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PubMed1997

[Value of diagnostic laparoscopy and minimal invasive procedures in acute abdomen].

During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.

Abdomen, Acute↗

PubMed1997

Comparison of lighted ureteral catheter luminance for laparoscopy.

Urologists may be asked to place a lighted ureteral catheter for laparoscopic surgeons. Presumably, the lighted ureteral catheter with the greatest luminance will provide the best visual roadmap to the ureter during laparoscopy. The purpose of this article was to compare the luminance of three lighted ureteral catheters and characterize technical characteristics so that urologists could select the lighted ureteral catheter most appropriate for laparoscopy. Four lighted ureteral catheters were evaluated: Cook 5F single lumen, Cook 5F double lumen, Cook 7F, and Rüsch 5F. Each catheter was attached to a standard fiber-optic light source at maximum output. Each catheter was placed in a porcine ureter. Luminance was measured with a photometer in a dark room. Luminance was characterized at catheter locations corresponding to the proximal, middle, and distal ureter. The luminance measured in foot-Lamberts (fL) in the middle ureter for each catheter was as follows: Cook 5F single lumen 98+/-47, Cook 5F double lumen 42+/-14, Cook 7F 98+/-11, Rüsch 5F 58+/-45 (p=.01). The luminance (fL) in the distal ureter for each catheter was: Cook 5F single lumen 129+/-40, Cook 5F double lumen 110+/-108, Cook 7F 22+/-2, Rüsch 5F 49+/-30 (p=.02). The luminance was not significantly different among the catheters when measured in the proximal ureter. The Cook 5F single-lumen ureteral catheter overall has the greatest luminance. This catheter should be easiest to identify at laparoscopy.

Analysis of Variance↗

PubMed1989

Ectopic tubal pregnancy treated by operative laparoscopy.

Between July 1986 and May 1988, all 23 patients with ectopic tubal pregnancies of 5 to 10 1/2 weeks' gestation and with serum beta-human chorionic gonadotropin levels between 51 and 92,610 mIU/ml (first international reference preparation) were treated by operative laparoscopy. Twenty-two (96%) of the ectopic pregnancies were unruptured or leaking and one (4%) was ruptured. Fifteen patients (65%) were treated with electrosurgical linear salpingotomy, and three of these patients (20%) later needed subsequent operative procedures. Six patients (26%) were treated with laparoscopic partial or total salpingectomy, and two patients were treated with either fimbrial expression of the pregnancy or completion of a partial abortion. Twenty patients (87%) spent less than 24 hours in the hospital for successful treatment of the ectopic pregnancy. It is concluded that operative laparoscopy should be considered an alternative to laparotomy or minilaparotomy for the treatment of ectopic pregnancy.

Adult↗

PubMed1988

Incarcerated Richter's hernia after laparoscopy: a case report.

An unusual case of Richter's hernia on the 5th day after laparoscopy is presented. The complaints simulated a postoperative hematoma, but they became so intense that the expansion was surgically explored: a conservative procedure on the loop of small bowel was possible. To prevent this complication after laparoscopy careful shaking of the abdominal wall at removal of the instruments is necessary.

Adult↗

PubMed1980

Laparoscopy in Southland.

A review was made of 625 consecutive gynaecological laparoscopies carried out in the Southland Hospital. Forty-one point seven percent were for diagnostic reasons, mainly in the diagnosis of pelvic pain and infertility, and 57.3 percent were for sterilisation. Complications occurred with 2.2 percent and 5.6 percent respectively, but the serious complications and those requiring laparotomy only came to 1.1 percent. Four women (1.1 percent) became pregnant after sterilisation, all four occurring during the first year of the procedure. Overall, laparoscopy is confirmed to be a valuable diagnostic technique and a safe method of sterilisation.

Adolescent↗

PubMed2002

The effect of laparoscopy on survival in pancreatic cancer.

