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PubMed1979

[Laparoscopic picture and a working laparoscopic classification of chronic perihepatitis].

The author established chronic perihepatitis, via laparoscopy, in 61.6 percent of the investigated 350 patients in the course of 12 years. Describing the most characteristic mascoscopic varieties of chronic perihepatitis, the author groups them in seven separate form: I. Perihepatitis diffusa, corresponding to Zuckergussleber of Curschmann. II. Perihepatitis adhesiva and III. Perihepatitis circumscripta. The latter, on its part is subdivided to 5 separate forms of chronic perihepatitis: 1. Perihepatitis arachnoidealis, 2. Perihepatitis marginalis, 3. Perihepatitis areata et striata, 4. Perihepatitis miliaris disseminata, 5. Perihepatitis paravesicalis. That working laparoscopic classification contributes to the precise diagnostics and to the clinical interpretation of the separate forms of chronic perihepatitis. With the aid of lapraoscope the author performed a partial decapsulation of diffuse perihepatitis in 12 patients, without complications observed. Diffuse perihepatitis is, for the first time, described in patients with chronic hepatitis, in a patient with multiple liver abscesses and in one female-patient with peritoneal carcinosis and hemorrhagic ascites.

Biopsy, Needle↗

PubMed2026

Structured Visualization for Laparoscopic Skill Acquisition:A Randomized Controlled Study.

OBJECTIVE: To evaluate whether structured visualization can support acquisition of basic laparoscopic skills during simulation training and whether this approach can achieve outcomes comparable to repeated physical practice. DESIGN: Prospective randomized comparative study. SETTING: Simulation-based laparoscopic skills training at a university-affiliated teaching center. PARTICIPANTS: Fifty laparoscopy-naive medical students were randomly assigned to a laparoscopic practice group or a visualization group. The laparoscopic practice group performed a validated Gynecological Endoscopic Surgical Education and Assessment (GESEA) Laparoscopic Skills Training and Testing (LASTT) hand-eye coordination task 7 consecutive times. The visualization group performed the same task physically on attempts 1, 4, and 7, while attempts 2, 3, 5, and 6 consisted of guided visualization. Each attempt lasted up to 2 minutes, and performance was scored as the number of correctly placed rings (range 0-12). RESULTS: Baseline performance was comparable between groups (2.92 ± 2.14 vs 2.88 ± 1.72; p = 0.94). Both groups improved significantly over time (p < 0.001). No statistically significant between-group differences were found on the 4th attempt (6.52 ± 3.25 vs 5.76 ± 2.57; p = 0.48) or 7th attempt (8.24 ± 2.86 vs 7.44 ± 2.99; p = 0.39). The final physical performance of the visualization group was significantly better than the 3rd physical attempt of the laparoscopic practice group (p = 0.025). CONCLUSIONS: Structured visualization may support early laparoscopic skill acquisition and achieve short-term outcomes comparable to repeated hands-on simulator training. Visualization should be considered an adjunct, rather than a replacement, for physical practice in simulation-based laparoscopic education.

Laparoscopy↗

PubMed1977

Laparoscopic exposure and sequential observation of the ovary of the cycling bitch.

A method was developed to alter surgically the bursa of the bitch to allow sequential observation of the ovary by means of laparoscopy. Adult anesthetized female dogs of three breeds underwent laparoscopic examinations in which each natural bursa slit was lengthened 1.0-1.5 cm using laparoscopic hook scissors in conjunction with electrocautery. The ovary could be effectively and repeatedly exposed for laparoscopic viewing through the lengthened bursa slit. Neither laparoscopic surgery nor frequent routine laparoscopic examinations of the reproductive organs had an effect on subsequent ovarian activity. All dogs subjected to the laparoscopic ovarian exposure technique exhibited estrus behavior, follicle development, ovulation and corpus luteum formation. Preovulatory follicular development was detected as early as 11 days before ovulation with the most rapid follicular maturation occurring two to three days before ovulation. Follicular collapse and extensive hemorrhage at the rupture site during ovulation did not occur. Release of the cumulus mass from a vesicular follicle was observed in one bitch. The cumulative mass adhered to the follicular wall for an indefinite time following ovulation. The structural size of the bitch corpus luteum was maximal four to eight days following ovulation. Corpora lutea remained visible on the ovarian surface for 16 weeks. No differences in cyclic ovarian morphology were observed among the three breeds of dogs studied.

Animals↗

PubMed1979

Sterilization of laparoscopes. Is soaking sufficient?

