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PubMed1993

[Laparoscopy in clinical practice. I. Indications].

In the paper the authors analyzed indications to 1527 laparoscopies. The most frequent indications were: sterility (72.2%) and suspicions of adnexal tumours or extrauterine gravidity (14.1%). In 173 diagnostically difficult cases laparotomy was avoided. In these cases laparoscopy allowed to exclude the pelvic pathology or to quality to laparoscopic operation of ovarian cysts and intact tubal pregnancy. Diagnostic and operative laparoscopy give the possibility of quick diagnosis in diagnostically difficult cases and enables avoidance of laparotomy in many cases.

Adolescent↗
PubMed1993

[Laparoscopy in clinical practice. II. Usefulness in diagnosis of sterility].

The paper presents results of 1099 laparoscopies performed in sterility. Laparoscopy was made in the second phase of the menstrual cycle, 5 to 7 days after probable ovulation, as a last stage in diagnosis of sterility. Normal state of genital organs and minor pelvis was noted in 20.9% of investigated patients. In the remaining more than one etiologic factor was found, which may influence the sterility. The authors concluded, laparoscopy is valuable, accessory method in the diagnosis of sterility, which enables sometimes to find the etiologic factor in patients with "unexplained infertility".

Adult↗
PubMed1993

[The role of laparoscopy in the evaluation of chronic pelvic pain].

Chronic pelvic pain, defined as cyclic or acyclic pain reported for a minimum of six months, is one of the most common gynecological symptoms and one of the most important in terms of social costs. From January 1987 to December 1991, 127 patients suffering from chronic pelvic pain were submitted to diagnostic laparoscopy at the Department of Obstetrics and Gynecology of the Università Cattolica del Sacro Cuore in Rome. The mean age of the patients was 30 years, ranging from 14 to 46. All patients were submitted to bimanual pelvic examination upon hospital admission, and most of them (No. = 99, 78%) to pelvic ultrasonographic examination. In 117 patients (92%) samples for the isolation of Chlamydia trachomatis in 5-iodo-2-deoxiuridine treated McCoy cell cultures were obtained from the cervix, the endometrium and the cul-de-sac peritoneal fluid. At laparoscopy, in 25 patients (20%) the exam showed normal pelvic anatomy, whereas in 102 patients (80%) some pelvic pathology was found. The most frequent conditions observed were: pelvic adhesions in 55% (No. = 70), endometriosis in 29% of the cases (No. = 37), and other pathologies (non-endometriotic ovarian cysts, hydrosalpinges, myomas, etc.) in 25% of the cases (No. = 32). At the comparison of bimanual examination and laparoscopic findings, out of 71 patients with normal findings at bimanual examination, 75% (No. = 53) were found to have abnormal findings at laparoscopy; out of 55 patients with abnormal bimanual examination, 11% (No. = 6) were found to have normal laparoscopic findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Laparoscopy useful in the diagnosis and surgery of acute appendicitis].

The value of diagnostic laparoscopy was evaluated in 74 patients who had clinical signs of acute appendicitis. The average age was 27 years (5-67). The laparoscopically determined degree of inflammation was compared with the results of histologic examination, and the results of laparoscopic appendectomy were evaluated. In 6 patients laparoscopic appendectomy was not performed, because of infiltrative disease (twice), twisted ovary, ovulatory bleeding, enteritis and partially incarcerated inguinal hernia. In 2 patients suffering of acute appendicitis conversion to laparotomy was necessary because of obscured anatomy. On 57 out of 68 patients who underwent appendectomy, the laparoscopic findings were in accordance with histologic examination; i.e. 54 times acute appendicitis and 3 times appendix sana. In 7 patients the appendix was classified as inflamed during laparoscopy, histological examination revealing lymphoid hyperplasia or a subacute inflammation. In 4 patients with a laparoscopically normal appendix, inflammation was seen histologically. The average operation time was 29 minutes and the average postoperative hospital stay was 4 days. Three complications occurred: an inflammatory mass developed in 2 patients post-operatively and I patient had a hematoma in the trocar puncture site and a wound abscess developed. Laparoscopy is an aid in diagnosing appendicitis, and may prevent unnecessary appendectomy. If inflammation is established appendectomy can be performed safely and effectively.

