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At least 631 records · Page 35Linked to original sources
PubMed2002

Retroperitoneoscopic partial nephrectomy using microwave coagulation for small renal tumors.

OBJECTIVES: The outcome of laparoscopic partial nephrectomy using a microwave tissue coagulator for treatment of small renal tumors was studied. PATIENTS AND METHODS: From June 1999 to May 2001, eight patients with small renal tumors of less than 5.0cm in diameter (1.0-5.0cm, T1N0M0) underwent retroperitoneoscopic partial nephrectomy. To control bleeding during the partial nephrectomy, the renal parenchyma around the tumor was coagulated using a microwave tissue coagulator with a needle of 1.5cm length. The tumor was circumscribed within the coagulated area with 8-13 punctures of the coagulation needle, and partial nephrectomy was performed using scissors and bipolar forceps. RESULTS: All eight patients successfully underwent the procedure retroperitoneoscopically. The average operative time was 295 minutes and the average blood loss was 129ml. Three patients showed urine leakage from the renal calyces, which was controlled by suturing retroperitoneoscopically. In two patients, the surgical margin was revealed to be positive for renal cell carcinoma by frozen section pathology and additional resection was performed in these individuals. The patients were discharged from the hospital with almost full convalescence on day 10 on average. Within the mean follow-up period of 10.4 months, no recurrence was found when examined with computer tomography (CT) using contrast media. As a complication, one patient experienced a decrease in function of the operated kidney caused by unknown reason. CONCLUSION: Retroperitoneal partial nephrectomy using a microwave tissue coagulator is useful for treatment of small renal tumors located at the peripheral area of the kidney. Bleeding from the renal parenchymal incision site is well controlled without occlusion of the renal artery with additional use of a bipolar coagulator, when necessary. Further experience and long-term follow-up are mandatory however, to establish the usefulness of this technique.

Adult↗
PubMed1998

[Frequency, intensity, development and repercussions of postoperative pain as a function of the type of surgery].

Type of surgery is the most important factor conditioning intensity and duration of postoperative pain. Thoracic and spinal surgery are the most painful procedures. Abdominal, urologic and orthopedic surgery lead to severe postoperative pain. Duration of severe pain rarely exceeds 72 hours. Mobilization increases pain intensity after abdominal, thoracic and orthopaedic surgery. Pain could occur after daycase minor surgical procedures and is often underestimated. Postoperative complications related to pain are difficult to disclose because of the interposition of the direct effects of analgesic treatments. Respiratory and cardiovascular postoperative complications are unrelated to postoperative pain in healthy subjects. This could be different in high risk patients. The surgical procedure is the major determinant of metabolic and psychologic postoperative deterioration. Adequate pain relief allows postoperative rehabilitation and physiotherapy programmes after abdominal and orthopaedic surgery. This could be expected to reduce hospital stay and improve convalescence.

Humans↗
PubMed1989

Laparoscopic treatment of ectopic pregnancy.

Over the last decade and a half the success and safety of endoscopic surgery for ectopic pregnancy has been established. Shapiro and Adler (1973) reported laparoscopic salpingectomy using electrocoagulation followed by excision. Soderstrom (1981) followed with the snare technique of salpingectomy. Valle and Lifchez (1983) reported tubal patency rates approaching and attaining 100% following salpingostomy in the sole oviduct during laparotomy encouraged continued laparoscopic approach. DeCherney (1981) described linear salpingostomy via a cutting current in 18 women with an intrauterine pregnancy rate of 50% 1 year afterwards. No spontaneous abortions or repeat ectopics were reported. Pouly et al (1986) described laparoscopic salpingostomy in 321 women with a resultant 64% intrauterine pregnancy and 22% repeat ectopic rate. These studies support the realization that previous surgical approaches per laparotomy for ectopic pregnancy may be achieved endoscopically, but intraoperative and postoperative complications have occurred. As noted by Kelly et al (1979) and Richards (1984) these consist mainly of persistent or delayed haemorrhage along with continued trophoblastic growth. Haemorrhage is most often a result of failed salpingostomy in larger ectopics. Continued trophoblastic development requiring repeat surgical exploration due to incomplete removal of tissue has been reported by Pouly (1986) in as many as 5% of cases. This rare but reported consequence signals the importance of following quantitative HCG concentrations into the negative range. Occasionally HCG levels remain elevated more than 30 days postoperatively with eventual resolution; Cartwright et al (1986) claim that tubal patency rates appear to be unaffected by this prolonged clearance of tissue. Despite infrequent morbidity, laparoscopic treatment of ectopic pregnancy, in comparison to laparotomy, significantly shortens hospital stays, operating time, convalescence and postoperative analgesic requirements (Brumsted et al, 1988). Endoscopic surgery also reduces postoperative formation of pelvic adhesions (Fayez and Schneider, 1987). As familiarity and technical expertise with endoscopy continues to increase, exploratory laparotomy may be considered too radical an approach to ectopic pregnancy treatment regardless of the procedure performed.