Controversy exists over the proper methods of sterilizing laparoscopic telescopes. An edict requiring gas sterilization rather than solution soaking of these instruments is in force in all federal hospitals. This rule has necessitated capital investments for new instruments and has led to a severe reduction in the number of cases of laparoscopy that may be scheduled in one day. Fear of contamination is based on theoretical considerations and rusn counter to the actual, observed safety record seen with laparoscopes soaked in activated glutaraldehyde between cases. In an effort to dispassionately approach this problem, cultures of the umbilical area, the laparoscope and the pelvic serosal surfaces were taken to document the type of organisms commonly encountered under clinical conditions. Cultures for aerobic and anaerobic bacteria as well as for fungi were taken after soaking the telescope in activated glutaraldehyde. The results demonstrated growth of common skin organisms even after skin preparation with povidone-iodine and ethyl alcohol. Similar organisms were recovered in some cases from the laparoscope and the pelvic surfaces. The actual degree of contamination suggested by a colony count falls well within the range of the healthy peritoneum to cope with these organisms. Recommendations for laparoscopic sterilization or disinfection are based on the results obtained.

Ascitic Fluid↗

PubMed1979

Silicone band technique for laparoscopic tubal sterilization in the gravid and nongravid patient.

Laparoscopic tubal sterilization by the Falope ring technique was performed on 196 patients. Sixty-four patients underwent laparoscopic tubal sterilization at the time of gestation termination. One hundred thirty-two patients underwent interval laparoscopic sterilization. The complication and failure rates in the group that had both laparoscopic tubal sterilization and gestation termination was lower than in the group that had laparoscopic tubal sterilization alone. The Falope ring sterilization technique is a safe method when combined with gestation termination, and spares the patient the inconvenience and increased hazard of 2 separate procedures.

Abortion, Induced↗

PubMed2026

Laparoscopic Surgery Is Associated With Reduced Small Bowel Obstruction Risk After Colorectal Cancer Surgery: A Nationwide Cohort Study of 5458 Patients.

INTRODUCTION: Postoperative small bowel obstruction (SBO) is a major complication following colorectal cancer surgery, yet evidence-based prevention strategies remain unclear. We aimed to clarify site-specific risk factors for SBO and evaluate the effectiveness of laparoscopic surgery and adhesion prevention materials (APMs) in preventing SBO after colorectal cancer surgery. METHODS: This retrospective cohort study analyzed 5458 patients who underwent colorectal cancer surgery at 32 Japanese institutions between 2012 and 2014. The primary endpoint was the 5-year risk of SBO. We evaluated the effects of laparoscopic surgery, APM use, and stoma creation on SBO risk. Clinical variables included demographics, tumor site, operative approach, operative details, and postoperative complications. Hospital-level clustering was addressed using mixed-effects logistic regression. RESULTS: Overall SBO incidence was 5.2% (n = 283). Rectal cancer had the highest risk, whereas all colonic sites except the descending colon showed significantly lower odds. Laparoscopic surgery was associated with a 42% reduction in odds (OR 0.58; 95% CI 0.45-0.74; p < 0.001), with significant reductions in ascending (NNT = 22.2, p = 0.001) and sigmoid colon surgery (NNT = 30.2, p = 0.003). APMs showed no protective effect (OR 1.01; 95% CI 0.78-1.32; p = 0.94). Stoma creation significantly increased SBO risk (OR 1.84; 95% CI 1.35-2.51; p < 0.001). Secondary analysis identified reoperation and postoperative ileus as additional independent risk factors. DISCUSSION: Laparoscopic surgery was associated with reduced long-term SBO risk, with significant benefits in ascending and sigmoid colon surgery. APMs showed no measurable benefit. Stoma creation increased SBO risk, with no observed difference between ileostomy and colostomy.

adhesion prevention material↗

PubMed1975

Injury to the ureter during laparoscopic tubal sterilization.

As the use of laparoscopy and laparoscopic tubal sterilization has increased, a number of serious complications have been reported. A case is described in which the ureter was damaged during laparoscopic sterilization. The majority of serious complications associated with laparoscopic sterilization have been burn injuries resulting from the use of cautery instruments. Thermal injuries are likely to occur when the operator is inexperienced, and when cautery instruments of the high-energy type are used. Meticulous technique is required in the performance of laparoscopic sterilization and low-energy "cold cautery" units should be used in this procedure.

Adult↗

PubMed2026

Hydrodissection-assisted laparoscopic orchiopexy utilizing needle grasper for palpable undescended testes: Clinical efficacy analysis.

