Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “laparoscopy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMedDate not supplied

Should diagnostic hysteroscopy be a routine procedure during diagnostic laparoscopy in women with normal hysterosalpingography?

The advantage of hysteroscopy (HSC) over hysterosalpingography (HSG) in the accuracy of the diagnosis of uterine cavity abnormalities that may cause or contribute to infertility has been shown by numerous studies. The aim of this study was to analyse the results obtained from diagnostic HSC performed routinely during diagnostic laparoscopy in the investigation of the infertile women, to evaluate the effectiveness of the procedure in the diagnosis of uterine causes of female infertility. Ninety-three infertile patients with normal uterine cavity as demonstrated in HSG underwent diagnostic laparoscopy and hysteroscopy in this infertility unit. The hysteroscopy showed a normal cavity in 80 cases (88%), giving a false-negative rate of 12% for HSG. The pathologies found included small adhesions (two cases), an arcuate fundus (two cases), an endometrial polyp (three cases), and endometrial hyperplasia was diagnosed in four cases. In the absence of a positive history or a radiographical suggestion of endometrial abnormalities, or both, HSC made little diagnostic contribution towards elucidating the cause of female infertility or to finding a pathology that could affect the chances of achieving a normal pregnancy. However, in view of the low complication rates, minimal time requirement, and a negligible effect on the post-operative course, HSC could be performed on all infertile patients undergoing diagnostic laparoscopy.

Female↗
PubMed2002

Effects of taurolidine and octreotide on port site and liver metastasis after laparoscopy in an animal model of pancreatic cancer.

Port site metastasis is a dreadful event following laparoscopy; however, the exact pathomechanism is still unknown. In order to prevent trocar metastasis we determined the effects of intraperitoneal lavage with either taurolidine or octreotide on port site and liver metastasis after laparoscopy in a chemically induced, solid pancreatic adenocarcinoma. Pancreatic adenocarcinoma was induced in 60 Syrian hamsters by weekly injection of 10 mg/kg body weight N-nitrosobis-2-oxopropylamine s.c. for 10 weeks. Six weeks later, a laparoscopic pancreatic biopsy was performed by the use of a pneumoperitoneum with carbon dioxide (12 mm Hg), followed by an abdominal irrigation with 5 ml normal saline (group 1, n = 20), 5 ml 0.5% taurolidine (group 2, n = 20) or 5 ml octreotide (20 mg/ml) (group 3, n = 20). After 8 weeks, all hamsters were sacrificed and histopathologically examined. There was only one macroscopic visible primary tumor in the taurolidine group (5.9%), compared to 42.1% in the saline group and 62.5% in the octreotide group (P < 0.05). The size of carcinomas was smaller in the saline group than after octreotide irrigation (median 6, range 2-25 vs. median 70, range 40-160 mm2, P < 0.05). The number of liver metastases per animal was increased after saline irrigation (median 4, range 2-6), compared to taurolidine (median 2, range 1-3) or octreotide (median 2.5, range 2-4) (P < 0.05). Port site metastases were found in 36.8% after saline, in 37.5% after octreotide and in 0% after taurolidine irrigation (P < 0.05). Thus port site metastasis was effectively prevented by taurolidine irrigation after staging-laparoscopy in pancreatic cancer.

Animals↗
PubMed1997

Superiority of laparoscopy compared to ultrasonography in diagnosis of widespread liver diseases.

The aim of the study was to compare the results of ultrasonography (US) and laparoscopy in a series of 210 patients referred to our institution for the diagnosis of widespread liver diseases. Among 205 patients, laparoscopy revealed cirrhosis in 114, chronic widespread disease in 70 (chronic persistent hepatitis in 21, chronic active hepatitis in 28, steatosis in 14, acute hepatitis in 5, fibrosis in 2), and absence of liver disease in 21. Four of these cases had minor complications. A corroborative diagnosis was obtained in 122 patients (59.5%). Overall sensitivity of US was 84% with a low specificity due to the high rate of false negatives. From the results of this study we conclude that laparoscopy is a safe and essential diagnostic tool in the final diagnosis of widespread liver diseases and that US is not a reliable screening method because of its incidence of false negatives.

