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At least 1,009 records · Page 56Linked to original sources
PubMed2000

Laparoscopy-assisted Ruge procedure for the creation of a neovagina in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

OBJECTIVE: To describe the successful use of a laparoscopy-assisted Ruge procedure for the reconstruction of a vagina in a patient with Mayer-Rokitansky-Küster-Hauser syndrome. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 19-year-old Japanese woman with Mayer-Rokitansky-Küster-Hauser syndrome. INTERVENTION(S): Creation of a neovagina by a laparoscopy-assisted Ruge technique. MAIN OUTCOME MEASURE(S): Clinical examinations were performed during the follow-up period. The depth and diameter of the neovagina were measured by vaginography. Patient satisfaction also was determined. RESULT(S): The neovagina was 12 cm in length and 4 cm in diameter. The mucosa of the neovagina was pinkish and had a moist surface. No intraoperative or postoperative complications were observed. CONCLUSION(S): The use of an isolated segment of the sigmoid colon for vaginal construction has the advantages of providing a sufficient length of neovagina and not requiring immediate postoperative self-dilatation. We believe that our procedure has various advantages in addition to those of the original Ruge method, including its minimally invasive nature and excellent cosmetic results. Further, a laparoscopy-assisted operation allows for the diagnosis of uterine defects and the creation of a neovagina at the same time.

Adolescent↗
PubMed1987

Laparoscopy in staging, follow-up, and restaging of ovarian carcinoma.

Laparoscopy was systematically employed for the study of 143 cases of primary ovarian tumor in the various phases of staging, treatment, follow-up, and restaging. We found that laparoscopy allowed a more precise staging if used before laparotomy. Verification of response at any time in the course of therapy was readily achieved by laparoscopy.

Adolescent↗
PubMedDate not supplied

Role of laparoscopy in the evaluation of patients with suspected hepatic or peritoneal malignancy.

The purpose of this study was to determine the role of laparoscopy in patients with suspected hepatic or peritoneal malignancy and a normal computerized tomograph (CT). Twenty-five consecutive patients with a normal liver and no peritoneal lesions on CT were evaluated. Patients with a documented primary neoplasm or a positive ascitic fluid cytology were excluded. At laparoscopy, malignancy was documented by biopsy in 12 patients for an incidence of 48%. Of the patients with exudative ascites, 75% had peritoneal metastases. In addition seven patients had benign liver disease documented by laparoscopic biopsy. Liver enzymes were not helpful in distinguishing benign and malignant disease in this group of patients. This study indicates that a negative CT does not exclude liver or peritoneal malignancy. Laparoscopy has a significant yield in patients with a negative CT suspected of having hepatic or peritoneal malignancy and is the procedure of choice in evaluating these patients.

Adenocarcinoma↗
PubMed1996

Diagnostic laparoscopy in childhood Crohn's disease.

In some children, contrast radiography and endoscopy fail to confirm suspected Crohn's disease, or fail to evaluate the extent of disease. This report documents seven cases in which laparoscopy was used to look for creeping mesenteric fat involving the small intestine, a pathological finding reported only for Crohn's disease. One child had extensive Crohn's colitis and possible terminal ileitis that remained clinically disabling despite intensive immunosuppression therapy. The lack of creeping fat in the small intestine was used to justify colon resection and forego further aggressive medical therapy. The patient had complete resolution of her symptoms after the colectomy. Six children had suspected Crohn's disease and underwent diagnostic laparoscopy after other studies were inconclusive. In three, creeping mesenteric fat of the small intestine was found, and all three responded to treatment for Crohn's disease, with resolution of symptoms. The other three children had Crohn's disease excluded based on the absence of creeping mesenteric fat, and subsequently other pathological conditions were identified. The usual radiographic and endoscopic studies will diagnose most cases of Crohn's disease, but this report emphasizes that, in select cases in which other investigations are inconclusive, laparoscopy can be useful to search for creeping mesenteric fat, a finding characteristic of Crohn's disease.

Adolescent↗
PubMed2002

The effect of previous abdominal surgery on urological laparoscopy.

