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At least 1,153 records · Page 64Linked to original sources
PubMed2002

[Gasless laparoscopy-assisted live donor nephrectomy].

PURPOSE: We evaluated both efficacy and feasibility of laparoscopy-assisted live donor nephrectomy. MATERIALS AND METHODS: Since September 2000, 11 living kidney donors (2 males and 9 females) underwent laparoscopy-assisted live donor nephrectomy. All of sides were left. Gasless surgery was performed with a 7 cm pararectal upper abdominal incision and three trocars via a retroperitoneal approach. After creating the working space using balloon dissection technique, the abdominal wall was lifted using a metal retractor attached to the margin of the abdominal incision. Additionally, a metal plate, which was attached to the abdominal wall inside, was raised. The surgeon dissected left kidney from the skin incision under both direct vision and magnificated view on the monitor. RESULTS: The operating time, estimated blood loss and warm ischemic time were a mean of 209 minutes, 219 g, and 4.2 minutes, respectively. The mean times for the return to a normal diet and unassisted ambulation were 1.3 and 1.8 days, respectively. One case required blood transfusion due to subcutaneous hematoma at trocar entry site on the second day after surgery, in the remaining 10 cases there were no complications. All of donated kidneys achieved immediate function after engraftment. CONCLUSIONS: Gasless laparoscopy-assisted donor nephrectomy is recommended and advantageous for healthy kidney donors as a minimally invasive method.

Adult↗
PubMedDate not supplied

The accuracy of diagnostic laparoscopy in trauma patients: a prospective, controlled study.

BACKGROUND: Numerous studies advocate the use of diagnostic laparoscopy (DL) for abdominal trauma, but none have documented its ability to diagnose specific injuries. This study tests the hypothesis that DL can accurately identify all significant intra-abdominal injuries in trauma patients. METHODS: Of trauma patients requiring laparotomy for presumed injuries, 47 underwent DL followed by laparotomy. Injuries noted at laparoscopy were compared with those found at laparotomy. RESULTS: Of these, 14 patients had no significant injuries necessitating operative intervention noted at laparoscopy and celiotomy. The remaining 33 patients harbored 93 significant injuries at laparotomy, of which only 57.0% were found by DL. DL possessed poor sensitivity (<50%) for injuries to hollow viscera. Despite DL's poor performance in finding specific injuries, it possessed excellent sensitivity (96.2%), and specificity (100%) for determining the need for therapeutic celiotomy. CONCLUSIONS: DL offers no clear advantage over diagnostic peritoneal lavage and computed tomography in blunt trauma. Its utility lies in assessment of the need for laparotomy in patients with penetrating wounds. Currently, DL cannot consistently identify all abdominal injuries, disqualifying it as a therapeutic tool in abdominal trauma.

Abdominal Injuries↗
PubMed1994

Day-case laparoscopy revisited: have post-operative morbidity and patient acceptance improved?

Previous studies of day-case laparoscopy have indicated considerable post-operative morbidity, with high incidences of nausea, vomiting and pain, often resulting in overnight admission. These studies also indicate that 30% of patients would have preferred an overnight stay. Changes in day surgery anaesthetic practice since then have included the wider use of non-steroidal analgesics and the specific use of propofol, a new short acting anaesthetic drug, with improved recovery and anti-emetic properties. We audited 74 patients who had day-case laparoscopy for diagnosis or sterilisation, and found that the incidence of nausea and vomiting was lower than any previously recorded, and mean pain scores were minimal. No patient was admitted for recovery problems, despite the inclusion of afternoon procedures; two patients only were admitted for surgical complications. Despite considerable morbidity after their return home, only 8% of patients said they would have preferred an overnight stay. Changes in anaesthetic practice would seem to make day-case laparoscopy a more acceptable procedure than previously reported.

Adult↗
PubMed1999

[Laparoscopic transsection of Ladd's bands: a new indication for therapeutic laparoscopy in neonates].

