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At least 1,063 records · Page 59Linked to original sources
PubMed2005

[Suspicion for intraabdominal adhesions -- is open laparoscopy the gold standard?].

Laparoscopy is used for most surgical procedures in gynaecology. In general complications are rare. However, one of the most critical steps is the initial laparoscopic entry into the peritoneal cavity. According to the literature serious complications occur in approximately 1-2/1 000 cases. Whereas major vascular injuries are mainly recognised immediately, delayed recognition of bowel injuries is frequent. Complication rates of different entry procedures used in gynaecological laparoscopy are similar even in high risk patients (intraperitoneal adhesions, obesity). Utilising an open - instead a closed - entry (either by Veress needle or first trocar) technique or alternativ entry positions are suggested by some authors. This review presents data available in the literature and highlights that open laparoscopy is no gold standard.

Abdomen↗
PubMed1987

Laparoscopy with artificial ascites.

Since September, 1985 we have performed laparoscopy with artificial ascites on 52 patients. First a laparoscopy with a pneumoperitoneum (2-31 CO2) is initiated, as usual under general anesthesia. After performing an orientating inspection, the CO2 is replaced by 2-31 warm physiological saline. The gas-containing intestinal loops, the air-containing stomach and the greater omentum float on the surface of the liquid, thus causing the mesenterium to spread out. By immersing the optical instrument in the liquid, accurate inspection of the intra-peritoneal organs becomes possible. By additionally inserting the optical instrument in the right upper quadrant, examination of the omental bursa can be performed. Tumors and adhesions in the posterior abdominal cavity and between neighboring organs can be seen, and with practice surgery is even possible. Further mastery of the new technique will provide additional diagnostic information. The indication for "second-look laparotomy" or "staging laparotomy" has now been made questionable by laparoscopy with artificial ascites.

Humans↗
PubMed1992

[Treatment of acute salpingitis with tetracycline/metronidazole with or without additional balneotherapy, Augmentin or ciprofloxacin/metronidazole: a second-look laparoscopy study].

110 patients suffering from laparoscopical verified salpingitis and desire for a baby, were treated with tetracycline (oxytetracycline or doxycycline; TC)/metronidazole (n = 67), augmentan (n = 22) or cipropfloxacin/metronidazole (n = 21). After an average period of 11.6 weeks, all patients underwent second-look laparoscopy with dye insufflation. In 34 patients treated with TC/metronidazole, the effects of additional physio-therapeutical measures were examined under conditions as they prevail in a Spa. 33 patients without balneotherapy served as controls. All the 4 groups were comparable (p greater than 0.05) in respect of mean age, percentage, share of nulliparous women, salpingitis gonorrhoica, contraceptive behaviour and also of the stage of salpingitis. All antibiotic regimens used resulted in a prompt decrease of inflammatory clinical signs after five days (temperature, blood sedimentation rate, leukocytes). Only 2 of 34 patients treated by additional cure at a Spa reported complaints, whereas complaints were reported by 14 of 33 control patients (p less than 0.01), 7 of 22 (p less than 0.01) treated with augmentan and to 7 of 21 (p less than 0.01) treated with ciprofloxacin/metronidazole. The tubal occlusion rates amounted to 33.3% (TC/metronidazole), 32.3% (TC/metronidazole and balneotherapy), 22.7% (augmentan) and 23.8% ciprofloxacin/metronidazole. The differences did not attain statistical significance (p greater than 0.05). With regard to adhesions, there were, likewise, no significant differences between findings at first laparoscopy and second look-laparoscopy, respectively. It is concluded, that additional physiotherapeutic measures, after antibiotic therapy of acute salpingitis, reduce the frequency of lower abdominal pain, but do not result in an improvement of tubal occlusion and reduction of adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Open laparoscopy in patients at risk].

A variant of the technique of open laparoscopy is reported. The principal feature of this technique is that creation of a pneumoperitoneum is simplified. No additional instruments are required, nor sharp instruments, except for the skin incision and splitting of the fascia. The modified open laparoscopy technique was used on 23 high-risk patients in a group of 224 patients on whom laparoscopy was performed at Ludwigshafen Gynecological Clinic. The technique is discussed with reference to the literature.

Female↗
PubMed1988

[Indications and results of diagnostic laparoscopy in the assessment of lower abdominal pain].