PURPOSE: Abdominal surgery causes adhesions that may render subsequent laparoscopic access and dissection problematic. We determined the effect of previous surgery on the operative outcome in a large series of patients undergoing urological laparoscopy. MATERIALS AND METHODS: The records of 700 consecutive laparoscopic procedures performed at a single institution from 1995 to 2001 were reviewed. Patient gender, American Society of Anesthesiologists (ASA) patient classification, surgical history, operative time, estimated blood loss, transfusion rate, rate of conversion to an open procedure, complication rate and hospital stay were assessed in each patient. Patients were categorized by anatomical site of previous surgeries and the type of laparoscopic procedure performed. Statistical analysis was performed with 1-way ANOVA, and the chi-square, Fisher exact and Kruskal-Wallis tests. RESULTS: Of the 700 patients 366 (52%) had never undergone surgery, 105 (15%) had a history of abdominal surgery at the same anatomical region and 229 (33%) had a history of abdominal surgery at a different region. Overall previous abdominal surgery of any type was associated with female gender, higher ASA classification, increased age and an increased rate of perioperative transfusion (p = 0.0001). A history of surgery at the same site was associated with increased operative time (p = 0.03) and increased hospital stay (p = 0.02). Differences in operative blood loss (p = 0.3), and the complication (p = 0.11) and conversion (p = 0.08) rates in patients with and without a history of surgery did not attain significance. Outcomes analysis of individual types of surgery showed similar results except for renal biopsy. In these cases previous surgery was not associated with increased age, ASA score or transfusion rate. CONCLUSIONS: Of all patients presenting to a single center for urological laparoscopy 48% had a history of abdominal surgery. Overall compared with patients with no history of surgery those with such a history tended to be older, predominantly female and at significantly higher operative risk. Patients with a history of surgery who underwent nephrectomy or pyeloplasty were also more likely to have received blood transfusion perioperatively, which was probably related to their increased age and higher degree of medical co-morbidity. There were no significant differences in operative blood loss, rate of conversion to open procedure or rate of operative complications. Therefore, previous abdominal surgery does not appear to affect adversely the performance of subsequent urological laparoscopy.

Abdomen↗
PubMed1994

Laparoscopy for impalpable testes: significance of the patent processus vaginalis.

Laparoscopy often is performed in the evaluation of boys with an impalpable testis. Previously it has been reported that if laparoscopy disclosed a patent processus vaginalis the testis was likely to be present, whereas if the processus vaginalis was closed then the testis usually was absent. This study was performed to examine this association further. In 111 boys with 124 impalpable testes 45 testes (36%) were viable and suitable for orchiopexy, including 7 that were in the inguinal canal and 38 intra-abdominal testes. Another 79 testes (64%) were absent or vanishing, including 72 in which the cord structures had descended through the internal ring, 5 in which the vas and vessels ended blindly in the abdominal cavity, and 2 in which the testis, vas and vessels could not be identified. When a patent processus vaginalis was present 43 of 47 testes (91%) were viable, whereas if it was closed 75 of 77 (97%) had vanished or were absent. An algorithm for surgical management of the impalpable testis based on laparoscopy findings is proposed.

Adolescent↗
PubMed1989

Laparoscopy: its selected use in patients with unilateral nonpalpable testis after human chorionic gonadotropin stimulation.

Laparoscopy has been used to help evaluate patients with a unilateral nonpalpable testis. This procedure can be performed quickly just before exploration with the patient under the same anesthetic. With laparoscopy it has been possible to localize either a testis or the course of the spermatic vessels in 100 per cent of the patients. Preoperative knowledge of testis location is helpful to plan the location of the incision as well as the type of repair. The incidence of vanishing testis in our series is much higher than that reported previously. This difference is attributed to a careful examination with the patient under anesthesia and preoperative treatment with human chorionic gonadotropin, which made many testes palpable. These results indicate that laparoscopy can be performed safely and quickly, and that it is helpful to manage patients with a unilateral nonpalpable testis.

Adolescent↗
PubMed1990

Laparoscopy for the nonpalpable testis: how to interpret the endoscopic findings.

We evaluated by laparoscopy 38 patients with 45 nonpalpable testes. Of 24 testes identified in the abdominal cavity 15 were atrophic, 2 had no epididymal connection and 7 were normal in appearance. Of the 38 patients 32 (84.2%) underwent exploration. A correlation of 100% occurred between laparoscopy and surgery concerning the presence or absence of the testis. Of the testes sought 60% were present (all but 1 in the abdomen) and 40% were absent. We conclude that diagnostic laparoscopy is as effective as exploration in adults and children, with a low risk of complication.

