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PubMed1992

[Laparoscopy in diagnosing and treating endometriosis].

Clinical study in 98 women with genital endometriosis was performed. In 33 patient endometriosis was treated by operative laparoscopy-electrocauterization of foci in 20 women, ovarian cyst resection in 9 and cyst extrication in 4. In 10 cases laparoscopy was followed by laparotomy. Very high correlation between endometriosis and infertility was found (71.4%). Very few patients conceived till now (28.57%). Searching in the time of laparoscopy very subtle foci of endometriosis was stressed.

Adult↗
PubMed1992

[Nineteen years of laparoscopy in the gynecology clinic IPG PAM].

The aim of the paper was the analysis of 1450 laparoscopic procedures performed in the Clinic of Gynecology--IOG PMA in Szczecin in the years from 1974 to 1992. The above number include 320 laparoscopic operations. In the analyzed three five-year periods, the number of laparoscopies increased twofold, while in the years 1989-1992 it constituted 26.8% of all the operative procedures. Indication for laparoscopy in 74.6% of cases was sterility, in 13.38% pelvic pain of undefined etiology, in 7.7% ectopic pregnancy, 1.8% oncologic indications, in 0.5% internal ones, in 0.3% sterilization and others in 1.6%. Among operative laparoscopies electrocoagulation of endometriosis was carried out in 46.6% of cases, resection of intraperitoneal adhesions in 27.5%, in the region of abdominal orifices of oviducts in 7.5%, ectopic pregnancy operations in 7.2%, excision of ovarian cysts in 6.6% as well as extirpation of myomas in 4.7%. At the analyzed period the following complications were disclosed, namely: interstitial lesion in 2 cases, hemorrhage from inferior epigastric artery in 1 and subcutaneous emphysema in 34 cases.

Female↗
PubMed1975

[Position and significance of gynecologic laparoscopy].

Over the last 1 1/2 years diagnostic laparoscopy has been performed in 135 cases and laparoscopic tubal cauterization carried out in 15 patients. Indications and the diagnostic Value of the gynecological laparoscopy are discussed. In agreement with other authors, laparoscopy is found to have a definite place for the diagnosis of the following gynecological disorders and complaints: 1. Examination of fallopian tubes in cases of infertility, diagnosis of malformations of the genital organs and of grave functional disorders of the ovaries; 2. Possible ectopic pregnancy; 3. Differential diagnosis of pelvic mass; 4. Evaluation of chronic pelvic pain; 5. Differential diagnosis of acute diseases of pelvic and lower abdominal organs. Histological examinations of coagulated human fallopian tubes yielded information on the mechanism of action of this modern method of sterilization.

Diagnosis, Differential↗
PubMedDate not supplied

Operative laparoscopy for uterine pathology.

In the first years of its use, operative laparoscopy for uterine pathology was employed in the surgical treatment of myomas and in the correction of uterine retroversion (hysteropexy). More recently the technique has been employed for the laparoscopically assisted hysterectomy or for subtotal laparoscopical hysterectomy using the Semm Kit. Also radical hysterectomy has been performed in advanced centers by laparoscopy. In this paper, the Authors discuss the indications, the counterindications, the risks and complications of the operative laparoscopy in the different forms of ovarian pathology.

Female↗
PubMedDate not supplied

Operative laparoscopy for pelvic and extrapelvic pathology.

The treatment of pelvic adhesions has been the first and more successful indication for operative laparoscopy. Frequently this intervention is the first step of others laparoscopic procedures. The different modalities of these interventions, i.e. by electrocautery or by scissor, or by laser are discussed. Among indications of operative laparoscopy for pelvic pathology the treatment of endometrial implants has been considered. In this paper less frequent indications for operative laparoscopy as pelvic abscess, or complementary operation as appendicectomy and colecistectomy are also discussed.

Abscess↗
PubMed1976

[Laparoscopy in the diagnosis and differential diagnosis of ascites].

