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At least 577 records · Page 32Linked to original sources
PubMed1994

Laparoscopic pelvic lymphnodes dissection for prostate and bladder cancer: indication, techniques and results.

Laparoscopic pelvic lymphadenectomy has been proposed for staging of prostate cancer and it might be used, in selected cases, also in bladder cancer. On a total of 31 laparoscopic lymphadenectomies (LPND), 18 for prostate cancer and 13 for bladder cancer, we found positive nodes in 8 cases (26.1%), 4 in prostate and 4 in bladder cancer group. We had no intraoperative complications and negligible postoperative complications (in 10% of cases shoulder-tip pain and in 24% subcutaneous emphysema); all these spontaneously disappeared after 24-36 hours. Patients with negative nodes underwent radical surgery except two prostate cancer patients who underwent radiotherapy, and patients with positive nodes underwent hormonal therapy (for prostate cancer) or chemoradiotherapy protocol (for bladder cancer). In conclusion, laparoscopic lymphadenectomy proved to be a feasible and safe method for staging urological malignancies, being less invasive, with shorter hospitalization and postoperative convalescence than open lymphadenectomy. It should be mainly indicated in high risk prostate cancer patients (elevated PSA and/or Gleason score). In bladder cancer patients, it could be proposed in bladder sparing investigational protocols, as the percentage of pelvic nodes metastases in T2/T3 bladder cancer is sufficiently high to justify an additional staging procedure.

Adenocarcinoma↗
PubMed1994

Videothoracoscopic wedge resection for peripheral pulmonary nodules.

BACKGROUND: This study was done to evaluate the use of the endoscopic multifire linear stapler for videothoracoscopic wedge resection (VTWR) of peripheral pulmonary nodules and to define the indications, advantages, and drawbacks of this minimally invasive technique. STUDY DESIGN: A case study review of 57 consecutive video-assisted thoracic operations for wedge resection of peripheral pulmonary nodules performed upon 55 patients admitted to a community hospital from June 1991 through July 1993 is presented. RESULTS: There were 44 malignant and 13 benign lesions. Of the malignant peripheral pulmonary nodules (PPN), there were 19 adenocarcinomas, ten squamous cell carcinomas, two undifferentiated large-cell carcinomas, three bronchoalveolar carcinomas, two carcinoid tumors, one neuroendocrine tumor, and seven metastatic carcinomas. The benign nodules included five hamartomas, two granulomas, one aspergilloma, one nodular amyloidosis, one Wegener's granulomatosis, one focal pulmonary infarct, and two interstitial fibroses. Videothoracoscopic wedge resection alone was performed upon 37 patients, 17 of whom had primary carcinoma of the lung; seven had metastatic lesions, and the remainder had benign disease. Of the 17 patients with primary carcinoma of the lung who had VTWR alone, eight patients had marked impairment of pulmonary function, six had significant co-morbid disease, two had peripheral carcinoid tumors, and one had bilateral metachronous carcinomas. Videothoracoscopic wedge resections with concomitant lobectomies were performed upon 20 patients with primary carcinoma of the lung, including one patient with bilateral synchronous carcinomas. Five of the patients with nodules ranging from 2 to 3 cm in diameter were found to have metastasis to regional nodes. None of the patients who had lobectomies for peripheral carcinomas less than 2 cm in diameter had regional nodal metastases. There was no perioperative mortality and no significant morbidity. CONCLUSIONS: Videothoracoscopic wedge resection is a useful alternative to traditional transthoracic resection for suspicious, undiagnosed PPN, for low grade malignant neoplasms, such as carcinoid, for peripheral metastatic lesions, for bilateral synchronous or metachronous tumors, for the occasional clinically localized peripheral small-cell carcinoma as a surgical adjunct to chemotherapy, and for small, peripheral, T-1, N-0, M-0 bronchial carcinomas in compromised patients at high risk with marginal pulmonary reserve. The procedure is effective, minimally invasive, and has potential advantages over conventional thoracotomy, including less postoperative pain and morbidity, shorter hospitalization period and convalescence, and an earlier return to work and normal activities.