Female↗
PubMed1999

Cardiac reoperations in octogenerians.

OBJECTIVE: In recent years, satisfactory outcome of primary cardiac operation in octogenerians and increased ageing of cardiac surgical population in western hospitals have led to increased expectations and referrals for reoperation. Outcome of reoperation in this aged subset was analysed. METHODS: Consecutive 18 octogenerians (mean age 81.2 years, 10 men, eight women) undergoing cardiac reoperations from November 1989 through August 1998 were retrospectively reviewed. RESULTS: They represented 6.2% of all octogenerian cardiac surgical patients and 2.7% of all reoperations during the same period. Mean preoperative NYHA class was 3.4 and Parsonnet score was 29.4. The interval to reoperation was 114.5+/-11.96 (4-188) months. Priority was urgent in 11 and elective in seven patients. The procedures included four AVRs, five MVRs (including two associated TVAs), six CABGs and one each of MVR with CABG, AVR with CABG and AVR, MVR and CABG. Average graft/patient was 2.3. Mean ICU stay was 4.6+/-1.5 (1-28) days. There was one hospital death (5.5%) on 18 pod after MVR in an 83-year-old woman. Mean postoperative stay was 20.2+/-5.13 (8-93) days. There were three late deaths (17.6%)--at 32 months after MVR, at 44 and 63 months after CABG. Long-term survivors were 90% among men and 50% among women who were followed up for 42.7+/-6.9 (9-93) months. Mean Karnofsky score in survivors at 1 year of follow-up was 78.5+/-2.9. Despite continued medication in all survivors, mean current NYHA is 1.9 and most have improved lifestyle. CONCLUSIONS: Satisfactory outcome may be expected after cardiac reoperations in highly selected octogenerians. However, increased procedural risks, complications, hospital stay and slower convalescence during early follow-up may be anticipated, and will indicate very careful screening. These results indicate a need to reconsider the treatment policy in primary operation with regard to choice of graft conduits and prosthetic valves in other elderly patients.

Age Factors↗
PubMed2000

Complications of laparoscopic surgery for benign ovarian cysts.

STUDY OBJECTIVE: To assess complications of laparoscopic surgery in the management of ovarian cysts. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Consecutive patients (513) undergoing laparoscopic surgery for ovarian cysts not suspected to be malignant. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: A total of 587 ovarian cysts were removed from 513 women. Conversion to laparotomy was necessary in five cases (<1%). Mean +/- SD cyst diameter was 5.5+/-2.9 cm, with endometriomas (44. 5%) and dermoids (24.3%) being the two most common pathologies; 6.6% were functional. Mean +/- SD operating time was 69+/-31 minutes, and hospital stay and postoperative convalescence was 2.6+/-1.5 and 14.3 +/-9.6 days, respectively. The overall complication rate was 13.3%. Major complications occurred in three patients (0.6%): one small bowel injury and two ureter injuries. Cannula site complications were five inferior epigastric vessel injuries and four incisional hernias at the 10-mm lateral port site. CONCLUSION: Laparoscopic ovarian surgery was associated with 13.3% complications, with 0.6% being major. Careful patient selection and proper surgical training are critical to ensure safe performance of laparoscopy.