Adolescent↗
PubMed2001

Intraperitoneal gas drain to reduce pain after laparoscopy: randomized masked trial.

OBJECTIVE: To determine whether a drain placed in the peritoneal cavity during laparoscopy is both a clinical and cost-effective method of reducing postoperative pain. METHODS: Two hundred twenty-five women undergoing diagnostic or minor operative laparoscopic procedures were recruited. Women were assigned to receive either an intraperitoneal gas drain or a dummy drain during surgery. Sample size to detect a two-point difference in visual analogue score was estimated at 158 subjects, with 79 in each arm. The patients and nursing staff were unaware of the position of the drain. A visual analogue score was used to assess pain preoperatively and at 4, 24, and 48 hours postoperatively. Data on the experience of nausea, frequency of vomiting, and site of pain were collected. The analgesic and antiemetic use was recorded. An economic evaluation of the analgesic use and the material costs for the two groups was performed. RESULTS: One hundred sixty-one complete sets of data (72%) were available for analysis. The two groups were well matched for age, parity, previous surgery, body mass index, volume of carbon dioxide used, and operative time. No significant differences were found between the two groups with regard to the overall pain scores preoperatively (8 versus 7) or at 4 (30 versus 34), 24 (40 versus 44), and 48 (26 versus 26) hours postoperatively, after adjusting for multiple point testing. On assessment at different sites, the dummy drain group experienced shoulder pain more frequently at 4 (19 of 79 versus 10 of 82, P =.05) and 48 (16 of 79 versus 7 of 82, P =.03) hours postoperatively compared with the drain group. The placebo group had a 33% greater usage of oral analgesia after discharge, but this was $2.50 cheaper than the use of an intraperitoneal drain. No statistically significant differences were found between the groups with regard to nausea and vomiting postoperatively. CONCLUSION: An intraperitoneal drain after minor gynecologic laparoscopy decreases the frequency of shoulder pain and reduces postoperative analgesia requirements. However, it is less cost-effective to reduce pain using an intraperitoneal gas drain than simple oral analgesia after minor gynecologic laparoscopy.

Adult↗
PubMed1996

Laparoscopy-assisted radical vaginal hysterectomy modified according to Schauta-Stoeckel.

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.

Adult↗
PubMed1999

Laparoscopic leash: a simple technique to prevent specimen loss during operative laparoscopy.

BACKGROUND: Surgical specimens can be lost in the peritoneal cavity during operative laparoscopy. Although specimens left might cause no complications, peritonitis and adhesion formation have been reported, requiring subsequent laparoscopy or laparotomy. We report a simple technique to prevent loss of surgical specimens during laparoscopy. TECHNIQUE: A suture is placed through the specimen, and the trocar sleeve is removed. Free ends of the suture are held with a clamp outside the abdomen while the port is reinserted into the abdomen. The suture is pulled to see the specimen when necessary. When morcellation is required, the leashed area of the specimen is the last to be extracted. This procedure takes less than 2 minutes. EXPERIENCE: We have used this technique for longer than 1 year for 18 myomectomies and seven bilateral salpingo-oophorectomies. No specimens were lost in the peritoneal cavity, and there were no complications related to the procedure. CONCLUSION: The laparoscopic leash is a simple and reproducible preventive technique that adds insignificant time to operations but saves much time that might be wasted localizing a misplaced specimen.

Equipment Design↗
PubMed2000

Endobag extractor to remove masses during laparoscopy.

BACKGROUND: Intra-abdominal masses are removed during laparoscopy using different types of endobags. However, in many cases the specimens are larger than the trocar or the incision in the abdomen, with a potential risk of endobag rupture. INSTRUMENT: We developed an instrument to facilitate extraction of an endobag during laparoscopy without the need for a conventional minilaparotomy. The endobag extractor has three removable diverging blades that symmetrically enlarge the operative canal in the abdominal wall if spread after sharp extension of the skin incision. The full endobag can be drawn through the canal without the risk of endobag rupture because the size of the canal can be individualized, building a funnel. EXPERIENCE: We removed various kinds of ovarian tumors, specimens from salpingo-oophorectomies, and other specimens in 22 cases. CONCLUSION: This new instrument allows easy removal of surgical specimens during laparoscopy without conventional minilaparotomy, regardless of the type of endobag used. We believe this instrument lessens the risk of endobag rupture.