Humans↗
PubMed1993

Transaxillary endoscopic sympathectomy--a report of experience in 150 patients with palmar hyperhidrosis.

We report our 1-year experience with transaxillary endoscopic sympathectomy in 150 patients with palmar hyperhidrosis (PH). The double-puncture technique of video laparoscopy was used in a transaxillary approach to perform the sympathectomy by either electrocautery (EC; 93.3%) or electroresection (ER; 7.7%). The procedure was successfully completed in 299 operated limbs and required conversion to open surgery in 1 operated limb because of extensive pleural adhesions. The mean operative time of EC was significantly less than that of ER. In a total of 29 procedures, there were three technical complications. Most patients (92.7%) were discharged after an overnight hospital stay. On the seventh postoperative day, the cure rate was 99.3%. During the mean follow-up period of 200.1 days, there was no recurrence in 130 patients. Apparent compensatory hyperhidrosis occurred in 28 patients (21.5%). In conclusion, transaxillary endoscopic sympathectomy offers a simple and effective treatment to patients with PH, resulting in a shorter hospital stay and convalescent period.

Adolescent↗
PubMed1996

Laparoscopic live donor nephrectomy: the initial 3 cases.

PURPOSE: Successful laparoscopic live donor nephrectomy in 3 patients is described. MATERIALS AND METHODS: The procedures were performed completely laparoscopically and the kidneys were extracted via 8 cm. infraumbilical incisions. RESULTS: In all 3 cases warm ischemic time was less than 5 minutes, and the renal vessels and ureter of the harvested kidneys were of adequate length for routine transplantation. Donors required minimal postoperative parenteral analgesia and were discharged home 1 to 3 days after the procedure. All harvested kidneys were successfully transplanted, and functioned well initially and at hospital discharge. CONCLUSIONS: Laparoscopic live donor nephrectomy may be an alternative surgical modality to conventional open nephrectomy. Advantages include less postoperative pain, shorter hospital stay and convalescence, and a more desirable cosmetic result. Additionally, these advantages may encourage more individuals to consider live donation, resulting in an increase in organ supply.

Adult↗
PubMed1996

[Surgical treatment of extrauterine pregnancy: end of the era of laparotomy?].

Ectopic pregnancies can now be recognized very early, and in most cases, before the appearance of dramatic symptoms. This can be attributed mainly to improved diagnostic methods, such as endovaginal sonography and serial determinations of human, chorionic gonadotropin and progesterone. For this reason, extrauterine pregnancies can currently be treated by several methods, and emergency laparotomy is seldom indicated. Advances in treatment modalities, including tubal-conserving operations, laparoscopic approaches, medical treatment with methotrexate, and expectant management have all been proved to be safe and effective. Between January 1994 and June 1995, 166 patients were treated surgically for extrauterine pregnancy. Of these, 94.6% were treated by laparoscopy; laparotomy was required in only 9 (5.4%). Fecundity rates after laparoscopic treatment for ectopic pregnancy are comparable, if not better, than in those treated by laparotomy. Laparoscopic surgery offers advantages, such as reduction in operating time and shorter hospital stay and convalescence, as compared to conventional abdominal surgery. To date, surgical removal of an ectopic pregnancy remains the method of choice and this can be performed safely by laparoscopy.

Female↗
PubMed1996

Laparoscopic colorectal surgery--new advances and techniques.

Laparoscopic colorectal surgery is being assessed in many centres worldwide. This paper looks at the authors' experiences of 320 laparoscopic colorectal procedures and discusses modifications of technique, new instruments and changes in outcomes as experience is attained. Operating times are now approaching that of open surgery as the "learning curve" levels out. For example, the median operating time for the last 20 patients undergoing a laparoscopic right hemicolectomy was 2.1 hours and anterior resection was 2.2 hours. Of the 320 laparoscopic colorectal procedures performed, the conversion rate of 8.1% (26 patients) and perioperative death rate of 2.2% (7 patients) appear to be acceptable for the extent of surgery performed. The median inpatient stay for the last 20 patients undergoing a laparoscopic-assisted right hemicolectomy or high anterior resection was 5 days (range 3 to 11 days) and 4 days (range 3 to 18 days) respectively. Outcomes for cancer patients are encouraging. Of 106 selected patients having a potentially curative resection for colorectal and anal cancer, there have been 10 recurrences (9.4%) to date. Sixty-four patients have now been followed-up for more than 2 years. It is our belief that with appropriate patient selection a laparoscopic approach can give outcomes similar to open surgery with a slightly decreased hospital stay and convalescence. Laparoscopic colorectal surgery, particularly for benign disease, should be encouraged.