Acute Disease↗
PubMed1996

A comparison of the strength of knots tied by hand and at laparoscopy.

BACKGROUND: The strength of knots tied at laparoscopy was compared with that of hand-tied knots. STUDY DESIGN: The force needed to undo or break eight types of knots that were tied in fresh postmortem human stomachs was measured. The knotting performance of nylon, polyglactin 910, braided silk, polytetrafluoroethylene, braided polyester fiber, braided polyester suture, polyamide 66, and polydiaxone was also compared. RESULTS: Measurements of knot strength of two to six half hitches (hand tied) showed that four half hitches were necessary to tie a secure nonslipping knot with most monofilament threads (nylon, polytetrafluoroethylene, braided polyester suture, and polyamide 66), while three half hitches were adequate to secure a knot when polyglactin 910, braided polyester fiber, silk, and polydiaxone were used. Additional throws did not increase knot strength once the knot no longer slipped (p = NS). Some commonly tied knots, three half hitches and surgical knots at laparoscopy were weaker than the same hand-tied knots (p < 0.05) but an additional throw increased knot security (p < 0.01). Differences between laparoscopic and hand-tied knot strengths were greater for monofilament than multifilament threads. There was a wider distribution of strengths for laparoscopically tied than hand-tied knots. Four half hitches were the most secure configuration for laparoscopically tied knots and were significantly stronger than three half hitches and surgical knots (p < 0.01). The extracorporeally tied slipknot (Roeder loop) was significantly less secure than four half hitches (p < 0.05). CONCLUSIONS: This study demonstrates that laparoscopically formed knots may be weaker than those tied by hand and shows that improvements in knot strength at laparoscopy can be achieved by choice of optimal knot configuration for different suture materials.

Evaluation Studies as Topic↗
PubMed1996

Laparoscopy and laparoscopic ultrasound in the staging of gastric cancer.

As patients with gastric cancer are offered choices between surgical resection, investigational neoadjuvant chemotherapy, palliative chemotherapy, or symptomatic relief alone, the need for accurate preoperative staging becomes apparent. Laparoscopy has been suggested as an accurate staging modality in a variety of upper gastrointestinal malignancies. It allows for assessment of the stage of the primary tumor, identification of hepatic or regional nodal metastases, and the detection of small volume peritoneal disease unappreciated by other noninvasive staging modalities such as computerized tomography, magnetic resonance imaging or endoscopic ultrasound. This article reviews the current literature concerning laparoscopy and laparoscopic ultrasonography (LUS) in the staging of gastric cancer. The Memorial Hospital experience with 92 patients is described. In this group, metastatic disease unappreciated by conventional staging modalities was found in 31 cases. The preliminary experience with LUS suggests that its addition to standard laparoscopy increases the sensitivity and specificity of M1 screening as well as introducing T and N staging capabilities.

Gastroscopy↗
PubMedDate not supplied

[Laparoscopy as a clinical diagnostic method at a hospital center in Peru].

Laparoscopy is an invasive endoscopic procedure, that permits the vision of the abdominal cavity, through a little hole in the abdominal wall. This method permits a almost complete vision of abnormalities. It also helps to define diagnosis and classify or visualize the progress of some diseases. In this study done in 141 patients with liver diseases detected by laparoscopy and biopsy in the Arzobispo Loayza General Hospital in Lima, Perú, we verified the diagnostic efficacy of laparoscopy in hepato-biliary diseases like cirrhosis and hepatocarcinoma etc., and also to establish the etiology of peritoneal diseases. Emphasis is made in the importance of biopsies taken under visual control.

Adolescent↗
PubMed1996

[Laparoscopy in 100 consecutive patients with 128 impalpable testes].