Fallopian Tubes↗
PubMed2001

Diagnostic and interventional laparoscopy and intraoperative ultrasonography in the management of pancreatic disease.

The laparoscopic management of pancreatic disorders has evolved dramatically from its inception in 1911 and its rediscovery in the 1970s. Although investigators once proclaimed that "it seems unlikely that laparoscopy will have any more than an extremely limited use in the investigation of pancreatic disorders," laparoscopy and LUS now have a well-recognized role in the staging of pancreatic cancer and an increasing part in the management of benign pancreatic disease at many institutions. Although the appropriate role of LS and LUS is debatable, the development and refinement of laparoscopic techniques and instrumentation and the improvement of noninvasive diagnostic modalities will provide new data, increase the rate of resection at laparotomy, and allow surgeons to treat a broader range of pancreatic disease by minimally invasive methods. The value of LS and LUS for benign and malignant pancreatic disorders has been clearly demonstrated, but the inevitable issues of hospital resource, operative expertise, and surgical philosophy will ultimately determine the role of laparoscopy and LUS in clinical practice.

Angiography↗
PubMed2003

Low-molecular-weight heparin (reviparin) diminishes tumor cell adhesion and invasion in vitro, and decreases intraperitoneal growth of colonadeno-carcinoma cells in rats after laparoscopy.

BACKGROUND: Metastases, adhesion and invasion of tumor cells involve a cascade of complex phenomena, which potentially can be affected by glycosaminoglycans. We studied the influence of a low-molecular-weight heparin, reviparin, on the intraabdominal tumor growth in rats undergoing laparoscopy. We also studied cytotoxicity, anti-adhesive, and anti-invasive effects of reviparin in vitro using adenocarcinoma cells CC531. METHODS: In vitro assays: Adhesion of 1 x 10(5) CC531 adenocarcinoma cells onto microtiter plates coated with 10 microg/ml collagen type I or 10 microg/ml Matrigel was studied in the presence of 0.55; 1.10 and 2.76 mg/ml reviparin, and compared to saline. The cytotoxicity of 1 x 10(4) adenocarcinoma cells was studied in a similar assay. Transwell dual chambers with polycarbonate filters coated with 100 microg/cm2 Matrigel were used to investigate the effect of 0.55; 1.10 and 2.76 mg/ml reviparin on the invasion of 1 x 10(5) adenocarcinoma cells/ml. In vivo experiments: CC531 adenocarcinoma cells (5 x 10(6) cells/ml) were intraperitoneally applied to Wistar Albino Glaxo rats (n=150, Harlan, Germany) with a median weight of 278 g. The rats were divided into 15 groups with 10 animals in each group, underwent laparoscopy, and 1 ml saline containing 0, 0.5, 2.0, 4.0, and 10 mg reviparin per kg b.w. was introduced for intraperitoneal lavage or s.c. After 21 days the animals underwent an autopsy, and the tumor weight was determined. RESULTS: In vitro experiments: We found a highly significant inhibition of tumor cell adhesion and invasion (p<0.001) by all reviparin concentrations used in the assays. There was no effect of reviparin on the viability of cells in the cytoxicity assay. In vivo experiments: We found that application of 4.0 and 10.0 mg/kg b.w., but not 0.5 or 2.0 mg/kg b.w. significantly (p<0.01) decreased the tumor mass compared to controls, receiving only saline. This effect was most pronounced after the combined i.p. and s.c. application, whereas after a sole i.p. application, only the highest dose of 10 mg/kg b.w. caused a significant inhibition of tumor growth. CONCLUSION: Low-molecular-weight heparin, reviparin, given in combination of i.p. lavage and s.c. injections, significantly diminishes intraabdominal tumor growth of CC531 adenocarcinoma cells in rats undergoing laparoscopy. This may offer additional therapeutic options for patients undergoing laparoscopic cancer surgery.

Abdominal Neoplasms↗
PubMed2003

Laparoscopy for the diagnosis and treatment of radiologically occult but symptomatic hypoplastic kidneys.

