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PubMed1992

Laparoscopy for evaluation of cryptorchid testis.

Four male patients with a unilateral nonpalpable testis were considered for laparoscopy. Preoperative evaluation by computerized tomography and ultrasonography failed to demonstrate cryptorchid testis. Laparoscopy clearly identified the anatomy in all 4 cases. Two patients had an absent testis, 1 patient underwent orchiectomy for a dysmorphic testis, and 1 patients underwent orchiopexy for a testis located within the inguinal canal. Pediatric laparoscopy is an effective and safe adjunct in the management of cryptorchid testis.

Adult↗
PubMed1993

Laparoscopy in pediatric urology.

Laparoscopy has been used in pediatric urology for the diagnosis of nonpalpable testes for more than fifteen years. Expansion of pediatric urologic applications of laparoscopic surgical techniques is inevitable with the recent explosion of urologic laparoscopy. While the needs are distinct and at times divergent from those in the adult population, many benefits may be realized with this developing technology in children. Refinement of diagnostic capabilities as well as interventional procedures for the undescended testis are being developed. Increased use for varicocele treatment and intersex evaluation can be expected. Potential applications of laparoscopic techniques for the pediatric urologist include nephrectomy for various benign diseases, ureteral surgery for reflux, bladder autoaugmentation, and hernia repair. Laparoscopic possibilities are limited only by imagination and technology. A skeptical approach is justified and judicious application of these technologies in children is essential. Just as the child is not a small adult, pediatric laparoscopy is not just the use of smaller instruments.

Child↗
PubMed1993

Therapeutic laparoscopy for intra-abdominal testes.

Fourteen laparoscopic surgical procedures were performed in 10 children with 11 intra-abdominal testes. In addition to localizing the testes, laparoscopy aided in the surgical approach. In 8 patients, the first phase of a two-stage Fowler-Stephens orchiopexy was performed. Five children underwent an open surgical procedure three months later and have a viable testis in the scrotum after at least nine months of follow-up. In 5 patients (6 testicles), laparoscopy was used to dissect the testis. Three patients underwent the second phase of the two-stage Fowler-Stephens procedure laparoscopically. In all 3 patients, the testicle could be easily mobilized into the scrotum. Two other testicles were mobilized by dissecting the spermatic vessels up to the renal hilum laparoscopically; this allowed the intra-abdominal testes to come into the scrotum without dividing the spermatic vessels. In one teenager with a small intra-abdominal testis and a normal contralateral testis, laparoscopic orchiectomy was performed. We believe laparoscopy has a role both diagnostically and surgically in the treatment of intra-abdominal testes.

Adolescent↗
PubMed1994

The nonpalpable testis and the changing role of laparoscopy.

OBJECTIVE: To show the reliability of laparoscopic procedures in case of cryptorchidism. It also shows the growing possibilities of laparoscopic manipulations of the cryptorchid testis obviating in a great percentage the need for open operative procedures. METHODS: Starting from the standard diagnostic laparoscopic procedure we gradually extended its use to a full operative procedure. The standard procedure is extensively elucidated in the way we used it in sixty-one laparoscopic procedures for seventy-four non-palpable testes. RESULTS: All laparoscopies were technically successful. Forty testes (60.3%) were found intra-abdominally. Four testes (5.5%) were found lying in the inguinal canal or in an ectopic position. Twenty-five testes were absent. The diagnosis of a vanishing testis could be established in most of these cases. In the beginning period the following open procedures were done after the diagnostic laparoscopy: sixteen open explorations, ten formal standard orchidopexies; nine orchiectomies, nine autotransplantations, and three Fowler-Stephens procedures. In recent years we proceeded with laparoscopic manipulation, performing eleven laparoscopically assisted orchidopexy procedures (LAOPs), six extended laparoscopic explorations, and two laparoscopic orchiectomies. CONCLUSIONS: Laparoscopy is not only a safe and reliable method in diagnosing the presence of a nonpalpable testis, but also thanks to more sophisticated instruments allows us more and more to perform the complete treatment. It can facilitate the placement of surgical incisions or obviate the need for further open intervention if no spermatic vessels are visualized in the abdomen.

Adult↗
PubMedDate not supplied

Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy.