HYPOTHESIS: Exposure to laparoscopy influences survival in patients with unresected pancreatic cancer who have a diagnostic or staging surgical procedure. METHODS: We used the Surveillance, Epidemiology, and End Results Medicare-linked database to identify a cohort of persons 65 years and older, who were newly diagnosed with primary pancreatic cancer between 1991 and 1996 and who had a diagnostic laparoscopy or laparotomy during the course of their disease. Patients with a prior malignancy and those who had a pancreatic resection were excluded. We used proportional-hazards regression to adjust risk estimates for demographic factors, medical comorbidities, tumor characteristics, and the use of other treatment modalities. RESULTS: We identified 112 individuals with pancreatic cancer who had a laparoscopic procedure and 791 who had only conventional surgery. More patients who had laparoscopic surgery had distant metastases at diagnosis (67.9% vs 41.2%; P =.001). Median duration of survival in the laparoscopic surgery group was 4.8 months (95% confidence interval [CI], 4.1-6.8) compared with 5.3 months in the group that had only open surgery (95% CI, 4.9-5.6; P =.83). Compared with patients who only had a laparotomy, patients who had laparoscopic surgery did not have an increased rate of death when adjusted for the effects of age, sex, tumor size, grade, the presence of nodal and distant metastases at diagnosis, and the use of radiation, chemotherapy, therapeutic endoscopic retrograde cholangiopancreatography, and biliary and gastric bypass (adjusted hazard ratio, 0.93; 95% CI, 0.62-1.40). CONCLUSION: Exposure to laparoscopic surgery did not adversely affect survival in a cohort of elderly patients with pancreatic cancer who had a diagnostic procedure but no pancreatic resection.

Aged↗

PubMed2005

The evolving role of staging laparoscopy in the treatment of colorectal hepatic metastasis.

HYPOTHESIS: Laparoscopy is an increasingly important tool in the staging and treatment of hepatic malignancies. This study evaluates the effect of staging laparoscopy (SL) using intraoperative ultrasonography (IOUS) on the regional treatment of isolated hepatic colorectal metastasis. DESIGN: Analytic cohort study. SETTING: Tertiary care center. PATIENTS: Consecutive patients who have a colorectal metastasis confined to the liver and selected for surgical regional treatment. INTERVENTIONS: All patients underwent preoperative evaluation followed by SL/IOUS. Operative plans were based on preoperative imaging and were either carried out or altered intraoperatively according to SL/IOUS findings. MAIN OUTCOME MEASURE: Effect of SL/IOUS on surgical management. RESULTS: Between September 1996 and May 2004 one hundred fifty-two SL/IOUSs were performed in 136 patients (77 males and 59 females), who had a mean (SD) age of 63 (11) years. Data sets were complete in 138 events. All patients had isolated hepatic disease as defined by preoperative computed tomography in 152 (100%) and positron emission tomography in 107 (70%). Staging laparoscopy/IOUS identified surgically untreatable disease in 34 events (25%) because of peritoneal metastases (n = 15), nodal involvement (n = 11), diffuse hepatic disease (n = 5), no identifiable disease (n = 2), and untreatable disease (n = 1). Laparoscopic treatment events included radiofrequency ablations (n = 78), hepatic artery pump implantations (n = 40), resections (n = 26), and combined procedures (n = 37). Overall, SL/IOUS changed the treatment plan in 66 (48%) of 138 of events. This includes 32 (23%) of 138 events in which SL/IOUS findings significantly altered the actual procedure performed relative to the preoperative plan. Three minor complications occurred in the SL/IOUS-only group with a mean (SD) hospital stay of 1.3 (1) days. CONCLUSION: In the regional management of isolated colorectal hepatic metastasis, SL/IOUS avoids unnecessary laparotomies and influences definitive surgical intervention in a substantial proportion of patients.

Aged↗

PubMed1978

Effects of laparoscopy on mesenteric blood flow.

The increased intraperitoneal pressures that accompany laparoscopic examinations produce significant hemodynamic alterations. Studies of the effects of such pressures on mesenteric blood flow in laboratory animals with normal and compromised superior mesenteric artery blood flow lead us to conclude that laparoscopy in patients with suspected compromised intestinal blood flow should be undertaken with great caution. Since major alterations in blood flow did not occur at intraperitoneal pressures less than 20 mm Hg, intraperitoneal pressures during laparoscopy should be maintained below this level and for as brief a period of time as possible when this procedure is used in patients with suspected intestinal ischemia.

Animals↗

PubMed1995

Increased tumor establishment and growth after laparotomy vs laparoscopy in a murine model.

