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At least 1,351 records · Page 75Linked to original sources
PubMed2000

[Loss of a 10 mm optic trocar tip in the abdominal cavity during introduction into the subumbilical groove while performing ambulatory laparoscopy--a rare complication].

We report on a 26-year-old patient with primary infertility since 3 years, when whilst undergoing an office laparoscopy to find out the causes of her infertility, the tip of a 10-year-old 10 mm optictrocar broke and fell in the abdomen. The patient was referred to our clinic to remove this foreign body after discovery of the breakage and loss of the trocartip in the abdomen. We discuss in this case report and literature review on the loss of parts of instruments in the abdomen during laparoscopy as well as the management of such complication and measures to their careful prevention. This case report shows and stresses the importance of security tests and proof of instruments before laparoscopy by the laparoscopic and operation theatre nurse, more especially when reusable instruments are used.

Adult↗
PubMed1991

[Decreasing the surgical risk of laparoscopy by using a newly developed, blunt trocar].

Laparoscopy is one of the most frequent interventions used in operative gynaecology. Because of the possible, occasionally grave complications through the use of the trocar forms applied so far, we have developed a new blunt trocar. By using this trocar throughout 1889 interventions, we have had no complications which could be ascribed to the use of this blunt instrument. The advantage of this trocar lies in the avoidance of the possible and feared injuries to the intestines and vessels. Even though overall complication rates in laparoscopy are low and there is no evidence of a statistically significant reduction compared with the use of the sharp trocar, the advantages of the blunt trocar are obvious. There is only one disadvantage, namely the slightly prolonged training time of the younger colleagues, as well as the theoretical possibility of a prolapse of the omentum. Nevertheless, in our opinion, the use of the blunt trocar is advisable to reduce the complication rate in laparoscopy.

Aorta, Abdominal↗
PubMed2003

Tumor implantation during laparoscopy using different insufflation gases - an experimental study using cultured cancer cells.

Recent work using an experimental model in our laboratory has shown that the likelihood of tumor implantation at laparoscopy port-sites following laparoscopy might be influenced by the specific gas used for insufflation. In particular helium insufflation was associated with less port site metastases. The model entailed an inbred rat strain and a tumor cell suspension of mixed heterogeneity, native to the rat strain. To determine whether our previous findings could be reproduced using a different model, we investigated the effect of insufflation with either helium or carbon dioxide gas on the implantation of a purified cell suspension of cultured cancer cells. Thirty-eight Dark Agouti rats were randomized to undergo a 40 minute period of laparoscopic insufflation with either helium or carbon dioxide (19 animals in each group/three different experiments). Three laparoscopy ports were placed and 2 x 10 5 cultured mammary adenocarcinoma cells were introduced into the abdominal cavity at the beginning of the period of insufflation. The rats were killed nine days after surgery and the port sites and abdominal cavity were examined for presence of tumor. Rats undergoing helium insufflation were equally likely to develop port-site metastases compared to rats undergoing carbon dioxide insufflation. There was, however, a predilection for port site metastases to develop at the port site used for camera placement in both groups. Because this port site accommodated a 2 mm laparoscope, it was associated with a larger wound than the other two port sites. Peritoneal tumor deposits elsewhere in the peritoneal cavity were more common following helium insufflation, compared to carbon dioxide. The outcome of this study is different to the results from previous studies using a heterogeneous tumor cell suspension in the same model in our laboratory, or elsewhere, with no advantages demonstrated for insufflation with helium gas. Purified cell suspensions could behave differently to a heterogeneous cell suspension of identical cancer cells in a port-site implantation model, and other cells present within heterogeneous tumor suspension might influence the likelihood of metastasis. As reported previously, tumor implantation is more likely in larger port site wounds and this is independent of the insufflation gas.

Journal Article↗
PubMed2000

Experimental study of effect of embolism of different laparoscopy insufflation gases.