Within the last ten years and by the introduction of some new instruments, laparoscopy is a safe and effective method that has been further extended in children. We report our experience in the treatment of laparoscopy on a seven day old newborn affected by malrotation with an intermittent duodenal obstruction. The treatment consisted of a duodenal liberation after the section was easily performed in congenital Ladd's bands. The spiral twists of the small intestine found in the upper gastrointestinal series, disappeared in a new study done after surgery. We consider this operation as a new indication for an operative laparoscopy. It allows a good visualization of this congenital abnormality, and it is easy to perform with a significantly reduced operative trauma.

Duodenal Obstruction↗
PubMed1998

[The cost of laparoscopy in the diagnosis of female infertility].

DESIGN: The aim of the study was to estimate the usefulness of laparoscopy in diagnostics of women's infertility. MATERIALS AND METHODS: This study is a retrospective review of the notes of 133 infertile women who had undergone laparoscopic procedures--in 88 (66.2%) patients the reason of their infertility was unknown (study group I) and in 45 (33.8%) pelvic pathology (PCO syndrome-37 cases, endometriosis-6 cases and tubal inpatency-2 cases) was supposed (study group II). RESULTS: In 96 (72.2%) patients (in 51 from group I and in 45 from group II) pelvic pathology was estimated (p < 0.0001 in comparison with diagnostic estimation before laparoscopy). Most frequent pathology in women with unexplained infertility was seen: endometriosis, adhesions and tubal inpatency. During laparoscopy procedure we changed totally preoperative diagnosis in 43.6% patients (58 cases--51 from group I and 7 from group II) and in 9.8% women additional pelvic abnormalities were detected. CONCLUSION: In authors opinion the laparoscopic procedure is very helpful in infertile women and ought to be included in diagnostic standard in cases of unexplained infertility.

Adult↗
PubMed1999

[Vascular complications during laparoscopy. An analysis of a personal case].

Vascular complications of laparoscopy most often occur during Veress needle or primary trocar placement. Veress needle punctures are insignificant and require no further treatment, whereas trocar induced vascular injuries can be catastrophic. The frequency of vascular or viscus injuries is difficult to calculate since several complications are not published. A vascular complication occurred in a young girl with neurologic problems and a kyphoscoliosis operated on in laparoscopy for a gastroesophageal reflux is discussed. After the establishment of pneumoperitoneum, an important hemoperitoneum was rapidly evident at insertion of the laparoscope. An open laparotomy was performed showing right common iliac vessel injuries and several intestinal perforations. After a complex vascular reconstruction and a multiple intestinal suture, the Nissen fundoplication with pyloroplasty was performed traditionally and the patient leave the hospital free of symptoms after 20 days. In laparoscopy, as in all areas of surgery, experience knowledge and meticulous attention to details are the most important factors in order to avoid complications. The authors believe that the open approach with Hasson cannula is the most important factor in avoiding complications.

Child, Preschool↗
PubMed1999

Diagnostic and therapeutic laparoscopy for the adult cryptorchid testicle.

Laparoscopy can be utilized in the management of male patients with impalpable gonads. However, there have been few reports of its application in the management of adult men with cryptorchidism. Fourteen adult men with 15 undescended testicles were referred to our urology department over 6 years. Eight testicles from seven men could not be localized clinically or radiographically to the inguinal canal. Laparoscopy was utilized to assess for the presence and location of the gonad and to perform orchiectomy when testicular tissue was encountered. The average age of the seven men undergoing laparoscopy was 40 years. Three testicles were found proximal to the internal ring and were removed using laparoscopic techniques. The ipsilateral testicular vessels and vas deferens were visualized entering the internal ring in three cases and dense ipsilateral adhesions from previous inguinal surgery prevented adequate visualization of the cord structures in one individual, leading to four inguinal explorations in the same setting. Two inguinal orchiectomies were performed and two vanishing testicles were identified. Gonadal vessels were absent in the remaining patient as demonstrated by extensive laparoscopic dissection. The average total operative time was 105 minutes, which included additional procedures in four patients. No patient experienced an intraoperative or postoperative complication. Six of seven patients were discharged on the day of surgery. An intratesticular germ cell neoplasm was found in one of seven specimens, which stresses the importance of diagnosing and managing this uncommon problem in the adult man.