Adult↗
PubMed2000

Comorbidity of obsessive-compulsive disorder in recovered inpatients with bipolar disorder.

OBJECTIVE: To determine the frequency of obsessive-compulsive disorder (OCD) in inpatient subjects with bipolar disorder (BD) and to examine the clinical characteristics of BD subjects with OCD. METHOD: The sample consisted of 143 inpatient subjects with DSM-III-R BD-I and BD-NOS (BD-II), recovered from a current episode of either depression or mania. Demographic and clinical variables were obtained on the day of admission. Current comorbid conditions including OCD were determined by the Structured Clinical Interview for DSM-III-R Ifollowing recovery from the acute affective episode. RESULTS: The frequency of current OCD was 7% (N = 10). All BD subjects with OCD were BD-II, were male, and had a diagnosis of current dysthymia. They had fewer episodes and a higher incidence of prior suicide attempts than bipolar subjects without OCD. None of the bipolar subjects with OCD fulfilled criteria for cyclothymia. CONCLUSIONS: Our findings suggest that BD-II, OCD, dysthymia, and suicidality cluster together in some subjects with BD. We discuss the clinical implications of our findings.

Adult↗
PubMed2001

Hand-assisted laparoscopic approach to multiple-organ removal.

BACKGROUND: Over the past decade, laparoscopy has matured to a common, and in some cases, standard surgical approach. Over this time period, many technological advances have contributed to this progression, one of which is hand assistance. Hand-assisted laparoscopy allows a shortened technical learning curve, security and ease in dissection, the ability to remove organs en bloc, and shorter operative times while maintaining the postoperative advantages of laparoscopy. PATIENTS AND METHODS: We present our experience with a hand-assisted laparoscopic approach for two patients requiring bilateral nephrectomy in preparation for renal transplantation and a third patient having concurrent right simple nephrectomy and simple cystectomy for chronic pyocystis. RESULTS: The hand-assisted approach allowed for utilization of one anesthetic, repositioning of the patient without violating the sterile field, and a short convalescent time. The average hospital stay was 5 days, including two patients who required postoperative revascularization of their clotted arteriovenous fistulas. CONCLUSION: The established indications for hand-assisted laparoscopy include removal of large surgical specimens en bloc, anticipated difficult dissection, and failure of standard laparoscopic procedure progression. We propose that removal of multiple organs should be added to this list.

Adult↗
PubMed2004

Hand-assisted laparoscopic nephroureterectomy for upper urinary-tract transitional-cell carcinoma.

Hand-assisted laparoscopic nephroureterectomy with laparoscopic, cystoscopic, or open management of the distal ureter and bladder cuff allow anyone from the novice to the advanced laparoscopic surgeon to perform en-bloc resection of the kidney, ureter, and bladder cuff without compromising oncologic principles. Patients receive significant benefits in the form of less pain, shorter hospital stay, and rapid convalescence. As more urologic surgeons develop skills with this procedure, a more critical analysis of early and long-term results will be possible. As operative times decrease, hand-assisted laparoscopic nephroureterectomy may become the procedure of choice for upper-tract transitional-cell carcinoma. The techniques and early results are described.

Carcinoma, Transitional Cell↗
PubMed2004

Laparoscopic pyeloplasty: history, evolution, and future.

Ureteropelvic junction (UPJ) obstruction is characterized by a functionally significant impairment of urinary transport caused by obstruction in the area where the ureter joins the renal pelvis. The majority of cases are congenital; however, acquired conditions at the level of the UPJ may also present with symptoms and signs of obstruction. Until recently, open pyeloplasty and endoscopic techniques have been the main surgical options with the intent of complete excision or incision of the obstruction. The introduction of laparoscopy has allowed minimally invasive reconstructive surgery that mirrors open surgical techniques. In the hands of experienced surgeons, laparoscopic pyeloplasty offers a less invasive alternative to open surgery with decreased morbidity, shorter hospital stay, and faster convalescence. During the last decade, laparoscopic pyeloplasty for the treatment of congenital or acquired UPJ obstruction has garnered much interest, but, as this procedure is technically challenging, it is being performed only at selected medical centers by surgeons with advanced laparoscopic training. This review describes the early results, ongoing evaluation, and future role for this novel surgical procedure.

