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PubMed1996

[Is diagnostic laparoscopy a reliable addition to preoperative staging of pancreatic carcinoma?].

Over the last decade several authors proposed adopting diagnostic laparoscopy as an early diagnostic routine method in the staging of pancreatic carcinoma to prevent exploratory laparotomy. In our hospital only 11.6% of all patients who underwent explorative laparotomy would have benefitted from diagnostic laparoscopy. Therefore, we do not recommend diagnostic laparoscopy as a routine method to assess resectability of pancreatic carcinoma?

Angiography↗
PubMedDate not supplied

Using movement parallax for 3D laparoscopy.

The lack of depth perception hampers the surgeon during laparoscopic operation. Laparoscopes usually are monocular, but binocular ones are currently available. Depth perception, however, does not exclusively rely on binocular disparity. An observer, with only one eye, who is able to move that eye, obtains the same information as an observer who has two eyes. This principle of movement parallax can be applied to laparoscopy by coupling the head movements of the surgeon to the motions of the tip of the laparoscope. In an experiment we investigated if this principle is applicable to laparoscopy. Two groups of testees with no background in surgery were used. The first group was assisted by movement parallax, the second group was viewing a static image. Both groups of testees had to perform an exploration and a manipulation task. Since the amount of space for camera motion within the laparoscope is limited, implementation potential depends on the amount of movements that will be made by the observer. Therefore the movements of the observer performing the exploration task were registered and analysed. Results of the experiment indicate the advantage of movement parallax for the exploration task (performance increases by factor 2 while using only 30% more time) but not for the manipulation task. The analysis of the movements indicates that small movements are sufficient for implementation. Based on these results we concluded that movement parallax is applicable to laparoscopy.

Depth Perception↗
PubMed1997

[Treatment of ovarian cysts by laparoscopy].

OBJECTIVE: to define limits, risks and results in the long term of laparoscopic treatment of ovarian tumors. METHOD: retrospective study of adnexal tumors managed initially by laparoscopy from January 1986 to December 1992, among which 9 cancers, 25 borderline tumors, and 769 benign lesions. The ultrasonographic appearance was known for 698 of 803 lesions. 86 patients were postmenopausal (92 lesions). RESULTS: we treated 191 functional cysts, 160 serous cystadenomas, 178 endometriomas, 105 dermoid cysts, 39 mucinous cystadenomas and 96 miscellaneous lesions among which fibrothecomas, paraadnexal cysts, ovarian pregnancies, ovarian abscess. There is a great diversity of ultrasonographic patterns for a same histological type, specially for functional cysts and borderline tumors. Laparoscopic exploration has misdiagnosed two cancers and 10 borderline tumors and considered wrongly as suspects 19 benign lesions. 714 procedures have been led to term by laparoscopy, 89 have been ended by laparotomy, 26 for suspicion of malignancy and 50 for dissection failure. 27 postoperative complications have been counted among which 2 grafts on trocard sites after non protected extraction of one dermoid cyst and one borderline tumor. CONCLUSION: ultrasonographic appearance could not predict reliably the organic or functional nor benign or malignant character of an adnexal mass. Even careful laparoscopic examination can underestimate early stage ovarian cancer or borderline tumors. When diagnosed during or after laparoscopic procedure an ovarian cancer should always be managed by laparotomy. On the other hand, some borderline tumors can be treated by exclusive laparoscopy. When malignancy is suspected, an adnexectomy can be performed laparoscopically as a biopsy and allows a quick and appropriate treatment after paraffin-embedded sections. Both intraperitoneal and transparietal techniques have a minimal morbidity and allow a feasibility of more than 90%. The management of postmenopausal ovarian tumors differs only by the use of systematic oophorectomy if surgical procedure is indicated.

Adolescent↗
PubMed1997

Laparoscopy for adnexal torsion in pregnant women.