Adult↗
PubMed1999

Total intravenous anesthesia using propofol and ketamine for ambulatory gynecologic laparoscopy.

Laparoscopy under total intravenous anesthesia (TIVA) with spontaneous respiration is a commonly encountered procedure in ambulatory gynecologic surgery. The purpose of this study was to evaluate the efficacy of TIVA using propofol and ketamine, compared with endotracheal inhalational general anesthesia (EIGA) for ambulatory gynecologic laparoscopy. Fifty-eight female patients, aged 17-48 years, were randomly allocated into two groups. Group 1 (TIVA) (n = 28) received propofol at the induction of anesthesia followed by propofol infusion for maintenance. Intravenous ketamine 0.5 mg/kg was administered before operation for anesthetic effect. Natural airway and spontaneous breathing were then maintained in patients. Group 2 (n = 30) received EIGA with isoflurane under controlled ventilation. We found that the two groups demonstrated similar trend characters of pH and PaCO2 during operation and in recovery room. The incidence of postoperative vomiting was higher in group 2 than in group 1 (30% vs. 7%; p < 0.05). The incidence of intraoperative arrhythmia was higher in group 2 than in group 1 (40% vs. 3%; p < 0.001). Furthermore, the incidence of sore throat was higher in group 2 than in group 1 (47% vs. 7%; p < 0.001). We conclude that TIVA with spontaneous respiration is suitable for ambulatory gynecologic laparoscopy.

Adolescent↗
PubMed1999

Preoperative laparoscopy in the management of the nonpalpable testis.

The purpose of laparoscopy in the management of the nonpalpable testis is to provide information regarding testicular presence and location to facilitate overall surgical management. Laparoscopy was performed at operation in 20 patients between 14 months to 21 years old (average 63 months), who had 22 nonpalpable testes. Of the testes 13 (59 per cent) were in the inguinal region or just proximal to the inguinal ring, 8 (36 per cent) were in a high intra-abdominal position and 1 (5 per cent) were absent. Anatomical localization of nonpalpable testes facilitated accurate planning of operative repair and the laparoscopy rendered exploration unnecessary in patients with intraabdominal vanishing testes syndrome, and laparoscopic orchiectomy is the treatment for the unilateral intraabdominal testes in patients more than 10 years old.

Adolescent↗
PubMed2000

[Staging laparoscopy for a patient with advanced gastric cancer whose serum CA 19-9 level decreased remarkably after 2 courses of F/P therapy].

The prognosis of patients with Stage IVb gastric cancer remains poor, and therapy for these patients is not easy. Recently, neoadjuvant chemotherapy is thought to be one of the better strategies for such patients. In this paper, we report a 48-year-old female patient with advanced gastric cancer whose serum CA 19-9 level decreased remarkably after 2 courses of F/P therapy. We also operated on this patient with staging laparoscopy, a new and more useful technique for the patients such as the present one. The advantages of staging laparoscopy are as follows: 1. The entire intraabdominal space can be observed from a small wound, and the clinical stage of the patient can be diagnosed more correctly. 2. It is easy to obtain cells from small amounts of ascites or tissues of small nodules in the abdominal wall and lymph node involvements. 3. Patients suffer less pain and movement of the body is not as limited after operation. 4. Administering drugs into the intra abdominal space is easy using this technique. Staging laparoscopy might therefore be one of the better surgical strategies for the patients with advanced patients when selecting a suitable therapy.

Adenocarcinoma↗
PubMed2000

[A comparative study between hysterosalpingography and laparoscopy in evaluating female infertility].