BACKGROUND AND PURPOSE: Whilst carbon dioxide is the gas generally used for insufflation during laparoscopy, several studies have reported adverse effects specifically associated with its use. These effects may be attributable to chemical, metabolic, or immunologic effects specific to CO2. Because helium is chemically, physiologically, and pharmacologically inert, it has been suggested as a possible substitute insufflation gas. However, there has been concern about the potential implications of venous gas embolism during helium insufflation. The aim of this study was to examine the physiological effect of the intravenous injection of He and CO2 in an experimental model. MATERIALS AND METHODS: Eleven domestic white pigs were randomly allocated to receive multiple intravenous injections of increasing volumes of either CO2 or He gas. Cardiorespiratory function was measured, and the intravenous volumes of gas that resulted in cardiac arrest were determined. RESULT: Cardiorespiratory functional measures returned to normal quicker after CO2 than after He injection. Helium injection quickly overwhelmed the animal's ability to compensate and resulted in death at a lower volume than did CO2 injection. CONCLUSIONS: Gas embolism during He insufflation is more likely to be lethal than is CO2 embolism. This scenario is most likely following Veress needle insertion into a large vein. Therefore, if He is to be used for insufflation during clinical laparoscopy, the possibility of venous injection should be minimized by avoiding Veress needle use. Further investigation of the safety of He insufflation is warranted before a role during clinical laparoscopy can be recommended.

Animals↗
PubMed2005

Laparoscopy-assisted exploration of obscure gastrointestinal bleeding after capsule endoscopy: the Korean experience.

BACKGROUND: Obscure gastrointestinal bleeding (OGB) is generally defined as recurrent acute or chronic bleeding for which no source has been identified by routine radiologic and endoscopic examination. The aim of this study was to report our early experiences detecting small bowel bleeding by capsule endoscopy (CE) and the results of laparoscopy assisted surgery for OGB. MATERIALS AND METHODS: Seventy-five patients with OGB were examined by CE. Twelve of 24 patients in the active bleeding group underwent laparoscopic or laparoscopy assisted surgery and we carried out intraoperative enteroscopy to find the focus of the bleeding. RESULTS: Laparoscopic localization of the lesion was successful for 4 patients-those with Meckel's diverticulum, gastrointestinal stromal tumor, lymphoma, and ischemic necrosis. In 3 cases in which there was no natural passage of the capsule endoscope, lesions were identified by small bowel exploration through simple palpation by hand. Intraoperative enteroscopy was performed extracorporeally in 5 cases through a minilaparotomy window using an extended incision of a port site less than 7 cm in length. The lesions that were identified by CE preoperatively were resected successfully, via laparoscopic or laparoscopy-assisted surgery. The gastrointestinal bleeding has not recurred during the postoperative follow-up period (mean, 10.6 months). CONCLUSION: The laparoscopic approach can be chosen for surgical management of OGB patients with active bleeding whose lesions have been identified by CE. This approach allows minimally invasive surgical treatment for ongoing OGB.

Adolescent↗
PubMed2004

Reversed 5 pattern of diagnostic laparoscopy during laparoscopic cholecystectomy and its standardization.

An attempt at standardization of the diagnostic laparoscopy (DL) procedure during laparoscopic cholecystectomy (LC) was undertaken by establishing a simple pattern and checking its applicability in 100 consecutive LCs. DL was performed following the reversed number 5 pattern, starting from the right upper quadrant and moving to the left upper quadrant, left flank, back to the right flank along the transverse colon, down to the pelvis, along the sigmoid to the left flank, and back to the right upper quadrant inspecting small bowel. DL was incomplete in 11 patients. Inspection lasted 6-12 minutes (operation time increase, 14%). Abnormalities were discovered in 38% of patients, diagnosis elucidated in 8%, intervention undertaken in 11%, and control or further treatment proposed in 33%, without morbidity and mortality. The reversed 5 pattern of diagnostic laparoscopy is feasible and safe. It can be routinely done during LC in the general hospital setting. Standardization of diagnostic laparoscopy during laparoscopic cholecystectomy seems necessary for early disclosure of visible disorders and for medicolegal purposes.

Adolescent↗
PubMed2006

The effects on the lower esophageal sphincter of sevoflurane induction and increased intra-abdominal pressure during laparoscopy.