OBJECTIVE: Laparoscopic orchiopexy has emerged as a viable alternative for the treatment of palpable undescended testis (UDT). This study aims to evaluate the feasibility and efficacy of needle-grasper hydrodissection-assisted laparoscopic orchiopexy (NHLO) in comparison to conventional laparoscopic orchiopexy (CLO) for palpable UDT. METHODS: A cohort of 96 patients diagnosed with palpable UDT, admitted between January 2020 and April 2024, was included in this study. Among these, 54 patients underwent NHLO, while 42 patients were treated with CLO. In the NHLO procedure, normal saline was injected into the retroperitoneal space to create a hydrodissection barrier, facilitating the separation and protection of the vas deferens and spermatic cord. The vas deferens and spermatic cord were meticulously dissected following the principles of integrity and minimal tissue trauma. Outcome measures included final testicular position, testicular volume growth, testicular atrophy, success rate, and postoperative complications. RESULTS: No significant differences were observed between the NHLO and CLO groups in terms of age, laterality, operative time (NHLO: 38-46 min; CLO: 39-48 min), or complication rates (NHLO: 1.9 %; CLO: 0.0 %). At follow-up, all patients in both groups exhibited palpable testes in satisfactory scrotal positions. Notably, no visible abdominal scarring was observed in the NHLO group, whereas there were two noticeable scars on the abdomen in CLO. CONCLUSION: Needle-grasper hydrodissection-assisted laparoscopic orchiopexy is a safe, effective, and minimally invasive technique that provides optimal protection of the vas deferens and spermatic cord while achieving excellent cosmetic outcomes.

Humans↗

PubMed2026

Clinical effectiveness of transversus abdominis plane block versus local anaesthesia wound infiltration for postoperative pain relief after laparoscopic appendicectomy in children: A multicentre, double-blind, randomised, controlled phase III trial.

BACKGROUND: Postoperative pain relief after laparoscopic appendicectomy in children provided by transversus abdominis plane (TAP) block and local anaesthesia wound infiltration (LAWI) of trocar insertion sites has never been compared. OBJECTIVE: To investigate whether TAP block could decrease postoperative opioid requirements after laparoscopic appendicectomy in children compared with LAWI. DESIGN: Multicentre, double-blind, phase III randomised trial. SETTING: Two tertiary paediatric surgery centres. PATIENTS: Children aged 3 to 15 years admitted for laparoscopic appendicectomy. MAIN OUTCOME MEASURES: The primary outcome was the total dose of nalbuphine delivered within 24 h after surgery. Secondary outcomes were the Face Legs Activity Cry Consolability (FLACC) scale values at 1, 2, 6, 12 and 24 h, the time from levobupivacaine injection to the first dose of nalbuphine, and the time from the end of surgery to the first mobilisation. Patients received either ultrasound-guided TAP block (TAP group) or LAWI of trocar insertion sites (infiltration group) with 0.6 ml kg -1 of levobupivacaine 2.5 mg ml -1 , combined with standardised systemic multimodal analgesia including paracetamol, ketoprofen, phloroglucinol and nalbuphine. RESULTS: Forty-six and 50 patients were analysed in the TAP and infiltration groups, respectively [age: 10 [7 to 12] versus 10 [8 to 12] years; females: 16 (35%) versus 25 (50%); duration of surgery: 71 [64 to 90] versus 69 [56 to 89] min]. The primary outcome (total nalbuphine dose) was 0.2 [0.0 to 0.2] and 0.2 [0.0 to 0.2] mg kg -1 in the TAP and infiltration groups, respectively ( P  = 0.95). FLACC scale values did not significantly differ between the two groups ( P  = 0.78). Time to the first dose of nalbuphine or to first mobilisation was not significantly different between groups ( P value for log-rank test = 0.095 and 0.18, respectively). CONCLUSION: TAP block does not appear to provide a greater opioid-sparing effect than LAWI of trocar insertion sites after laparoscopic appendicectomy in children, when combined with systemic multimodal analgesia including nonsteroidal anti-inflammatory drugs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04969133.

Humans↗

PubMedDate not supplied

Instrumentation for laparoscopic tubal sterilization.

The numbers and results of laparoscopic tubal sterilizations performed between 1971 and 1975 show widespread public and professional acceptance of this operation. The need for safe and effective laparoscopic equipment led to the development of three types of sterilization viewing systems: the viewing laparoscope, the operating laparoscope, and the needlescope. A number of operative procedures have been developed. The instruments currently being used for tubal destruction via electrocoagulation and endocoagulation are described. Advances in externally applied mechanical occlusive devices are also mentioned. Experimental work with intraluminal stents is noted. The criteria that must be met to ensure worldwide acceptance of these operations are discussed.