OBJECTIVE: To report on six cases of adnexal torsion in pregnant women treated by operative laparoscopy. STUDY DESIGN: A retrospective study. Between January 1989 and March 1996, 26 patients with adnexal torsion were treated by operative laparoscopy. Of these patients, six were pregnant (23%). The types of operative procedure and outcome were studied. RESULTS: Adnexal torsion occurred between 6 and 13 weeks of amenorrhea. Two cases involved hyperstimulation, 3 cases a functional cyst and 1 case a dermoid cyst. In 4 cases laparoscopic treatment consisted of untwisting followed by puncture of the ovarian cyst; in 1 case it involved intraperitoneal cystectomy and in another simple untwisting of the adnexa. The immediate postoperative history was uncomplicated. In one patient with ovarian hyperstimulation, torsion recurred three weeks after the initial operation. No miscarriages occurred. CONCLUSION: In the hands of skilled surgeons, laparoscopy is well suited to the diagnosis and treatment of adnexal torsion occurring during the first trimester of pregnancy. Beyond 16 weeks or when there is any suspicion of torsion on a suspected tumor, it is preferable to use laparotomy.

Adnexal Diseases↗
PubMed1997

[Operative laparoscopy and the adnexal cystic mass: where to set the limit?].

OBJECTIVE: To study the importance and the consequences of several managements options for adnexal cystic masses suspicious at ultrasound and/or at laparoscopy. MATERIAL AND METHODS: The importance of this question was evaluated by studying the correlation between the ultrasonographic appearance, the macroscopic diagnosis and the pathologic diagnosis in a series of 1098 patients operated over a 14-year period. The laparotomy rates obtained with the managements proposed were calculated by adding the laparotomies which would be performed because of the suspicious appearance to the laparotomies effectively performed in the department when treating the non suspicious masses. RESULTS: 32 of the 323 suspicious cases at ultrasound were malignant. The negative predictive value of the laparoscopic diagnosis of malignancy was 100%. Depending on the management used, the incidence of laparotomy could have varied from 6.1% to 31.3% between 1987 and 1991, and from 12.9% to 41.9% between 1992 and 1993. These results were related to preoperative selection. CONCLUSION: Using a simple management which includes diagnostic laparoscopy for masses suspicious at ultrasound and laparotomy for masses suspicious at laparoscopy, 80.1% of the patients would be treated by laparoscopic. This management seems reasonable until the long term results of large series about the laparoscopic treatment of ovarian cancer become available.

Adnexal Diseases↗
PubMed1997

[Treatment of adnexal tumors with laparoscopy].

This article shows the experience in 61 patients with adnexal tumors studied from June 1988 to June 1994; the origin of the patients in private and semiprivate, to whom we practiced a diagnostic and operative laparoscopy (56/61) at the same time. The inclusion and exclusion criteria were determined by clinical history (past history, age, symptoms, size, etc.), vaginal ultrasonography scan (ascites, papillas, cyst's content, etc.), laboratory tests (Ca 125 in postmenopausal patients), the macroscopic assessment during the diagnostic laparoscopy, transoperative biopsy (19/61) was made in order to confirm the benign findings seen before laparoscopy; and the results were accordingly on the 61 cases. The cause of consult was infertility in 24/61; 18/61 were primary infertility; 6/61 were secondary infertility. We did 22 cystectomies and 2 oophorectomies; 10 of them became pregnant. 37 from 61 had pain, nine of this group we did an oophorectomy (2 by torsion, 3 had hemorrhagic cysts that were ruptured and 4 were residual ovary), the rest 28 we performed cystectomy with frank improvement of their symptoms. The postoperative diagnosis of the tumors were: luteomas 13/61; functional cysts 17/61, Hemorrhagic cysts 8/61; endometriomas 9/61; serous cystoadenoma 3/61; mucinous cystoadenoma 1/61; ovaric fibroma 1/61; mature cystic teratoma 2/61; residual ovaries 4/61; paraovaric cysts 2/61 and Morgagni's hydatide 1/61. It is concluded that if one follows all the correct parameters for the evaluation of adnexal tumors, the endoscopic procedure could be safe with the benefits of the laparoscopic procedure.

Adnexal Diseases↗
PubMed1997

Rapid hospital discharge following laparoscopy for ectopic pregnancy. A promise unfulfilled?

