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PubMed1975

Peritoneoscopy: A valuable technic for surgeons.

1. Modern peritoneoscopy which uses advanced optics and instrumentation now available is a valuable technic that can and should be learned by surgeons. 2. Peritoneoscopy is a safe procedure with a high diagnostic yield and minimal discomfort and inconvenience to the patient. 3. Earlier and more frequent use of peritoneoscopy will enable the surgeon to give appropriate surgical treatment more promptly and avoid unnecessary exploratory celiotomy. 4. The value of this technic in seventy-five consecutive cases is reported. There was no mortality and negligible morbidity. The over-all diagnostic accuracy was 91 per cent. An accurate peritoneoscopic diagnosis avoided surgical exploration in forty-five patients, and in fifteen patients the peritoneoscopic diagnosis provided indications for prompt abdominal surgery.

Abdomen↗
PubMed1995

The liver-spleen scan as a quantitative liver function test: correlation with liver severity at peritoneoscopy.

Sulfur colloid distribution on liver-spleen scan is determined by the perfused Kupffer cell mass. The perfused Kupffer cell mass is proportional to the perfused hepatocyte mass, but is less affected by acute changes in hepatocyte function. Thus, sulfur colloid distribution parameters (precisely measured by quantitative liver-spleen scan [QLSS]) may be an excellent test of the perfused hepatic mass. Although no gold standard exists for confirmation, a close correlation should exist between liver disease severity assessed at peritoneoscopy and sulfur colloid distribution. Peritoneoscopy severity (scored as total peritoneoscopy score [PS]; range, 0-5) was assessed in 76 patients who also had QLSS. Multivariate equation were generated to estimate liver disease severity from the QLSS. These were then applied prospectively in 20 consecutive patients to validate these equations. In 76 patients, 62 were evaluated because of chronic liver disease (CLD) and included those with micronodular (20) and macronodular (20) cirrhosis with various degrees of severity (Child's A, 16; B, 29; C, 17). Multivariate analysis yielded a number of combinations of QLSS parameters that correlated with peritoneoscopic severity. These equations were used to estimate liver disease severity. Estimates of liver disease severity (estimated PS [EPS]) correlated well with the PS in these 76 patients (r = .9064; r2 = .8216; P < .0001). Adding histological fibrosis to the QLSS parameters yields an equation for estimating PS that was even more effective (r = .9462; r2 = .8953; P < .001). However, validation of multivariate equations requires confirmation of their value in a second population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Transvesical endoscopic peritoneoscopy: a novel 5 mm port for intra-abdominal scarless surgery.

PURPOSE: Recently various groups reported successful attempts to perform intra-abdominal surgery through a transgastric pathway. We assessed the feasibility and safety of a novel transvesical endoscopic approach to the peritoneal cavity through a 5 mm port in a porcine model. MATERIALS AND METHODS: Transvesical endoscopic peritoneoscopy was performed in 8 anesthetized female pigs, including 3 nonsurvival and 5 survival animals. Under cystoscopic guidance a vesical hole was created on the ventral bladder wall with an open-ended ureteral catheter. An over tube with a luminal diameter of 5.5 mm was placed in the peritoneal cavity, guided by a 0.035-inch guidewire. In all animals we performed peritoneoscopy of the entire abdomen as well as liver biopsy and falciform ligament section. A vesical catheter was placed for 4 days in all survival animals, which were sacrificed by day 15 postoperatively. RESULTS: After a learning curve in the first 3 nonsurvival animals the creation of a vesical hole and placement of the over tube were performed without complication in all survival animals. In these animals we easily introduced an EndoEYEtrade mark into the peritoneal cavity, which provided a view of all intra-abdominal viscera, as well as a 9.8Fr ureteroscope, which allowed simple surgical procedures without complications. In survival experiments all pigs recovered. Necropsy examination revealed complete healing of the vesical hole and no signs of infection or adhesions into the peritoneal cavity. CONCLUSIONS: Transvesical endoscopic peritoneoscopy was technically feasible and it could be safely performed in a porcine model. This study provides encouragement for additional preclinical studies of transvesical surgery with or without combinations with other natural orifices approaches to design new intra-abdominal scarless procedures in what seems to be third generation surgery.

Animals↗
PubMed1976

Peritoneoscopy in adult polycystic kidney disease: its diagnostic value.