Ascites was found in 772 (30,89%) from all the 2500 laparoscopy examined patients. Ascites was due to liver cirrhosis in 57.78 per cent of the patients, to peritoneum carcinosis in 26.29 per cent and to primary and metastatic liver carcinoma in 12.95 per cent, to tuberculous peritonitis in 1.42 per cent and more seldom to some other diseases. A reliable diagnosis of liver cirrhosis, malignant tumors and the rest of the liver diseases, progressing with ascites is made by laparoscopy. Laparoscopy with a biopsy of peritoneum and liver is of decisive importance in the differentiation of peritoneum carcinosis and tuberculosisé. The clinico-laboratory diagnosis in carcinosis coincides completely with the laparoscopic one, the histologic--in 24.5 per cent, partially in 45.5 per cent and in 30 per cent it fails completely to coincide.

Abdominal Neoplasms↗
PubMed1976

Sequential laparoscopy and laparotomy combined with bone marrow biopsy in staging Hodgkin's disease.

In a series of 121 unselected, previously untreated patients with Hodgkin's disease staging laparoscopy combined with needle bone marrow biopsy detected the presence of extranodal disease in the liver or marrow or both in 9% of the patients. A spleen biopsy yielded positive findings in 13%. Subsequent laparotomy with open marrow biopsy performed in 110 patients with negative liver and marrow findings from the first combined procedure revealed the presence of extranodal hepatic lymphoma in two additional spleens. Surgical marrow biopsy was always interpretey. Although devoid of major complications, biopsy of the spleen is not recommended as a routine procedure in staging laparoscopy. This prospective sequential study confirms that laparoscopy plus needle marrow biopsy is a useful, rapid, safe, and economic procedure to establish stage IV disease in the large majority of patients with nodal involvement. Considering the recent more extensive use of chemotherapy for intermediate stages of Hodgkin's disease, our findings suggest that laparotomy with splenectomy needs a critical re-evaluation as a routine staging procedure for patients with no overt extranodal lymphoma.

Biopsy, Needle↗
PubMed1977

Laparoscopy and hysterosalpingography in the assessment of tubal patency.

Laparoscopy was performed after hysterosalpingography in 409 patients complaining of infertility. Despite the use of general anesthesia and continuous screening technics during hysterosalpingography, conflicting diagnoses were made in 77 of the 117 patients where an abnormality of patency was detected by one or another technic. Peritubal adhesions were detected by hysterosalpingography in only 18 of the 54 cases where they were demonstrated by laparoscopy. Laparoscopy gave much useful information either at variance with or in addition to that yielded by hysterosalpingography.

Fallopian Tube Patency Tests↗
PubMed1977

Hospitalization for laparoscopy. The exception rather than the rule.

After studying a series of patients who underwent laparoscopy, the authors found that they are currently hospitalizing only 6.6% of them. They found that more patients are hospitalized for diagnostic laparoscopy than for surgical laparoscopy because of the potential need for laparotomy.

Female↗
PubMed1977

[Laparoscopy in the diagnosis and differential diagnosis of ascites].

Out of 2,500 patients who underwent laparoscopy 772 (30.89%) had ascites; liver cirrhosis underlay it in 57.78%, peritoneal carcinosis in 26.29%, primary and metastatic carcinoma, respectively, in 12.95%, tuberculous peritonitis in 1.42%, more rarely other diseases. Liver cirrhosis, malignant tumours and the other hepatic affections with concomitant ascites in their course can certainly be diagnosed laparoscopically. Laparoscopy with oriented biopsy of peritoneum and liver is of decisive importance in differentiating peritoneal carcinosis from tuberculosis. In peritoneal carcinosis the diagnosis (as based in clinical and laboratory findings) coincided perfectly with the laparoscopic and histologic one in 24.5%, partially in 45.5%. In 30% there was no congruence at all. Laparoscopy and the test methods associated with it contributed to the accurate diagnosis of peritoneal carcinosis in 75.5% of the patients. Ovarian carcinoma (20.9%) and cancer of the stomach (16.3%) underlay peritoneal carcinosis most frequently, other diseases by far more seldom.

Adult↗
PubMed1977

The use of laparoscopy to determine the results of chemotherapy for ovarian cancer.