OBJECTIVE: To test our hypothesis that tumors would be more easily established and grow more aggressively after laparotomy than after laparoscopy. This hypothesis was based on studies that have demonstrated that surgery can suppress immune function and facilitate tumor growth and that have shown preservation of immune function after laparoscopic procedures. DESIGN: Double-blinded, randomized, control trial. SETTING: Research laboratory and animal care facility. ANIMALS: One hundred forty 5- to 6-week-old C3H/He female mice. INTERVENTIONS: Three experiments with three groups each: laparotomy, insufflation, and anesthesia controls. All animals received an intradermal inoculation of tumor cells in the dorsal skin. The anesthesia control cohort underwent no procedure. The laparotomy cohort underwent a midline laparotomy from the xiphoid process to the pubis, which was closed after 30 minutes. The insufflation cohort underwent peritoneal insufflation with carbon dioxide for 30 minutes. MAIN OUTCOME MEASURES: Tumor volume, tumor mass, and incidence of tumor establishment. RESULTS: In the first experiment, the tumor volumes of the anesthesia control and insufflation groups followed a similar pattern of plateau and regression. The tumor volumes of the laparotomy group followed a different pattern and were significantly larger than those of the control and insufflation groups on postoperative days 6 and 12 (P < .05 for all comparisons). In the second experiment, tumors in the laparotomy group were approximately three times larger than those of the control group (P < .01) and almost twice as large as insufflation group tumors (P < .01) by mass. In the third experiment, there was a significantly higher incidence of tumor establishment in the laparotomy group than in the insufflation (P < .04) or control (P < .01) groups. The incidence was not different between the control and insufflation groups. CONCLUSIONS: Tumors were more easily established and grew more aggressively after laparotomy than after insufflation. These results, coupled with those that demonstrate an immune advantage to laparoscopy over laparotomy, suggest that the difference in observed tumor growth may be related to immune function. While much work remains to be done, we believe these data provide evidence of a previously undemonstrated benefit of laparoscopic intervention.

Animals↗

PubMed1999

Role of laparoscopy in the management of stomach cancer.

The use of laparoscopy for staging and treatment of gastric cancer has evolved in the past decade along with other advanced laparoscopic procedures. Laparoscopic staging of gastric cancer, especially with the addition of laparoscopic ultrasonography, has been shown more reliable than radiologic modalities and it effectively decreases the incidence of unnecessary laparotomy. Although it is not commonly performed in Western countries, the use of laparoscopic curative resection for gastric cancer is growing, especially in Japan. Laparoscopic resection of early gastric cancer has been shown to be safe and effective in many retrospective series though no prospective randomized studies comparing it to open resection have been performed. Despite being more controversial, laparoscopic curative resection of advanced gastric cancer also has been performed at multiple institutions with encouraging early results. This review will present the current worldwide experience of laparoscopy for gastric cancer.

Adenocarcinoma↗

PubMed1995

The role of laparoscopy in gynecologic oncology.

The use of laparoscopy in the management of gynecologic malignancies has significantly increased over the last 5 years. The safety and adequacy of pelvic and para-aortic lymphadenectomy has been established by several investigators. Patients with early carcinoma of the cervix are now undergoing Schauta (radical vaginal) hysterectomy after laparoscopic lymphadenectomy. Patients with carcinoma of the endometrium are treated by laparoscopically assisted vaginal hysterectomy in conjunction with laparoscopic pelvic and para-aortic lymphadenectomy. Staging and second-look procedures are now being performed laparoscopically in patients with carcinoma of the ovary. The Gynecologic Oncology Group is currently investigating the role of laparoscopic surgery for patients with carcinoma of the cervix, endometrium, and ovary in four Phase II trials. A randomized Phase III trial comparing laparoscopy to laparotomy for patients with carcinoma of the endometrium will begin soon.

Clinical Trials as Topic↗

PubMed2001

Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma.

BACKGROUND: The current study was conducted to assess the feasibility of laparoscopy in the treatment of women with early stage endometrial carcinoma and to compare the surgical outcome, cost, and quality of life among these patients with those treated with laparotomy. METHODS: A prospective study was conducted over 2 years in which all women with early stage endometrial carcinoma who could tolerate laparoscopic surgery were treated with laparoscopically assisted vaginal hysterectomy (LAVH), bilateral salpingo-oophorectomy (BSO), and lymphadenectomy. Women with a similar disease stage who underwent similar surgical procedures through laparotomy in the previous 2 years were used as the control group. Both groups were compared with regard to their characteristics, surgical outcome, and cost and were interviewed regarding their quality of life. RESULTS: Eighty-six of 90 women with endometrial carcinoma underwent LAVH. The procedure was converted to laparotomy in 5 patients (5.8%). Laparoscopic surgery thus was successful in 90% of the women. There were no significant differences noted between those women who underwent LAVH and those who underwent total abdominal hysterectomy (TAH) (n = 57) with regard to patient characteristics, type of surgical procedure, preoperative and postoperative hematocrit, complications, patient recall of postoperative pain, and tumor recurrence. LAVH patients had significantly smaller body mass indices, a longer surgical time, more pelvic lymph nodes, a smaller decrease in postoperative hematocrit, received less pain medication, had a shorter hospital stay, an earlier return to full activity and work, and a higher level of satisfaction with their treatment, although their procedures had a higher cost compared with TAH patients. CONCLUSIONS: The majority of women with early stage endometrial carcinoma can be treated with laparoscopy with an excellent surgical outcome, shorter hospitalization, earlier recovery, and improved quality of life, but with a higher financial cost.