Laparoscopy is frequently associated with postoperative shoulder pain that may last several days. We have assessed the analgesic effect of intraperitoneal local anaesthetics during day-case diagnostic laparoscopy. 80 young women were randomly assigned to one of four groups of 20 patients each: group 1, no peritoneal administration; group 2, 80 ml saline injected under direct vision in the right subdiaphragmatic area at the start of the procedure; group 3, 80 ml 0.5% lignocaine with adrenaline (320,000 dilution); group 4, 0.125% bupivacaine with adrenaline (800,000 dilution). Scapular pain was assessed with a visual analogue pain scale, and information about nausea, vomiting, abdominal pain, and analgesic requirements during the first 48 h was sought. Both local anaesthetics were more effective in reducing postoperative shoulder pain than either control or saline. Analgesic requirements were greater in the non-treatment groups than in the local anaesthetic groups. Intraperitoneal local anaesthetic administration during laparoscopy is both a non-invasive and an efficient method of reducing the intensity of scapular pain.

Adult↗
PubMed1989

Laparoscopy in the abdominal staging of melanoma.

A retrospective study on laparoscopic results in the abdominal staging of 297 patients with melanoma, is reported. In 195 (99.3%) of patients, laparoscopy was technically feasible, and in 10% the clinical stage was changed on the basis of the findings. In 34% of patients with metastasis of the liver and peritoneum, the tumor had a diameter of under 1 cm and therefore was not detectable with non-invasive techniques. In the light of these results laparoscopy is advisable in patients with Stage I melanoma at a high risk of metastatization (Clark IV-V; Breslow greater than 0.76 mm) and in Stage II patients. In Stage III patients, laparoscopy seems indicated for an evaluation of the efficacy of systemic treatment.

Adolescent↗
PubMedDate not supplied

Assessment of follicular development in clomiphene induced cycles by means of ultrasound and laparoscopy: a comparative study.

Fifty clomiphene/H.C.G. stimulated patients undergoing laparoscopy as part of their infertility work up consented to participate in a study on: the reproducibility of ultrasonic measurement of follicular size as expressed by the inter and intra observer variation; the accuracy of ultrasonic assessment of location, number and size of follicles and the growth rate of the Graafian follicle during the last 12 hr prior to oocyte collection. The inter and intra observer variation was moderate to good. Correct diagnosis of the dominant follicle was made in 73%, of the number of follicles in 72% and of follicular size (difference in size between ultrasound and laparoscopy less than 2 mm) in 48% of the material studied. There was a rather wide range in follicular growth rate values during the last 10-17 hr prior to laparoscopy.

Chorionic Gonadotropin↗
PubMedDate not supplied

Changes in end-tidal carbon dioxide during gynecologic laparoscopy: spontaneous versus controlled ventilation.

STUDY OBJECTIVE: To study the changes in PETCO2 during spontaneous and controlled ventilation in patients undergoing gynecologic laparoscopy. DESIGN: Randomized, unblinded study. SETTING: Department of Gynecology, University Hospital, Linköping, Sweden; Central Hospital, Norrköping, Sweden. PATIENTS: Forty healthy patients undergoing gynecologic laparoscopy. INTERVENTIONS: Patients were divided into 4 groups: Group 1 breathed spontaneously via an endotracheal tube, while the other three groups underwent controlled ventilation to an initial PETCO2 of 3 kPa (22 mmHg) (Group 2), 4 kPa (30 mmHg) (Group 3), or 5 kPa (37 mmHg) (Group 4). MEASUREMENTS AND MAIN RESULTS: PETCO2 levels were measured at fixed time intervals. Arterial blood gas analyses were done to compare the difference between PETCO2 and PaCO2. In Group 1, PETCO2 increased soon after insufflation and remained above 6 kPa (44 mmHg) throughout the procedure. In Groups 2, 3, and 4, PETCO2 also rose after insufflation, and an initial PETCO2 of 4 kPa (30 mmHg) was ideal, as all PETCO2 values were less than 5.5 kPa (41 mmHg). Occasional episodes of arrhythmia were seen in Group 1. However, no major adverse effects were observed in any of the groups. CONCLUSIONS: In view of the high PETCO2 levels, spontaneous breathing should be avoided during gynecologic laparoscopy, and ventilation to an initial PETCO2 of 4 kPa (30 mmHg) is recommended during controlled ventilation.

Adult↗
PubMed2006

Laparoscopy as an educational and recruiting tool.

