC ureterolithotomy in 15 cases in 1.5years from 1383 to 1384. Mean age was 41.2±21 years and male to female ratio was 4/1 all patients treated intraperitonealy. In two patients (one patients had one stone in upper ureter and another in pelvis and in second patient stone pushed to pelvis with manipulation) we needed assisting technique. In this two patients we guided ureteroscope from 5 mm port to ureter and pelvis and stones were captured with basket.Results: 12 stone were in upper ureter; 2 in midureter and 1 patient had two stone in upper ureter and pelvis. Mean stone size was 18±7 mm. In all patients stones were removed successfully. Blood transfusion, conversion to open surgery, fever or urine leakage was not seen. Mean operating time was 98±50 minutes and mean patients hospital stay was 3.8±2.2 days.Conclusions: LAPAROSCOPIC ureterolithotomy is a safe and reliable substitute of open surgery and in very hard and big stones can replace it for ESWL and TUL. LAPAROSCOPIC assisted TUL aids this technique in difficult situation so we can select a wider range of cases with better treatment results.

Purpose: To report our experience of transperitoneal LAPAROSCOPIC plasty for reconstruction in patients with horseshoe kidney. Materials and Methods: We retrospectively analyzed 12 patients with the symptomatic horseshoe kidney who presented to our institution from March 2005 to July 2008 and underwent LAPAROSCOPIC reconstruction for horseshoe kidney. Computed tomography angiography was performed prior to surgery for evaluation of the anatomic variations, since preoperative knowledge is necessary for achieving reliable vascular control. Five patients had renal stones which were extracted during surgery. All LAPAROSCOPIC operations were performed by the same urologist. Results: All procedures were completed successfully and no one needed for conversion to open surgery. Mean operative time was 150 min and no major complications were observed. The average follow-up time was 28. 7 months. All patients had good renal function and improved drainage with successful reconstruction. Conclusion: LAPAROSCOPIC reconstruction has since been demonstrated to be an attractive alternative in the management of the horseshoe kidney. It provides a feasible and effective alternative to conventional management.

Purpose: This study was to introduce the modified mini-LAPAROSCOPIC surgery for renal cyst and investigate its advantages on operative time, cosmetic effect and pain reduction by comparison with laparo-endoscopic single site surgery (LESS) and conventional LAPAROSCOPIC surgery. Methods and patients: Between May 2015 and October 2018, 140 consecutive patients with benign renal cyst underwent LAPAROSCOPIC decortication of renal cyst. Of which, 48 cases were in mini-LAPAROSCOPIC surgery group (M group), 56 cases in LESS group and 36 cases in conventional LAPAROSCOPIC surgery group (C group). The operative time, blood loss, visual analog scale (VAS) and Scar Cosmesis Assessment and Rating (SCAR) Scale was recorded. Results: The mean operative time in M group (26. 08± 7. 70 min) and C group (28. 56 ± 7. 99 min). was significantly less than that in LESS group (47. 32 ± 10. 53 min) (P < 0. 01). Mean blood loss did not differ between the 3 groups (P > 0. 05). Mean VAS pain scores in M group were significantly lower than that of LESS group and C group on postoperative day (POD) 1 and 3 (P < 0. 01). The SCAR scale of POD 30 in C group (6. 25 ± 1. 0) was significantly higher than that in M group (0. 77 ± 0. 59) and LESS group (0. 98 ± 0. 70). The postoperative course was uneventful with no morbidity within 1to 6 months of follow-up. Conclusion: Modified mini-LAPAROSCOPIC decortication of renal cyst have more comprehensive advantages comparing with LESS and conventional LAPAROSCOPIC surgery. It is convenient and offered significant cosmetic benefit and reduced incisional pain.