BACKGROUND: Today sevoflurane is one of the most frequently used volatile anesthetics. The speed of induction can approach that of intravenous anesthetics, and case reports using sevoflurane induction for emergency anesthesia have been published. The purpose of this study in laparoscopic cholecystectomy patients was to investigate the effects of sevoflurane during inhalation induction on the lower esophageal sphincter pressure (LESP) and barrier pressure (BrP). The effects on lower esophageal sphincter (LES) and BrP of increased intra-abdominal pressure during laparoscopy were also evaluated. METHODS: We recorded LESP and BrP in nine patients using a Dent sleeve device. Recordings were made before and after inhalation induction of anesthesia with 8% sevoflurane, as well as before and after insufflation of CO(2) into the abdomen. RESULTS: After induction with sevoflurane, LESP (P= 0.039) and BrP (P= 0.020) decreased. Nevertheless, BrP was kept positive in all patients. Insufflation of CO(2) into the abdomen during laparoscopy induced a significant increase in LESP (P= 0.02) and gastric pressure (P= 0.004). However, there was no significant change in BrP (P= 0.66); it increased in four patients and decreased in five. CONCLUSION: BrP was kept positive in all patients after induction of anesthesia. Therefore, we believe that in combination with cricoid pressure, inhalation induction with sevoflurane might be a safe choice. As the adaptive increase in LESP during laparoscopy was not enough to retain a barrier pressure in all patients, it is important to be aware of the risk of regurgitation throughout the anesthesia.

Adult↗
PubMed2006

Guidelines for emergency laparoscopy.

Acute abdominal pain is a leading symptom in many surgical emergency patients. Laparoscopy allows for accurate diagnosis and immediate therapy of many intraabdominal pathologies. The guidelines of the EAES (European Association for Endoscopic Surgery) provides scientifically founded recommendations about the role of laparoscopy in the different situations. Generally, laparoscopy is well suited for the therapy of the majority of diseases that cause acute abdominal pain.

Editorial↗
PubMed2004

Prophylaxis of postoperative nausea and vomiting with oral, long-acting dimenhydrinate in gynecologic outpatient laparoscopy.

UNLABELLED: Dimenhydrinate is an inexpensive antiemetic with few side effects available as an oral, long-acting (LA) formulation (Gravol L/A) containing 25 mg of immediate and 50 mg of sustained release drug. We designed this double-blind comparison trial to assess the efficacy of dimenhydrinate LA versus droperidol alone and the combination for prophylaxis of nausea, vomiting, and retching in outpatient gynecologic laparoscopy. One-hundred-forty-one women were randomized into 3 groups: 1) droperidol (placebo capsule preoperatively and IV droperidol 0.625 mg before induction), 2) dimenhydrinate LA preoperatively and IV placebo before induction, or 3) combination. Information regarding nausea, vomiting, retching, pain, and sedation was recorded in the postanesthesia care unit (PACU) and collected by telephone for the presence of symptoms: on arrival home; at bedtime; upon arising, and at lunchtime the following day. The overall incidence of complete treatment failure (rescue medication in PACU or nausea, vomiting, or retching at any time point) was 28 of 46 (61%), 28 of 48 (58%), and 22 of 47 (47%); and for treatment failure vomiting (rescue medication in PACU or vomiting or retching at any time point) was 16 of 46 (35%), 11 of 48 (23%), and 5 of 47 (11%), for the droperidol, dimenhydrinate, and combination groups, respectively (P = 0.007 for droperidol versus combination). There were no differences in sedation or pain. Preoperative administration of an oral dose of LA dimenhydrinate in combination with droperidol when compared with droperidol alone effectively reduced the incidence of vomiting but not nausea in women undergoing elective outpatient gynecologic laparoscopy. IMPLICATIONS: Dimenhydrinate is an inexpensive antiemetic with few side effects available as a long-acting oral formulation. Women undergoing outpatient gynecologic laparoscopy were given droperidol, an effective antiemetic, dimenhydrinate alone, or the combination of the two drugs. Dimenhydrinate plus droperidol significantly reduced the overall incidence of vomiting, but not nausea, when compared with droperidol alone.

Administration, Oral↗
PubMed2002

Evolution of virtual CT laparoscopy for preoperative imaging in laparoscopic cholecystectomy.

The purpose of this study was to determine the feasibility of virtual endoscopy, named as "virtual CT laparoscopy", in the hepatobiliary system prior to laparoscopic cholecystectomy. We applied this technique to 28 patients suspected of having biliary disease. These images were compared and analyzed qualitatively based on visualization of the structures critical to operative cholangiography and surgical findings. Twenty-four patients, who underwent laparoscopic cholecystectomy, were evaluated as follows: the common bile duct and the hepatic duct were adequately visualized in 23 (96%) of the 24 patients, the cystic duct in 21 (88%), the gallbladder opacification in 20 (83%), the liver inferior surface in 20 (83%). Four patients had anatomic variations detected virtual CT laparoscopy and were proven by operative cholangiography and surgical findings. We emphasize that our new technique may contribute to the laparoscopy during surgery as the aid of understanding of anatomical structures in these organs.