Adolescent↗
PubMed2002

Disappearance of intraperitoneal gas following gynaecological laparoscopy.

We investigated 25 day case gynaecological laparoscopy patients to determine the duration of the pneumoperitoneum, the rate at which residual gas disappeared and the relative contribution of this gas to pain in the early postoperative period. The volume of gas was calculated from measurements of the subdiaphragmatic gas bubble obtained from an erect chest X-ray. Each patient was X-rayed twice, either immediately prior to discharge and at 24 h post laparoscopy, or at 24 h and 48 h post surgery. Patients were contacted by telephone at 24 and 48 h to confirm fitness to return for the X-ray and at the same time verbal pain and activity scores were recorded. We found that residual gas was almost entirely gone by 48 h following surgery and that it appeared to reduce in an exponential manner. The contribution of this gas to postoperative pain was significant in the first 24 h, but by 48 h it was considerably reduced. We conclude that in day case gynaecological laparoscopy patients, postoperative pneumoperitoneum is short-lived, and that by 48 h its volume and contribution to postoperative pain should be minimal.

Ambulatory Surgical Procedures↗
PubMed1998

Laparoscopy in the management of the impalpable undescended testis.

BACKGROUND: This study evaluates the role of laparoscopy for managing the intra-abdominal testis. METHODS: Over 30 months, 48 children (six with previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 years. RESULTS: Eleven children required insertion of 'working ports' for mobilization of obscuring colon before the diagnosis could be established. Twenty-eight children had an absent testis. In nine, vas and vessels entered the internal ring. In 19, vas and vessels ended blindly above the internal ring. Twenty children had an intra-abdominal testis. Ten underwent a laparoscopic single-stage orchidopexy (eight without and two with ligation of vessels); at a minimum follow-up of 2 years, one testis in this group had atrophied, three were located in the lower half of the scrotum and six in the upper half. The remaining ten children underwent a laparoscopic two-stage Fowler-Stephens operation. At a minimum follow-up of 6 months, eight of these testes were palpable in the lower half and two in the upper half of the scrotum. CONCLUSION In the majority of cases, laparoscopy obviates the need for groin exploration. Technically a first-stage Fowler-Stephens procedure can be performed easily and effectively via the laparoscope. However, the second-stage Fowler-Stephens procedure or single-stage orchidopexy requires laparoscopic skills and may not necessarily provide sufficient length to the testicular attachment.

Ambulatory Surgical Procedures↗
PubMed1999

Experimental study of the effect of intraperitoneal heparin on tumour implantation following laparoscopy.

BACKGROUND: Conclusions drawn from clinical reports of port site metastases following laparoscopic resection of intra-abdominal malignancy are now supported by a burgeoning experimental literature which suggests that laparoscopy promotes tumour metastasis to wounds. This study investigated the effect of intraperitoneal blood and heparin on the incidence of tumour cell implantation and port site metastasis. METHODS: Twenty-four Dark Agouti rats underwent laparoscopy with carbon dioxide insufflation and the instillation of a tumour cell suspension and/or blood into the peritoneal cavity. Rats were allocated randomly to one of the following study groups (six rats per group): (1) controls; (2) intraperitoneal blood (2 ml blood introduced from a syngeneic donor rat); (3) intraperitoneal heparin; (4) intraperitoneal blood and heparin. Rats were killed 7 days after the procedure, and the peritoneal cavity and port sites were examined for the presence of tumour. RESULTS: Tumour implantation and port site metastases were reduced by the intraperitoneal administration of heparin, but increased by the presence of intraperitoneal blood. CONCLUSION: The results of this study suggest that tumour implantation following laparoscopy is promoted by the presence of intraperitoneal blood and that this effect may be reduced by the use of intraperitoneal heparin.

Animals↗
PubMed1999

Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain.

