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At least 505 records · Page 28Linked to original sources
PubMed2004

Should retroperitoneoscopic nephrectomy be the standard of care for benign nonfunctioning kidneys? An outcome analysis based on experience with 449 cases in a 5-year period.

PURPOSE: Laparoscopic nephrectomy has become a routine procedure at specialized centers with the advantages of less postoperative pain, minimal scars, rapid recovery and short convalescence. We report our experience with the establishment of retroperitoneoscopic nephrectomy as the standard of care for benign nonfunctioning kidneys. MATERIALS AND METHODS: We retrospectively compared the records of patients who underwent simple nephrectomy retroperitoneoscopically or by open surgery from January 1998 to October 2003 at our center. RESULTS: A total of 351 simple nephrectomies were done retroperitoneoscopically, while 83 were done as an open procedure. Mean operative time was significantly longer in the retroperitoneoscopic group. However, mean blood loss, complication rate, hospital stay and convalescence were significantly less in the retroperitoneoscopic group. CONCLUSIONS: Retroperitoneoscopic nephrectomy has become a standardized procedure. It should be offered as the primary treatment modality to patients with benign renal disease scheduled for elective nephrectomy except in those in whom it is contraindicated.

Blood Loss, Surgical↗
PubMed1999

Totally endoscopic Ivor Lewis esophagectomy.

Esophagectomy is associated with significant risks of perioperative morbidity and mortality, as well as prolonged convalescence due to effects of the incisions used for conventional surgical access. Because the outcome of this procedure is palliative in the majority of patients, it is possible that laparoscopic techniques could improve initial postoperative outcomes and therefore make surgery more acceptable for patients with esophageal cancer. A new technique is described for Ivor Lewis esophagectomy, which incorporates a hand-assisted laparoscopic approach for gastric mobilization and a thoracoscopic approach for esophageal dissection and anastomosis. Initial experience in two patients has been encouraging, with postoperative hospital stay and convalescence shortened.

Adenocarcinoma↗
PubMed1997

[Closure of patent ductus arteriosus in thoracoscopy: analysis of the experience in the Gaslini Institute of Genoa].

In 1993, Laborde et al described a new surgical approach for closure of the patent ductus arteriosus (PDA), using a videoassisted technique. For the first time, videosurgery was utilized in pediatric cardiovascular surgery. The advantages of this new method are that it is minimally invasive (thoracotomy is replaced by three small holes), it reduces postoperative pain, recovery is more rapid with a shorter hospital stay and convalescence, and last but not least, it offers better aesthetic results. Between July 1994 and June 1996, we utilized the videoassisted thoracoscopic technique described by Laborde in 23 patients with PDA (age: 8 m-12 yrs, mean 45.2 m +/- 37.8; weight: 5.3-32 kg, mean 23 kg +/- 10.3). In two patients, we converted the procedure to standard thoracotomy due to anatomic problems. Echo-doppler evaluation, performed in the operating room shortly after the procedure, confirmed the complete closure of the PDA in all patients. There was neither morbidity nor mortality. The average hospital stay was four days. At a mean follow-up interval of 7.2 months (range 1-13 months), all patients showed excellent cosmetic results. We conclude that thoracoscopic closure of PDA is a valuable therapeutic option that can be used as an alternative to open-chest surgery and interventional cardiology.

Adolescent↗
PubMed2004

Abnormalities in liver enzyme levels during Salmonella enteritidis enterocolitis.

OBJECTIVE: To evaluate the prevalence, associated factors, and time-course changes of abnormal liver enzyme serum levels in adult patients with Salmonella enteritidis enterocolitis. METHODS: The clinical records of 104 patients (age range 15-86 years, 46.2% males) admitted to hospital because of S. enteritidis enterocolitis were reviewed. The prevalence of abnormal liver enzyme levels was evaluated, as well as its possible relationship to data of systemic inflammatory response, severe sepsis, and bacteremia. In addition, time-course changes in serum levels of liver enzymes were studied in 16 cases with available follow-up after hospital discharge. RESULTS: In patients without a pre-existing cause for liver enzyme abnormalities (n = 84), the prevalence of serum AST elevation was 23.0% (95% CI 15.4-34.5%), of serum ALT elevation was 17.9% (95% CI 0.6-20.0%), and of GGT elevation was 19.0% (95% CI 11.6-29.3%). The prevalence of abnormality for any of these enzymes (AST, ALT, or GGT) was 35.7% (95% CI 25.7-46.8%). The prevalence of altered serum alkaline phosphatase was lower. Alteration in liver enzyme serum levels was moderate in the majority of cases, and was found in association with the presence of fever. Serum enzyme levels decreased during the convalescence period after hospital discharge. CONCLUSIONS: Abnormalities in liver enzyme levels are frequent during severe enterocolitis due to S. enteritidis in adult patients. These abnormalities are moderate and self-limited.