This study was done to determine whether laparoscopy for ectopic pregnancy in the United States is associated with rapid postoperative discharge, defined as 2 days or less, and to estimate how often ambulatory treatment of ectopic pregnancy occurs without subsequent hospital admission. We used the National Hospital Discharge Survey to estimate the frequency of ectopic pregnancy admissions, operations, and length of hospital stays in 1990. We used the National Ambulatory Medical Care Survey to estimate the number, type, and disposition of office visits for ectopic pregnancy in 1990. According to National Hospital Discharge Survey data, tubal pregnancy led to an estimated 57,000 hospital admissions in 1990. Most (70%) of the 26,000 patients treated with laparoscopy were in the hospital 3 days or more, and most (73%) underwent salpingectomy. The number of ambulatory visits for ectopic pregnancy was too low to estimate reliably according to the standards of the National Center for Health Statistics. We found that laparoscopy was used frequently for the treatment of ectopic pregnancy but was not associated with rapid postoperative discharge. Further research is needed to determine whether these findings persist and whether reimbursement incentives, patient preference, or problems with the diffusion of technology are responsible.

Adolescent↗
PubMed1997

Preoperative Nyhus classification of inguinal hernias and type-related individual hernia repair. A case for diagnostic laparoscopy.

The goal of this prospective study was to determine the clinical value (sensitivity and specificity) of preoperative hernia classification (Nyhus classification) using three distinct methods: clinical examination, Doppler ultrasonography, and diagnostic laparoscopy. Thirty patients with 35 suspected groin hernias were included. Definitive hernia classification was achieved by laparoscopic peritoneal incision and dissection of the inguinal floor. Twenty-eight laparoscopic hernia repairs followed. Sensitivity and specificity were calculated for each preoperative evaluation method. Clinical examination was found to be more accurate than Doppler ultrasonography. The highest scores for sensitivity (0.93) and specificity (1.00) were achieved, however, by diagnostic laparoscopy. Therefore, the authors consider diagnostic laparoscopy to be a valuable preoperative tool for assessing hernia type. An accurate preoperative hernia classification will allow an individualized type-related hernia repair (open: anterior, posterior approach, or laparoscopic: transabdominal preperitoneal, total preperitoneal, inner-ring closure, mesh insertion).

Adult↗
PubMed1997

Laparoscopy for the impalpable testis.

BACKGROUND: Use of laparoscopy in the management of the impalpable testis remains controversial. Localization of the testis may help plan or obviate the need for groin exploration. This study reviews the need for inguinal exploration with respect to laparoscopic findings, particularly of vas and vessels entering a closed deep inguinal ring. METHOD: Case notes of boys undergoing laparoscopy for undescended testes were reviewed retrospectively. RESULTS: Of 86 impalpable testes, 32 were intra-abdominal and ten were absent with intra-abdominal blind ending vas and vessels. In 17 instances the vas and vessels entered an open internal ring and in 26 a closed internal ring. In one boy neither vas, vessels nor testis were visualized. Of the 26 impalpable testes with a closed internal ring, excision of testicular remnants in 18 revealed no histological testicular parenchyma, one boy had bilateral perineal ectopic testes missed clinically and six were not explored. CONCLUSION: The laparoscopic finding of vas and vessels entering a closed deep inguinal ring should prompt a careful examination for an ectopic testis. If a palpable testis can be ruled out, inguinal exploration is not necessary, as viable testicular parenchyma is rarely found. Laparoscopy would have avoided negative exploration in 42 per cent of impalpable testes in this series.

Adolescent↗
PubMed1997

Office laparoscopy under local anesthesia.

It is no secret that health care has changed, and we must change with it. As equipment and drugs become more sophisticated, surgical procedures are becoming less complicated to perform, and patients are experiencing less morbidity and mortality. Industry is continually addressing the product needs of surgeons who are or will be performing office laparoscopy under local anesthesia so that it can be done with the greatest of ease and safety. Therefore, the environment in which surgical procedures are performed should become less technically complicated as well. As hospitals are downsizing and more and more procedures are moving into outpatient and office settings, there is a tremendous opportunity for nurses to assume the challenge of OLULA and expand their horizons in a new direction. There is no better time for nurses to use the professional skills they were educated for, that is, to provide continuous bedside nursing care for patients undergoing office laparoscopy under local anesthesia while maintaining the perioperative skills that they have grown to love. For more information about office laparoscopy, contact the American Association of Office Endoscopy, 3088 Rosa Parks Avenue, Montgomery, AL, 36105. Telephone: (334) 262-0259.