BACKGROUND: Abdominal pain of uncertain aetiology (non-specific abdominal pain; NSAP) is the commonest reason for emergency surgical admission. The aim of this study was to examine the role of early laparoscopy in the management of NSAP. METHODS: Some 120 patients, admitted between November 1995 and October 1998 with acute abdominal pain of uncertain aetiology, were randomized into two groups: group 1 had laparoscopy during the first 18 h of admission and group 2 had close observation, conventional investigation and surgical intervention if signs of peritonism developed. Outcome measures were diagnosis, operative procedures, duration of hospital stay, readmission rate, morbidity and death, patient satisfaction and total number of investigations performed. RESULTS: Median hospital stay was 2 (range 1-13) days in both groups (P = 0.87). A diagnosis was established in 48 (81 per cent) of 59 patients in group 1 compared with 22 (36 per cent) of 61 in group 2 (P < 0.0001). The morbidity rate was 14 (24 per cent) of 59 in group 1 and 19 (31 per cent) of 61 in group 2 (P = 0.3629). The readmission rate at a median follow-up of 21 (range 1-35) months was 17 (29 per cent) of 59 in group 1 compared with 20 (33 per cent) of 61 in group 2 (P = 0. 6375). Well-being scores improved from 134 on admission to 149 of 177 6 weeks later in group 1 (P = 0.007) and from 132 to 143 of 177 in group 2 (P = 0.089). CONCLUSION: Early laparoscopy provided a higher diagnostic accuracy and improved quality of life in patients with NSAP.

Abdominal Pain↗
PubMed2002

Tumour implantation following laparoscopy using different insufflation gases.

BACKGROUND: Because of the possibility of intraperitoneal seeding and port-site recurrences following laparoscopic surgery, the role of laparoscopy in cancer surgery remains controversial. Previous experimental studies have suggested that chemical, metabolic and immunological changes following carbon dioxide (CO2) insufflation may be responsible for this phenomenon. Earlier experimental studies done by the University of Adelaide Department of Surgery have also shown that helium insufflation is associated with none of the adverse changes brought about by CO2 insufflation. Helium insufflation is also associated with lower rates of intra-abdominal tumour spread. The aim of this study was to determine whether these identified benefits apply to inert gases in general. METHODS: Twenty-four Dark Agouti rats were randomized to undergo laparoscopy with 40 min insufflation using one of the following four gases (six rats in each group); CO2, helium, argon and nitrogen. A tumour cell suspension was injected into the abdominal cavity at the beginning of laparoscopy. The rats were killed 7 days after surgery, and the peritoneal cavity and port sites were examined for the presence of tumour. RESULTS: Rats undergoing helium insufflation, had the least number of port-site recurrences and the least amount of intraperitoneal tumour spread. Argon and nitrogen pneumoperitoneum were associated with a large number of port-site recurrences and widespread tumour seeding. The effect of CO2 insufflation was intermediate. CONCLUSION: The choice of insufflation gas influences the incidence of port-site metastases and the degree of intraperitoneal tumour spread following laparoscopic cancer surgery. The reduced port-site recurrences and intraperitoneal spread that followed helium pneumoperitoneum is likely to be a unique property of this gas rather than a property of inert gases in general.

Adenocarcinoma↗
PubMed2001

Diagnostic laparoscopy in prolonged jaundice.

BACKGROUND: The early diagnosis of surgical jaundice in a neonate is an important step for the surgical success in extrahepatic biliary atresia. Diagnostic laparoscopy, as in many areas in surgery, is included in the conventional diagnostic methods of extrahepatic biliary atresia. METHODS: Since 1992, 24 infants with prolonged jaundice, in whom extrahepatic biliary atresia and neonatal hepatitis could not be differentiated with conventional diagnostic interventions, have been evaluated laparoscopically. RESULTS: A coarse, irregular, greenish-brown liver with some degree of fine angiomatous development and an atretic gallbladder are the findings of laparoscopic evaluation in an infant with extrahepatic biliary atresia. However, in neonatal hepatitis, the liver is smooth, sharp-edged, and chocolate brown in color, and simultaneously performed cholangiography should show the passage of the contrast material both into the proximal biliary tracts and the intestinal system. In this series, 10 of 24 cases were proved to be neonatal hepatitis diagnosed by laparoscopy, so unnecessary laparotomy was avoided in 42% of the cases. CONCLUSION: When the diagnostic laparoscopy, in which the liver and the gallbladder are directly visualized, is combined with the cholangiographic examination, the most accurate and earlier diagnosis in an infant with prolonged jaundice can be achieved, and the important period of time for the surgical success in extrahepatic biliary atresia will be minimally wasted.