The diagnostic accuracy of hysterosalpingography and laparoscopy was compared. One hundred fourty three infertile women were prospectively investigated in two years duration. Laparoscopic chromopertubation using methylen blue dye performed on days 8-16. Hysterosalpingography performed on days 7-10 with water soluble contrast medium. There was agreement between the results of both methods in 66.4 per cent /95/ of the patients. In 15 of the 63 patients with a normal hysterosalpingography, however, peritubal or tubal disease was observed at the time of laparoscopy/false-negative results, 10.4%/Eighty patients with tubal obstructions were detected by hysterosalpingography, but 33 obstructions were not confirmed by laparoscopy/false-positive results, 23%/. The greatest discrepancy between the hysterosalpingography and laparoscopy was found in peritubal adhesions--58.7%. Laparoscopic evaluation demonstrated also endometriosis in 41 cases, poly cystic ovaries in 12, ovarian cyst in 9, and uterine fibroids in 15. Intrauterine abnormalities were diagnosed by hysterosalpingography in only 2.9% per cent of the patients. No significant laparoscopic complications were noted. The results suggest that hysterosalpingography is useful as a primary screening procedure, but laparoscopy provides a more accurate assessment of tubal patency and peritoneal factors in the investigation of infertility.

Adult↗
PubMed2000

Are liver cirrhosis and portal hypertension associated with an increased risk of bleeding during laparoscopy? A retrospective analysis of 1,000 consecutive cases.

Laparoscopy is a relatively safe invasive procedure. However, the rate of bleeding complications during this procedure is still debatable. Moreover, it is not clear whether portal hypertension may increase the risk of this event. The authors analyzed retrospectively the records of 1,000 consecutive patients with chronic liver disease undergoing laparoscopy and guided direct-vision hepatic biopsy, and they examined the rate of bleeding complications from the trocar site after insertion of the Veress needle or after liver biopsy. A total of 400 of 1,000 patients had liver cirrhosis. Of these, 22.7% had splenomegaly, 13.0% had laparoscopic signs of portal hypertension, and 8.2% had esophageal varices. Bleeding occurred in 0.9% of patients from the trocar site, in 0.2% from the biopsy site, and in 0% from the Veress needle site. These figures were independent of the presence of advanced liver disease, with or without portal hypertension. Bleeding complications occur rarely during laparoscopy with guided liver biopsy and do not seem to be related per se to the presence of liver cirrhosis and portal hypertension. If anything, bleeding complications represent an unpredictable event in most cases.

Adolescent↗
PubMed2000

[Ovarian transposition by laparoscopy in young women before curietherapy for cervical cancer].

OBJECTIVES: To evaluate the place of ovarian transposition by laparoscopy in an effort to preserve ovarian function without compromising oncological safety among young women requiring intravaginal brachytherapy before surgery for cervical cancer. MATERIAL AND METHODS: The series was represented by 20 cases, all FIGO stage I squamous cell malignant diseases of the cervix. Mean age: 32 years (range 23-40). Oophoropexy (7 instances) or lateral high ovarian transposition (13 instances) was performed by laparoscopy, just before brachytherapy using cesium 137. RESULTS: Continued hormonal function was achieved in 58% of the available cases, 50% (3/6) after oophoropexy, 68% (8/11) after ovarian transposition. Mean follow-up was 8.5 years (range 5-13). The mean radiation dose absorbed by the displaced ovary was 2.6 Gy (range 1. 2-5.9). CONCLUSION: Ovarian transposition through laparoscopy before brachytherapy should be advised for selected stage I squamous type malignant tumor size 2 cm without lymphatic/vascular channel invasion by neoplastic emboli and without lymph node involvement. This procedure has been abandoned in our institution, instead of this, primary surgical treatment is accomplished (laparoscopically-assisted vaginal) radical hysterectomy is associated with orthotopic ovarian conservation.

Adult↗
PubMed2000

[Endometriosis as an unexpected finding during laparoscopy on sterile women].

OBJECTIVES: Assessment of the laparoscopy as endoscope method at diagnosing as unsuspected finding at sterile women. MATERIALS AND METHODS: Studying is retrospective and includes 20 years period of time (1976-1996). We have examined the documentation of 912 patients on whom performed laparoscopy. 678 from them have been primary and 234 have been with secondary sterility. RESULTS: We have established the following findings: cases only with endometriosis--164 patients; endometriosis and polycystic disease of the ovaries--11 patients; endometriosis and tubal sterility--42 patients; endometriosis and pelvic inflammatory disease (PID)--56 patients; endometriosis and uterus myomatosus--6 patients. DISCUSSION: Diagnosis of endometriosis by laparoscopy effectively helps in the further treatment of sterile women.