Adult↗
PubMed1997

Bilateral laparoscopic adrenalectomy for adrenocorticotropic dependent Cushing's syndrome.

PURPOSE: We report our experience with bilateral laparoscopic adrenalectomy for total adrenal ablation in patients with Cushing's syndrome. MATERIALS AND METHODS: Four women (mean age 63 years) with Cushing's syndrome secondary to nonlocalized ectopic adrenocorticotropic hormone production in 3 and pituitary microadenoma after failed transsphenoidal ablation in 1 underwent bilateral transabdominal laparoscopic adrenalectomy. Preoperatively risk was III or IV according to the American Society of Anesthesiologists classification. RESULTS: In all cases bilateral laparoscopic adrenalectomy was successfully performed. Operative time ranged from 375 to 475 minutes (mean 404) and mean blood loss was 162 cc. All patients resumed oral intake on postoperative day 1, mean number of postoperative parentral narcotic doses was 2.25 and mean postoperative hospital stay was 5.75 days (range 3 to 8). Complications included an abdominal wall hematoma. All patients resumed baseline activity by postoperative day 14. CONCLUSIONS: Our experience in 4 cases of Cushing's syndrome suggests that bilateral laparoscopic adrenalectomy is a safe and effective alternative to open adrenalectomy. Further experience with this technique will likely decrease operative time, and confirm the benefit of a decreased hospital stay and convalescence.

Adrenalectomy↗
PubMed1997

[Gastroesophageal reflux (II). Surgical interventions: results and indications].

ANTIREFLUX SURGERY: Peri and postoperative morbidity is higher with Nissen fundoplication than with a 180 degrees posterior fundoplasty (Toupet procedure) which carries the risk of a compromised result with time. Although a 270 degrees posterior gastric valve may be the best technique, the surgeon's skill looks more important than the procedure used, especially for laparoscopic surgery. Its advantages include reduced postoperative pain, shorter hospital stay and convalescent time. INDICATIONS FOR SURGERY: Surgery must only be entertained in patients with severe GOR disease, especially those who require continuous PPI treatment. Excluding cases of esophagitis with deep ulcers and/or stenosis, severity criteria to be taken into account are mainly symptomatic and not anatomical. Age is an important decision-making factor. IN CLINICAL PRACTICE: Patients over 60 years of age or with any surgical risk and patients with associated severe motor disorders such as sclerodermia should be given drug therapy unless high-dose PPI are unsuccessful. Conversely, laparoscopic surgery performed by a skilled surgeon should be preferred in younger subjects, especially under 40. In the intermediate age range, patients should be informed about the advantages and drawbacks of the various methods as patient participation is essential in the decision making process.

Fundoplication↗
PubMed1998

[Results from laparoscopically assisted vaginal hysterectomy in the Ikazia Hospital, Rotterdam, 1993-1997].

OBJECTIVE: Evaluation of experience with laparoscopy-assisted vaginal hysterectomy (LAVH). DESIGN: Retrospective review. SETTING: Dept. of Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands. PATIENTS AND METHODS: Of 84 patients undergoing a LAVH instead of an abdominal hysterectomy in the period 1993-1997, data on indications for surgery, hospital stay and complications were analysed from the medical records. RESULTS: Mean age was 45 years (range: 30-62). The most frequent indication was hypermenorrhoea (75; 89%). The mean duration of the operation was 87 min (range: 45-130). There was one conversion to laparotomy. Three times a major complication was seen: twice a bladder injury and once a major haemorrhage for which laparotomy was performed. Mean hospital stay was 6 days, in accordance with protocol. CONCLUSION: LAVH offers a safe technique to convert some of the abdominal hysterectomies into vaginal ones. The higher costs of disposable equipment and increased operation time must be overcome by a shorter time in hospital and shorter convalescence time.