Adolescent↗
PubMed1997

[Laparoscopic fundoplication in gastroesophageal reflux].

Gastro-oesophageal reflux disease (GORD) is a chronic disorder requiring lifelong medical therapy or surgery. In the present study we evaluated the postoperative course and effect of laparoscopic fundoplication on GORD in 27 patients with a median age of 44 (range 27-73) years. Fifteen were operated on with a Watson procedure, and 12 patients had a Nissen procedure. Median stay and convalescence after surgery was one and 10 days respectively. Three patients had to be converted into open surgery (bleeding: two, unclear anatomy: one). No major complications were seen, but four patients had postoperative complications (stenosis requiring dilatation: one, subcutaneous emphysema: one, wound sepsis: one, hernia: one. The two latter complications were seen in converted patients). Two patients had prolonged dysphagia, and two patients needed slight dietetic advice for gasbloat syndrome. In 25 of 27 patients good control of GORD was accomplished as judged by symptomatology, endoscopy and 24-hour pH measurements. It is concluded that laparoscopic fundoplication offers good control of GORD with few complications, and short hospital stay and convalescence.

Adult↗
PubMed2004

[Living donor nephrectomy for kidney transplantation. Experience in the first two years].

OBJECTIVES: Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy METHODS: Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure. RESULTS: Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l. CONCLUSIONS: We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.

Humans↗
PubMed2000

Interventions for tubal ectopic pregnancy.

BACKGROUND: The diagnosis of ectopic pregnancy can now often be made by non-invasive methods due to sensitive pregnancy tests (in urine and serum) and high resolution transvaginal sonography, which have been integrated in diagnostic algorithms. These algorithms, in combination with the increased awareness and knowledge of risk factors among both clinicians and patients, have enabled an early and accurate diagnosis of ectopic pregnancy. As a consequence, the clinical presentation of ectopic pregnancy has changed from a life threatening disease to a more benign condition. This in turn has resulted in major changes in the options available for therapeutic management. Many treatment options are now available to the clinician in the treatment of tubal pregnancy: surgical treatment, which can be performed radically or conservatively, either laparoscopically or by an open surgical procedure; medical treatment, with a variety of drugs, that can be administered systemically and/or locally by different routes (transvaginally under sonographic guidance or under laparoscopic guidance); expectant management. The choice of a treatment modality should be based on short-term outcome measures (primary treatment success and reinterventions for clinical symptoms or persistent trophoblast) and on long-term outcome measures (tubal patency and future fertility). OBJECTIVES: In the treatment of tubal pregnancy various types of treatments are available: surgical treatment, medical treatment and expectant management. In this review the effects of various treatments are summarized in terms of treatment success, need for reinterventions, tubal patency and future fertility. SEARCH STRATEGY: The Cochrane Menstrual Disorders and Subfertility Group trials register and MEDLINE were searched. SELECTION CRITERIA: Randomized controlled trials comparing treatments in women with ectopic pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extracted independently by two reviewers. Differences were resolved by discussion with all reviewers. MAIN RESULTS: Laparoscopic conservative surgery is significantly less successful than the open surgical approach in the elimination of tubal pregnancy due to a higher persistent trophoblast rate of laparoscopic surgery. Long term follow-up shows similar tubal patency rates, whereas the number of subsequent intrauterine pregnancies is comparable, and the number of repeat ectopic pregnancies lower, although these differences are not statistically significant. The laparoscopic approach is less costly as a result of significantly less blood loss and analgesic requirement, and a shorter duration of operation time, hospital stay, and convalescence time. Compared to laparoscopic conservative surgery (salpingostomy) local methotrexate is not a treatment option. Injection of this drug, both under laparoscopic guidance and under ultrasound guidance, is significantly less successful in the elimination of tubal pregnancy. Systemic methotrexate in a single dose intramuscular regimen is not effective enough in eliminating the tubal pregnancy compared to laparoscopic salpingostomy. This as a result of inadequately declining serum hCG concentrations after one single dose of methotrexate necessitating additional methotrexate injections or surgical interventions. If methotrexate primarily given in a multiple dose intramuscular regimen is compared with laparoscopic salpingostomy no large differences are found in medical outcomes, both short term and long term. However, this treatment regimen is associated with a greater impairment of health related quality of life and is more expensive, due to surgical interventions for clinical signs of tubal rupture, generating additional direct costs due to prolonged hospital stay. Furthermore, indirect costs due to productivity loss are higher. Only in patients with low initial serum hCG concentrations systemic methotrexate leads to costs savings compared to laparoscopic salpingostomy.