The value of peritoneoscopy in the diagnosis of renal polycystic disease was tested in nine patients with adult polycystic disease and one with congenital hepatic fibrosis. The right kidney was visualized in all ten cases and the left in seven. Renal cysts were recognized by peritoneoscopy in eight of the ten patients. Factors impeding visualization of the kidneys and the cysts were: a) fixation of the splenic flexure of the colon; b) non-superficial renal cysts. Of six cases in which intravenous pyelography was not diagnostic, peritoneoscopy was positive in four. No correlation was found between the degree of hepatic and renal cystic involvement.

Adolescent↗
PubMed1975

Percutaneous liver biopsy, peritoneoscopy and laparotomy: an assessment of relative merits in the lymphomata.

The relative merits of percutaneous liver biopsy, peritoneoscopy directed liver biopsy and wedge liver biopsy during laparotomy were examined in a series of 100 consecutive untreated patients with non-Hodgkin's lymphoma. Sixteen of 77 patients had positive findings on percutaneous liver biopsy specimens, with the best yield in patients with nodular (21%) and diffuse (33%) poorly differentiated lymphocytic lymphoma. Forty-nine of the 61 patients having negative percutaneous biopsies were subjected to peritoneoscopy and 9 additional positive biopsies were obtained. Thirty-two of the 40 patients having negative percutaneous and peritoneoscopy findings underwent laparotomy and wedge biopsy of the liver, and 8 specimens (25%) were positive for liver involvement; all but one of these were in patients with nodular or diffuse poorly differentiated lymphocytic lymphoma. This study indicates that over two-thirds of untreated patients with non-Hodgkin's lymphoma can be shown to have Stage IV disease without undergoing laparotomy, and that in the remaining patients, laparotomy proved of consistent value only in patients with poorly differentiated lymphocytic lymphoma.

Biopsy↗
PubMed1976

[Peritoneoscopy with 2 optical devices: reduced risk - better diagnostic results (author's transl)].

Peritoneoscopy with 2 optical devices was performed in two cases; the technique of this procedure is described. The method allows inspection of areas, which cannot be seen during routine peritoneoscopy, especially of the anterior abdominal wall and of intraabdominal organs covered by adhesions. In addition, this method allows to find out, whether the anterior abdominal wall and vessels in it were injured by the troikart; the risk of the procedure is reduced thereby. Using a second optical device allows to visualize areas, which cannot be studied during routine peritoneoscopy because of intraabdominal adhesions. Thus better diagnostic results can be achieved with this method as compared to the routine technique.

Aged↗
PubMed1978

[Rupture of postoperative adhesions and hemorrhage--a rare complication of peritoneoscopy (author's transl)].

A case report is given of a patient, who had been operated upon because of gall stones before; the gall bladder had not been removed. At a later date peritoneoscopy was planned and gas insufflated into the abdominal cavity in the usual manner; the patient did not complain about anything particular during peritoneoscopy. However adhesions apparently having formed after the earlier operation between the spleen and the abdominal wall did rupture during this procedure leading to a continously oozing hemorrhage from the spleen. At surgery 3 1 of blood were found in the abdominal cavity and splenectomy became unavoidable. This case report is given in order to draw attention to this sort of complication of peritoneoscopy.

Female↗
PubMed1976

Peritoneoscopy and guided biopsy in the diagnosis of intraabdominal disease.

In 145 cases of intraabdominal disease, a laparotomy was considered the next diagnostic step, but peritoneoscopy was performed instead. In 37 cases with a suspicion of metatastic carcinoma, peritoneoscopy with guided biopsy demonstrated carcinoma in 29. In 32 cases, with biopsy-proven cirrhosis of the liver with high suspicion of a hepatoma, peritonescopy demonstrated the presence of hepatoma in 12. In 28 cases, protracted unexplained jaundice was present; nonsurgical causes for jaundice were found in 15. In 48 cases an exudative (protein greater than 2.5 per 100 ml) ascites was present. In 19 cases, either tuberculosis or carcinomatous implants of the peritoneum were found, and ovarian carcinoma was found in 9. Peritoneoscopy with guided biopsy obviated the need for laparotomy in 90% of these cases.

Abdomen↗
PubMed1989

Alterations in oxygen saturation and ventilation after intravenous sedation for peritoneoscopy.