Adult↗
PubMed2006

Laparoscopic marsupialization of postrenal transplantation lymphoceles.

BACKGROUND AND PURPOSE: Clinically significant post-transplantation lymphoceles are not uncommon. Surgical marsupialization with internal peritoneal drainage is the treatment of choice. We describe the successful laparoscopic formation of a peritoneal window for post-transplantation lymphocele drainage as an effective and minimally invasive procedure. PATIENTS AND METHODS: Between August 1995 and September 2001, 135 consecutive renal transplantations were performed, and 9 patients developed clinically significant lymphoceles. Four of the nine patients were treated by laparoscopic drainage via a peritoneal window. Analysis of predisposing risk factors commonly associated with lymphoceles was performed. The surgical outcome was assessed. RESULTS: Laparoscopic drainage was successful in all patients. The average operative time was 40 minutes. The mean hospital stay was 1.5 days for patients undergoing laparoscopic drainage versus 5 days for those having open surgical drainage. Accidental division of the right native ureter occurred in one patient, which was identified intraoperatively. None of the patients had developed recurrence of lymphocele after a mean follow-up of 10.7 months (range 6-22) months. CONCLUSION: In patients with a clinically significant post-transplantation lymphocele of appropriate size and location, laparoscopic drainage is easy, safe, and effective. It decreases hospital stay and hastens convalescence.

Adolescent↗
PubMed1993

Complications after surgery as expressed by patients and health care--the Project Peri-Operative Risk (PROPER).

In the present study, which is a part of a clinical-epidemiological study of complications, (the Project Peri-Operative Risk, PROPER), 510 patients, admitted for elective surgery, participated. During their time in hospital, the incidence of complications was registered by nurses. Three months after surgery, the patients were asked in a questionnaire if they had, during their time in hospital or during their convalescence at home, suffered from postoperative complications. Statements by patients and health care professionals regarding the nature and frequency of complications have been compared. Our results confirm the findings that a prospective method in registering complications results in the detection of a higher incidence than if a retrospective method is used. The analysis also reveals that patients and professionals report different types of complications. They also describe complications from different perspectives and present identical complications in different terms.

Attitude to Health↗
PubMed1992

Laparoscopic adnexectomy--indications, technique and results.

Laparoscopic adnexectomy was performed successfully in 38 patients in whom the procedure was attempted. Failure may result from inexperience of the surgeon or when preliminary dissection near bowel suggests trauma is likely. The duration of the operation was between 15 and 105 minutes, blood loss was minimal and all but 2 patients were discharged within 24 hours of surgery. Pain was relieved in 33 of 35 patients in whom this was the dominant symptom. In 1 patient a small ovarian remnant implanted on the bladder was removed at subsequent laparoscopy. Preliminary experience of this procedure suggest it may be preferable to laparotomy because of the reduced risk of wound complications, pain, time in hospital and duration of convalescence.

Adolescent↗
PubMed1981

Human cases of furuncular, traumatic, and nasal myiasis in Connecticut.

Case histories are reported for four persons who had furuncular, traumatic, and nasal myiasis in Connecticut during 1980. Third-stage Sarcophaga sp. and Musca domestica larvae were removed from sores or wounds, a 2nd-stage Cuterebra sp. larva was dislodged from cutaneous tissue, and 3rd-stage larvae of Phaenicia sericata were extracted from nasal membranes. Human exposure to these facultative or obligate dipteran parasites occurred at residences in urban and suburban settings, including a convalescent home and a hospital. Infestations were asymptomatic in three cases, and following removal of larvae, each person recovered without further complications.

Adult↗
PubMed2001

Laparoscopic bilateral hand assisted nephrectomy for autosomal dominant polycystic kidney disease: initial experience.