Adult↗
PubMed2005

Diagnostic laparoscopy and laparoscopic ultrasonography with local anesthesia in hepatocellular carcinoma.

Diagnosis of hepatocellular carcinoma (HCC), a common digestive malignancy, remains a challenge. The aim of this study was to evaluate the feasibility of performing laparoscopy and laparoscopic ultrasound with local anesthesia as a diagnostic procedure in HCC. Laparoscopy and laparoscopic ultrasound with local anesthesia was performed in the gastrointestinal endoscopy unit in three patients diagnosed of HCC. Endoscopy staged diffuse liver disease. Laparoscopic ultrasonography identified all liver tumors not visible during endoscopy and guided needle biopsy in one case. No complications happened. In conclusion, laparoscopy and laparoscopic ultrasound, performed as a minimally invasive diagnostic procedure can be a safe and very promising tool in planning therapy of HCC.

Anesthesia, Local↗
PubMedDate not supplied

Profiles in laparoscopy: Mouret, Dubois, and Perissat: the laparoscopic breakthrough in Europe (1987-1988).

In the late 1980s, laparoscopy was essentially a gynecologist's tool. One of the French private surgeons, Phillipe Mouret of Lyon, shared his surgery practice with a gynecologist and thus had access to both laparoscopic equipment and to patients requiring laparoscopy. In March of 1987, Mouret carried out his first cholecystectomy by means of electronic laparoscopy. Although he never published anything about this experience, the news on his technique reached Francois Dubois of Paris. Although having no prior laparoscopic experience, Dubois acted immediately. He borrowed the instruments from gynecologists, performed his first animal experiments and, in April 1988, carried out the first laparoscopic cholecystectomy (LC) in Paris. Inspired by Dubois, Jacques Perissat of Bordeaux, introduced endoscopic cholecystectomy in his clinic and presented this technique at a SAGES meeting in Louisville in April 1989. Very soon, news of the French work in LC soon swept beyond the country's borders. Dubois and Perissat spoke enthusiastically about their work at the meetings and were largely responsible for establishing what is today called the French technique.

Cholecystectomy, Laparoscopic↗
PubMed1976

Laparoscopy and the infertility evaluation.

Results of laparoscopic evaluation of 112 infertile women are presented. Laparoscopy performed prior to comtemplated fallopian tube reconstructive surgery changed the plan of management of 41% of 44 cases. Of 64 women with a normal hysterogram, 58% were found to have evidence of pelvic disease, and 47% had changes in their management based on the findings at laparoscopy. The specific indications and timing of laparoscopy in relation to the remainder of the infertility evaluation are discussed.

Evaluation Studies as Topic↗
PubMed2005

Use of laparoscopy in pediatric urology.

The goal of laparoscopy is to minimize patient morbidity while maintaining successful outcomes. The use of laparoscopy in urology has grown significantly over the past 30 years. Its use has been slower to gain acceptance in pediatrics than in the adult population. Laparoscopic orchidopexies and nephrectomies are commonly performed and have become widely accepted as alternatives to open surgery, if not the gold standard. The more technically demanding procedures, such as laparoscopic pyeloplasty, laparoscopic-assisted bladder reconstruction, and laparoscopic ureteral reimplantation, tend to be performed at selected centers and have yet to achieve widespread acceptance. As laparoscopy is applied more widely in pediatric urology, its potential benefits and drawbacks will be clarified.

Journal Article↗
PubMed1995

[Laparoscopy and laparoscopic endosonography as staging examination of tumors of the upper gastrointestinal tract].

UNLABELLED: Accurate staging of gastric and oesophageal cancer is of major importance for the therapeutic strategy. However conventional imaging procedures are often not sensitive enough for precise assessment of resectability and curability. In this study laparoscopy and laparoscopic ultrasound were evaluated for preoperative staging. PATIENTS AND METHODS: Laparoscopy was performed on 21 patients for staging of intraabdominal malignancy using a standard equipment. Laparoscopic ultrasound was done with a flexible echoendoscope equipped with a curved array transducer (5/7,5 MHz). The ultrasound probe was introduced via a 15 mm trocar. RESULTS: By laparoscopy and laparoscopic ultrasound additional informations compared to conventional staging were obtained and revealed a disseminated disease in 15 out of 21 (71%) patients. These informations induced a change of the initially planned treatment concept in 14 of these patients (67%). A definitive palliative treatment was performed in 5 patients after diagnosis of incurable disease. Laparoscopic ultrasound proved to be useful for the detection of small non superficial lesions followed by biopsy and can improve laparoscopic staging of intraabdominal tumor spread.