BACKGROUND: General surgeons can supplement traditional gross anatomy instruction by using laparoscopy to provide clinical correlations. Early, positive interaction with surgeons may stimulate student interest in this field. METHODS: Basic laparoscopy was performed on fresh cadavers for first year medical students in gross anatomy over 2 consecutive years. Surgical residents reviewed anatomy of the abdomen, and students manipulated intra-abdominal organs using laparoscopic instruments. Students completed pre- and post-demonstration questionnaires that were compared independently. RESULTS: More than 95% of responding students agreed the demonstration enhanced their understanding of abdominal anatomy. Regardless of planned area of specialization, students felt the demonstration reinforced the clinical relevance of gross anatomy. Among students already anticipating surgical careers, 88.2% said the demonstration increased their interest in general surgery; this was significantly higher than among those intending careers in internal medicine (27.3%) or other fields (23.5%; P < .0001). CONCLUSIONS: Cadaver-based laparoscopy demonstrations by general surgeons supplement didactic sessions and enhance learning in gross anatomy. Furthermore, such demonstrations may stimulate student interest in general surgery at an early point in their medical education, particularly in those already interested in a surgical career.

Abdomen↗
PubMed2005

General principles of laparoscopy.

Laparoscopic surgery is minimally invasive and minimally traumatic in cattle. It allows the animal to return rapidly to production. These techniques are destined to develop further, especially in the dairy and show cattle industries, where recovery periods must be as short as possible. Although it is important to remain skeptical about new procedures if they do not offer advantages over open techniques, in many cases laparoscopy is clearly superior. Laparoscopy is not an easy surgical technique. It requires a good knowledge of anatomy and abdominal topography and rigorous training. It must be performed with great care and delicacy because complications, such as perforated organs, can occur. Laparoscopy also requires the use of sophisticated and costly technology.

Animals↗
PubMed2006

Operative laparoscopy in The Netherlands: Diffusion and acceptance.

OBJECTIVE: To evaluate and update the current status of the implementation of operative laparoscopy in gynaecology in The Netherlands by assessing diffusion and acceptance of each specific procedure per hospital. STUDY DESIGN: In 2003 a questionnaire was sent to all hospitals (n = 102), which addressed the total number and type of laparoscopic procedures performed in 2002 stratified by level of difficulty (level 1: diagnostic laparoscopy, sterilization, tubal patency tests; level 2: adhesiolysis, ectopic pregnancy (EP), laparoscopic treatment of endometriosis, cystectomy, oophorectomy, LAVH, tubal surgery for infertility; level 3: myomectomy, total laparoscopic hysterectomy (TLH) and sacropexy). Data were compared to previously published data of 1994. RESULTS: Response rate was 79% (81/102). Diffusion and acceptance of level 2 procedures increased significantly, except endometriosis and tubal surgery for infertility. Diffusion of LAVH was only 58%. Four percent of hysterectomies were LAVH. TLH and sacropexy were not performed. The diffusion of myomectomy increased significantly (p = 0.01), whereas its acceptance remained low. CONCLUSIONS: Although the diffusion of operative procedures has increased over the last decade, acceptance is still limited, especially for laparoscopic hysterectomy. The implementation of operative gynaecological laparoscopy in The Netherlands seems to develop at a slow pace.

Diffusion of Innovation↗
PubMed2005

Ringer's lactate solution remains in the peritoneal cavity after laparoscopy longer than expected.

OBJECTIVE: To evaluate by serial ultrasound scans how long a Ringer's lactate instillation remains in the peritoneal cavity after laparoscopy. DESIGN: Prospective, randomized, double blind, clinical trial. SETTING: Tertiary care, university hospital. PATIENT(S): Thirty-six patients undergoing diagnostic or minor operative laparoscopy. INTERVENTION(S): At the end of laparoscopy, the patients were tilted to an anti-Trendelenburg position and all fluid was aspirated. The patients were then randomized to receive an instillation of 300 mL of Ringer's lactate or no fluid instillation. Serial transvaginal ultrasound scans were performed at the end of surgery and at 24, 48, and 96 hours after the surgery. MAIN OUTCOME MEASURE(S): Through direct measurements of scalar fluid volumes instilled in the operating room and real-time ultrasound comparisons, an empiric formula was calculated to correlate actual intraperitoneal volumes to ultrasonically derived measurements of fluid pockets. With this formula, the volume of intraperitoneal fluid at 24, 48, and 96 hours after surgery was calculated. RESULT(S): Twenty-four hours after surgery, a mean volume of 184 mL was present in the Ringer's lactate group versus 46 mL in the control group. At 48 hours after surgery, the mean volumes were 78 mL versus 30 mL, respectively. No statistically significant differences were found after 96 hours. CONCLUSION(S): Peritoneal absorption of instilled crystalloids is traditionally reported to be 30 to 60 mL/hour. We report detecting statistically significant amounts of fluid at 24 and 48 hours after surgery, after infusion of 300 mL of Ringer's lactate. This suggests that fluid remains in the peritoneal cavity longer than traditionally believed.