The effect of intravenous sedation on oxygen saturation and ventilation was studied in 11 patients undergoing peritoneoscopy. Oxygen saturation (mean +/- SD) decreased from baseline (94.7% +/- 1.7%) to nadir (78.6% +/- 10.7%) after sedation. Respiratory depression was evident in these patients by concomitant decreases in minute ventilation and tidal volume. Baseline to nadir arterial blood gas changes in eight patients were consistent with hypoventilation and also suggested a superimposed ventilation perfusion mismatch. Mean respiratory rate did not significantly change during peritoneoscopy. Peritoneal gas insufflation stimulated increased ventilation and oxygen saturation, but no further changes in PCO2 or pH. We conclude that serious arterial oxygen desaturation and possibly some ventilation perfusion mismatch occur after sedation with intravenously administered meperidine-diazepam for peritoneoscopy with resultant hypoxemia, hypercarbia, and acidosis.

Adolescent↗
PubMed1980

Peritoneoscopy in a developing country.

Peritoneoscopy in medical cases remains largely unpopular in the USA and the UK. In many developing countries there is often a heavy demand on medical facilities and the rapid diagnosis of intra-abdominal problems is of major importance. We present a series of 193 patients in whom peritoneoscopy was carried out during a 2 1/2-year period. Eighty-six per cent (166) of examinations yielded information of positive diagnostic value. The most common diagnoses were hepatocellular carcinoma, liver cirrhosis, bilharzial fibrosis and peritoneal tuberculosis. The peritoneoscopic appearances in the various lesions are illustrated and discussed. Peritoneoscopy is a safe procedure and its value in a developing country is great, both in terms of economy of man-hours employed and, more particularly, of diagnostic yield.

Adolescent↗
PubMed1980

Hepatic involvement in the cutaneous T-cell lymphomas: results of percutaneous biopsy and peritoneoscopy.

Forty-three patients with cutaneous T-cell lymphomas (mycosis fungoides and the Sezary syndrome) underwent routine staging procedures to assess extent of disease prior to therapy. Evaluation of the liver included physical examination, liver function tests, 99mTc-liver-spleen scans, percutaneous liver biopsy, and peritoneoscopy with multiple liver biopsies. Seven patients (16%) had biopsy-documented hepatic lymphoma, histologically defined as focal aggregates of atypical convoluted lymphocytes in portal zones or hepatic lobules. The liver was the most frequently involved visceral site. Involvement of peripheral blood, leukocytosis, and generalized erythroderma were significantly associated with hepatic lymphoma. Biopsy examination was the only accurate method of detecting hepatic involvement, and peritoneoscopy with multiple biopsies appeared to be more sensitive than a single percutaneous biopsy, since the yield of positive biopsies increased from three to seven. In order to better understand the natural history of the cutaneous T-cell lymphomas and the relation of hepatic involvement to survival, histologic evaluation of the liver in patients with the cutaneous lymphomas should be carried out prior to therapy.

Adult↗
PubMed1979

Role of peritoneoscopy in the postoperative evaluation and treatment of adenocarcinoma of the exocrine pancreas.

Our experience with peritoneoscopy in the postoperative staging and evaluation of ten patients with locally unresectable adenocarcinoma of the exocrine pancreas is presented. In contrast to the German experience with previously unexplored patients, the pancreas was visualized only 30% of the time and biopsy was not possible for technical reasons. Based on our experience in these ten patients, postoperative peritoneoscopy for staging or for following the effectiveness of treatment is of limited value in carcinoma of the pancreas. Preoperative evaluation of this technique deserves greater attention.

Adenocarcinoma↗
PubMedDate not supplied

The role of peritoneoscopy (laparoscopy) in the evaluation of the acute abdomen in critically ill patients.

Emergency peritoneoscopy (laparoscopy) to evaluate a suspected intraabdominal catastrophe was performed in ten critically ill patients over a 3-year period. The examination was negative in six cases, thereby avoiding celiotomy in this high-risk group. The examination was positive in four cases and, on this basis, celiotomy was recommended. Verification of the peritoneoscopic findings by clinical follow-up, operative findings, or autopsy was obtained in eight out of the ten cases. Based on our experience, we feel that peritoneoscopy is of value in defining the indications for celiotomy in this high-risk group of patients.

Abdomen, Acute↗
PubMed1981

Peritoneoscopy in the diagnosis of tuberculous peritonitis.

Seventy-four patients with tuberculous peritonitis were examined by peritoneoscopy (laparoscopy). The characteristic features were uniform miliary tubercles studding the visceral and parietal peritoneum together with numerous adhesions between bowel loops, liver capsule, and abdominal walls. Guided biopsy yielded a definitive diagnosis in 56 cases. Special precautions are urged to avoid an increased risk of complications by peritoneoscopy and biopsy in tuberculous peritonitis.