A cohort of 100 patients underwent laparoscopy for 128 impalpable testes. They ranged in age from 2.7 to 19.3 years (median 10.8 years). There were no complications associated with laparoscopy. In 50% of the cases either blindending cord structures above the internal inguinal ring or intra-abdominal testes were identified; in the remainder, cord structures could be seen passing through the ring, indicating an intracanalicular testis. The impalpable testis was absent in 77% of patients with a contralateral scrotal testis. A seminoma was found in one 18.6-year-old patient with bilateral cryptorchidism. No intratubular germ cell neoplasia (carcinoma in situ) was proved. Germ cell hypoplasia or aplasia was demonstrated in 95% of cases with testicular parenchyma. We recommend laparoscopy as a safe procedure which leads to a diagnosis in patients with impalpable testes; the advent of laparoscopic procedure makes definitive treatment possible in about 50% of such cases.

Adolescent↗
PubMedDate not supplied

Value of diagnostic laparoscopy in abdominal malignancies.

Diagnostic laparoscopy was performed in 72 patients for diagnosis of suspected cancer or staging of intraabdominal malignancies. In 66 of 72 patients (91.7%) a diagnosis was possible laparoscopically and in 53 patients (73.6%) a laparotomy was avoided. In 19 of 72 patients (26.4%) laparoscopy changed staging of preoperative non-invasive test and helped to plan proper surgical management. Laparoscopy has proved to be an effective diagnostic tool in abdominal malignancies and should help to avoid unnecessary laparotomies in case of incurable disease. It should be used complementary to non-invasive imaging methods and the addition of laparoscopic ultrasonography will improve the accuracy of examination.

Abdominal Neoplasms↗
PubMed1996

Serial laparoscopies over 30 months show that endometriosis in captive baboons (Papio anubis, Papio cynocephalus) is a progressive disease.

OBJECTIVE: To test the hypothesis that spontaneous endometriosis is a progressive disease in baboons. DESIGN AND SETTING: Prospective cohort study, Institute of Primate Research, Nairobi, Kenya. PARTICIPANTS: Twelve baboons with histologically proven spontaneous endometriosis. INTERVENTIONS: Fifty-four serial laparoscopies (4.2 +/- 1.9 per animal, range 1 to 7) were performed after 1 to 3 months (n = 2), 4 to 6 months (n = 1), 7 to 9 months (n = 6), 10 to 12 months (n = 17), 13 to 15 months (n = 7), 16 to 18 months (n = 1), 19 to 21 months (n = 8), 22 to 24 months (n = 8), 25 to 27 months (n = 2), and 30 to 32 months (n = 2). MAIN OUTCOME MEASURE: During each laparoscopy the pelvis was examined for the presence of endometriosis. The number, size, and type of endometriotic implants were noted on a pelvic map and both endometriosis score and stage were calculated. Remodeling was defined as a change in laparoscopic appearance (typical, subtle, suspicious) of an individual endometriotic lesion. Data were analyzed by a signed rank test. RESULTS: Endometriosis was progressive as shown by the significant increase in the number and surface of lesions and in endometriosis scores after 24 months. The total number of endometriotic lesions after 24 months consisted of 69% new (and mostly subtle) implants, 10% remodeled lesions, and 21% unchanged implants. CONCLUSIONS: This study demonstrated that endometriosis in captive baboons undergoing repeated laparoscopies is a dynamic and moderately progressive disease with periods of development and regression and active remodeling between different types of lesions.

Animals↗
PubMed1996

Ultrasound-guided fine needle biopsy and laparoscopy in the study of pancreatic masses: report on 136 cases.

The authors report their experience from 136 fine needle ultrasound (FN-US)-guided biopsies and laparoscopies. The pancreatic diseases considered by these methods were as follows: 9 cases of Pancreatitis, 11 cases of Pancreatic cysts, 5 cases of endocrine cancer, 109 cases of Exocrine cancer and 2 not conclusive cases. Diagnostic accuracy of FNB and laparoscopy was evaluated for each group and, in particular, for cancer patients. In the latter group, FNB helped to detect abdominal diffusion in 25 cases (33%) while laparoscopy, including laparoscopic washing, revealed a micro-diffusion in 31 cases (55%), the latter not shown previously by CT, RNM and US. The combination of these methods allows us to confirm the advanced stage of the majority of pancreatic cancers at onset. Furthermore, this seems to be a very reliable method to select resectable patients, thus avoiding useless, sometimes hazardous and expensive further investigation.