Biliary Atresia↗
PubMed2002

Laparoscopy-assisted suction colonic biopsy and intraoperative rapid acetylcholinesterase staining during transanal pull-through for Hirschsprung's disease.

BACKGROUND: It is crucial to identify the exact level of transition to normal ganglion cells in instances of Hirschprung's disease. This report describes a technique for laparoscopy-assisted suction colonic biopsy during transanal pull-through. METHODS: Laparoscopy-assisted suction colonic biopsy (SCBx) was used in 12 patients with Hirschsprung's disease affecting the rectosigmoid. Average age was 4.4 +/- 2.1 months with a mean operative weight 6.2 +/- 1.0 kg. The pull-through was performed as the primary operative procedure in 11 patients. Using a 2-team approach (laparoscopic team and transanal team), the site was chosen for transanal suction biopsy and marked externally by the laparoscopic team with a silver clip. Biopsies were processed for ganglion cells and rapid AChE technique. RESULTS: There were no biopsy-induced perforations. Abnormal biopsies were repeated more proximally until ganglion cells were observed. Transanal pull-through was performed and an open full-thickness biopsy performed to confirm the presence of ganglion cells. All procedures were performed successfully. CONCLUSIONS: Laparoscopy-assisted SCBx can be used successfully in patients with Hirschsprung's disease affecting the rectosigmoid (80% of cases). The technique, when used with rapid AChE staining, provides accurate identification of the level of normoganglionosis.

Acetylcholinesterase↗
PubMed2003

Carbon dioxide elimination during laparoscopy in children is age dependent.

UNLABELLED: The absorption of carbon dioxide (CO2) used for positive pressure pneumoperitoneum may lead to an increased CO2 load. CO2 elimination during laparoscopy has not been investigated previously in paediatrics. The aim of this study was to characterise the pattern of CO2 elimination during laparoscopic surgery in infants and children. METHODS: Twenty children undergoing laparoscopy and 19 children undergoing laparotomy for elective abdominal operations were studied. Pneumoperitoneum was achieved using insufflation of unheated CO2. CO2 elimination (metabolically produced + absorbed; milliliters per kilogram per minute) was measured minute by minute during the operation by indirect calorimetry. End-tidal CO2 (kPa) was recorded every 10 minutes. The above variables were assessed before CO2 insufflation, during pneumoperitoneum, and after desufflation. RESULTS: Before insufflation, CO2 elimination was 4.6 +/- 0.3 ml/kg/min and increased after 15 minutes of pneumoperitoneum to 5.2 +/- 0.3 (P <.001). Post desufflation, CO2 elimination decreased toward preinsufflation values, but did not return to baseline by the end of operation (5.8 +/- 0.3; P <.001). End-tidal CO2 was 4.7 +/- 0.2 preinsufflation, peaked at 1 hour (5.3 +/- 0.2; P <.001) and subsequently decreased in response to ventilatory adjustments. The total amount of CO2 insufflated was positively correlated with patient age (r2 = 0.27; P <.01). CO2 elimination was age related, as indicated by multilevel model analysis and by negative correlations between maximum increase in CO2 elimination and both age (r2 = 0.27; P <.01) and weight (r2 = 0.29; P <.01). These data suggest that the younger or smaller the child, the larger the increase in CO2 elimination. Seven patients (35%) responded to desufflation with a sharp transient increase in CO2 elimination, which did not appear to be related to patient age, length of pneumoperitoneum, abdominal pressure, or type of operation. CONCLUSIONS: During pneumoperitoneum, younger children absorb proportionately more CO2 than older individuals. The short-lived increase in CO2 elimination postdesufflation may be related to an increase in venous return from the lower limbs after release of the abdominal pressure. These findings suggest that small children warrant close monitoring during laparoscopy and during the immediate postoperative period.