Adnexal Diseases↗
PubMed2000

[Laparoscopy in diagnosis and treatment of acute abdominal diseases in children].

2765 children with abdominal pains were observed in the clinic of pediatric surgery from 1995 to 1999. During the observation period the abdominal pains persisted in 85 children. As it was not possible to resect the acute abdominal diseases, these children underwent diagnostic laparoscopy. Destructive changes in the appendix were revealed in 12 patients, 73 patients have avoided unnecessary laparotomy and appendectomy. It is concluded that diagnostic potential of laparoscopy is not inferior to diagnostic laparotomy. Moreover laparoscopy has advantage as a method of final diagnosis.

Abdomen, Acute↗
PubMed2001

[The general surgeon's experience in emergency gynaecological laparoscopy].

BACKGROUND: Early laparoscopy plays a very important role in the diagnosis and treatment of uncertain surgical diseases. Its use is not very clear, in part because it is a very new technique and secondly because its application in emergency surgery is very recent. The aim of this study is to evaluate the efficacy of this surgical approach. METHODS: In the last six years, during emergency laparoscopy, we diagnosed various gynaecological diseases. We performed 4 ovarian cystectomies (25%), 2 salpingectomies (12.5%), 6 salpingo-oophorectomies (37.5%), 2 myomectomies (18.75%), 1 endocoagulation (6.25%). RESULTS: Neither conversion in open surgery, nor major postoperatory complications were noted. Intervention time was shorter than that of the open technique. Return to normal activity was earlier. CONCLUSIONS: The results of this study contribute to demonstrate that, in emergency surgery, laparoscopy constitute a valid and efficient diagnostic and therapeutic technique. It is indicated for the treatment of acute abdomen of unknown origin.

Adult↗
PubMed2001

[Retrospective comparative study of extended nephrectomies by surgery and by retroperitoneal laparoscopy].

OBJECTIVE: To evaluate the results of radical retroperitoneal laparoscopic nephrectomy in terms of tolerance, morbidity and oncologic control. MATERIAL AND METHODS: 22 radical nephrectomies have been carried out by retroperitoneal laparoscopy. One surgical conversion has been necessary. This series has been retrospectively compared to 16 radical nephrectomies by open surgery. RESULTS: Both series were comparable. Operative time was not significantly different in the two groups. Blood loss was less with laparoscopic surgery (p < 10-3). We did not see any difference in antalgic consumption during the first post-operative day and in intensive care and hospital stay. Post-operative complications were less in the laparoscopy group (p = 0.04). We observed no death or reccurrence with a mean follow-up of 8.7 months for the laparoscopy group vs 32.2 for the open group. CONCLUSIONS: Radical retroperitoneal laparoscopic nephrectomy is a recent surgical technique which has the same oncologic standards as open surgery. Blood loss and post-operative complications are significantly reduced. Survival needs to be evaluated on long term follow-up.

Female↗
PubMed2001

Gynecological procedures under gasless laparoscopy.

OBJECTIVE: To evaluate gasless laparoscopy in treating gynecological conditions. METHODS: With Kirschner wire lifting, transversely or longitudinally introduced into abdominal wall subcutaneously, we exposed the operative field and pelvic organs with routine operative instruments under epidural anesthesia. When a dense pelvic adhesion was confronted, we used the temporarily low-pressured pneumolaparoscopy to dissect it. RESULTS: All procedures were carried out without organ injury, hematoma, or other complications. The operative field can be clearly seen with this method. The mean time for appendagectomy was one hour and for laparoscopic assisted vaginal hysterectomy 80 minutes. CONCLUSION: Gasless laparoscopy avoids the complications which occur in the routine laparoscopy such as subcutaneous or mediastinal pneumatoma, hypercarbonemia, air embolism, cardiopulmonary dysfunction. Our lifting method is simple, convenient, time and money saving, as well as more flexible for treating gynecological conditions.

Adult↗