Anesthesia, Local↗
PubMed1997

Diagnostic-staging laparoscopy.

Recently instead of the old fashioned, traditional explorative laparotomy the newer up-to-date procedure, the diagnostic-staging laparoscopy has been generally used in the everyday surgical practice of the Authors. Evaluating 32 diagnostic and staging laparoscopy Authors draw the attention to the importance of this procedure which has high diagnostic value, and reduces the complication rate. Biopsy, cytology, frozen section can be done. Authors carries out diagnostic and staging laparoscopy in cases of esophageal, liver, stomach and pancreas tumours just immediately before surgery.

Abdomen↗
PubMed1998

The role of laparoscopy in the management of intussusception in the Peutz-Jeghers syndrome: case report and review of the literature.

A 15-year-old girl with known Peutz-Jeghers syndrome and with nausea and vomiting of all ingested food was transferred from an outside institution. Physical examination revealed a palpable upper abdominal mobile mass. Upper gastrointestinal series revealed a stacked coin appearance consistent with small bowel intussusception. An abdominal computed tomographic scan showed a left upper quadrant sausage-shaped mass with invagination of bowel into bowel suggestive of small bowel intussusception. The patient was taken to the operating room for a combined upper endoscopy and laparoscopy. Laparoscopy confirmed the radiologic findings and a jejuno-jejunal intussusception was identified and reduced laparoscopically. The endoscope could not be passed to the level of the polyp, thus, this loop of small bowel was resected laparoscopically. The final pathologic diagnosis was multiple hamartomas. We conclude that laparoscopy is a safe and effective method of managing intussusception in the Peutz-Jegher syndrome because the pathologic lead point is a benign hamartoma. A combined endoscopic and laparoscopic approach can be used to treat proximal small bowel intussusception and this could possibly eliminate the need for laparotomy and reduce the post-operative complications associated with multiple reoperations in this patient population.

Adolescent↗
PubMed1998

[The value of examination and treatment using laparoscopy in non-palpable testes: apropos of a series of 48 cases].

OBJECTIVES: Laparoscopy now constitutes the reference technique for the diagnosis and treatment of cryptorchid testes. We report our experience over the last three years (1993-1996). MATERIAL AND METHODS: 48 strictly impalable testes were investigated in 46 boys between the ages of 11 months and 14.5 years (mean age: 40 months). The intraperitoneal investigation assessed both deep inguinal regions looking for gonads, vas deferens and pedicles. Intra-abdominal gonads were ligated and their pedicle was sectioned laparoscopically allowing transinguinal descent 6 months later according to the Fowler-Stephens technique. RESULTS: We found 21 cases of typical antenatal torsion, including one bilateral case (pedicle and vas deferens present, but gonad absent), one case of total unilateral agenesis and 3 cases of incomplete agenesis (only the vas deferens was detected) and performed three resections of the gonadal rest for histological examination. The first-stage of cryptorchid testis descent was performed in 20 cases, by laparoscopy in 19 cases (1 failure of insufflation). Definitive descent was possible in 13 cases, with early onset of atrophy in only one case. CONCLUSION: Laparoscopy is therefore a simple technique, allowing a definitive diagnosis and two-stage descent without increasing the risk of testicular atrophy.

Adolescent↗
PubMed1997

[Efficacy and economic aspects of preoperative diagnosis: laparoscopy is useful in only 13% of patients with pancreatic carcinoma].

The value of diagnostic laparoscopy to improve tumor staging in patients with pancreatic and periampullary cancer is still a matter of controversial discussion, especially with regard to whether diagnostic laparoscopy can identify patients in whom a laparotomy can be avoided due to metastases. To answer this question, all patients who underwent operations for pancreatic cancer (n = 97) or periampullary cancer (n = 30) between 11/1993 and 12/1995 were evaluated. Only 10% of the patients with periampullary/pancreatic cancer and 13% with pancreatic cancer could avoid laparotomy through diagnostic laparoscopy. Due to these low numbers, a diagnostic laparotomy cannot be recommended in general in patients with pancreatic and/or periampullary cancer on economic grounds and because of the risk of trocar metastases.