Electrocoagulation↗

PubMed2026

The Efficacy of Erector Spinae Plane Block Versus Subcostal Transversus Abdominis Plane Block in Laparoscopic Nephrectomy: A Randomized Clinical Trial.

OBJECTIVES: This study compared the efficacy and safety of erector spinae plane block (ESPB) versus subcostal transversus abdominis plane (TAP) block in reducing postoperative pain among patients undergoing laparoscopic nephrectomy. METHODS: This randomized clinical trial enrolled 70 adult patients, ASA physical status I or II, who underwent total (radical) laparoscopic nephrectomy under general anesthesia. Patients were randomly assigned to 2 groups. Group ESPB received an ultrasound-guided ESPB at the T7 transverse process level, while group TAP received an ultrasound-guided subcostal TAP block. The primary outcome was the total amount of morphine consumed at 6 and 24 hours postoperatively. Secondary outcomes included the incidence of patients requiring opioid analgesia, time to rescue analgesia, visual analog scale of pain intensity, time to postoperative ambulation, intraoperative and postoperative hemodynamics, arterial partial pressure of oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 or P /F) ratio, and incidence of complications. RESULTS: Compared with the TAP group, the ESPB group exhibited significantly lower median morphine consumption at 24 hours ( P =0.032), prolonged time to first analgesic rescue ( P =0.049), and lower incidence of rescue morphine requirement (OR=0.23; 95% CI=0.06-0.94; P =0.031), with lower visual analog scale pain scores at 12, 18, and 24 hours postoperatively ( P <0.001). The mean arterial blood pressure and heart rates were comparable between groups. No significant adverse effects from either approach. DISCUSSION: In laparoscopic nephrectomy, ultrasound-guided ESPB may safely and effectively be used to improve pain management and reduce pain intensity, with stable hemodynamics and a comparable risk of postoperative complications to the ultrasound-guided subcostal TAP block.

Humans↗

PubMed1976

Laparoscopic sterilization in the immediate puerperium.

The safety and effectiveness of laparoscopic sterilization with electrocoagulation and separation of the tubes when performed within five days of a normal delivery is evaluated. The majority of patients (53.5%) were sterilized within 36 hours of delivery and were discharged on either the same day or the first post-sterilization day (91.0%). While some form of complications were reported for 9.5 percent of the patients, potentially serious complications occurred for only 2 patients (1.%). Most of the complications were probably unrelated to the laparoscopic procedure. At six months after sterilisation, complications were reported by 2.9 percent of the patients who returned for a follow-up visit. One patient became pregnant 3.5 months after sterilization. The results of this study suggest that performing laparoscopic sterilization in the immediate puerperium does not significantly increase the complication or failure rates of the procedure.

Electrocoagulation↗

PubMed1976

Hysterosalpingographic follow-up of laparoscopic sterilization.

Two hundred and fifty of 323 laparoscopically sterilized patients had hysterosalpingographic (HSG) follow-up. A Foley catheter was used in hysterosalpingography. Of these patients, 3.6 per cent demonstrated fistula; 1.2 per cent were found to have round ligament burns, and 0.618 per cent became pregnant. Mechanism of fistula formation, prevention, and management is discussed. The incidence of intrauterine pregnancy and ectopic pregnancy after laparoscopic sterilization is discussed, and the literature is reviewed. Based on these data, it is concluded that HSG follow-up is helpful in teaching institutions and where the laparoscopic sterilization is carried out by inexperienced operators. Routine HSG follow-up is not recommended.

Burns↗

PubMed1977

Recovery of preimplantation blastocysts in the squirrel monkey by a laparoscopic technique.

A laparoscopic uterine flushing technique has been developed for the recovery of preimplantation embryos from the squirrel monkey. Fourteen adult female squirrel monkeys were induced to ovulate with 4 or 5 days' treatment with follicle-stimulating hormone (1 mg) followed by human chorionic gonadotropin (HCG) (500 IU). Natural mating with a fertile male or artificial insemination was performed near the time of ovulation. Thirty-six hours and eleven days after HCG administration, the females were laparoscoped to determine whether ovulation had occurred. Under laparoscopic control, 1.2 to 3 ml of warmed saline were flushed through the uterine lumen 4 to 7 and 15 to 17 days after HCG administration. Flushed fluid was recovered with a plyethylene catheter or a Pasteur pipette inserted into the cleaned vagina. Fifty-eight uterine flushings were performed, with an average of 65.4% fluid recovery. Six nonfertilized ova and two preimplantation blastocysts were recovered by this technique.