Background: Severe abdominal pain is not common after LAPAROSCOPIC surgeries, but acute or chronic pain after operation is considerable in some patients. Post-operative Pain control after LAPAROSCOPIC surgeries, is conventionally achieved using analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and narcotics, but their administration has a lot of side effects. This study compares the efficacy and side effects of local anesthetic drugs versus conventional analgesics in post-operative pain control.Materials and Methods: This prospective investigation was conducted into two groups of patients (n=93). Group 1, as control group, was given conventional analgesics such as narcotics and NSAIDs. In investigational group, at the end of LAPAROSCOPIC surgery, prior to port withdrawal, a local anesthetic mixture, a short acting (Lidocaine 2%) plus a long acting (Bupivacaine 0.5%) is instilled through the port lumen between the abdominal wall layers. The efficacy of both types of medications was compared to their efficacy and side effects.Results: 85% of the control group, received 5 to 20 ml Morphine for pain control while the others were controlled with trans-rectal NSAIDs. In the treatment group, the pain of 65% of the patients was controlled only by local anesthetic drugs, 30% required NSAIDs and the other 5% required narcotics administration for pain control.Conclusion: The administration of local anesthetic drugs after LAPAROSCOPIC surgery is an effective method for pain control with a low complications rate and side effects of narcotics.

Purpose: To compare the quality of life (QoL) of renal cancer patients following LAPAROSCOPIC and open radical nephrectomy. Materials and Methods: Seventy-two (64. 9%) patients who were treated with open radical nephrectomy (ORN group) and 39 (35. 1%) patients who were treated with LAPAROSCOPIC radical nephrectomy (LRN group) were included in this study. QoL was evaluated by Short Form-36 (SF-36) physical domain scores obtained before surgery, 1 and 6 months after surgery. Analgesic requirement and visual analog scale (VAS) pain scores following surgeries were recorded. Results: The demographic features of the groups were similar. There was a significant difference in tumor size between the ORN group (71. 59 ± 29. 83 mm) and LRN group (57. 08 ± 19. 33 mm) (P =. 011). In the LRN group there was less blood loss, a lower transfusion rate, earlier ambulation, more rapid convalescence and shorter hospitalization; however, the difference in surgical duration between the ORN group (122. 86 ± 36. 8 min) and LRN group (140. 17 ± 50. 71 min) was not significant (P =. 383). Analgesic requirement and VAS pain scores were similar in both groups. In terms of SF-36 physical domain scores, the general health perception score in the LRN group was higher than that in the ORN group at pre-surgery, 1 and 6 months after surgery. SF-36 physical functioning and general health perception scores in both groups were significantly lower in 1 month after surgery and were higher in 6 months after surgery, as compare to before surgery. Bodily pain scores in LRN group did not change significantly after surgery (P =. 376). Conclusion: LRN exhibited some technical advantages, including less blood loss, shorter hospitalization and more rapid recovery. Although the ORN patients had relatively larger tumors, analgesic requirement, postoperative complications, body pain, and physical functioning weren't significantly different between the groups. QoL was higher 6 months after surgery than before surgery in both groups.

Purpose: To present our experience with synchronous or metachronous LAPAROSCOPIC pyelolithotomy and ureterolithotomy for patients with bilateral urolithiasis. Materials and Methods: The data of all patients who underwent LAPAROSCOPIC pyelolithotomy (± ureterolithotomy) for bilateral renal and/or ureteral stones from November 2009 to July 2014 were included. LAPAROSCOPIC operations were performed through a transperitoneal approach. Results: 10 patients underwent LAPAROSCOPIC operations for renal stones (19 kidney stones) and ureteral stones (1 ureteral stone). 4 patients underwent synchronous operations and 6 patients underwent metachronous operations. The mean ± SD of operation duration were 212 ± 51 minutes for synchronous operations and 166 ± 41 minutes for metachronous operations. Residual stone was observed 5 patients. No patient developed urinary leakage. Conclusion: LAPAROSCOPIC pyelolithotomy and/or ureterolithotomy for bilateral stones is a feasible option in centers with experience in laparoscopy.