Between 1976 and 1986 laparoscopy was performed in 3,584 patients to establish the cause of acute and chronic lower abdominal pain. The most frequent indications for laparoscopy were lower abdominal pain of unknown etiology, adnexitis, and adnexal tumors. The overall level of agreement between the clinical and laparoscopic diagnoses was 56.8%. In 50% of the cases with unknown etiology there was no correlation with the complaints. It also proved impossible to establish any organic cause in 8% to 32% of the other cases clinically diagnosed. The principal advantage of laparoscopy is, that the diagnosis is definite, rendering medication and laparotomy unnecessary in many cases. This applies in particular, with regard to appropriate treatment for lower abdominal pain of unknown etiology with no organic findings, and the treatment of benign ovarian cysts.

Diagnosis, Differential↗
PubMed1987

[What does laparoscopy contribute to explaining fever of unknown origin?].

The diagnostic value of laparoscopy with biopsy under vision was analysed retrospectively in 70 patients with persisting or recurrent fever of at least six weeks' duration which had remained unexplained despite detailed noninvasive studies. In 42 of these patients an intra-abdominal process had been suspected. The cause of fever was directly or indirectly diagnosed by the laparoscopy in 31 patients (44%), 29 of whom had clinical findings or abnormal biochemical results pointing to an involvement of abdominal organs. The most common laparoscopic diagnosis was granulomatous disease, isolated liver disease or malignant lymphoma. If clinical signs pointing to abdominal involvement are absent, laparoscopy is unlikely to aid in the diagnosis of fever of unknown origin.

Adolescent↗
PubMed1999

Laparoscopy combined with conventional operative techniques.

In order to establish minimal invasive methods further, it should be guaranteed that laparoscopy is not only performed in a few pediatric surgical centers. A simple approach to gain experience would be the performance of diagnostic laparoscopy. However, benefit could be increased if the surgeon combines the minimal invasive laparoscopy to establish the diagnosis with the conventional surgical technique to continue. This approach for example applies to complicated cases of appendicitis. In a combined procedure, even bowel resections and tumor extirpations can be performed with minimal invasion. In twenty-seven cases--11 appendicectomies, 14 resections of cystic ovarian tumors and 2 resections of Meckel's diverticulum--we applied this technique and found no complications so far. The surgical method presented is convenient and safe.

Appendectomy↗
PubMed1998

Wound metastasis after laparoscopy with different insufflation gases.

BACKGROUND: There is growing evidence that laparoscopy for malignancy is associated with an increased incidence of metastasis to port sites. This study investigated the effect of different insufflation gases on port-site metastasis after laparoscopy in an established animal model. METHODS: Forty-eight Dark Agouti rats with an established adenocarcinoma in the left flank underwent laparoscopic intraperitoneal tumor laceration. The gas used for insufflation was one of the following (12 rats in each group): (1) CO2, (2) N2O, (3) helium, or (4) air. Rats were killed 7 days after the procedure, and the port sites were examined for the presence of tumor metastasis. RESULTS: Tumor involvement of port sites was significantly less likely after helium insufflation than in the other groups (p < 0.0001). There was no significant difference between the air, CO2, and N2O groups. CONCLUSIONS: This study suggests that the development of metastases in port sites after laparoscopy may be influenced in part by the choice of insufflation gas used to create the pneumoperitoneum. In particular, helium was associated with a reduced rate of metastases.

Adenocarcinoma↗
PubMed1998

Staging laparoscopy in the management of intra-abdominal malignancies.

BACKGROUND: Laparoscopy in the evaluation of intra-abdominal malignancies has become a debated issue. Proponents have claimed that it increases resectability rates, whereas opponents suggest that many patients require laparotomy regardless of the laparoscopic findings. The purpose of this study was to compare outcomes in patients undergoing staging laparoscopy versus those who were managed by initial exploratory laparotomy. METHODS: The medical records of all patients during an 18-month period who underwent surgical evaluation for upper gastrointestinal or hepatobiliary malignancies were reviewed. Forty-eight patients underwent staging laparoscopy (SL) initially; 80 patients underwent initial exploratory laparotomy (EL). Data obtained included type of cancer, laparoscopic findings, laparoscopic determination of resectability, laparoscopic procedures, open determination of resectability, open procedures, and length of stay (LOS). Statistical analysis was done by using Fisher exact test or the Mann-Whitney U test. RESULTS: The malignancies of 75% of patients were deemed resectable by SL. Of these, 77.8% were resected. This compares to 56.3% resectability rate in the EL group (P = .025). SL findings in patients with unresectable malignancies were carcinomatosis (75%), liver metastasis (33.3%), and direct invasion (16.7%). In the 8 false-negative SLs, 75% were unresectable as a result of vascular invasion and 25% for other reasons. Findings in the EL group whose malignancies were unresectable were carcinomatosis (34.3%), direct invasion (22.6%), liver metastasis (42.9%), and vascular invasion only (17.1%). Therefore 82.9% of patients in the EL group could have been determined to have unresectable malignancy by SL. In the EL group 22.5% of the laparotomies were nontherapeutic, whereas 4.2% of patients in the SL group underwent nontherapeutic laparotomy. Average LOS for unresectable patients in the SL group was 0.5 days, with 75% discharged the same day of operation. This compares to 10.9 days in the EL group (P < .00001) and 7.6 days in the nontherapeutic EL group (P < .00001). CONCLUSIONS: SL increases the resectability rate, decreases the nontherapeutic laparotomy rate, and decreases LOS in patients with unresectable disease. SL is poor at detecting unresectability as a result of vascular invasion only, but this accounts for less than one-fifth of patients. Laparoscopic sonography and palliation may further decrease the need for EL.