The chemotherapeutic management of patients with epithelial tumors of the ovary is hampered by a lack of diagnostic tests that are sufficiently sensitive for detecting residual or recurrent tumor. At the completion of a chemotherapy program, direct visualization of the peritoneal cavity is necessary to accurately assess the amount and location of residual tumor. Laparoscopy, with visually directed biopsies of residual tumor masses, can spare some patients a laparotomy and yet provide a safe and easy route for assessment of intraabdominal disease. If residual tumor is not seen at laparoscopy, than laparotomy with multiple peritoneal biopsies must be done so that residual tumor will not be missed and chemotherapy prematurely stopped. Laparoscopy is not an alternative to "second look" laparotomy but is a useful adjunct for determining the presence of resectable, unresectable or diffuse disease after chemotherapy.

Female↗
PubMed1992

The role of laparoscopy in the diagnosis of acute appendicitis.

Patients with acute appendicitis who present with an atypical clinical picture are frequently subjected to a series of laboratory and x ray tests and sometimes to prolonged observation before surgery. There is a significant number of normal appendixes found at laparotomy, particularly in some subgroups of patients such as the immunocompromised, the elderly, and the young woman. Laparoscopy was done in 38 patients with right lower quadrant pain of undetermined cause after extensive diagnostic efforts. This group of patients included men and women with an even distribution of ages between 20 and 78 years. Laparoscopy was done under local anesthesia to better establish the site of pain if no obvious pathology could be visualized. Acute appendicitis was confirmed in only 26.3 per cent of the cases, and a wide variety of nonappendiceal diseases were identified, the majority of them requiring no surgery. Diagnostic laparoscopy performed under local anesthesia should be considered in patients suspected to have acute appendicitis, regardless of age and sex, who present with an atypical picture and who still offer diagnostic doubts after other available conventional tests.

Acute Disease↗
PubMed1992

[Technique and preliminary results in second-look laparoscopy in epithelial malignant ovarian tumors].

Second-look laparotomy is the usual mean of intraperitoneal evaluation in patients treated for ovarian carcinoma. We present a preliminary study of 33 second-look. Thirteen of these procedures were performed by laparoscopy. Because of previous surgical history a specific technique is necessary including safety tests, cytologic evaluation after peritoneal washing, and biopsies of any abnormal peritoneal areas, original tumors sites and normal appearing peritoneum. In order to achieve the evaluation of the entire peritoneal cavity a complete bowel adhesiolysis is required. For trained laparoscopists the surgical complication rate is low. In this preliminary study we found that prognosis following negative second-look laparoscopy and second-look laparotomy are similar, suggesting that laparoscopy is a valuable alternative to laparotomy for second-look evaluation in ovarian cancer.

Carcinoma↗
PubMed1992

[Laparoscopy in the diagnosis of abdominal diseases in children].

The results of laparoscopy performed in 1988-1990 in 112 children with tumours and cysts of the abdominal cavity, with diseases of the liver and bile ducts are presented. Of them in 60%, the puncture biopsy was performed. Use of laparoscopy in 64.28% of the sufferers with closed abdominal trauma permitted to avoid performance of needless laparotomy. For suspected acute appendicitis, laparoscopy was performed in 80 patients: in 36 of them, no signs of the disease were revealed, in 14--other diseases were detected, in 30--diagnosis was confirmed. A high informative value of the given method in the diagnosis of abdominal diseases in children was noted.

Abdominal Injuries↗
PubMed2003

Laparoscopy and laparoscopic ultrasonography in judging the resectability of pancreatic head cancer.

OBJECTIVE: To explore the clinical value of laparoscopy and laparoscopic ultrasonography (LUS) in judging the resectability of pancreatic head cancer. METHODS: LUS was employed as a prospective diagnosis of tumor staging before exploratory laparotomy in 22 patients diagnosed with pancreatic head cancer to identify whether the liver and peritoneum had small metastases or local invasion to the portal vein, superior mesenteric vessel, aorta, inferior vena cava. RESULTS: In the 22 patients receiving laparoscopy and LUS, we found peritoneal or surface liver metastases (3 patients), hepatic parenchyma metastases (1), and pancreatitis proved by biopsy under ultrasound guidance (1). Laparotomy was avoided in these 5 patients. Of the remaining 17 patients, 8 patients, including 2 patients with portal vein emboli due to tumor metastases had hypertrophic lymph nodes or tumor invasion of local vessels in the peritoneal cavity, retroperitoneum, and omentum and the other 9 patients had resectable tumors shown by LUS. The 17 patients were subjected to exploratory laparotomy, and pancreaticoduodenectomy was successful in 8 patients. CONCLUSIONS: Laparoscopy and LUS can be used to precisely estimate the possibility of resection of pancreatic head cancer, and prevent unnecessary exploratory laparotomy and its complications. It can be used as a routine examination before exploratory laparotomy.