Animals↗

PubMed1977

The laparoscopic staging of primary biliary cirrhosis.

The laparoscopic photographs of 38 cases of primary biliary cirrhosis with high titres of mitochondrial antibodies were reviewed. The quality of laparoscopic photography is now so high that it proved possible to use these photographs as the basis of a system of laparoscopic staging. By analogy with the system of histological classification, the disease was divided into four stages. Laparoscopy provides an alternative approach to the diagnosis of primary biliary cirrhosis, which should be based on clinical, biochemical, immunological and morphological data. However, by laparoscopy alone it is improssible to separate pure primary biliary cirrhosis from its mixed forms with chronic active hepatitis.

Humans↗

PubMed2026

Oliceridine used for patient-controlled analgesia on postoperative quality of recovery in patients undergoing laparoscopic gynecological tumour resection: a randomized clinical trial.

BACKGROUND: Oliceridine, a novel biased μ-opioid receptor agonist, is widely used perioperatively, yet limited data exists regarding its impact on postoperative quality of recovery. This study investigated the effect of oliceridine-based patient-controlled intravenous analgesia (PCIA) on postoperative quality of recovery among patients undergoing laparoscopic gynecological tumour resection. METHODS: Ninety‑four female patients scheduled for elective laparoscopic gynecological tumour resection were included. Patients were randomized to two groups: oliceridine group (loading dose 1.5 mg, PCIA 0.55 mg/kg) or sufentanil group (loading dose 10 μg, PCIA 3 μg/kg). The primary outcome was the Quality of Recovery-40 (QoR-40) score on postoperative day 1. The secondary outcomes included the QoR-40 score, the numeric rating scale (NRS) pain score, the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score, the Fatigue, Resistance, Ambulation, Illness and Loss of weight (FRAIL) index and adverse events within 3 postoperative days. RESULTS: Higher QoR-40 scores were found in the oliceridine group on postoperative day 1 (182.9 ± 3.1 versus 177.5 ± 3.9, p < 0.001). Compared with the sufentanil group, the oliceridine group showed better QoR-40 scores within 3 days after operation. No significant differences were observed in NRS pain scores or HADS-A scores between the two groups (all p > 0.05). However, the median FRAIL score in the oliceridine group was lower on postoperative day 2 (p = 0.018). CONCLUSION: Oliceridine used in PCIA improves early postoperative recovery quality of patients undergoing laparoscopic gynecological tumour resection. It provides analgesic effect comparable to sufentanil and lowers incidences of postoperative frailty, nausea and vomiting. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR.org.cn, identifier: ChiCTR2400094271.

Humans↗

PubMed1976

Assessment of the role of laparoscopic ovarian biopsy.

Seventy-four patients with either endocrine and/or infertility problems were subjected to laparoscopic ovarian biopsy. The patients were divided into 4 categories: those with primary amenorrhea, secondary amenorrhea, ovarian androgenic hyperfunction, and infertility. The results were critically examined to evaluate the procedure in the investigation and treatment of each of these disorders. It was concluded that laparoscopic ovarian biopsy is most helpful in primary amenorrhea but justified in secondary amenorrhea only if a histologic diagnosis of premature ovarian failure is though to be essential. Patients with ovarian androgenic hyperplasia should not be candidates for the procedure as the laparoscopic appearance of the ovaries offered equally valuable information and the hazards of biopsy in this particular group of patients outweighed its diagnostic and therapeutic usefulness. The ovarian biopsy offered very little benefit for the infertility patients.

Adolescent↗

PubMed1978

Laparoscopic sterilization with therapeutic abortion versus sterilization or abortion alone.

Records of 606 therapeutic abortions performed by suction curettage, 693 interval laparoscopic sterilizations, and 442 combined procedures were analyzed and compared. The following conclusions were obtained: 1) Abortion alone and abortion with laparoscopic sterilization are similar in rates of postoperative morbidity (4.3 and 7%, respectively) and early complications (3.3 and 2.9%, respectively). 2) The risks in laparoscopic sterilization alone are significantly lower for postoperative morbidity (2.2%) and early complications (0.9%) than for abortion alone or for the combined procedure.

Abortion, Therapeutic↗