Abdominal Neoplasms↗
PubMed2005

Comparison of carbon dioxide and room air pneumoperitoneum for day-case diagnostic laparoscopy.

Laparoscopic examination is useful in the evaluation of infertile women. To perform this test, pneumoperitoneum is required to distend the abdomen, improve visibility and displace the intestines out of the pelvis. Several gases have been used to achieve this purpose including nitrous oxide (N2O), carbon dioxide (CO2), helium, xenon and air. This is a prospective study in a private fertility centre comparing CO2 and room air pneumoperitoneum for diagnostic laparoscopy. Also the safety of room air was evaluated. One hundred and forty five patients received CO2 (group 1, n=73) or room air (group 2, n=72) pneumoperitoneum. Ketamine anaesthesia was used for all the patients and the cost of the procedure was same for the study. CO2 pneumoperitoneum offered better visibility during laparoscopy and the patients also had a better outcome: Wound infection (CO2-2/73: 2.7% Vs. Air-11/72: 15.3%); abdominal discomfort (feeling of retained gas in the abdomen) CO2-5/73: 6.9% Vs. Air-61/72: 84.7%) and shoulder pain (CO2-0/73; 0.0% Vs. Air-56/72: 77.8%). Group 1 patients returned to normal activity earlier (1.5 days +/- 1.3 SD Vs. 4.8 days +/- 2.1 SD). We conclude that CO2 pneumoperitoneum has a better outcome than Air especially for day-case diagnostic laparoscopy. However, room Air pneumoperitoneum is safe, cheap, and available and may be recommended for low resource settings.

Air↗
PubMed2005

The cost of out-patient culdoscopy compared to in-patient laparoscopy in women with infertility.

Diagnostic laparoscopy is a common procedure performed in many hospitals worldwide to investigate infertile women. However, morbidity and cost prevent it being considered a first-line diagnostic tool. If out-patient culdoscopy could replace in-patient laparoscopy then a major component of the cost of investigations could be avoided. We studied ten consecutive infertile patients who had laparoscopy under general anaesthesia and another ten patients who had culdoscopy under local anaesthesia in The One Stop Fertility Clinic (OSFC) in The Royal Free Hospital in London. The costs for each patient from both groups was calculated and compared. We found that out-patient investigation in an OSFC produced a saving of over 350 pounds sterling per case or 28% to the hospital compared with in-patient investigation. Although there were other factors which may influence the costs of out-patient culdoscopy, it did provide noticeable savings to the healthcare system.

Adult↗
PubMed1985

Laparoscopy in small animal medicine.

Laparoscopy is described as a safe, simple, and relatively non-invasive diagnostic technique for the visualization of abdominal organs. The instruments required, the procedure of laparoscopy, and indications and contra-indications are described. The advantages of laparoscopy above laparotomy are discussed.

Anesthesia, General↗
PubMed2002

Scoring and diagnostic laparoscopy for suspected appendicitis.

OBJECTIVE: To develop a reproducible scoring system to identify patients who present with a doubtful diagnosis of appendicitis and who would benefit from diagnostic laparoscopy. DESIGN: Prospective observational study. SETTING: Regional teaching hospital, The Netherlands. SUBJECTS: 577 consecutive patients during the period 1994-5, and 343 who presented during the period 1996-7. INTERVENTIONS: The variables that seemed to be predictive of acute appendicitis were abstracted from the earlier group. a logistic regression analysis applied, and score created. The score was validated on the 343 patients who presented during 1996-7, and then the groups were combined for further analysis. MAIN OUTCOME MEASURES: Reproducibility of the scoring system obtained by comparing odds ratios (OR) of the two groups; its effectiveness judged by comparing the delayed and normal appendicectomy rates. RESULTS: The following variables were significantly correlated with the presence of acute appendicitis: white cell count 10 x 10(9)/L or more (score 3), rebound tenderness and male sex (score 2 each); and symptoms present for < 48 hrs and temperature 38 degrees C or more (score 1 each). The OR for the two groups were 1.80 and 1.76, respectively, indicating that score was reproducible. With a sensitivity of 93% and a specificity of 83% it would be at least as accurate as clinical judgment. The normal appendicectomy rate would be 7% instead of 9%. and the negative exploration rates (laparoscopy and primary appendicectomy) would both be 22%. The score would also result in a lower perforation rate (2% compared with 17%). CONCLUSION: The score can indicate when there is an indication for laparoscopy in patients with suspected appendicitis.