PURPOSE: The laparoscopic technique for bilateral nephrectomy in patients with autosomal dominant polycystic kidney disease is technically difficult. The procedure may be more acceptable if alterations to the technique made it safer and easier to perform. We describe our initial experience with, and the feasibility and potential benefits of hand assisted laparoscopic nephrectomy for approaching these large kidneys in patients with autosomal dominant polycystic kidney disease. MATERIALS AND METHODS: This approach was successfully applied in 3 patients with end stage renal disease due to autosomal dominant polycystic kidney disease. After obtaining transumbilical pneumoperitoneum ports were placed in the umbilicus (12 mm.), sub-xiphoid in the midline (12 mm.) and subcostal in the midclavicular line on each side (12 mm.). The table was tilted 40 degrees away from the planned side of initial nephrectomy with the patient in the half lateral position. A 7 cm. midline incision was made that incorporated the umbilical port and a commercially available hand assistance device was positioned. One surgeon hand was inserted into the abdomen to serve as a retractor/blunt dissector, while the other operated the electrosurgical instruments. The right hand was inserted for left nephrectomy and the left hand was inserted for right nephrectomy. The laparoscope was passed via the sub-xiphoid port and the instruments were placed through the ipsilateral subcostal laparoscopic port. Nephrectomy was completed and the specimen was removed through the hand port incision by draining the cysts as they were exposed to view via the midline incision. When dissection was difficult, an additional port was placed in the anterior axillary line at the umbilical level. Some cysts were ruptured or aspirated to decrease overall kidney size and make extraction possible via the 6 to 7 cm. midline incision. RESULTS: All procedures were successfully completed. Mean operative time for bilateral hand assisted laparoscopic nephrectomy was 5.5 hours (range 4.5 to 6.6). Estimated blood loss was 200 cc or less. Patients resumed oral intake on postoperative day 1. The mean amount of parenteral analgesics required postoperatively was decreased. Mean hospital stay was 4.3 days but it was 3 days when considering nephrectomy only. Patients returned to normal activity after an average of 2 weeks. There was sustained resolution of preoperative discomfort based on pain analog scales. At 1 month or less all patients recorded absent pain. They uniformly noticed improved preoperative pulmonary and gastrointestinal symptoms CONCLUSIONS: Hand assisted laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease makes bilateral nephrectomy a reasonable option. The bilateral procedure may be performed as rapidly as laparoscopic only, unilateral nephrectomy in these cases. The advantages of the hand assisted approach include using tactile sensation to facilitate dissection, rapid blunt finger dissection, hand retraction and the application of immediate tamponade when needed. This procedure provides the benefits of minimal intraoperative blood loss, minimal postoperative pain, brief hospital stay and rapid convalescence in this group of patients at high risk.

Adult↗
PubMed1964

TUBERCULOSIS AND REHABILITATION: DYNAMIC PHYSICAL RESTORATION OF PATIENTS WITH ACTIVE DISEASE.

In a study carried out over a period of seven years, 454 patients with active tuberculosis were placed on a program of intensive physical exercise, combined with chemotherapy and antibiotics. In the initial group of 155 patients studied from 1956-1960, the intensive rehabilitation program was not instituted until the last two months of the patient's stay in hospital, whereas in a late phase of the study 1960-1963 the dynamic physical restoration program was instituted early for 299 patients and was carried on simultaneously with chemotherapy and antibiotics. The beneficial results of these programs appear to show that the concept of minimum exercise and prolonged bed rest in the hospital and a prolonged convalescent period after discharge, is no longer justified.

Antibiotics, Antitubercular↗
PubMed1992

[Peroperative endoscopic papillosphincterotomy].

The authors describe their experience with combinations of endoscopic and surgical procedures when dealing with stenoses of the papilla Vateri. They give a detailed account of the endoscopic phase of surgical intervention. In their opinion the most important thing is exclusion of duodenotomy which should reduce the risk of a duodenal fistula. Another important advantage is more rapid convalescence and a shorter hospitalization period as well as a shorter time required for the intervention. Next the authors discuss possible complications described in the literature and their relationship to endoscopic papillotomy. The authors evaluate contemporary possibilities of endoscopic treatment and emphasize the necessity to extend the use of endoscopic methods in everyday surgical practice.

Adult↗