Female↗
PubMed1998

Long-term experience with endoscopic staple-assisted esophagodiverticulostomy for Zenker's diverticulum.

The authors have previously described the endoscopic staple-assisted esophagodiverticulostomy (ESED) technique for treatment of Zenker's diverticulum. In the initial series of six patients, ESED was shown to be safe and effective in the short term, with a significant reduction in hospital stay and convalescence as compared with other surgical techniques. This report documents the authors' long-term experience with ESED (average follow-up, 9.3 months; range, 1.5 to 25 months) and discusses the long-term results of this therapy, technical issues, and variations they have utilized, as well as the advantages and limitations of this approach. Thirty-six patients with Zenker's diverticula have been treated from March 1995 to March 1997. In 34 of the patients, ESED was accomplished, resulting in successful resolution of preoperative symptoms in 32 (94%). Two patients had persistent dysphagia after initial ESED; a revision ESED was successfully performed without complication in both. Two patients were unable to be treated with ESED because of inability to expose the diverticulum with the Weerda laryngoscope. Oral liquid diet has been resumed, on average, 0.8 days after surgery (range, 0 to 4 days), with solid diet resumed by day 5 (range, 1 to 14 days). The average hospital stay has been 1.3 days (range, 1 to 4 days). There have been no postoperative deaths, infections, or airway difficulties. Perioperative morbidity to date has included one case of iatrogenic pharyngeal perforation, one postoperative fever, one transient true vocal fold paralysis, and two dental injuries, with no long-term sequelae. The results support the use of ESED as the initial treatment of choice for patients with Zenker's diverticula.

Aged↗
PubMed1990

Sartorius myoplasty for deep groin wounds following vascular reconstruction.

Groin wound infections following vascular reconstructive surgery prolong hospital admission and convalescence and may lead to more serious morbidity with prosthetic graft infection, false aneurysm formation, or hemorrhage. Therefore, it is imperative to achieve wound closure as expeditiously as possible. Herein, we describe 11 patients with complicated groin wounds and report our management using sartorius myoplasty. Five of these patients had underlying prosthetic grafts at risk. All patients underwent wound closure with sartorius myoplasty after adequate debridement of necrotic and infected soft tissue. Success of wound closure with complete primary healing was observed in nine patients, while in two, adequate early coverage of femoral vessels was achieved, but extended wound care for superficial skin separation was necessary with eventual complete healing. There was no morbidity or mortality related to the added surgical procedure. One patient underwent late repair of a femoral false aneurysm. There were no other complications seen after an average follow-up of 20 months (range: 6 to 49 months). In summary, we recommend that sartorius myoplasty be considered for wound infections to hasten groin closure, decrease hospital stay, and reduce the chance of infectious complications.

Adult↗
PubMed1998

The evolution and maturation of laparoscopic cholecystectomy in an academic practice.

BACKGROUND: The technique of laparoscopic cholecystectomy (LC) has evolved since its adoption in the late 1980s. We sought to document these changes and assess whether patient outcomes were influenced during this maturational process. STUDY DESIGN: A prospective data base was used to record the outcomes of all LCs performed in an academic surgeon's practice. Trends over time among 1,165 consecutive patients were assessed by comparing the first 100 LCs (group I), the middle 100 LCs (group II), and the most recent 100 LCs (group III). RESULTS: During a 93-month period with 1,165 patients undergoing LC, 25 procedures (2.1%) were converted to open cholecystectomy. Perioperative complications occurred in 31 patients (3%): grade I in 9 (0.8%), grade II in 16 (1.4%), grade III in 5 (0.4%), and grade IV (death) in 1 (0.1%). Length of hospital stay and convalescence were 1.1 +/- 0.1 and 9.5 +/- 0.5 days, respectively. Nineteen patients (2%) were readmitted early after operation and 10 (1%) developed long-term complications (port-site hernia or retained stone). In group III, cholangiography was largely replaced by intraoperative ultrasonography for ductal evaluation. Operating room time decreased, while the rates of conversion, morbidity, and readmission remained the same. Patients had higher ASA classifications in the latter two groups, whereas operative charges were greater in Group III than in Groups I and II. These trends occurred even though most procedures are currently performed by residents, and fewer LCs are being done. CONCLUSIONS: Laparoscopic cholecystectomy has matured into a more efficient operation, yet remains safe with low morbidity when performed by residents at an academic institution.