Humans↗
PubMedDate not supplied

Value of peritoneoscopy for nonfunctioning continuous ambulatory peritoneal dialysis catheters.

We examined our results in restoring continuous ambulatory peritoneal dialysis (CAPD) catheter function via peritoneoscopy in 10 procedures performed on nine patients. Malfunction was caused by the catheter being encased in adhesions, being buried in small bowel, or being wrapped and occluded in omentum. In five of these cases we were successful in restoring catheter patency, thereby allowing immediate reinstitution of dialysis. Neither previous abdominal surgeries nor the length of time the catheter had been in place prior to malfunction appeared to be predictive for the cause of malfunction or the success of peritoneoscopic manipulation. We found outpatient peritoneoscopy to be safe and cost effective. We recommend it as the initial procedure to restore patency to malfunctioning CAPD catheters after conservative therapy has failed.

Adult↗
PubMed1998

Diagnostic flexible peritoneoscopy: assessment of the contralateral internal inguinal ring during unilateral herniorrhaphy.

BACKGROUND: Inguinal hernia is the most common pediatric surgical condition, with 75% of cases presenting unilaterally. No diagnostic study exists to determine preoperatively which children are at risk for subsequent contralateral hernia. The literature is not clear in advising whether surgeons should explore the contralateral side at the time of initial unilateral herniorrhaphy. METHODS: Twenty-four patients presenting clinically with a unilateral hernia underwent flexible peritoneoscopy by isolation of the ipsilateral hernia sac and placement of a flexible cystoscope into the peritoneal cavity. After establishing a CO2 pneumoperitoneum, the contralateral side is checked for patency of the internal inguinal ring. RESULTS: Our study found an open internal inguinal ring in 4 of 24 patients examined (16.7%). The other 20 patients were spared the usual routine contralateral exploration. An open contralateral internal inguinal ring was appreciated in two of nine (22.2%) left herniorrhaphy and 2 of 15 (13.3%) right herniorrhaphy patients. This technique requires an average of 4.5 minutes to perform. With 18-to 32-month follow-up, no hernias have developed on the contralateral side. CONCLUSION: Diagnostic flexible peritoneoscopy is safe, quick, simple, and could be used to evaluate the contralateral internal inguinal ring in unilateral pediatric herniorrhaphy patients.

Adolescent↗
PubMed1982

Peritoneoscopy of peliosis hepatis.

Five cases of peliosis hepatis diagnosed by peritoneoscopy (two confirmed by liver biopsy) are presented. The patients were 4 males and one female, and their ages ranged from 31 to 43 years. Each patient had had an episode of jaundice with fever in the past. At peritoneoscopy, the lesions appeared as reddish-purple spots measuring up to 2.0 mm in diameter. These spots did not show protrusion or retraction, and had no clear relationship with the lobular markings formed by portal triads. In one case, spots were connected to form irregular meshworks in places. In other cases, spots were found or oblong. Histologically, a spot obtained with a punch biopsy forceps had dilated sinusoids filled with red blood cells. Similar dilated sinusoids were observed in deep tissues of the liver obtained with a Vim-Silverman needle. Reconstruction studies of a liver biopsy specimen proved that peliosis lesions were collections of dilated sinusoids. The lesions formed ellipsoids with an irregular margin and were located in the central and intermediate zones of a liver lobule. Other histological features of the liver, mainly observed in the central area were: central fibrosis, fatty metamorphosis, slight liver cell necrosis, and cholestasis. Peliosis hepatis in cases with acute hepatitis and chronic alcoholic liver injury as in the present series is a new finding. The lesion was also seen in a case of primary liver cancer.

Adult↗
PubMed2002

Macroscopic and microscopic findings of livers in malignant hematologic disorders, biopsied under peritoneoscopy.

It is important to detect liver involvement in extranodal lesions in malignant hematologic disorders to make accurate diagnoses and estimate their clinical stage. We report seven cases of malignant lymphoma and a case of histiocytosis X. All patients expressed positive C-reactive protein and a high erythrocyte sedimentation rate, and a high serum value of alkaline phosphatase or lactic dehydrogenase was seen. Image analyses revealed enlarged livers without any space-occupying lesions. Peritoneoscopy with liver biopsy showed a diffuse presence of white maculae or peliosis hepatis on the liver surface among all the patients, and granulomas with or without malignant cells were observed histologically and congestion was seen in the lobules. Thus, peritoneoscopy with liver biopsy appears to be a useful tool not only to detect early liver involvement in malignant hematologic disorders but also to make their accurate diagnosis.

Adult↗