Biopsy, Needle↗
PubMed1996

Operative laparoscopy in the management of ovarian cancer.

Advances in operative laparoscopic techniques have made possible the extension of this technology to the treatment of women with ovarian cancer. We present a detailed case series of eight patients with ovarian cancer who underwent a total of 11 operative laparoscopies for treatment of ovarian cancer ranging in stage from IA to IIIC. Three patients underwent initial laparoscopic staging and therapeutic debulking procedures. In three other cases that were incompletely staged via laparotomy, laparoscopy was used to complete the staging. Interval laparoscopic tumor debulking combined with second-look laparoscopy was performed in four cases. We describe our experience with these new applications of evolving techniques with particular regard to potential advantages, disadvantages, and complications. This detailed preliminary case series suggests the need for prospective clinical studies to establish the safety and efficacy of the approach.

Adult↗
PubMed1996

[The advantage of an umbilical micro-laparotomy, "open laparoscopy", for laparoscopic surgery. Experimental study].

This study was carried out to evaluate the respective safety of standard introduction of the umbilical trocar after insuflation of the abdomen through a veress needle, direct trocar insertion, and the open laparoscopy approach. Abdominal adhesion were induced by standardized peritoneal trauma in 60 New Zeland white female rabbits. Three weeks later, the animals were randomly assigned to one of three techniques: group 1: standard approach; group 2: direct trocar insertion; group 3: open laparoscopy. Twenty-four bowel injuries occurred in group 1, thirty nine in group 2, and six in group 3. The differences between groups were statistically significant (group 1 vs group 2: p = 0.03; group 3 vs group 1: p = 0.004; group 3 vs group 2: p = 0.0001). These findings favor the use of the open laparoscopy approach when abdominal adhesions are suspected. The standard approach is safer than the technique without pneumoperitoneum, but would require an endoscopic visualization of the umbilical trocar insertion to reduce the complication rate.

Animals↗
PubMed1996

Complications of major operative laparoscopy. A review of 452 cases.

OBJECTIVE: To evaluate complications of operative laparoscopy. STUDY DESIGN: Operative and postoperative complications in 452 consecutive cases from January 1, 1991, to August 31, 1993, were evaluated. The series was divided into three time segments--8, 12 and 12 months. Common and serious complications were classified and reviewed. RESULTS: Complications developed during and after major operative laparoscopy in 47 (10.4%) patients in the series; 24 (5.3% of cases, or 51% of total complications) were serious, such as hemorrhage, ureteral injuries and fistulas, and intestinal obstruction. Seventeen (3.8%) patients required unplanned surgery for management of complications. During the initial learning period of eight months, the rate of complications averaged 17.3%, decreasing to 7.7% and 10.1%, respectively, in the second and third periods in the series. There were no cases of death, postoperative ileus, thrombophlebitis or pulmonary complications. CONCLUSION: The overall incidence of complications in major operative laparoscopy was 10.4%. Serious complications accounted for half the complications. Surgical experience reduced the incidence of complications. Ovarian cystectomy produced the lowest rate of common complications and no serious ones. Laparoscopically assisted vaginal hysterectomy had the highest rate of serious complications.

Dysmenorrhea↗
PubMed1996

Pain intensity following laparoscopy.

The temperature of the gas used for insufflation during laparoscopy has a significant influence on postoperative shoulder and subphrenic pain according to a prospective randomized study of 103 female patients who filled out a standardized pain assessment questionnaire with a visual analogue scale from 0 to 10. Women in group B (n = 53), who had been insufflated with warm CO2 gas during laparoscopy, had significantly less pain than women in the control group (group A; n = 50). The declared value for shoulder pain at the first postoperative day was 3.6 with cold gas versus 2.5 with warm CO2 (p = 0.013). The strongest pain was found following long operations (5.4 vs. 4, respectively) and following high CO2 gas use (5.5 vs. 2.3); in both cases, a significant advantage was noted for the group treated with warmed CO2. Further research is needed regarding the etiology and possible prevention of postoperative pain following laparoscopy. As the use of warm CO2 gas leads to significant reduction of pain, technical and mechanical parameters should be changed accordingly.

