XXXX cell dissemination during laparoscopy: prevention and therapeutic opportunities.

@entity5 @entity843 @entity189 @entity420 @entity3337 @entity130
@entity3337 ( @entity3337 ) are abdominal wall recurrences that occur in the subcutaneous tissue within a trocar site after @entity5 laparoscopy and are not associated with peritoneal @entity189 . In order to develop @entity3337 , viable @entity5 cells must be liberated from the @entity5 , be transported to a wound, and find there a favorable environment for growth. The short clinical delay in the occurrence of @entity3337 and their size suggest massive cell seeding into the abdominal wall. @entity5 , slipping of trocars, liquid projection, as well as poor extraction techniques can all cause implantation of malignant cells into the subcutaneous tissue. Such contact can also occur postoperatively if the trocar channels remain open. Some histologies (e.g. @entity420 ), the presence of @entity843 and advanced @entity5 stage are risk factors for @entity3337 . Further conditions--including the use of gas--might also play a limited role. The first preventive measure is the correct indication for a laparoscopic approach. Several techniques have been demonstrated to prevent @entity3337 in the animal model: (a) fixation of trocars to the abdominal wall; (b) prevention of leakage; (c) careful specimen handling; (d) reducing @entity130 to the abdominal wall; (e) specimen isolation before extraction from the abdominal cavity; (f) trocar-site irrigation with a cytotoxic solution, and (g) closure of peritoneum. Further innovative therapies are currently under investigation. In the clinical setting, correct indication, surgical expertise and application of prophylactic measures seem to be the best way to prevent the occurrence of @entity3337 .