Esophageal Neoplasms↗
PubMed1995

Isopneumic laparoscopy in general surgery and trauma: an update.

The purpose of this study was to assess the capability of a retractor system that permits laparoscopic surgery without carbon dioxide pneumoperitoneum and to determine if the system facilitates the use of traditional surgical instruments during minimally invasive surgery. This study was performed at a university-affiliated county hospital (Alameda County Medical Center, Highland General Hospital campus) in Oakland, California. The study design was prospective evaluation with data collection. Eighty-eight isopneumic laparoscopic procedures were performed between July 1992 and October 1993. A planar abdominal wall distention system consisting of an intra-abdominal fan retractor and an electrically powered mechanical arm was used to provide exposure. Conventional surgical instruments as well as laparoscopic instruments were used in each case. Laparoscopy without pneumoperitoneum was used in the evaluation of 43 patients with abdominal trauma (gunshot wound, 18; stab wound, 19; blunt trauma, 6). The need for formal abdominal exploration was obviated in 35 of 43 (81%) cases. Repair of three enterotomies, four diaphragmatic lacerations, and one gastric perforation was performed with conventional instruments. Isopneumic laparoscopic techniques were also used for cholecystectomy (n = 36), diagnosis laparoscopy (n = 4), appendectomy (n = 3), sigmoidopexy (n = 1), and closure of a perforated duodenal ulcer (n = 1). Abdominal exposure approximating that obtained by pneumoperitoneum was obtained in 37 of 45 cases. One major (trocar tip enterotomy) and two minor complications (superficial wound infection) occurred in this group of patients. The ability to use traditional surgical instruments was advantageous in several cases. Laparoscopic surgical procedures can be performed without pneumoperitoneum in the majority of cases. The ability to use conventional surgical instruments is an advantage of this technique. Further improvements in abdominal wall distention systems and modifications of existing surgical instruments are required to further expand the role of isopneumic laparoscopy.

Abdominal Injuries↗
PubMed1996

[Open laparoscopy for prevention of puncture injuries].

Perforating lesions occurring during the establishment of the pneumoperitoneum using the Veres needle and blind introduction of the camera trocar are among the major complications of laparoscopic surgery. Even when all the necessary safety measures are observed and despite complete mastery of the technique, this complication cannot be completely avoided during the blind procedure. The technique of open laparoscopy, so-called, with the introduction of a blunt trocar under direct vision is the sole alternative available for the prevention of such injuries. The advantages of this procedure are that, with appropriate practice, it takes no longer, can be employed in all possible situations, including previous surgery, and, in particular, when assisting a surgeon who is in the process of gaining experience in laparoscopic surgery. Severe perforating injuries and their sequelae are often advanced as an argument against the use of laparoscopic surgical procedures. Through the use of open laparoscopy, injuries to blood vessels and viscera can be virtually completely eliminated, and patient safety considerably improved. On the basis of our own experience, we can unreservedly recommend open laparoscopy as the routine approach for all laparoscopic interventions.

Abdominal Injuries↗
PubMed1997

[Complications of laparoscopy caused by trocars. Preliminary study from the national registry of the French Society of Gynecologic Endoscopy].

OBJECTIVE: To describe laparoscopic complications due to trocar insertions and to define their prevention as well as their risk factors. STUDY DESIGN: The SFEG registry of laparoscopic complications was used for our study; 26 complications due to trocar insertions were recorded to this day by the register including 12 vascular injuries, 9 bowel injuries, 3 bladder perforations and 2 incisional herinas. In order to avoid accidents of this technique, patient profile, laparoscopy indications, trocar type, diagnosis and treatment of the complications as well as the outcome must be defined. RESULTS: Whatever the operator's experience, the indication of laparoscopy and the trocar type some patients seem to have complications at laparoscopy: 70% of studied group had prior surgical treatment and 50% were over weight. However, it appeared that safety rules were not been taken into account for one-third of the trocar injuries. Consequently, laparotomy was used by the same surgeons for these complications in 89% of cases, laparotomy was delayed in 27% of the cases. CONCLUSION: In order to prevent laparoscopic complications, the surgeon must (i) inform the patients about risks which may occur, (ii) be careful, and (iii) declare each complication to a national registry such as the SFEG registry.

Adult↗