Female↗
PubMed1996

[Diagnostic laparoscopy and laparoscopic ultrasonography: value of staging and assessment of resectability of pancreatic carcinoma].

The dismal prognosis of pancreatic cancer and the development of new, minimally invasive bypass techniques require a differentiated indication for open pancreatic resection. Diagnostic modalities, which facilitate an accurate assessment of resectability, have to be found. Modern imaging and endoscopic techniques fullfill these requirements in only about 50% of cases. Diagnostic laparoscopy is the only method for visualization of peritoneal metastases. The use of diagnostic laparoscopy and laparoscopic sonography raises the resectability rate to between 75% and 100%. 33% up to 67% of patients deemed resectable by preoperative imaging show signs of irresectable cancer at laparoscopy and can be spared a negative laparotomy. These patients can be treated by laparoscopic or endoscopic bypass techniques.

Endosonography↗
PubMed1996

[Detection of microbubbles formed in the blood/CO2 interphase during decompression in barometric conditions similar to laparoscopy].

HYPOTHESIS AND OBJECTIVES: Intraperitoneal insufflation (IPI) with CO2 during laparoscopic surgery establishes a pressure gradient that determines the passage of gas from the peritoneal cavity to the blood and surrounding tissues. The transport and clearance of CO2 are assured by proper sweeping when regional blood flow is adequate in volume and distribution. But if IPI hyperpressure surpasses regional venous capillary pressure (10 to 15 mmHg) and there is no cardio-circulatory adaptation to the phenomenon, CO2 clearance may be compromised. Under these conditions, the expected post-insufflation increase in PetCO2 will not take place. Bearing in mind the physical characteristics of CO2, retention of this gas in the intraperitoneal cavity produces blood and tissue saturation under a higher-than-atmospheric pressure, after a certain period of time in contact. Rapid intraperitoneal decompression after laparoscopic surgery carries with it the risk of microbubble formation due to release of CO2 that had been dissolved under hyperbaric conditions. MATERIAL AND METHODS: To test this hypothesis, the barometric conditions of laparoscopy were reproduced inside an observation capsule containing blood and CO2. RESULTS: Magnification revealed that after decompression bubbles formed in the blood/CO2 interphase. The images were recorded on magnetic videotape. Thirty minutes after decompression, the bubbles could still be seen, even after the interphase was swept with a current of air. DISCUSSION: Rapid intraperitoneal decompression after laparoscopy can generate the formation of microbubbles which, if not eliminated, will give rise to local ischemic manifestations. This same decompression, correcting the local circulatory alterations and activating the CO2 transport that had been compromised, could introduce gas bubbles into the blood stream such as are responsible for delayed gaseous microembolism. The simultaneous observation of changes in PetCO2 (stability or post-insufflation decreases) and hemodynamic parameters during laparoscopy, would allow evolving anomalies to be detected early and therapeutic action to be taken to prevent the formation of microbubbles.

Carbon Dioxide↗
PubMed1997

[Incisional hernia after surgical laparoscopy: a case of hepatic ligament incarceration and review of the literature].

The authors report a case of incisonal hernia occurring 5 years after laparoscopic treatment of extra-uterine pregnancy. This involved incarceration of the hepatic suspensor ligament during insertion of a 10 mm umbilical trocard. Laparoscopy permitted diagnosis and treatment of the hernia. Parietal complications after laparoscopy usually concern epigastric vascular lesions, infections at trocard sites, and residual abdominal wall pain. Incisonal umbilical and extra-umbilical hernias, described for the first time in 1968, are highly unusual complications, with an incidence of 21/100,000 in the Mintz study. The hernia sac usually contains omentum or small intestine. The present observation alems to be the first case of incarceration of the hepatic suspensor ligament in an umbilical trocard. This observation is remarkable not only for the hernia sac contents but also for the delay between laparoscopy and the occurrence of the umbilical hernia.

Constriction, Pathologic↗