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PubMed1999

Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy.

BACKGROUND: This study compares laparoscopic ultrasonography to fluorocholangiography in detecting common bile duct (CBD) stones and delineating biliary anatomy. METHODS: A prospective nonrandomized study of 300 consecutive patients undergoing laparoscopic cholecystectomy in a university hospital was performed. After port placement but before dissection, laparoscopic ultrasonography of the extrahepatic CBD was performed in both transverse and longitudinal planes. Cystic duct fluorocholangiography was attempted in all patients. RESULTS: Of 300 patients, CBD stones were detected in 26 (9%) with 25 of these (96%) detected on laparoscopic ultrasonography. Sonography identified the location and size of the CBD as well as anomalous anatomy prior to dissection. No CBD injuries were encountered. End-fire transducers were easier to use than rigid or flexible side-fire transducers; all gave excellent image quality. CONCLUSIONS: In this large study, laparoscopic ultrasonography and fluorocholangiography were equally sensitive in detecting CBD stones. Sonography delineates the biliary anatomy noninvasively and does not require dissection or opening of the biliary system. Laparoscopic ultrasonography may improve the safety of laparoscopic cholecystectomy, especially in cases of acute inflammation or distorted anatomy.

Cholangiography↗
PubMed2004

Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003.

Over the past decade, laparoscopic adrenalectomy has become the operation of choice for resecting adrenal tumors. However, few reported data exist regarding the reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy. We retrospectively reviewed the records of 261 consecutive laparoscopic adrenalectomies performed by one surgeon between 1993 and 2003. Laparoscopic adrenalectomy could not be completed in 8 of the 261 patients (3%); four of the operations were converted to hand-assisted laparoscopic adrenalectomy and four to open adrenalectomy. The reasons for the conversion were as follows: In three patients the tumor was too adherent to surrounding structures to be resected laparoscopically; in three patients the tumor was found to have malignant features during laparoscopy, and the operation was converted to achieve proper resection margins; in two patients the tumors were too large (15 and 16 cm, respectively) to be safely removed laparoscopically. The eight resected tumors included three pheochromocytomas, one myelolipoma, one angiomyolipoma, one solitary fibrous tumor, one liposarcoma, and one metastatic hepatocellular carcinoma. There were no cases in which conversion was required emergently for bleeding or other intraoperative catastrophes. All eight of the tumors removed were at least 5 cm in size (range 5-16 cm). The mean length of hospitalization was 4.4 days (range 3-8 days).

Adrenal Gland Neoplasms↗
PubMed2002

Laparoscopic antireflux surgery for gastroesophageal reflux disease: experience with 668 laparoscopic antireflux procedures.

BACKGROUND AND AIMS: In the past decade laparoscopic antireflux surgery has become the standard operation for treating severe gastroesophageal reflux disease. Several studies have been published showing that it can achieve good to excellent results at short- and medium-term follow-up. We present our experience with 668 laparoscopic antireflux procedures. PATIENTS AND METHODS: Between September 1993 and July 2001 we performed 668 laparoscopic antireflux procedures (76% laparoscopic 360 degrees "floppy" Nissen fundoplications in patients with normal esophageal motility, 24% laparoscopic 270 degrees Toupet partial fundoplications in patients with poor esophageal motility or severely disordered peristalsis). Patients with achalasia were excluded from analysis. Preoperative and postoperative data including 24-h pH monitoring, esophageal manometry, and analysis of failure were prospectively reviewed. RESULTS: Overall complication rate was 7.6%. Conversion to open surgery was necessary in five patients (0.8%). Seventy-four laparoscopic redo procedures were performed due to failed primary intervention. There was no death. At a mean follow-up of 4.8 years (range 3-94 months) 24-h pH monitoring and esophageal manometry showed normal values in 93% of patients. CONCLUSION: Laparoscopic antireflux surgery is feasible and effective and can be performed safely without mortality and low morbidity with good to excellent functional and symptomatic results.

Austria↗
PubMed2001

Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy: applicability, immediate clinical outcome, inflammatory response, and cost.