Adult↗
PubMed2005

Improved preoperative tumor staging by 5-aminolevulinic acid induced fluorescence laparoscopy.

BACKGROUND: We report our data in 35 patients who underwent preoperative conventional and fluorescence-based staging laparoscopy. We use the data to address the questions of whether fluorescence examination increases the yield of metastatic lesions and alters treatment intervention. METHODS: Fluorescence laparoscopy was successfully performed in 30 patients with GI malignancies. After sensitization with 5-aminolevulinic acid, conventional white-light mode and fluorescence-light laparoscopies were sequentially performed. A suspected malignancy was biopsied. OBSERVATIONS: In 5 patients, examinations were incomplete because of adhesions. In 9 of 10 patients, hepatic or peritoneal metastases were detected by white-light examination. In 4 of these 9, blue-light examination yielded more metastatic lesions. In one patient with no lesions by white- or blue-light examination, surgery revealed hepatic metastasis in a location not accessible to laparoscopic examination. In 18 patients, surgery confirmed the absence of metastatic lesions. CONCLUSIONS: A fluorescence, blue-light examination yielded more lesions than the conventional white-light examination but did not alter treatment intervention and did not enhance yield when metastatic lesion is in an inaccessible location. Continued research should focus on whether treatment intervention will be altered by the fluorescence examination.

Administration, Oral↗
PubMed2004

Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval.

BACKGROUND: Laparoscopy-assisted surgery has proved useful in the treatment of early gastric cancer, but its use in advanced cancer may be hindered by limitations in lymphadenectomy. STUDY DESIGN: Data on lymph node retrieval after distal gastrectomy with D1 or D2 lymphadenectomy (n = 89) performed by the laparoscopy-assisted approach were collected between 1998 and 2002 and compared with data obtained from conventional open surgery performed for T1 cancer at a high-volume hospital (n = 342) during the same period. Comparisons of total number of lymph nodes, retrieval at each lymph node station, and the rate of noncompliance (no nodal tissue documented at a node station that should have been resected) were conducted using Student's t-test and the chi-square test. RESULTS: D2 resection by the laparoscopy-assisted approach harvested a sufficient number of nodes for adequate TNM classification (>15 nodes) in 86% of patients. Nevertheless, a significantly greater number of lymph nodes were harvested by open surgery. The difference was significant for the perigastric lymph nodes along the major curvature (Nos. 4 and 6) and second tier nodes along the celiac and splenic arteries (Nos. 9 and 11). CONCLUSIONS: The extent of lymphadenectomy achieved by current laparoscopic procedure approaches the global standard for accurate staging, although performing extended resection as recommended in Japan remains a challenge.

Feasibility Studies↗
PubMed2005

The contribution of laparoscopy in evaluation of penetrating abdominal wounds.

BACKGROUND: Penetrating abdominal wounds are traditionally explored by laparotomy. We investigated prospectively the role of laparoscopy within a defined protocol for management of penetrating abdominal wounds to determine its safety and advantages over traditional operative management. STUDY DESIGN: The study inclusion criteria were: stab and gun shot abdominal wounds, including junction zone injuries; stable vital signs; and absence of contraindications for laparoscopy. Diagnostic end points included detection of peritoneum or diaphragm violation, visceral injuries, and other indications for laparotomy. Systematic examination was undertaken using a multiport technique whenever the peritoneum or diaphragm had been violated. All repairs were done by open operation. RESULTS: A total of 40.6% of patients with penetrating trauma fulfilled study criteria (52 patients). Of these, 33% had no peritoneal penetration; 29% had no visceral injuries despite violation of peritoneum or diaphragm; 38% had visceral injuries, of which 40% (mainly liver and omentum) required no intervention. Twelve patients (23% of total) had open repairs. No missed injuries or death occurred in the study. Overall, 77% of penetrating injuries with stable vital signs avoided exploratory laparotomy. Compared with National Trauma Data Bank information for patients with the same Injury Severity Scores, hospitalization was reduced by more than 55% for the entire series. CONCLUSIONS: Laparoscopy for penetrating abdominal injuries in a defined set of conditions was safe and accurate, effectively eliminating nontherapeutic laparotomy and shortening hospitalization.