Adult↗
PubMed1976

Personal experience.

Three attacks of infective endocarditis with consequent emergency surgery to the aortic and mitral valves leave their mark. These are the impressions of a physician at the receiving end of his medical environment, an experience which entailed 4 periods of hospitalisation in 2 hospitals.

Convalescence↗
PubMed2002

Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost.

OBJECTIVE: To compare effectiveness, complications, and cost of Amplatzer with surgical atrial septal defect (ASD) closure. DESIGN: Prospective study. SETTING: Tertiary cardiac referral centre. PATIENTS: 43 consecutive patients (excluding non-UK residents) aged between 2.1 and 56.8 years (median 7) undergoing ASD closure. MAIN OUTCOME MEASURES: Procedural success, complications, regression of right ventricular dilatation (up to one year postprocedure), cost, inpatient stay, and home convalescent time. RESULTS: Amplatzer ASD closure was successful in 24 of 27 (89%) patients. Surgical closure was successful in all 19 cases. Cardiac complications affecting management occurred in three (11%) of the Amplatzer group (two procedural failures, one device embolisation) and 4 of 19 (21%) surgical patients (one pericardial pain, one global pericardial effusion requiring drainage, and one patient with anaemia requiring haematinics in addition to an incidental pericardial effusion and one further incidental pericardial effusion) (p = NS). There were complications that did not affect management in a further 5 of 19 surgical patients. There was no significant difference in regression of right ventricular dilatation by six months postprocedure (median right ventricular end diastolic diameter decrease: Amplatzer group 17.5%, surgical group 15.1%; median cardiothoracic ratio decrease: Amplatzer 7.9%, surgical 7.5%). Both hospital stay and home convalescent times were significantly shorter after Amplatzer closure (median hospital stay: Amplatzer one day, surgery six days; median convalescent time: Amplatzer two weeks, surgery 5.5 weeks). Median cost was similar for both groups (Amplatzer pound5375, surgical pound5412). CONCLUSIONS: Amplatzer ASD closure has a lower chance of success with a single procedure than surgery. Overall, there were more complications in the surgical group but the majority of these were minor and did not require any change in management. Resolution of right ventricular dilatation over the study period was similar for both techniques. Time spent in hospital and away from work or school was shorter for the Amplatzer group. The cost of both techniques was similar.

Adolescent↗
PubMed1993

Helicopter Emergency Medical Service operating from the Royal London Hospital: the first year.

The additional workload on the support hospital created by using a helicopter for emergency trauma has been assessed in the first year of operation. A total of 135 patients were brought to the Royal London Hospital, of whom 30 died, 34 were transferred for convalescence or rehabilitation to another hospital, and 71 discharged home. The median Injury Severity Score was 17 (range 0-75) and 82 patients (60.7 per cent) had a reduced Revised Trauma Score at the scene. Blunt injury greatly outnumbered penetrating trauma (117 versus 15 patients). Accidental injuries accounted for 77.0 per cent of the total, self-inflicted wounds 14.1 per cent and assaults 8.9 per cent. Parameters employed to assess workload were hospital bed-days used (total 2361), operations (118, occupying 287 h of theatre time) and blood transfusion (total 702 units used). The second 6-month study period showed a considerable increase in the number of patients admitted (102 versus 33) because of increased efficiency in call-out procedures.

Adolescent↗
PubMed1991

[Level of estradiol and progesterone in blood serum during the menstrual cycle in woman with acute hepatitis b].