BACKGROUND: Hand-assisted laparoscopic surgery (HALS) represents a useful alternative to conventional laparoscopic surgery (LS). Its potential advantages--(a quicker, safer procedure and less need to convert to open surgery) are due to the recovery of tactile feedback. However, HALS requires the performance of a mini-laparotomy when surgery commences, and the wound is stretched and compressed throughout the procedure. In addition, it is associated with a more intense manipulation of the intraabdominal viscera. All of these factors increase the surgical trauma, it is not known whether HALS maintains the minimally invasive characteristics of conventional LS. Therefore, we set out to study the applicability, immediate clinical outcome, inflammatory response, and cost of HALS compared with conventional LS using colectomy as a model. METHODS: We performed a prospective randomized trial comparing laparoscopic-assisted colectomy with HAL colectomy. The aims of the study were to assess (a) perioperative features, including time, advantages, and conversion; (b) the patient's immediate clinical response, including recovery of bowel sounds, refeeding time, postoperative pain, local and general morbidity, and hospital stay; (c) the effect on the inflammatory response, using interleukin-6 (ILG) and C-reactive protein (CRP) measurements; (d) oncological issues, including intraoperative cytology and features of the specimen; and (d) the relative costs of the two procedures. RESULTS: A total of 54 patients were enrolled in the study, 27 laparoscopic and 27 HALS. The operative times were similar, but HALS was associated with a far lower conversion rate--7% vs 23%. Immediate clinical outcomes, oncological features, and costs were similar for the two procedures, but HALS was associated with a significantly greater increase in IL6 and CRP than the conventional laparoscopic procedure. CONCLUSION: This comparative study shows that HALS simplifies difficult intraoperative situations, reducing the need for conversion. Although it is a more aggressive procedure, HALS preserves the features of a minimally invasive approach, maintains all of the oncological features of conventional laparoscopic surgery, and does not increase the cost. HALS should therefore be considered as a useful adjunct when difficult situations arise during conventional laparoscopic colectomy.

Aged↗
PubMed2003

Laparoscopic lymph node dissection for gastric cancer with intraoperative navigation using three-dimensional angio computed tomography images reconstructed as laparoscopic view.

BACKGROUND: Laparoscopic extended lymph node dissection for gastric cancer is difficult to perform because it requires dissection with preservation of vessels. Therefore, an intraoperative navigation system for the angioarchitecture would be helpful. Recent enhanced volume-rendering computed tomography (CT) can produce clear intraluminal three-dimensional (3D) images. This advanced radiological technology can provide 3D angiographic images reconstructed in the same view as would be observed from a laparoscope inserted into the abdominal cavity. We report our experience with laparoscopic gastrectomy with radical lymph node dissection using this advanced radiological technology. METHODS: 3D CT angiographic images from the celiac axis to the proper hepatic artery were reconstructed in two ways preoperatively. The first was only 3D angiographic images that were reconstructed as the laparoscopic view (LapView 3D CT angiography). The second was LapView 3D CT angiography with images of the body of the pancreas, which was more useful for intraoperative navigation in comprehensing anatomy. Two monitors were placed over the shoulder of the patient during surgery. One monitor, which was controlled by the image mixer, projected the laparoscopic images with picture in picture of 3D CT angiographic images. The surgeon performed the surgery with reference to this monitor during lymph node dissection. RESULTS: 3D angiographic CT clearly showed all vessels of interest in laparoscopic lymph node dissection for gastric cancer in 10 cases. The anatomy of vessels appeared as if looking beyond visible surface. LapView 3D CT angiography was useful for laparoscopic navigation surgery.

Adult↗
PubMed2005

A new device for bone anchor fixation in laparoscopic sacrocolpopexy: the Franciscan laparoscopic bone anchor inserter.