Adult↗
PubMed1998

Ovarian transposition by laparoscopy before radiotherapy in the treatment of Hodgkin's disease.

BACKGROUND: The use of inverted Y irradiation in the treatment of Hodgkin's disease with pelvic lymph node involvement can cause iatrogenic early menopause in young women as a result of ovarian exposure to radiation. Ovarian transposition protects the ovaries by removing them from the irradiation field. This surgical procedure, initially performed by laparotomy, can now be done by laparoscopy. METHODS: During the period July 1994 to April 1996, laparoscopic ovarian transposition was performed on 4 young women with Hodgkin's disease 1 week before inverted Y radiotherapy. The surgical procedure, complications, length of hospitalization, and hormonal, clinical, and biologic results were evaluated. RESULTS: The mean duration of hospitalization was 4 days, and there were no postoperative complications. Iatrogenic menopause did not occur in any of the patients during the mean follow-up period of 20.75 months (range, 6-35 months; median, 20 months). CONCLUSIONS: Laparoscopy offers many advantages over laparotomy for ovarian transposition. This procedure, which can be performed without opening the abdominal wall, is highly efficient, requires only a short period of hospitalization, and leads to few postoperative complications. Laparoscopy is an attractive alternative to laparotomy for ovarian transposition in young women with advanced Hodgkin's disease who require pelvic radiotherapy.

Adult↗
PubMed1998

Lower extremity paralysis after operative laparoscopy from conversion disorder. A case report.

BACKGROUND: Neurologic complications are rarely associated with laparoscopic procedures, and most nerve injuries are transient palsies. We present the first case of paraplegia following gynecologic laparoscopy. CASE: A 34-year-old woman, gravida 2, para 0-1-1-0, with long-standing infertility, underwent an uncomplicated laparoscopic ovarian cystectomy for a persistent ovarian cystadenoma. In the immediate postoperative period, the patient developed bilateral lower extremity paralysis. She regained her sensorimotor function in one extremity within hours, while both motor and sensory functions, but not proprioception, were deficient in the other extremity in a pattern of distribution that was inconsistent and paradoxical. Diagnostic studies to evaluate the patient's central and peripheral nervous systems and evoked sensory potentials were all normal. The patient's indifference to her persistent yet paradoxical neurologic deficits was a clue to her diagnosis. In the absence of an organic lesion to account for the patient's symptoms, the diagnosis of conversion disorder was made. CONCLUSION: Neurologic complications following laparoscopy are rare, generally involving nerve palsies from local injury. This is the first report of lower extremity paralysis after laparoscopy. Although conversion disorder is rare, it may occur in the gynecologic setting owing to its prevalence in women and especially in the presence of underlying affective disorders.

Adult↗
PubMed1998

[Laparoscopy in a syndrome of impalpable testes].

Thirty two patients aged between 2 and 19 years underwent laparoscopy for 32 impalpable testes. There were no complications associated with laparoscopy and the procedure clarified the condition in all patients. The purpose of this paper is to estimate the value of laparoscopy in boys with impalpable testes.

Adolescent↗
PubMedDate not supplied

Vascular complications following laparoscopy: two unusual cases.

BACKGROUND: Vascular complications following laparoscopic techniques may often be attributed to the incomplete control of bleeding sites at laparoscopy. When confronted with post-laparoscopy symptoms of hemodynamic insufficiency, the surgeon may infer the existence of hemorrhagic complications neglected at the laparoscopic session. METHODS: The author reviewed two otherwise normal cases of laparoscopic procedures that were complicated by bleeding disorders of unknown origin. RESULTS: Diagnosis and treatment of the hematologic complications revealed causes other than operator-inflicted injury. CONCLUSIONS: While laparoscopists should remain vigilant concerning the very real threat of overlooked vascular injury following laparoscopy, some patients may exhibit hemorrhagic symptoms unrelated to the laparoscopic procedure.

Adult↗