APACHE↗
PubMed1994

Transperitoneal nephrectomy for benign disease of the kidney: a comparison of laparoscopic and open surgical techniques.

OBJECTIVE: The objective of this study was to compare the results of laparoscopic nephrectomy for benign disease to open surgical nephrectomy for benign disease. METHODS: Twenty consecutive patients undergoing laparoscopic nephrectomy for benign disease were compared with 23 patients undergoing open surgical nephrectomy for benign disease and with 29 patients undergoing a donor nephrectomy. Data were collected in the following areas: patient age, anesthetic risk, operative time, estimated blood loss, postoperative time to resume oral intake, parenteral analgesics, oral analgesics, hospital stay, complications, and convalescence. Information was obtained through chart review, telephone interviews, and mailed questionnaires. RESULTS: Compared with open surgical nephrectomy, laparoscopic nephrectomy resulted in a statistically significant longer operative time; however, it afforded a statistically significant decrease in postoperative ileus (open group), hospital stay (both groups), oral analgesics (donor group), and convalescence (both groups). The incidence of complications was 15 percent in the laparoscopic group and 0 percent in the two open surgical groups; the majority of complications occurred during the initial seven laparoscopic procedures. CONCLUSIONS: Laparoscopic nephrectomy is a more time-consuming procedure than open surgical nephrectomy. Also, early in one's experience with this technique, the complication rate is higher than with open surgery. However, despite the newness of the technique, it results in significant benefits to the patient: decreased postoperative pain, shorter hospitalization, and more rapid convalescence.

Adult↗
PubMed1996

Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects.

Laparoscopic liver surgery is a tremendous challenge. The authors report a left liver lobectomy and removal by a total laparoscopic approach. Anatomical left lateral laparoscopic segmentectomy was performed on a woman who had a symptomatic hepatic adenoma. The patient was discharged after an uncomplicated postoperative recovery; the hospital stay and convalescence period were very short. The cosmetic result was good.

Adenoma, Liver Cell↗
PubMed2003

[Reducing trauma with minimally invasive surgery. Evidence and new strategies].

Minimally invasive surgery has become a viable alternative to conventional surgery. The technical advantages of minimally invasive surgery can be translated into clinical benefits for the patients, i.e., less postoperative pain and impairment of lung function, better cosmetic results, shorter hospitalization, and earlier convalescence. Laparoscopic operations have replaced a significant proportion of open surgical procedures and are now routinely used. While the role of laparoscopic surgery has been generally accepted for the management of benign disorders, there is ongoing debate regarding the adequacy of this technique in surgical oncology. There is evidence that minimally invasive surgery can reduce perioperative morbidity in cancer patients. However, definite validation of these procedures for tumor surgery is not yet available due to the lack of prospective randomized trials providing reliable long-term data on disease-free survival and overall survival. It seems likely that minimally invasive procedures will play an important role for the treatment of preneoplastic lesions and tumors of limited size.

Evidence-Based Medicine↗
PubMed2003

[Laparoscopic vs. open nephrectomy. 10 years' results of a nonrandomized comparative study of 549 patients with benign kidney diseases].

We report the results from a nonrandomized comparison of open flank vs laparoscopic nephrectomy in patients with benign renal disease. Between 1993 and 2002, 549 nephrectomies for benign renal disease were performed at the Department of Urology of the Medical University of Lübeck and the Urological Department of the Martin Luther University in Halle/Wittenberg. There were 236 patients in the open flank nephrectomy group and 313 patients in the laparoscopic nephrectomy group. Clinical parameters were compared among both groups. Median operative time in the open flank nephrectomy group was 90 min (range: 30-240 min) and also 90 min in the laparoscopic nephrectomy group (range: 41-210 min). There were 54 complications (17.2%) in the laparoscopic nephrectomy group compared to 60 complications (25.4%) in the open flank nephrectomy group. Patients in the laparoscopy group demonstrated clear advantages in terms of analgesic use for pain control, hospital stay, and convalescence. Laparoscopic nephrectomy results in a significantly briefer postoperative course when compared to open flank nephrectomy. However, due to a limited number of patients, a laparoscopic nephrectomy is mainly reserved for laparoscopic centers. Nevertheless, the laparoscopic approach should be offered to the majority of patients with benign renal disease requiring nephrectomy.