BACKGROUND: A laparoscopic modification of the sacrocolpopexy procedure with mesh and bone anchor fixation with the Franciscan laparoscopic bone anchor inserter was developed. METHODS: We developed a laparoscopic bone anchor inserter for the placement of a titanium bone anchor in sacral segment 3 as fixation for the mesh in laparoscopic sacrocolpopexy procedures performed in women with posthysterectomy vault prolapse. RESULTS: Surgery successfully corrected vaginal vault prolapse. Laparoscopic bone anchor insertion with this new and simple device took 2 minutes and provided a firm anchor for mesh fixation. MRI demonstrated an anatomically preferable vaginal axis toward the hollow of the sacrum. CONCLUSION: Application of the newly developed Franciscan laparoscopic bone anchor inserter in laparoscopic sacrocolpopexy is an easy and safe procedure that provides firm fixation and excellent anatomical results.

Equipment Design↗
PubMed1998

Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases.

BACKGROUND: The ultimate goal of surgery for hematological disorders is the complete removal of both the spleen and accessory spleens in order to avoid recurrence of the disease. Whereas splenectomy by open surgery provides excellent results, the validity of laparoscopic splenectomy in this regard remains unknown. OBJECTIVE: The purpose of this study was to evaluate the detection of accessory spleens during laparoscopic splenectomy for hematologic diseases. METHODS: We therefore evaluated the pre-, intra-, and postoperative detection of accessory spleens in a consecutive series of 18 patients treated by elective laparoscopic splenectomy for hematological diseases by using computed tomography (CT) and denatured red blood cell scintigraphy (DRBCS). RESULTS: Preoperative CT, DRBCS, and laparoscopic exploration detected 25%, 25%, and 75% of accessory spleens, respectively. At time of laparoscopy, 16 accessory spleens were detected in seven of the 18 patients (41%). In two patients (11%), laparoscopic exploration failed to detect accessory spleens, whereas preoperative CT (one case) and DRBCS (one case) did reveal them. Postoperatively, during a mean follow-up of 28 months (median, 24; range, 12-44 months), nine patients (50%) showed persistence of splenic tissue by DRBCS, and three of them had signs of disease recurrence. CONCLUSIONS: This prospective clinical study suggests that elective laparoscopic surgery for hematological diseases does not allow complete detection of accessory spleens. Moreover, after such a laparoscopic approach, residual splenic tissue is detectable in half of the patients during the follow-up.

Adolescent↗
PubMed1999

Laparoscopic sigmoid resection for acute and chronic diverticulitis. An outcomes comparison with laparoscopic resection for nondiverticular disease.

BACKGROUND: Sigmoid diverticulitis is a common benign condition; however, cases of acute and chronic diverticulitis may be difficult for the surgeon to treat. We designed a study to compare the outcomes of patients who undergo laparoscopic resections for sigmoid diverticulitis with those who have similar resections for other indications. METHODS: From a prospectively accumulated database of 397 consecutive laparoscopic colorectal procedures performed by three surgeons, we reviewed the outcomes of 178 patients who underwent laparoscopic sigmoid resections with primary anastomosis. RESULTS: Laparoscopic sigmoid colectomies or anterior resections were performed in 22 patients with acute diverticulitis (AD), 70 patients with chronic diverticulitis (CD), and 86 patients with nondiverticular disease (ND). Patients with ND were significantly older than those with AD or CD (67 +/- 14 year versus 55 +/- 13 year, 55 +/- 12 year, p < 0.05). Conversion to open surgery was required in three AD patients (14%), three CD patients (4%), and 17 ND patients (20%) (chi2 = 8.23, p = 0.016). In cases completed laparoscopically, there was no significant difference in median operative time (AD, 165 min; CD, 150 min; ND, 165 min), proportion of patients with intraoperative complications (AD, one; CD, six; ND, one), or postoperative complications (AD, four; CD, 13; ND, 11). The occurrence of a postoperative complication significantly prolonged median time to full diet (4 days vs 3 days, p < 0.001) and discharge (9 days vs 5 days, p < 0.001) but not return to normal activity (16 days vs 15 days). CONCLUSIONS: In this study, patients who underwent laparoscopic sigmoid colectomies and anterior resections had similar outcomes regardless of diagnosis. This finding substantiates our view that laparoscopic resections for diverticulitis can be performed safely and with the same benefits as resections for other indications.

Acute Disease↗
PubMed2003

Laparoscopic-assisted bowel resection in pediatric/adolescent inflammatory bowel disease: laparoscopic bowel resection in children.

PURPOSE: The purpose of this study is to discuss indications, technical approach, and morbidity of laparoscopic approaches to major bowel resection in the pediatric/adolescent population with inflammatory bowel disease and familial polyposis. METHODS: Retrospective review of laparoscopic-assisted bowel procedures between May 1991 and January 2002 was performed. Laparoscopic-assisted bowel resection is defined as complete intracorporeal mobilization and devascularization of a segment of colon or rectum. The indications for extracorporeal vs. intracorporeal anastomosis will be discussed. Clinically unstable, septic, or massively bleeding patients were not candidates for this technique. The decision to attempt the laparoscopic approach was based on the experience of the consulting surgeon. There were 31 patients, including 14 females. Five patients had undergone prior surgery. Twenty-nine patients had inflammatory bowel disease, one had familial polyposis, and one had a cavernous hemangioma. We included all pediatric/adolescent patients in our practice undergoing laparoscopic resection. RESULTS: Twenty-nine patients had 33 laparoscopic operations, including proctocolectomy with ileal pouch-anal anastomosis (n = 14), proctocolectomy with ileostomy (n = 3), ileocolectomy with ileocolic anastomosis (n = 13), and small-bowel obstruction (n = 1). Average operating time was 158 (range, 30-400) minutes, with average blood loss of 159 ml. Average wound length was 4.9 cm. The complication rate was 16 percent (n = 5), with one anastomotic leak. The rate of conversion to open operations was 5.8 percent. Liquid diet was begun on Day 3, and the average length of stay was 5.9 days. CONCLUSION: Major laparoscopic bowel surgery can be performed safely in the pediatric/adolescent population, with reasonable operative times, low conversion to open operations, and low morbidity.

Adolescent↗
PubMed2005

Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor.

We sought to compare perioperative and short-term outcomes of laparoscopic partial nephrectomy versus laparoscopic cryoablation in patients with peripheral small renal tumors. Prospectively accrued data of patients with a small renal tumor (< or = 3 cm) undergoing laparoscopic partial nephrectomy (group 1, n = 153) or laparoscopic cryoablation (group 2, n = 78) were compared retrospectively. Patients undergoing laparoscopic partial nephrectomy were younger (mean age, 60.6 vs 65.6 years; P = 0.005), healthier (American Society of Anesthesiologists class 3/4 present in 46% vs 75%; P = 0.001), had a lower baseline serum creatinine (90.1 vs 106.0 micromol/L [1.02 vs 1.2 mg/dL]; P = 0.01), a larger tumor size (2.3 vs 2.1 cm; P = 0.02), and fewer cases of solitary kidneys (5% vs 23%; P = 0.000). Laparoscopic partial nephrectomy was associated with greater blood loss (211 vs 101 mL; P = 0.000) and a higher incidence of delayed complications after hospital discharge (16.3% vs 2.2%; P = 0.01) compared with cryoablation. Both groups were comparable with regard to operative time (P = 0.77), intraoperative complications (P = 0.1), postoperative complications (P = 0.55), hospital stay (P = 0.13), convalescence (P = 0.96), and postoperative serum creatinine (112.2 vs 123.7 micromol/L [1.27 vs 1.4 mg/dL]; P = 0.31). Local recurrence was detected over a mean follow-up time of 5.8 months in group 1 (0.6%) and 24.6 months in group 2 (3%). Although the technical simplicity, decreased blood loss, and somewhat lower complication rate are attractive features of renal cryotherapy, this must be balanced against the current lack of long-term follow-up data that are needed to confirm the oncologic adequacy of this developmental procedure. Laparoscopic partial nephrectomy, albeit a technically advanced procedure, duplicates established open principles and has therefore evolved to become our current minimally invasive nephron-sparing procedure of choice in the majority of patients with a small renal tumor.

Adolescent↗
PubMed2005

Laparoscopic and hand-assisted laparoscopic splenectomy for recurrent and persistent ovarian cancer.

OBJECTIVE: Prolonged survival in patients with recurrent ovarian cancer isolated to the spleen has been demonstrated after successful splenectomy. The purpose of this study was to report the outcomes of a series of patients who underwent splenectomy for persistent or recurrent ovarian cancer via laparoscopy or hand-assisted laparoscopy. METHODS: We reviewed the charts of all patients who underwent laparoscopic or hand-assisted laparoscopic splenectomy for presumed persistent or recurrent ovarian cancer. Demographic, clinical, pathologic, and follow-up information was abstracted. RESULTS: Six patients underwent laparoscopy or hand-assisted laparoscopy for presumed ovarian cancer involving the spleen. In 5 of the 6 cases, laparoscopic or hand-assisted laparoscopic splenectomy was successfully performed. For the 5 laparoscopic cases, operative times varied from 155 to 315 min, and estimated blood loss ranged from 50 to 300 ml. There were no perioperative mortalities or significant complications. Hospitalization lasted from 3 to 5 days. Four patients are alive with no evidence of disease at 2-84 months from the splenectomy, while 1 patient died of disease 20 months after the procedure. The sixth patient underwent initial hand-assisted laparoscopy, and the case was immediately converted to laparotomy for resection of peritoneal carcinomatosis. CONCLUSION: Laparoscopic and hand-assisted laparoscopic splenectomies are safe and feasible in the management of patients with presumed persistent or recurrent ovarian cancer. Larger studies are necessary and eagerly awaited to help determine the long-term risks and benefits as well as the most appropriate candidates and selection criteria.

Aged↗
PubMed2001

Pregnancy outcomes after laparoscopic myomectomy with ultrasonic energy and laparoscopic suturing of the endometrial cavity.

STUDY OBJECTIVE: To evaluate pregnancy outcomes in women with laparoscopic removal of myomas that resulted in entry into the endometrial cavity and required laparoscopic repair of the endometrial cavity. DESIGN: Retrospective chart review (Canadian Task Force classification II-2). SETTING; Private obstetrics-gynecology practice and departments of obstetrics and gynecology at two university-affiliated hospitals. PATIENTS: Seven women with symptomatic uterine leiomyomata treated by laparoscopic myomectomy, who achieved pregnancy. INTERVENTION: Laparoscopic dissection of myomas with the ultrasonic scalpel and laparoscopic suturing of the uterus with the Endo Stitch device in three layers. MEASUREMENTS AND MAIN RESULTS: Indications for laparoscopic myomectomies were excessive bleeding and significant growth of uterine myomas. The size of myomas in all patients ranged from 12 to 2 cm. Average operating time was 232.8 minutes and average blood loss was 117.8 ml. The largest number of myomas removed from a single patient was nine. All procedures were performed on an outpatient basis and no complications occurred. All women easily achieved pregnancy and four were delivered at or near term by cesarean section. One delivered vaginally at 28 weeks secondary to uncontrolled premature labor, without uterine dehiscence. Two had elective terminations at 8 weeks. CONCLUSION: Laparoscopic suturing of the endometrial cavity in three layers does not prevent future pregnancies, and pregnancies can progress to term and in some cases be delivered vaginally without dehiscence. (J Am Assoc Gynecol Laparosc 8(1):129-136, 2001)

Adult↗
PubMed2002

Effect of laparoscopic failure on outcome of laparoscopic nissen fundoplication: independent review.

PURPOSE: This study was undertaken to determine whether conversion or early reoperation contributed significantly to the eventual outcome of laparoscopic Nissen fundoplication. PATIENTS AND METHODS: An independent surgeon, blinded to the operative events, administered two general and one system-specific quality of life tools to the first 100 consecutive patients booked for laparoscopic fundoplication in a community hospital, where the open conversion rate was 4 patients/surgeon and the early reoperation rate 1.5 patients/surgeon for the first 20 operations. Patients were also asked about need for medication, dysphagia, satisfaction (analog scale), and whether, if given it to do over, they would opt for surgery again. RESULTS: Of the original 100 patients, 40 were studied an average of 5 years after surgery: 26 completed laparoscopically and 14 with laparoscopic failure (13 conversions and 1 early reoperation). Patient characteristics in the two groups were similar, except that there were more older patients with more fixed intrathoracic hiatus hernias in the failure group. Among the parameters examined, no statistically significant differences could be detected between laparoscopic and converted patients. CONCLUSIONS: General and system-specific quality of life, digestive symptoms, need for medication, patient satisfaction, and willingness to have surgery over again are not altered by conversion or reoperation. Thus, surgeons who have adequate laparoscopic skills, experience with open fundoplication, and training in laparoscopic Nissen fundoplication should feel free to add it to their repertoires provided the likelihood of conversion and reoperation secondary to inexperience is understood by the patient.

Female↗
PubMed2004

Laparoscopic splenectomy combined with revision of previous laparoscopic gastric bypass.

Advanced laparoscopic operations can be performed in patients who have previously undergone laparoscopic gastric bypass, because there are fewer adhesions than after open procedures. Also, revisions of previous laparoscopic gastric bypasses can be done laparoscopically for the same reasons. To demonstrate this, we present a patient who had undergone a laparoscopic gastric bypass. The operation was successful initially. After 10 months, she started to regain some of her lost weight. It was also found that she had developed idiopathic thrombocytopenia purpura, which was unresponsive to steroids. She underwent a splenectomy and revision of her gastric bypass, both done laparoscopically. This case demonstrates that these advanced laparoscopic procedures can be performed safely, even after previous surgery.

Adult↗
PubMed1999

Hand-assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: a comparison study in the canine model.

The aim of this study was to compare live donor nephrectomy by hand-assisted laparoscopy to standard laparoscopy in a canine model. Fourteen dogs underwent a left laparoscopic nephrectomy; a standard laparoscopic nephrectomy technique was utilized in seven dogs. In a second group of seven dogs, a hand-assisted laparoscopic technique was used with a Dexterity Pneumo Sleeve hand port. All nephrectomies were performed as "donor" nephrectomies, dividing the vessels last. Total blood loss, operative warm ischemia, time and organ retrieval times were assessed for each group. The average operative time was significantly shorter for hand-assisted laparoscopic donor nephrectomy (32 +/- 8 minutes vs. 61 +/- 8 minutes; p = .02) than for the standard technique. The average warm ischemia (86 +/- 24 seconds vs. 224 +/- 52 seconds; p = .03) and average organ delivery times (4 +/- 3 seconds vs. 45 +/- 9 seconds; p < .01) also were shorter using the hand-assisted laparoscopic technique. No significant differences in average blood loss were found between the two groups (9 +/- 2 cc vs. 6 +/- 1 cc; p = 0.16, NS). Good parenchymal, ureteral, and vascular preservation was achieved by both techniques. Hand-assisted laparoscopy permits shorter operating times and warm ischemia times than standard laparoscopy in a canine model of donor nephrectomy. Hand assistance makes donor laparoscopic nephrectomy technically easier and significantly quicker to perform. If hand-assisted laparoscopy donor nephrectomy is confirmed to be a rapid and safe technique for removing an intact organ, laparoscopic nephrectomy will be a more widely accepted technique among urologists who participate in living related donor kidney transplantation.

Animals↗
PubMed2002

Clinical outcome, inflammatory response and tissue trauma in total laparoscopic hysterectomy: comparison to laparoscopically-assisted vaginal hysterectomy.

OBJECTIVE: Our aim was quantify and compare the clinical outcome and surgical inflammatory response and tissue trauma between the total laparoscopic hysterectomy (TLH) and laparoscopically-assisted vaginal hysterectomy (LAVH). DESIGN: Clinical study. SETTING: Departments of Gynaecology, Obstetrics and Biochemistry, Hospital Kladno, Department of Biochemistry, Faculty Hospital Motol-Prague. METHODS: Fifty-eight patients scheduled for laparoscopic hysterectomy were selected according patients or doctor preference to undergo either TLH or LAVH operative technique. Blood samples for assay of markers of tissue trauma (C-reactive protein, interleukin-6, creatine kinase, cortisol, cystatin C, serotonin and white blood cells count) were taken preoperatively, on the first and third postoperative day. One patient with intraoperative complication (ureteral injury) was excluded from tissue analysis. RESULTS: No differences were present in the demographic characteristics and clinical outcomes (blood loss, complications and hospital stay) in fifty seven laparoscopic hysterectomies. The statistically significant difference was found only in duration of surgery (70 min in TLH group vs. 90 min in LAVH group, P < 0.05). This difference can be related to difference in uterine specimen weight (185 g in TLH group vs. 289 g in LAVH group, P < 0.02). Both the LAVH (n = 37) and TLH (n = 20) resulted in statistically significant changes in the inflammatory and systemic immune response in comparison with preoperative value. No significant differences were observed in the studied inflammatory and tissue markers between the studied operative techniques of laparoscopic hysterectomy. CONCLUSION: The total laparoscopic hysterectomy and laparoscopically-assisted vaginal hysterectomy were equally traumatic in terms of surgical inflammatory response and tissue trauma.

Adult↗
PubMedDate not supplied

Laparoscopic supracervical hysterectomy compared with abdominal, vaginal, and laparoscopic vaginal hysterectomy in a primary care hospital setting.

OBJECTIVE: This study compares the operative parameters of laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, and total abdominal hysterectomy in patients in a small suburban medical center. METHODS: This investigation is a Canadian Classification II-2. It was performed in a 238 bed not-for-profit community general hospital. Charts of 117 patients were reviewed. These patients had undergone the following procedures: laparoscopic supracervical hysterectomy, laparoscopically assisted vaginal hysterectomy, total vaginal hysterectomy, total abdominal hysterectomy; questionnaires completed by the patients were reviewed. All patients had hysterectomies performed by members of the Ob/Gyn department of Alamance Regional Medical Center. Comparisons of intraoperative and postoperative events were made in those patients who consented to the study and who returned their questionnaires. Parameters compared were patient age, weight, preoperative diagnosis, operative time, operative complications, blood loss, uterine weight, length of stay, postoperative complications, return to hospital, return to work, resumption of intercourse, dyspareunia, and bowel or bladder problems. RESULTS: Patient demographics and outcomes are similar. Laparoscopic supracervical hysterectomy showed lower morbidity and quicker return to normal function, but most findings did not reach statistical significance. CONCLUSION: The results support the conclusion that the patients in each arm of the study are similar. The operative parameters show a longer operating time for the laparoscopic procedures than for total abdominal hysterectomy and total vaginal hysterectomy, respectively. The other indicators of morbidity show slight advantages of laparoscopic supracervical hysterectomy in blood loss, length of stay, and resumption of normal activities.

Adult↗
PubMed1997

[Laparoscopic surgery in gynecology. Surgical reform of mere luxury? (Physiologic and economic effects of laparoscopic surgery)].

This study compared the physiological and economical effects of laparoscopic and open surgery. The laparoscopic minimally invasive technique reduced the trauma of the tissue, the homeostasis of the organism was less damaged, therefore the metabolic and inflammatory responses were reduced, the respiration and blood gas values were nearer to the normal ones than at laparotomy. These results can explain that laparoscopic surgery leads to less pain and quicker postoperative recovery than conventional surgery. The cost of laparoscopic operations on the adnexa and laparoscopic hysterectomy was compared with the cost of the same open operations. According to USA and British data after laparoscopic surgery hospital stay was reduced by 6-8 days, less drugs, blood and infusion were used, the duration of the sick leave and pay was shorter by 20-30 days. The laparoscopic method is not an unnecessary luxury. Today reliable data attest to values of operative laparoscopy.

Cost-Benefit Analysis↗