Adult↗

PubMed1982

Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study.

More than one-third of all appendicectomies are unnecessary. A study was directed towards reducing the misdiagnosis of appendicitis, thus preventing needless operations. Thirty-six women in the fertile age group and with a diagnosis of appendicitis were subjected to laparoscopy before surgery. All women had undergone a gynaecological examination to rule out disease of the female genitalia. As a result of the laparoscopy, surgery was cancelled in one-third of the cases, which were found to have acute gynaecological disease not requiring surgery.

Acute Disease↗

PubMed1992

Laparoscopy in developing countries in the management of patients with an acute abdomen.

Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultrasonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P < 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.

Abdomen, Acute↗

PubMed1994

Abdominal wall metastases following laparoscopy.

Only 18 cases of recurrence at the sites of cannula insertion after laparoscopy have been reported in the literature, ten of them in the past year. The period between laparoscopic surgery and presentation of wound metastasis varies widely, from 7 days to 10 months; the lesions are typically hard, craggy and painful. The most likely mechanism is direct implantation of viable exfoliated tumour cells but three aspects specific to laparoscopy may also be important. First, there may be increased exfoliation of tumour cells following manipulation by laparoscopic instruments of an unsuspected malignancy. Second, there may be repeated close contact between tumour-laden instruments and the port. Third, the passage of resected tissue through a small incision may coat the wound with potentially malignant cells.

Abdominal Muscles↗

PubMed2004

Stereoscopic vision provides a significant advantage for precision robotic laparoscopy.

BACKGROUND: Current surgical robots provide no sense of touch and rely solely upon vision. This study evaluated the effect of new stereoscopic technology on the performance of robotic precision laparoscopy. METHODS: Eight experienced laparoscopists with no experience in robotics performed five tasks of increasing complexity using a laparoscopic robot. The tasks were as follows: rope pass, paper cut, needle capping, knot tying and needle threading. Each test was performed ten times under both stereoscopic and monoscopic conditions. Performance times and errors were recorded. RESULTS: Mean(s.e.m.) final performance times were calculated from the final five trial times for each test, and were as follows for monoscopic and stereoscopic conditions respectively: rope pass 112.8(4.2) and 97.0(3.7) s (P = 0.013), paper cut 117.1(6.0) and 98.4(9.8) s (P = 0.020), needle capping 144.5(12.7) and 99.7(6.8) s (P = 0.008), knot tying 138.7(14.3) and 70.3(6.0) s (P = 0.002), and needle threading 210.8(28.2) and 92.3(4.1) s (P = 0.002). The mean(s.e.m.) number of errors per candidate was 60.6(7.8) and 20.8(3.9) under monoscopic and stereoscopic conditions respectively (P = 0.004). CONCLUSION: Stereoscopic vision provided a significant advantage during robotic laparoscopy in situations that required a precise understanding of structural orientation.

Clinical Competence↗

PubMed1976

A comparative study of hysterosalpingography and laparoscopy in the investigation of infertility.

A comparison of hysterosalpingography and laparoscopy was carried out on 79 infertile women. Out of these, 60 had abnormal and 19 had normal hysterosalpingograms. Of the 19 patients with normal X-rays, nine (47%) had abnormal findings during laparoscopy. In 62% of patients with abnormal hysterosalpingograms, laparoscopic findings confirmed the radiological diagnosis, however in 38% the findings differed. Though hysterosalpingography is an important part of infertility evaluation, a final and definite diagnosis requires endoscopic evaluation of the pelvis.

Female↗

PubMed1978

Laparoscopy for the confirmation and prognostic evaluation of pelvic inflammatory disease.

A presumptive diagnosis of pelvic inflammatory disease (PID) is usually made in our gynecologic clinics when obscure, acute lower abdominal pain is accompained by fever and abnormal vaginal discharge, urinary and rectal discomfort, marked tenderness of the pelvic organs to palpation, or pelvic masses. In the present study, during a 2-year period, 223 women underwent laparoscopy to confirm this diagnosis. PID was confirmed in 103 (46.2%) of the cases; other serious conditions were diagnosed in 69 (30.9%) of the cases; and no evidence of disease was found in 51 (22.9%) of the cases. The authors conclude that laparoscopy is a valuable tool in the diagnosis of PID.

Diagnosis, Differential↗