Adult↗
PubMed1977

[On the value of the magnifying optic of Lent in laparoscopy) (author's transl)].

103 non selected patients underwent laparoscopy with the photolaparoscope equipped first with Luminaoptic and subsequently with the magnifying optic of Lent (Wolf GmbH, Knittlingen, W-Germany). The results are compared with the histologic findings and among each other. In 83.5% there was a satisfactory correlation between laparoscopy and histological findings, in 16.5% there was none. It was only in 2.9% of all cases that a different diagnosis resulted by means of the magnifying optic. From these results it is concluded that the magnifying optic does not provide a higher effectivity of laparoscopy. Thus the magnifying optic should be preserved for instruction.

Amplifiers, Electronic↗
PubMed2003

[Extended total nephrectomy with laparoscopy in localized renal carcinoma. Report of 25 cases compared with 32 conventional surgical cases].

STUDY OBJECTIVE: To evaluate the benefits obtained during the learning phase of laparoscopic nephrectomy (LN) for clinical stage cT1 and cT2 renal cancers. PATIENTS AND METHODS: We retrospectively compared our first 25 cases of LN (13 right, 12 left) with 32 nephrectomies performed by Conventional Surgery (CS) (17 right, 15 left) between May 2000 and December 2001. The LN group comprised 18 men and 7 women with a mean age of 63.8 years. The CS group comprised 18 men and 14 women with a mean age of 67.7 years. Preoperative, intraoperative, postoperative and histological parameters were compared by analysis of the variance or nonparametric Mann-Whitney U test for quantitative variables and Chi-square test for qualitative data. RESULTS: Preoperative and histological parameters, blood loss, quantity and duration of analgesics and the complication rate were similar in the two groups. Resection was complete in every case. The mean duration of radical nephrectomy was significantly shorter by CS (p < 0.001). Return of bowel sounds was more rapid (p = 0.002) and patients were discharged from hospital earlier (p = 0.004) after LN. CONCLUSION: Laparoscopic nephrectomy for cancer must be performed by an operator experienced in laparoscopy. During the learning phase, this procedure provided benefits in terms of return of bowel sounds and length of hospital stay, which should encourage teams performing laparoscopy to perform radical nephrectomy by laparoscopy.

Adult↗
PubMedDate not supplied

Gasless laparoscopy-assisted distal gastrectomy for early cancer via mini-laparotomy using an abdominal wall lift.

BACKGROUND/AIMS: To investigate the technical ease and results of gasless laparoscopy-assisted distal gastrectomy with lymph node dissection via mini-laparotomy using abdominal wall lift for early gastric cancer. METHODOLOGY: We submitted 20 patients to laparoscopy-assisted distal gastrectomy for early gastric cancer located in the middle or lower stomach. The initial 10 cases underwent perigastric lymph node dissection (D1), and the subsequent 10 cases received further dissection around the left gastric and common hepatic arteries (D1 + a). Mini-laparotomy was placed at the beginning of the procedure. We lifted up the laparotomy and the subcutaneous tissue around the umbilicus by retractors. We accomplished the dissection, resection and reconstruction mainly via the mini-laparotomy using a direct view and a laparoscopic image. RESULTS: Two cases were converted to open. The operative time was significantly longer in D1 + a (225 +/- 49 min) than in D1 (172 +/- 38 min). Blood loss was significantly more in D1 + a (247 +/- 155 mL) than in D1 (109 +/- 60 mL). There was no difference between the two groups in terms of days to first flatus, first oral intake or discharge from the hospital. Postoperative complications included 2 wound infections each in D1 and D1 + a group, and 1 anastomotic stenosis in D1 + a group. CONCLUSIONS: Gasless laparoscopy-assisted distal gastrectomy with D1 + a via mini-laparotomy using abdominal wall lift seems to be feasible and useful for early gastric cancer.

Abdominal Wall↗