The study was aimed at the determination of blood serum levels of the ovarian hormones (estradiol and progesterone) in women during the first menstrual cycle occurring in the course of hospitalization because of the acute viral hepatitis of type B, and in the same women during the first menstrual cycle occurring in the course of early convalescence after leaving the hospital. The observed group consisted of 20 women of age between 18 and 35 years treated because of acute hepatitis without coexisting diseases including gynecological ailments. All the women had a regular 28-day menstrual cycle. Twenty healthy women served as a control group. The blood serum concentrations of estradiol and progesterone were determined in all the subjects on 6-th, 12-th, 14-th, 18-th and 22-nd day of the menstrual cycle by RIA method using the ready made reagent kits. A significant decrease in the mean value of estradiol was found in the group of sick women as compared to the control group and to the same group of women in the course of early convalescence. On the other hand the value obtained during the first menstrual cycle after discharge from the hospital did not differ from that observed in healthy women. Mean value of blood serum progesterone concentration was higher in sick women than those in the control group and in the same women during convalescence all the time except on the 22-nd day of the cycle. These values did not differ significantly when comparing the group of sick women during convalescence and the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Patient and spouse responses to education early after myocardial infarction.

The impact of a post myocardial infarction education programme was assessed by comparing the increase in knowledge of patients and spouses about CHD in two hospitals, one (A) with and the other (B) without such a programme. Subjects completed the same two questionnaires twice, once within 4 days of admission and again within 16 days of leaving hospital. Q1 contained 83 questions about CHD and Q2, consisted of seven questions of immediate practical relevance to their convalescence. When the two hospitals were compared the only significant changes were observed in the responses of spouses and patients from hospital A. Spouses in A increased their scores on Q1 by a mean of 7.13% (p 0.001) in contrast to a fall of 2.01% in B. The mean increase in scores on Q2 for patients in A was 19.3% (p 0.001). It is concluded that an education programme increases the knowledge of patients and spouses but that their learning ability differs. Whilst it is suggested that spouses are included in patient education it appears likely that their educational needs may differ from those of the patient.

Adult↗
PubMed2003

No recurrence of mature ovarian teratomas after laparoscopic cystectomy.

Recurrence of ovarian teratomas was evaluated in a randomised trial to determine whether laparoscopic cystectomy had the same efficacy as laparotomy. Forty premenopausal non-pregnant women with a unilateral teratoma no larger than 10 cm were randomised to laparoscopy or laparotomy. Post-operative pain, duration of stay in hospital and duration of convalescence were compared. Women were reviewed every six months for five years. A higher proportion had milder pain, faster hospital discharge and faster recovery following laparoscopy than laparotomy. There were no recurrences of teratomas in both arms of the study, suggesting that laparoscopy has the same efficacy as laparotomy.

Adult↗
PubMed2006

No difference in length of hospital stay between laparoscopic and abdominal supravaginal hysterectomy--a preliminary study.

BACKGROUND: Although a number of well-designed studies have concluded that laparoscopic hysterectomy is associated with less postoperative pain, reduced hospital stay, and shorter periods of sick leave, thus far, studies on the perioperative and postoperative outcomes of laparoscopic supravaginal hysterectomy (LSH) versus abdominal supravaginal hysterectomy (ASH) are lacking. By applying multimodal intervention program for the postoperative care of patients, the primary aim of the current study was to compare length of hospital stay, time to convalescence, and long-term patient satisfaction between LSH and ASH. METHOD: The study was conducted at the departments of Obstetrics and Gynecology, Skellefteå Hospital and Lycksele Hospital. Forty-seven consecutive women scheduled for supravaginal hysterectomy were randomly assigned to LSH or ASH. Perioperative and postoperative parameters were compared between the two groups. RESULTS: The length of the postoperative hospital stay did not differ between patients undergoing LSH and ASH, but the number of disability days was greater in the ASH group. The operating time was significantly longer in the LSH group compared with the ASH group, whereas the estimated perioperative bleeding was greater in the ASH group. At the 6-month follow-up, 87.0% of patients in the ASH group and 91.3% in the LSH group were satisfied or very satisfied with the overall result of the surgical procedure. CONCLUSION: The present study has indicated that by applying a multimodal intervention program for the postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered for the length of postoperative hospital stay and long-term patient satisfaction.

Convalescence↗