Adolescent↗
PubMedDate not supplied

Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy.

BACKGROUND AND OBJECTIVES: The effectiveness of local anesthetic wound infiltration for treatment of postoperative pain appears to be variable and partly dependent on the surgical procedure. Although evidence was lacking, it was common practice at our institution to infiltrate the trocar wound of patients undergoing day-case laparoscopic procedures with long acting local anesthetic agents. The aim of this study was to investigate the analgesic efficacy, and the influence of the timing, of local anesthetic infiltration into surgical wounds for day-case diagnostic gynecological laparoscopy. METHODS: A double-blind, randomized trial was conducted on 100 women having general anesthesia for day-case gynecological laparoscopy. Ninety-two patients who had been randomized to 1 of 4 groups for trocar wound infiltration with 30 mL of 0.25% bupivacaine or saline either before or after surgery completed the study. Incisional pain, pain on pressing the umbilicus, severity of nausea, and patient satisfaction with anesthetic technique were all assessed postoperatively until discharge and on the following day through a telephone interview. A P value of <.05 was considered significant. RESULTS: There was no difference between groups in the mean pain scores or analgesic requirements for incisional pain, pain on pressing firmly on the umbilicus, or for patient satisfaction. There was a trend for those patients who had received bupivacaine to use less postoperative morphine (P =.079). CONCLUSIONS: Wound infiltration with local anaesthetic did not significantly reduce pain or opioid requirement after gynecological laparoscopy.

Adult↗
PubMed1977

Electrocardiogram, arterial and central venous pressure during laparoscopy under local anaesthesia.

Cardiovascular hazards of laparoscopy performed under local anaesthesia and with room air pneumoperitoneum are not well known. Therefore we have recorded electrocardiogram, arterial blood pressure and central venous pressure in 63 consecutive liver patients undergoing this procedure. Electrocardiographic changes were found in 34 cases, and consisted in transistory tachycardia and bradycardia, ectopic supraventricular and ventricular beats, ST segment depression and flattening of T wave. Blood pressure did not change significantly, but five patients had transitory hypotension during the procedure. Central venous pressure did not vary immediately after inflation, but a significant increase was found during the performance of laparoscopy and it was still observed after deflation. Our findings show that cardiovascular changes during laparoscopy under local anaesthesia are minimal, and that they are probably due to neurogenic factors.

Adult↗
PubMed1976

[Laparoscopy in patients with Hodgkin's disease (author's disease)].

Laparoscopy with spleen and multiple liver biopsies was performed in 94 patients with Hodgkin's disease in stages III B and IV B. In four of them involvement of the liver was demonstrated in this way. Exploratory laparotomy was subsequently performed in 35 patients, liver involvement being revealed in only one patient in whom it had not been previously demonstrated by laparoscopy and (or) biopsy. While laparoscopy proved to be of similar value to exploratory laparotomy in assessing liver involvement, it was no substitute for operation. It was valuable in determining the stage of the disease and following its course.

Biopsy↗
PubMed2000

Diagnostic laparoscopy.

Diagnostic laparoscopy continues to play an important role in the accurate evaluation of patients with abdominal disorders. Combined with laparoscopic ultrasound, it is highly accurate in the staging of intra-abdominal malignancies, and it is superior to transcutaneous ultrasonography and computed tomography. Other important applications include the evaluation of patients with acute and chronic abdominal pain, acute abdomen, peritonitis, and blunt and penetrating abdominal trauma. Laparoscopy now rests firmly in the hands of surgeons. The majority of last year's papers originated from departments of surgery; papers on laparoscopy in hepatic disorders are sorely missing in this year's review.

