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L T de Wit

Publications and source records attributed to L T de Wit.

At least 37 records · Page 2Linked to original sources
PubMed1999

Laparoscopic staging of biliopancreatic malignancy.

The main benefit of laparoscopic staging (LLU) of (distal) bilio-pancreatic malignancy is the detection of small superficial metastases at the liver surface and peritoneum and local tumor ingrowth. The different aspects of laparoscopic staging have been described extensively in the literature and the benefit is generally expressed in terms of prevention of laparotomy. The impact of this final staging procedure on outcome for the patient in terms of the efficacy of the subsequent non-surgical palliative treatment have been analysed scarsely. In this review the results of laparoscopic staging of bilio-pancreatic tumors concerning the detection of metastases and tumor ingrowth as well as the results of long term follow up after subsequent non-surgical treatment and the preferred palliative treatment after laparoscopic staging are discussed.

Bile Duct Neoplasms↗
PubMed1999

Local resection of biliopancreatic cancer.

Biliopancreatic tumors that are potentially amenable to local resection include proximal bile duct tumors (Klatskin tumors), mid-choledochal duct tumors and tumors arising from the papilla of Vater. This paper reviews our experience in the AMC, with local resection of these conditions. From 1983-1997, 112 patients underwent surgical resection of a carcinoma of the hepatic duct confluence (Klatskin tumor). Local resection was undertaken in 80 patients (52 patients with type I and II tumors, and 28 patients with type III tumors) whereas in 32 patients with type III tumors, hilar resection was performed with liver resection. Negative surgical margins were achieved in 10 patients after local resection of type I and II tumors (19.2%), in 1 patient after local resection of a type III tumor (3.6%), and in 5 patients after hilar resection and liver resection (15.6%). Middle-third carcinomas of the extra-hepatic biliary tract are less common than proximal or distal bile duct tumors. From 1993-1998, 12 patients underwent resection of a mid-choledochal duct carcinoma. In 8 patients, local resection was performed and in 4 patients, subtotal pancreatoduodenectomy (PPPD) because of the close relationship of the tumor and the pancreas. Four patients had negative surgical margins, 2 after local resection (25%) and 2 after PPPD (50%). Although accepted for villous adenomas located in the ampulla, local resection for ampullary carcinoma is controversial. Nine patients underwent local resection of a presumed adenoma that proved to be an ampullary carcinoma. In 4 patients with T1 tumors, resection of the carcinoma was locally complete (44%). Additional PPPD was performed in 6 patients, including the 4 patients with complete local resections, showing no residual tumor at the previous site of excision, but, lymphnode metastases in two resection specimens (both of patients with presumed T1 tumors). Hence, local resection of a T1 ampullary carcinoma might result in tumor free margins, but does not deal with (usually retropancreatic) lymphnode metastases. In conclusion, local resection is applicable to Klatskin type I and II tumors. Local resection may be considered in the proximally located, mid-choledochal duct carcinomas but, when located closer to the pancreas, PPPD is the preferred treatment. For ampullary adenomas, local resection is feasible unless frozen section examination raises suspicion on a malignancy. Local resection of even limited ampullary carcinomas is not advisable because of lymphatic dissemination of the tumor and consequently, inadequate clearance.

Adolescent↗
PubMed1999

Complications after resection of biliopancreatic cancer.

During the past decade the mortality after pancreaticoduodenectomy decreased to 0-4% in centers with experience. The morbidity however remains high although a decrease has also been demonstrated. Leakage of the pancreatic anastomosis is the most severe complication associated with a high mortality reported between 8-40%. Resection of the pancreatic remnant is the most radical treatment but unfortunately associated with insulin dependent diabetes. Subtotal resection of the pancreas tail seems an alternative. The incidence of postoperative bleeding is decreasing in particular bleeding from ulcers. Bleeding from a pseudoaneurysm (2%) is leading to a high mortality up to 50% and early aggressive intervention is mandatory. Delayed gastric emptying is reported between 20-30%, the pathophysiology is still unknown but postoperative intra-abdominal complications proved to be a risk factor. It is now evident that mortality is strongly related with hospital experience and regionalization reduced overall mortality. These findings are arguments to favour centralization of surgery for biliopancreatic cancer.

Anastomosis, Surgical↗
PubMed1999

Surgical palliative treatment in bilio-pancreatic malignancy.

Most patients with bilio-pancreatic malignancy are no candidate for curative resection and will need palliative treatment. Palliation in these patients is focussed on relief symptoms such as obstructive jaundice, duodenal obstruction and pain. It has been suggested that non surgical treatment (stenting) is the optimal palliation for patients with short survival and surgical bypass for those surviving more than 6 months. Unfortunately valid criteria for estimating survival are not available except for metastases. A prognostic score chart to predict survival probabilities for 3,6 and 9 months after diagnosis has been developed. The use of this prognostic score chart may help clinicians to select optimal palliative treatment for individual patients. Surgical biliary drainage can be performed by a simple cholecystoenterostomy; a choledochoduodenostomy or a choledocho/hepaticojejunostomy with Roux-Y jejunal limb reconstruction. The present data available in the literature do not give sufficient guidance to make a well deliberated selection between the different types of bypass surgery but choledochojejunostomy is generally preferred. Gastroentero-stomy is performed routinely during the biliary bypass procedure in our institution because gastric outlet obstruction has been described between 9-21% of the patients who underwent only a surgical biliary bypass but there is still controversy. Recently it was also suggested that there is an indication to perform palliative resections. No results are available to justify resections as a debulking procedure.

Biliary Tract Neoplasms↗
PubMed1998

[Treatment of 8 patients with an acute hemorrhage in a hepatocellular adenoma at the Academic Medical Center, Amsterdam].

OBJECTIVE: Evaluation of the early management and treatment of patients with an acute haemorrhage in a hepatocellular adenoma. DESIGN: Descriptive. SETTING: Academic Medical Centre (AMC), Amsterdam, the Netherlands. METHOD: In the period 1989-1996, eight women with an acute haemorrhage in a hepatocellular adenoma were treated in the AMC. Four had an intrahepatic bleeding which initially was treated conservatively. The other four patients arrived with a haemoperitoneum for which laparotomy was immediately performed: in three, the haemorrhage was stopped by gauze tamponade and in one, the tumour was removed by bisegmental resection. In all seven initially not subjected to resection, the tumour was removed later by partial hepatectomy. RESULTS: The condition stabilized in all patients after initial conservative treatment or after laparotomy and gauze tamponade. The tamponade gauzes were removed after 48 hours. The definite treatment, after 2-4 months, consisted of right-sided hemihepatectomy (four patients), left-sided hemihepatectomy and (bi)segmental resection (three). Three patients showed postoperative complications: infected haematoma, bile leakage and a non-infected subphrenic haematoma. In half the patients, the pathological diagnosis was not certain owing to the effects of the recent bleeding. In one patient, a highly differentiated hepatocellular carcinoma could not be excluded. CONCLUSION: Patients with a haemorrhage in a hepatocellular adenoma without signs of rupture should be treated conservatively. An effective and safe first treatment of an unstable patient with haemoperitoneum is laparotomy and staunching of the bleeding by gauze tamponade. This management is feasible in every general hospital, following which the patient may be referred to a specialized centre for further diagnosis and treatment. It is advisable to remove the tumour surgically after about three months.

Acute Disease↗
PubMed1998

Hepatic bile versus gallbladder bile: a comparison of protein and lipid concentration and composition in cholesterol gallstone patients.

Many studies have demonstrated that gallbladder bile (but not hepatic bile) of animals or patients with cholesterol gallstones contains higher protein concentrations than does gallbladder bile of control patients without stones or with pigment stones. The underlying defect has not been elucidated. To establish whether there is net production or net absorption/degradation of protein by gallbladder epithelium for different classes of protein, paired samples of hepatic and gallbladder bile were obtained from fourteen patients with cholesterol gallstones during elective cholecystectomy. In these paired samples, lipid and protein composition were determined. To obtain the concentration ratio (CR) of protein and lipid, its concentration in the gallbladder was divided by the concentration determined in the paired hepatic bile sample. The CR of bile salts was used as a parameter for water absorption in the gallbladder. Of the biliary proteins that were determined only mucin, albumin, immunoglobulin (Ig) G, and aminopeptidase N appeared to increase in the gallbladder from another cause than water absorption. A strong correlation was found between mucin, albumin, and IgG. Haptoglobin, alpha1-acid glycoprotein, IgM, and IgA appeared to be absorbed by gallbladder epithelium in the majority of patients. In cholesterol gallstone patients, total protein concentration in gallbladder bile of cholesterol gallstone patients is increased when compared with hepatic bile. The increase in protein concentration cannot be explained for all bile samples solely by water absorption. In this study we show that the defect is largely caused by a selective increase in albumin, mucin, and IgG. All other proteins which were investigated are taken up by the gallbladder.

Bile↗
PubMed1998

Laparoscopic ultrasonography for abdominal tumor staging.

In recent years, laparoscopic ultrasonography has been introduced as an adjunct to diagnostic laparoscopy for staging of tumors of the upper gastrointestinal tract, liver, biliary tree, and pancreas. It has proved feasible to visualize most anatomic structures in the upper abdomen consistently and in detail with laparoscopic ultrasonography. