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At least 847 records · Page 47Linked to original sources
PubMed2003

Venous thromboembolism in laparoscopic surgery.

Currently there are limited randomized data regarding thromboprophylaxis in laparoscopic surgery. The aim of this article is to identify principles to guide safe practice with regard to prevention of venous thromboembolism. With the exception of laparoscopic cholecystectomy, there are no prospective, randomized studies comparing the incidence of venous thromboembolism between a conventional procedure and a laparoscopic procedure for the same operation. Surveys of surgical practice indicate that policies for venous thromboembolism prophylaxis in laparoscopic surgery are generally the same as those for conventional surgery. The increasing use of a minimal access approach for a variety of abdominal, pelvic, and thoracic procedures demands further prospective, randomized studies in this area. Current guidelines endorsed by The Society of American Gastrointestinal Endoscopic Surgeons recommend following the adoption of protocols used in conventional surgery for the equivalent laparoscopic operation, and the European Association for Endoscopic Surgery has recommended the use of intraoperative intermittent pneumatic compression of the lower extremities for all prolonged laparoscopic procedures. There is only limited evidence to support these recommendations. Venous thromboembolism is an important and preventable complication in surgical patients. Evidence does not exist to consider laparoscopic surgery patients to be at a substantially lower risk for venous thromboembolism than those undergoing conventional procedures. Currently there is a lack of data regarding the prophylaxis against venous thromboembolism in laparoscopic surgery, and the practice is thus opinion based. The authors recommend that the use of standard prophylactic regimens tailored to specific patient populations for conventional operations be adopted for laparoscopic surgery until prospective data are available.

Humans↗
PubMed2001

Laparoscopic approach to small intestinal obstruction in children: a preliminary experience.

SUMMARY: The use of laparoscopy for the management of acute intestinal obstruction is increasing. It has potential advantages over classic laparotomy. The objective of the current study was to evaluate the feasibility and outcome of laparoscopic management of small intestinal obstruction. A retrospective review of 30 children admitted for attempt of laparoscopic management of acute intestinal obstruction was performed. Their mean age was 6.7 +/- 1.73 years. Of the 30 laparoscopic attempts, 20 (66.7%) were performed successfully, whereas 10 patients (33.3%) needed a conversion to laparotomy because of inadequate laparoscopic visualization in 6 cases, gangrenous bowel in 2 cases, and inability to relieve the obstruction laparoscopically in 2 cases. There were no intra-or postoperative complications in the laparoscopic group. The mean operative time for the laparoscopic release of intestinal obstruction was 68 +/- 12.32 minutes and 102 +/- 9.67 minutes for the converted cases. The mean time of return of bowel function and mean hospital stay in the laparoscopic release of intestinal obstruction were significantly shorter. The study showed that laparoscopic release of intestinal obstruction in children is worthy of attempting initially. It is a feasible, effective, and safe alternative to laparotomy for most patients with acute intestinal obstruction.

Acute Disease↗
PubMed2003

Laparoscopic ureterocalicostomy: a feasibility study.

PURPOSE: Ureterocalicostomy is occasionally indicated for reconstruction of recurrent, recalcitrant ureteropelvic junction obstruction associated with postoperative fibrosis and a relatively inaccessible renal pelvis. We investigated the feasibility of performing laparoscopic ureterocalicostomy in a survival porcine model. Anatomical, histological and chronic functional outcomes were evaluated. MATERIALS AND METHODS: Laparoscopic ureterocalicostomy was performed in 10 survival female swine. A ureteropelvic junction obstruction model was created by laparoscopic ligation of a 2 to 3 cm. segment of upper ureter. After an interval of complete ureteropelvic junction obstruction laparoscopic ureterocalicostomy was performed in a manner duplicating the steps of conventional open surgery. After transverse amputation of the lower renal pole end-to-end anastomosis of the proximal ureter to the inferior calix was formed by laparoscopic freehand suturing and knot-tying techniques. RESULTS: Mean ureter stricture length was 2.2 cm. (range 1.7 to 3.1). Mean duration of obstruction before laparoscopic ureterocalicostomy was 6.3 days (range 2 to 18). Mean operative time for laparoscopic ureterocalicostomy was 165.3 minutes (range 105 to 240). Mean estimated blood loss was 145 cc (range 25 to 400). Mean stent duration in 6 pigs was 8.7 days (range 7 to 11). Excretory urograms demonstrated immediate function with symmetrical and unobstructed drainage in all operated renal units. At 4 to 8 weeks of followup no urine leaks were noted and histological examination documented complete urothelial healing without fibrosis or scar formation. CONCLUSIONS: Laparoscopic ureterocalicostomy is technically feasible in the porcine model and it effectively duplicates the established principles of open surgery. Our technique further extends the application of laparoscopic surgery for difficult ureteropelvic junction obstruction.

Anastomosis, Surgical↗
PubMed2003

Laparoscopic reconstructive urology.

PURPOSE: Although laparoscopy has emerged as a feasible and effective alternative for a majority of open ablative abdominopelvic urological procedures, minimally invasive reconstruction has come to the forefront only recently. We present the current state of the art of laparoscopic reconstructive urology. MATERIALS AND METHODS: We conducted an extensive MEDLINE search of purely laparoscopic surgery from 1976 through 2002. Based on the results, we divide clinical reconstructive laparoscopic procedures into 2 broad categories-established and evolving. Each category is further classified according to the organ involved-adrenal and kidney, ureter (evolving only), bladder and prostate, and miscellaneous. Clinical procedures were considered established if our literature review revealed any report of more than 100 patients, or reports from at least 5 different centers greater than 20 patients each. If these criteria were not met, the procedure was considered clinically evolving. RESULTS: Laparoscopic reconstructive procedures such as pyeloplasty, radical prostatectomy and orchiopexy have achieved clinically established status. Laparoscopic bladder neck suspension, although reported in a significant number of cases, remains controversial because of its contradictory reported long-term success rates. Multiple additional laparoscopic reconstructive procedures have been performed in fewer numbers clinically with promising results. CONCLUSIONS: Until recently, urological laparoscopic surgery primarily focused on ablative procedures, with success. Building on this initial experience, advanced and sophisticated reconstructive procedures of considerable technical complexity are increasingly being performed purely laparoscopically. It is anticipated that in the future laparoscopic surgery could increasingly evolve into a preferred approach for advanced and sophisticated urological reconstruction.

Humans↗
PubMed2006

Laparoscopic surgery in inflammatory bowel disease: is the future already here?

PURPOSE OF REVIEW: Starting from easy operations like the creation of enterostomies, laparoscopic colorectal surgery has developed quickly towards comprehensive procedures like proctocolectomies. Because of their benign character, inflammatory bowel diseases are an ideal indication for laparoscopic surgical approaches. Inflammatory alterations of bowel and mesentery, however, may demand a high level of laparoscopic experience. RECENT FINDINGS: In severe anal Crohn's disease, laparoscopic stoma formation has become a standard procedure for low morbidity and reoperation rates. In comparison with conventional bowel resections for Crohn's disease, shorter times to first postoperative bowel movements and hospital stays have been observed with the laparoscopic approach. Even complex cases with previous surgery and enteric fistulas may be managed laparoscopically with a low complication rate. In ulcerative colitis, experience with laparoscopic restorative proctocolectomy is increasing, and its feasibility has been proven in multiple studies. An elevated risk of complications has been observed with increased body mass index and acute inflammation. Function and quality of life outcomes seem to be equivalent for open and laparoscopic surgery. SUMMARY: Laparoscopic management of Crohn's disease and ulcerative colitis is complex and may be demanding. Its feasibility has been proven in multiple studies and it is offered as a safe and durable alternative for selected patients. The selection criteria are under investigation.

Humans↗
PubMed2006

Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial.

BACKGROUND: Pyloric stenosis, the most common surgical condition of infants, is treated by longitudinal myotomy of the pylorus. Comparative studies to date between open and laparoscopic pyloromyotomy have been retrospective and report conflicting results. To scientifically compare the 2 techniques, we conducted the first large prospective, randomized trial between the 2 approaches. METHODS: After obtaining IRB approval, subjects with ultrasound-proven pyloric stenosis were randomized to either open or laparoscopic pyloromyotomy. Postoperative pain management, feeding schedule, and discharge criteria were identical for both groups. Operating time, postoperative emesis, analgesia requirements, time to full feeding, length of hospitalization after operation, and complications were compared. RESULTS: From April 2003 through March 2006, 200 patients were enrolled in the study. There were no significant differences in operating time, time to full feeding, or length of stay. There were significantly fewer number of emesis episodes and doses of analgesia given in the laparoscopic group. One mucosal perforation and one incisional hernia occurred in the open group. Late in the study, 1 patient in the laparoscopic group was converted to the open operation. A wound infection occurred in 4 of the open patients compared with 2 of the laparoscopic patients (P = 0.68). CONCLUSIONS: There is no difference in operating time or length of recovery between open and laparoscopic pyloromyotomy. However, the laparoscopic approach results in less postoperative pain and reduced postoperative emesis. In addition, there was a fewer number of complications in the laparoscopic group. Finally, patients approached laparoscopically will likely display superior cosmetic outcomes with long-term follow-up.

Follow-Up Studies↗
PubMed2007

Comparison of laparoscopic versus hand-assisted live donor nephrectomy.

BACKGROUND: The aim of the present study was to compare hand-assisted laparoscopic live donor nephrectomy with the classic laparoscopic method, using meta-analytical techniques. METHODS: A literature search was performed for studies comparing hand-assisted laparoscopic nephrectomy with classic laparoscopic nephrectomy for live kidney donation between 1999 and 2005. The following end points were evaluated: operative time, warm ischemia time, intraoperative adverse events, donor and recipient postoperative complications, and length of hospital stay. RESULTS: Nine comparative studies matched the selection criteria, reporting on 376 patients, of whom 202 (53.7%) had hand-assisted laparoscopic nephrectomy and 174 (46.3%) had the classic laparoscopic technique. Conversion to open surgery was 2.97% in the hand-assisted group and 4.60% in the laparoscopic group (P=0.35). Total operative and warm ischemia times were significantly shorter for hand-assisted laparoscopy by 30.03 minutes (P=0.02) and 1.14 minutes (P<0.001), respectively. The intraoperative blood loss was less for the hand-assisted laparoscopy group by 34.16 mL (P=0.008), although intraoperative (3.46% vs. 7.47%; P=0.24) and postoperative (5.94% vs. 10.34%; P=0.30) donor complications and recipient complications (including delayed graft function and primary nonfunction, 8.41% vs. 7.42%; P=0.32) were similar between the hand-assisted and laparoscopic groups. CONCLUSION: Hand-assisted laparoscopic nephrectomy appeared to have the same donor and recipient complication rate with standard laparoscopy but offered substantial advantages in terms of shortened operative and warm ischemia time as well as decreased intraoperative bleeding.

Adult↗
PubMed2005

An evaluation of laparoscopic tissue harvesting for human adult urological smooth muscle physiological experimentation.

OBJECTIVE: To evaluate the properties of laparoscopically harvested bladder neck and ureteric smooth muscle, compared with tissue obtained at open surgery. MATERIALS AND METHODS: Bladder neck was harvested from patients undergoing open (eight) or laparoscopic radical prostatectomy (11). Ureter was obtained from patients undergoing nephrectomy (laparoscopic or open) and cystectomy (open only); obtained openly from 16 and laparoscopically from seven. Muscle strips dissected from these samples were perfused in a Brading-Sibley organ bath, and stimulated using standard agonists (100 micromol/L carbachol for bladder neck, 100 mmol/L KCl-enriched Krebs' solution for ureteric muscle). Tensions produced were recorded using strain gauges and analysed using data-acquisition software. Results were compared by a two-tailed Fisher's exact test to determine significance. RESULTS: Openly harvested bladder neck muscle strips from six patients showed a measurable response to the standard agonist. Laparoscopically harvested bladder neck strips from only two patients showed any measurable response. Openly harvested ureteric muscle strips from 12 patients responded to K-enriched solution, while one patient's laparoscopically harvested strips responded to stimulation. This difference was significant in both tissue groups separately (P < 0.025). Histological evaluation identified no specific differences between openly and laparoscopically harvested tissue. CONCLUSION: The yield of smooth muscle available for research is significantly less when the resection is laparoscopic; this might be a result of diathermy damage at a subcellular level. With the increasing use of the laparoscopic approach in urological surgery, the effect on tissue availability for human smooth muscle physiological study is important to researchers in this field.

Adult↗
PubMed2001

Current role of laparoscopic adrenalectomy.

OBJECTIVE: Laparoscopic adrenalectomy is now a standard procedure for the vast majority of patients with surgical adrenal disease. Herein, we evaluate various techniques employed during laparoscopic adrenalectomy, and assess the current role of laparoscopic adrenalectomy, and possible future developments. MATERIALS AND METHODS: We reviewed large series of reports presenting the results of laparoscopic transperitoneal and retroperitoneal adrenalectomy and we compared the data of different series and authors, adding our experience. RESULTS: Laparoscopic adrenalectomy is a safe, reproducible and effective procedure with low complication rates. With increasing worldwide experience, the indications for laparoscopic adrenalectomy are expanding. When retrospectively compared to open surgery, laparoscopic adrenalectomy is superior in terms of postoperative pain, hospital stay, return to normal activity and complications. CONCLUSIONS: Laparoscopic adrenalectomy is a safe and effective option for most surgical adrenal pathologies. Moreover, laparoscopic adrenalectomy is associated with a superior patient tolerance profile. It is safe to say that today, laparoscopy must be considered the first choice procedure for excision of benign surgical adrenal lesions.

Adrenalectomy↗
PubMed2001

Laparoscopic radical prostatectomy. Technical aspects and experience with 125 cases.

PURPOSE: The laparoscopic access for radical prostatectomy offers an alternative to the open surgical procedure with less morbidity. We report on our experience with 125 laparoscopic prostatectomies, especially with respect to making the laparoscopic approach a routine procedure and with a view to the oncological and functional results. MATERIAL AND METHODS: From June 1999 to September 2000, we performed 125 laparoscopic prostatectomies. These included only patients with cancer stages T1 or T2. The mean PSA concentration was 10.5 ng/ml. Forty-four percent of the patients had undergone previous abdominal and 19% previous transurethral surgery. For our laparoscopic prostatectomies we used the descending technique. Free-hand laparoscopic suturing and in situ knot-tying technique were used for the urethrovesical anastomosis. The mobilized specimens were removed in an endobag via a muscle splitting incision. RESULTS: All 125 procedures could be completed successfully. No case required conversion to open surgery. The average operating time was 255 min, the last 40 procedures taking 200 min only. Mean blood loss was 185 ml. Two patients (2%) required postoperative blood transfusion. After an initial learning curve, catheter remained in place for an average of 5.5 days, and the average postoperative stay in hospital was 8 days. Intraoperative complications were seen in 5 patients (4%). In 13 patients (10.4%) postoperative complications were observed. 86% of the patients are continent 6 months postoperatively. Preservation of the neurovascular bundle and sexual potency is possible. CONCLUSION: Laparoscopic radical prostatectomy is an ambitious procedure with a steep learning curve, especially for the laparoscopic dissecting and suturing technique. The excellent sight for dissection results in a reduced blood loss and faster convalescence with an overall lower morbidity. Also with regard to oncological and functional (continence) results the minimally invasive access is at least equivalent to the open procedure. In our opinion, laparoscopic prostatectomy will be the future method of choice for radical prostatectomy.

Adult↗
PubMed2005

Laparoscopic gastrectomy for cancer.

There are three procedures for the management of early gastric cancer (EGC): laparoscopic wedge resection (LWR), intragastric mucosal resection (IGMR), and laparoscopic gastrectomy. LWR or IGMR can be applied to treat EGC without the risk of lymph node metastasis. However, owing to the recent technical advances in endoscopic mucosal resection for EGC, the use of laparoscopic local resection for these lesions has gradually decreased. On the other hand, laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy, is widely accepted for the treatment of EGC with the risk of lymph node metastasis. To establish the acceptability of laparoscopic gastrectomy with D2 lymph node dissection against advanced gastric cancers, safe techniques and new instruments must be developed. The following advantages of laparoscopic surgery for the treatment of gastric cancer have been well demonstrated: clinical course after operation, pulmonary function, immune response. In the future, laparoscopic surgeons have to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes by multicentric randomized control trial studies, and clarify the oncological aspects of laparoscopic surgery in basic studies.

Gastrectomy↗
PubMed2004

A comparison of open and laparoscopic approaches to adrenalectomy in patients with phaeochromocytoma.

We compared the perioperative profiles of patients undergoing unilateral phaeochromocytoma resection performed by open adrenalectomy with those performed by laparoscopic adrenalectomy. Data was collected prospectively on 24 patients (12 open, 12 laparoscopic). All patients underwent extensive preoperative medical preparation with phenoxybenzamine and beta-blockers. The final preoperative dose of phenoxybenzamine was similar in each group (laparoscopic 119+/-60 mg/day, open 100+/-25 mg/day). Intraoperative haemodynamic instability was assessed by the requirement for therapeutic intervention. More haemodynamic instability was observed in the laparoscopic group but the differences were not statistically significant. Sodium nitroprusside use to treat hypertension (systolic blood pressure >180 mmHg) was more frequent and the duration of the infusions longer in the laparoscopic group; high dose beta-blocker therapy with atenolol and/or esmolol to treat intraoperative tachycardia (heart rate >90) was also more frequent in the laparoscopic group. The small sample size of the study limited the ability to detect a true difference. Blood loss was greater in the open adrenalectomy group but the difference was not significant. The operating time was significantly longer (236+/-78 vs 147+/-47 min, P<0.01) but the duration of postoperative hospitalization was significantly shorter (5+/-2 vs 11+/-4 days, P<0.01) in the laparoscopic group. Postoperative complications were not significantly different. There were no perioperative deaths. Overall, we observed more haemodynamic instability in patients undergoing laparoscopic resection but were unable to demonstrate a statistically significant difference. In our experience, laparoscopic adrenalectomy has the advantage of a shorter time to discharge from hospital.

Adrenal Gland Neoplasms↗
PubMed2006

Clipless management of the renal vein during hand-assist laparoscopic donor nephrectomy.

BACKGROUND: Laparoscopic live donor nephrectomy has become the preferred method of donor nephrectomy at many transplant centers. The laparoscopic stapling device is commonly used for division of the renal vessels. Malfunction of the stapling device can occur, and is often due to interference from previously placed clips. We report our experience with a clipless technique in which no vascular clips are placed on tributaries of the renal vein at or near the renal hilum in order to avoid laparoscopic stapling device misfires. METHODS: From December 20, 2002 to April 12, 2005, 50 patients underwent hand-assisted laparoscopic left donor nephrectomy (LDN) at our institution. Clipless management of the renal vein tributaries was used in all patients, and these vessels were divided using either a laparoscopic stapling device or the LigaSureTM device (Valleylab, Boulder, CO). The medical and operative records of the donors and recipients were reviewed to evaluate patient outcomes. RESULTS: The mean follow-up time was 14 months. Of the 50 LDN procedures, there were no laparoscopic stapling device malfunctions and no vascular complications. All renal allografts were functioning at the time of follow-up. CONCLUSION: Laparoscopic stapling device failure due to deployment across previously placed surgical clips during laparoscopic live donor nephrectomy can be prevented by not placing clips on the tributaries of the renal vein. In our series, there were no vascular complications and no device misfires. We believe this clipless technique improves the safety of laparoscopic donor nephrectomy.