Adult↗
PubMed1999

Laparoscopic v laparoscopy-assisted donor nephrectomy in the porcine model.

PURPOSE: Laparoscopic donor nephrectomy is an established procedure in the porcine model. We sought to compare intraoperative variables between live laparoscopic (LAP) and laparoscopy-assisted (LAP-A) donor nephrectomy. MATERIALS AND METHODS: Eight domestic pigs underwent either traditional laparoscopic donor nephrectomy (N = 4) or laparoscopy-assisted donor nephrectomy (N = 4) using the Pneumosleeve followed by conventional heterotopic autotransplantation. RESULTS: No significant differences were noted between the groups with regard to vessel length, ureteral length, or postoperative urine output. The operating room time was 108+/-12 minutes in the LAP group v 75.8+/-10.3 minutes in the LAP-A group (P = 0.0065). Although the difference was not statistically significant, warm ischemic time, tended to be lower in the LAP-A than the LAP group: 70+/-3.0 seconds v 135+/-57 seconds, respectively (P = 0.059). Graft survival was identical in the two groups. CONCLUSION: Laparoscopy-assisted (via Pneumosleeve) live donor nephrectomy shortens the operative time without affecting graft survival in the domestic swine model.

Animals↗
PubMed2005

Laparoscopy.

Urologists around the world are doing more laparoscopy, with renal surgery being the most common procedure. Almost a third devote more than 20% of their practices to laparoscopy. Among those who do not use laparoscopy, lack of training and equipment are the most common reasons.

Asia↗
PubMed1994

Operative laparoscopy for the treatment of localized chronic pelvic-abdominal pain caused by postoperative adhesions.

One hundred fifty-six patients with chronic abdominal pain associated with postoperative adhesions were treated with laser laparoscopy. Eighty-eight percent of these patients had complete relief, 9% had satisfactory relief, and 3% required a second laparoscopy to lyse recurrent adhesions. It is concluded that chronic abdominal pain associated with adhesions can be treated successfully with laser laparoscopy.

Abdominal Pain↗
PubMed1997

Clinical experience with open laparoscopy.

A modified method of open laparoscopy was performed on 568 consecutive patients requiring laparoscopy or laparoscopic surgery. There were no intraoperative complications related to the technique. All patients were reviewed at 1 week following surgery; 4% had minor umbilical sepsis, while none had a postoperative hernia. The modifications to the technique of open laparoscopy described here make it simple and efficient while maintaining the safety inherent with this technique.

Cholecystectomy, Laparoscopic↗
PubMed1998

Laparoscopy in the diagnosis and management of Crohn's disease.

We have tried to evaluate the role of laparoscopy and laparoscopic-assisted surgery in the management of Crohn's disease. Over a 4-year period, we had 38 patients, of which 23 patients were suspected to have Crohn's disease and were admitted for diagnostic laparoscopy while 15 patients had already had a biopsy confirmation of Crohn's disease in the past and were admitted for specifically planned procedures. In the first group of 23 patients, 11 were found not to have Crohn's disease. In the remaining 12 patients, three were proven to have Crohn's disease, but no surgical procedure was undertaken. The remaining nine patients underwent laparoscopic-assisted procedures, of which two required conversion to a laparotomy because of intra-abdominal abscesses. All 15 patients in the second group underwent laparoscopic or laparoscopic-assisted procedures. In total, 14 patients were spared a potential diagnostic laparotomy and could go home the next day. The remaining 24 patients underwent procedures requiring longer hospital stays; five had a purely laparoscopic procedure, 17 had a laparoscopic-assisted procedure, and two required a laparotomy. Although there was little difference in the median stay for patients treated laparoscopically or by laparotomy, it is thought that the extent or severity of the disease process influenced the length of the stay rather than the approach used. The complication rate was similar to that found in Crohn's patients undergoing open surgery. It remains to be seen whether those in the laparoscopically treated group have less adhesive complications than those treated by laparotomy. It is our belief that laparoscopy is a valuable aid in the diagnosis of Crohn's disease. It remains to be proven whether or not laparoscopic-assisted surgery will be of significant value in the treatment of this condition.

Adolescent↗