OBJECTIVES: To evaluate the efficacy of different imaging modalities for visualization of small poorly functioning hypoplastic and dysplastic kidneys and to assess the role of laparoscopy in localization and treatment. METHODS: Between 1998 and 2002, 10 female patients who presented with urinary incontinence, flank pain, or hypertension secondary to small, poorly functioning hypoplastic or dysplastic kidneys were treated at our institute. We reviewed the results of the imaging studies, cystoscopy, and evaluation under anesthesia for these patients. After the diagnosis, all patients were treated with laparoscopic retroperitoneal or transperitoneal nephroureterectomy or nephrectomy. RESULTS: Intravenous urography and ultrasonography failed to visualize the affected renal units in all 10 cases. Computed tomography could locate small dysplastic renal units in only 5 patients (50%). Dimercaptosuccinic acid renal scintigraphy was diagnostic in all 10 cases (100%). Magnetic resonance urography was done in 2 cases only, and the affected renal units were identified in both. Cystoscopy and vaginoscopy were inconclusive in all but 2 cases. Laparoscopy efficiently located the offending renal units in all 10 cases. In 9 cases, the affected renal units were located in the lumbar region, and in 1 case it was situated ectopically in the pelvis. All 10 patients underwent laparoscopic retroperitoneal or transperitoneal nephroureterectomy or nephrectomy and were asymptomatic after surgery. CONCLUSIONS: Dimercaptosuccinic acid scintigraphy is an accurate and specific imaging modality for visualization of small hypoplastic renal units that are not visualized by conventional radiologic imaging techniques. Laparoscopy can be recommended as the ideal method of management, because it provides a minimally invasive technique for detecting the kidney and simultaneously correcting the problem.

Adolescent↗
PubMed2001

Urologic laparoscopy: the future is now.

Recent interest in urologic laparoscopy is a welcome renaissance of minimally invasive procedures that provide superior benefit to patients. It behooves the urologist to avoid complacency and embrace the resurgence of laparoscopy. Dedicated pursuit and perseverance will facilitate the evolution and future of urologic laparoscopy.

Forecasting↗
PubMed1980

Laparoscopy for presumed nonacute salpingitis: a new look at an old problem.

The increased prevalence of venereal disease among adolescents has resulted in a rise in nonacute salpingitis. Laparoscopy was evaluated as an aid in the diagnosis and treatment of presumed nonacute salpingitis in 29 adolescents. The patients had a mean duration of symptoms of 5.5 months, 50% had a recent history of discharge and/or bilateral pelvic pain, and on examination 50% had pain on motion of the cervix, 75% had adnexal tenderness, and 50% had a palpable adnexal fullness or mass. Anatomic findings at laparoscopy included normal pelvic structures in 8, active salpingitis in 13 and nonacute disease in 8. The anaerobic, aerobic, and viral peritoneal cultures obtained at laparascopy from 22 patients resulted in no growth in 18. The four with positive cultures had one organism identified in three cases and two organisms in one case. Anatomic findings were more helpful in diagnosis than the bacteriologic analysis, and our results suggest that laparoscopy increases diagnostic accuracy in the management of presumed nonacute salpingitis.

Adolescent↗
PubMed1997

Salpingo-oophorectomy for adnexal masses. Place and results for operative laparoscopy.

OBJECTIVES: The aim of the study is to specify the place, modalities and results of operative laparoscopy when adnexectomy is indicated in a patient presenting with an adnexal mass. STUDY DESIGN: A retrospective analysis of the 186 patients who underwent adnexectomy for an adnexal mass between January 1, 1989 and December 31, 1994. RESULTS: The operation took place via laparotomy in 34.9% of cases (65 patients) and by laparoscopic surgery in 65.1% of cases (121 patients). All the patients presenting a malignant ovarian lesion (15 cases) were operated by laparotomy. For these patients the laparotomy was decided from the outset in 7 cases and there was a conversion to laparotomy decided during the diagnostic phase of laparoscopy in 8 cases. The preoperative workup (clinical examination, study of past history, trans vaginal ultrasonography, doppler, tumoral markers etc.) together with the diagnostic phase of laparoscopy provide 100% sensitivity, a positive predictive value of 50% and a negative predictive value of 100% for diagnosis of malignancy. CONCLUSION: These results demonstrate that provided a strict selection system is used, it is possible to carry out adnexectomy using laparoscopic surgery in 70.8% of cases (121/171) for patients with benign adnexal mass.

Adnexa Uteri↗