Abdominal Injuries↗
PubMedDate not supplied

An evaluation of four tests used to ascertain Veres needle placement at closed laparoscopy.

STUDY OBJECTIVE: To determine the reliability of four commonly used tests to confirm the placement of the Veres needle during closed laparoscopy and their ability to determine other complications of entry. DESIGN: A prospective observational study (Canadian Task Force classification II-2). SETTING: A university-affiliated teaching hospital in Sydney, Australia. PATIENTS: Three hundred forty-five women undergoing closed laparoscopy using Veres needle peritoneal insufflation. INTERVENTIONS: The double click test, the hanging drop test, the aspiration test, and the initial five pressures at the time of insufflation following Veres needle placement were assessed for their sensitivity, specificity, and positive and negative predictive values for correct intraperitoneal placement of the needle and the presence or absence of any complication such as preperitoneal insufflation, omental emphysema, or visceral injury. MEASUREMENTS AND MAIN RESULTS: Complications occurred in 65 (18.8%) of 345 women, with preperitoneal insufflation in 19 (5.5%) of the 345, a superficial gastric injury in 1 (0.3%), and omental emphysema in 45 (13%). There was poor sensitivity and positive predictive values for preinsufflation tests. The first five pressures after commencement of insufflation were a sensitive predictor (79%) of complications, particularly preperitoneal insufflation (100% sensitivity for this complication). When two or more passes of the Veres were required, there was a significantly greater chance of preperitoneal insufflation (chi2 = 20.5, p <.0001). Preperitoneal insufflation was not reported when the first five successive insufflation pressures were less than 10 mm Hg. CONCLUSIONS: The double click, aspiration, and hanging drop tests provide very little useful information on the placement of the Veres needle at the time of closed laparoscopy. The initial gas pressures provide considerable information on the placement of the Veres needle, in particular the likelihood of preperitoneal insufflation. We conclude that the initial gas pressure is the only valuable measure to reflect correct intraperitoneal Veres needle placement.

Adult↗
PubMedDate not supplied

Management of adnexal cystic masses with unexpected intracystic vegetations detected during laparoscopy.

STUDY OBJECTIVE: To evaluate a prospective series of consecutive patients with unexpected intracystic vegetations detected during operative laparoscopy for adnexal masses. DESIGN: Prospective series of consecutive patients (Canadian Task Force classification: II-2). SETTING: Tertiary care university hospitals. PATIENTS: Consecutive patients found during surgery to have unexpected intracystic vegetations and treated by operative laparoscopy, out of a total series of 667 patients under 40 years of age with ultrasonographic evidence of an adnexal cystic mass without thick septa, internal wall papillarities, or solid components. INTERVENTIONS: Operative laparoscopy and follow-up. MEASUREMENTS AND MAIN RESULTS: Thirty-five (5.2%) of 667 patients were found at surgery to have unexpected intracystic vegetations. A frozen section was sent for pathologic analysis in all 35 patients. Frozen section diagnosis was benign in 32 patients and borderline in 3 patients. Final pathology diagnosis was borderline ovarian tumor in five of the 35 patients (14.3%), and benign in 30 patients (85.7%). No case of invasive carcinoma was diagnosed either at frozen section or at final pathology examination. The patients with borderline tumors are alive with no evidence of disease after a mean follow-up of 60 months. CONCLUSIONS: In the present series, with accurate preoperative selection, the rate of adnexal cysts with unexpected intracystic vegetations was 5%, of which 14% were borderline tumors. The laparoscopic management of these adnexal masses did not adversely affect the prognosis.

Abdomen↗
PubMedDate not supplied

Pelvic meningocele can be missed during laparoscopy.

Pelvic meningocele is an uncommon condition and is frequently asymptomatic. The diagnosis easily can be mistaken as ovarian cyst on pelvic sonography. In many reported cases, the diagnosis was made during laparotomy for presumed ovarian cysts. Myelography, computerized tomography (CT), or magnetic resonance imaging (MRI) is useful for definitive diagnosis. A 49-year-old woman, who had a normal diagnostic laparoscopy 3 years prior, was referred for a persistent ovarian cyst. Repeat laparoscopy revealed a retroperitoneal cyst in the left pelvic sidewall. Both ovaries and fallopian tubes were normal. Subsequent CT and MRI were used to diagnose pelvic meningocele. We speculate that pelvic meningoceles can be missed during laparoscopy due to the increased intraperitoneal pressure and the potential reduction in the cerebrospinal fluid pressure at the lumbosacral level.

Diagnostic Errors↗