Female↗
PubMed1992

Laparoscopic bowel resection: advantages and limitations.

Laparoscopic surgery has been successfully employed for many years by gynecologic surgeons. Over the last several years, a tremendous increase in the enthusiasm towards laparoscopic surgery has reached the general and colorectal surgical communities. This enthusiasm was initially directed towards laparoscopic cholecystectomy but subsequently has expanded to laparoscopic appendectomy and laparoscopic bowel resection. Currently, laparoscopic bowel surgery is undergoing critical appraisal. Through meaningful prospective data retrieval, answers are being obtained to questions dealing with the efficacy and utility of this technique for colorectal diseases. Specifically, although laparoscopic colorectal surgery is feasible, one cannot definitively attest to its superiority over or even equivalence to standard open laparotomy at the present time. However, in small select series, including our own, our preliminary experience indicates that laparoscopic surgery may well, in the near future, be an acceptable substitute for standard laparotomy. This article will discuss the techniques of, instrumentation for, and preliminary results with a program of laparoscopic bowel resection.

Adolescent↗
PubMed2000

Benefits of laparoscopic-assisted colectomy for colon polyps: a case-matched series.

OBJECTIVE: To clarify the true benefits of laparoscopic-assisted colectomy by comparing clinical outcomes from a series of laparoscopic right colectomies with matched open colectomies, all performed for the singular indication of polyp not amenable to colonoscopic removal. PATIENTS AND METHODS: A retrospective case-matched study was performed of consecutive patients undergoing laparoscopic-assisted right hemicolectomy for polyps between January 1992 and July 1997. Each case was matched to a control undergoing the equivalent open procedure for the same indication during the same time period. RESULTS: Thirty-eight patients undergoing laparoscopic-assisted right hemicolectomy for polyps were identified, and matches were found. The conversion rate was 18.4% (7/38), 21.4% early in the series and 10% in later experience. Operative times were longer for laparoscopic-associated colectomy (median, 208 minutes vs 150 minutes, P < .001). Laparoscopic-assisted colectomy resulted in shorter postoperative ileus (time to flatus, 3.0 vs 4.0 days, P < .001; time to bowel movement, 3.5 vs 5.0 days, P < .001) and in earlier tolerance of regular diet (3.5 vs 6.0 days, P < .001). Fewer days of narcotic administration were required by the laparoscopic group (3.0 vs 4.5 days, P < .001). This resulted in a significantly shorter length of hospital stay (4.0 vs 7.0 days, P < .001). There was no significant difference in the incidence of postoperative complications. CONCLUSIONS: Laparoscopic right hemicolectomy has significant patient benefits. These benefits are apparent when procedures of equal complexity and equivalent indications are compared. Laparoscopic-assisted resection has become our preferred approach for polyps not amenable to colonoscopic polypectomy.

Aged↗
PubMed2001

Laparoscopic herniorrhaphy: preference rate among surgeons in Ankara, Turkey.

OBJECTIVE: To determine the surgeons' and the surgical residents' choice for inguinal hernia repair. DESIGN: A questionnaire study. SUBJECTS: One hundred and forty two respondents who work in surgical clinics as surgeons or residents. SETTING: University hospitals and non-academic teaching hospitals in Ankara, Turkey. MAIN OUTCOME MEASURE: The preference rates of open and laparoscopic hernia repairs for respondents' own inguinal hernias: "If you had an inguinal hernia, how would you prefer to have it repaired?" RESULTS: Only 14.1% of the respondents preferred a laparoscopic hernia repair. Eight of 63 residents (12.7%) and 12 of 79 surgeons (15.2%) chose laparoscopic technique for their own hernia (p=0.67). Personal laparoscopic herniorrhaphy experience significantly affected the choice. Among 118 respondents who had performed no laparoscopic hernia repair, only 12 (10.2%) preferred laparoscopic technique for their own inguinal hernias, whereas the preference rate rose to 33.3% in other 24 participants who had previously done laparoscopic hernia repair (p=0.03). The only independent variable in multivariate analysis was personal experience on laparoscopic herniorrhaphy (SE:0.33, Wald 11.73, Sig:0.0006). The majority of the respondents who preferred open hernia repair stated that it was a better known technique. Other common reasons for open repair were being better repair and the advantage of local anesthesia. Top three reasons for choosing laparoscopic hernia repair were less pain, short hospital stay and early return to normal activity. CONCLUSION: Majority of surgeons and residents still prefer open hernia repair.

Attitude of Health Personnel↗
PubMed1996

[Experience of 143 cases of laparoscopic surgery in urology--clinical outcome in comparison to open surgery].

(BACKGROUND). The clinical outcome of laparoscopic surgery performed in 143 patients, including laparoscopic adrenalecotmy, nephrectomy, pelvic lymph node dissection (PLND) and varicocele ligation is reported. (METHODS). In patients who underwent laparoscopic adrenalectomy (32 cases), laparoscopic nephrectomy (7) or PLND (44), the following parameters were evaluated and compared to those obtained in patients undergoing the same surgeries but by conventional open procedure; operation time, hospital stay, pain killer doses and the time necessitated for ambulation. (RESULTS). The operation was successful in 95.8% (137/143). Open laparotomy was necessitated in 4 patients to control bleeding (two in adrenalectomy and two for PLND) and in one nephrectomy case due to massive adhesion with the descending colon. The major complication occurred in 4.2% of the cases, but without mortality. The laparoscopic adrenalectomy, nephrectomy and PLND had an average operating time of 260, 304 and 139 minutes, respectively, while the open surgery for each procedure required 251, 212 and 128 minutes, respectively (p = 0. 24 approximately 0.82). Likewise, the total dose of pain killer was 0.8, 1.8 and 0.9 for the former, whereas it was 3.2, 6.0 and 3.9 for the latter, respectively (p < 0.01). The average hospital stay for laparoscopic surgery was 4.9, 6.4 and 4.7 days in the same order, whereas open adrenalectomy or nephrectomy required about 14 days (p < 0.001). Convalescence was completed within significantly shorter term in patients with laparoscopic surgery. Potential complications of laparoscopic surgery included not only those unique to pneumoperitoneum (8.1%), but also those which may be encountered during any endoscopic operation such as compartment syndrome in the lower extremities. The physiologic changes accompanying increased intra-abdominal pressure affected renal function, characterized by a significant decrease in urinary output (p < 0.02), which, however, resumed to normal range within several hours after the operation without causing permanent renal dysfunction. (CONCLUSION). These results suggest that the laparoscopic surgery in certain area in urology has less morbidity and equal accuracy compared with conventional open surgery.

Adolescent↗
PubMedDate not supplied

Laparoscopic colon surgery for benign disease: a comparison to open surgery.

BACKGROUNDS AND OBJECTIVES: There remains a debate in the literature about the advisability of laparoscopic surgery for malignant disease of the colon. Current prospective studies will hopefully answer this question. However, for benign diseases of the colon, we believe laparoscopic surgery offers many advantages including decreased postoperative pain, early discharge from the hospital, and early return to normal activities. We retrospectively reviewed our experience with laparoscopic colectomies for benign disease to see whether these procedures could be done safely and if the proposed advantages could be realized. METHODS: Thirty-eight laparoscopic colon resections performed for benign disease were compared to 39 open colon resections with respect to operating times, length of hospital stay, estimated blood loss, days until first postoperative bowel movement, and complications. RESULTS: The laparoscopic colon resection group had decreased length of stay, less blood loss, earlier return of bowel function, and an equivalent number of complications. Laparoscopic cases did take an average of 24 minutes longer. CONCLUSION: The use of laparoscopic colon surgery for benign disease not only affords the patient the advantage of the laparoscopic approach, but also allows the surgeon to gain experience while awaiting the results of ongoing trials for laparoscopic colon surgery in malignant disease.

Adult↗