Abdomen, Acute↗
PubMed2002

[Prophylaxis of Postoperative Nausea and Vomiting FollowingGynaecological Laparoscopy].

OBJECTIVE: Compared to other procedures, gynaecological laparoscopies are followed rather frequently by postoperative nausea and vomiting (PONV). Therefore, we investigated the prophylactic antiemetic efficacy of metoclopramide and droperidol under general anaesthesia with isoflurane (part 1). Given the rather unsatisfying results of this monoprophylaxis we examined the effects of a quintuple prophylaxis in this setting (part 2). METHODS: Part 1: Following ethical committee approval and written informed consent 120 patients scheduled for elective gynaecological laparoscopy were allocated prospectively, randomly and observer-blinded to the following groups: group P (placebo): 2 ml NaCl 0.9 %, group D: 2.5 mg droperidol, group M: 10 mg metoclopramide. Part 2: Subsequently 50 patients scheduled for elective gynaecological laparoscopy and bearing a minimum risk of 25 % to experience postoperative vomiting were allocated prospectively and blinded to the observers to a quintuple prophylaxis group: group X: 10 mg metoclopramide, 2.5 mg droperidol, 12.5 mg dolasetron, 62.5 mg dimenhydrinate, 8mg dexamethasone. Part 1 and 2: Anaesthesia was induced with fentanyl, etomidate and succinycholine and maintained with isoflurane/N2O, fentanyl and cisatracurium. The antiemetics were applied intravenously 20 min prior to end of surgery. RESULTS: Within the first 24 h postoperatively vomiting occurred more frequently in group P (44 %) compared to group D (21 %, p = 0.046) and group M (33 %, n. s.). Nausea also occurred more frequently in group P (61 %) compared to group D (24 %, p = 0.003) and group M (48 %, n. s.). Intensity of nausea was reduced both in group D and group M compared to group P (p = 0.03). Likewise the requirements for antiemetics as a rescue medication were reduced in group D (p = 0.02) and group M (p = 0.047) compared to group P. In group X no patient suffered from postoperative vomiting, no patient required a rescue antiemetic. CONCLUSIONS: Whereas droperidol provides a reliable antiemetic effect, the prophylactic effect of metoclopramide is rather uncertain. Therefore, further studies regarding a dose response-relationship for metoclopramide are deemed necessary. Since a monoprophylaxis with droperidol or metoclopramide failed to attain a satisfying PONV-prophylaxis in patients at high risk for PONV, the quintuple antiemetic combination might be an effective and safe solution.

Adolescent↗
PubMed2002

Diagnostic laparoscopy: an update.

Diagnostic laparoscopy has been in use since the last century. Advances in technology, coupled with increasing evidence of enhanced outcomes following its use, have renewed interest in this modality. Diagnostic laparoscopy guides surgeons in preventing unnecessary laparotomies in settings of acute abdomen, oncologists for accurate staging of malignancies from the esophagus to the colon, and hepatologists in the evaluation of acute as well as chronic liver diseases. Prospective clinical studies are awaited that will allow experimental technological advances, refining the methods of diagnostic laparoscopy, to be translated into more widespread use.

Abdomen, Acute↗
PubMed2002

[The importance of laparoscopy in blunt abdominal trauma].

The importance of laparoscopy in the management of blunt abdominal trauma should be evaluated. Therefore we retrospectively analysed all patients with blunt abdominal trauma treated in the Department of Surgery at the Carl-Thiem-Hospital Cottbus between 1998 and 2000. Within this period a total number of 53 patients with blunt abdominal trauma underwent operative treatment, 20 (37.7 %) of them had primary laparoscopy. Of the 11 cases where laparoscopic operation could be completed without conversion to exploratory laparotomy, 8 patients had intra-abdominal injuries and underwent sufficient laparoscopic treatment. The percentage of so called "negative" exploratory laparotomies within this study was 13.2 %. Our analysis suggests that laparoscopy should become firmly established in the diagnostic management and, if indicated, in the treatment of blunt abdominal trauma as well.

Abdominal Injuries↗