Adolescent↗
PubMed2002

Improvement of post-transplant lymphocele treatment in the laparoscopic era.

Post-transplant lymphoceles are a common problem after renal transplantation, often inflicting the graft or adjacent iliac veins. Since 1991, there have been many reports on laparoscopic fenestration as the treatment of choice, but no larger series has been presented. At our department, 63 laparoscopic procedures were performed between 1993 and 2001 among 1502 renal graft recipients. The laparoscopic operation time, conversion rate, hospital stay, and complications have all decreased progessively. Duration of hospital stay and convalescence was markedly longer in patients treated with conventional open surgery (27 patients). Rejections, CMV disease, and post-transplant reoperations seem to have an increased incidence in the lymphocele population. According to our experience, laparoscopic fenestration is the superior treatment for symptomatic lymphoceles, allowing minimal trauma and fast recovery. Our series suggests that the rate of complications/graft injury decreases progressively with experience. Laparoscopic ultrasound seems useful in difficult cases. Prophylactic measures should be emphasised at the time of transplantation and reoperations.

Adolescent↗
PubMed2000

[Laparoscopic nephrectomy in geriatric patients: comparison with conventional nephrectomy].

INTRODUCTION: We report our experience with laparoscopic nephrectomy in comparison to open nephrectomy in geriatric patients. The laparoscopic technique is presented and the results are discussed with respect to the data from the current literature. MATERIAL AND METHODS: Since 1993, a total of 249 patient have undergone a nephrectomy for benign renal disease. In 131 patients a laparoscopic nephrectomy (in most cases via a transperitoneal approach) was performed and in 118 patients an open nephrectomy via a flank incision. Clinical parameters were compared between both groups as well as with respect to different age groups. RESULTS: There were no differences in terms of operative results (operative time, pre- and postoperative hemoglobin) between the laparoscopy group and open nephrectomy group as well as among the different age groups. Patients in the laparoscopy group demonstrated significant advantages with respect to blood loss, transfusion rate, analgesic consumption, hospital stay, and convalescence. These advantages were not related to patient age. The complication rate was comparable for both groups; however, both groups showed an elevation of the complication rate in the age groups 75 to 84 years. The mortality rate within the first 30 days after nephrectomy was 1.7% in the open nephrectomy group. CONCLUSIONS: The laparoscopic nephrectomy offers comparable operative results (with less blood loss and a lower transfusion rate) when compared to open nephrectomy. In terms of postoperative parameters, patients in the laparoscopy group have significant advantages. Especially geriatric patients benefit from these advantages and, therefore, the laparoscopic approach should be the preferred technique for a nephrectomy in these patients.

Aged↗
PubMed2005

Retroperitoneal laparoscopic adrenalectomy.

Laparoscopic adrenalectomy is considered to be the standard of care for the surgical excision of the adrenal gland. Since the initial report of laparoscopic adrenalectomy in 1992, it has evolved into a feasible and reproducible minimally invasive procedure for benign adrenal tumors. Transperitoneal and retroperitoneal approaches are the two principal laparoscopic routes to the adrenal gland. Both have proven to be safe and effective when compared with open adrenalectomy, offering the benefits of decreased blood loss, less postoperative pain, shorter hospital stay, rapid convalescence, and improved cosmetic effect. Although the transperitoneal approach is used more widely, the retroperitoneal approach offers distinct advantages that make it a valuable alternative route to the adrenal gland. This article describes retroperitoneal laparoscopic adrenalectomy including indications, operative technique, and a review of the literature.

Adrenal Gland Neoplasms↗
PubMed1995

Arthroscopically assisted placement of a supracondylar intramedullary nail: operative technique.

The use of retrograde interlocking intramedullary nails has been described for the treatment of selected supracondylar fractures. A medial parapatellar incision and arthrotomy with its attendant morbidity is generally used for nail placement. Although a closed technique of nail placement has been described, the risks of damaging intra-articular structures with a blind approach have precluded the widespread use of this method. In this article, we present a simple, arthroscopically assisted method for the retrograde intramedullary nailing of supracondylar femoral fractures. This technique affords the potential benefits of intramedullary fixation of these fractures while avoiding the morbidity and complications associated with an arthrotomy. Potential benefits over the standard placement using an arthrotomy include earlier ambulation and soft tissue healing, decreased risk of damage to the knee joint, earlier convalescence with decreased hospitalization time, and better cosmesis.

Adult↗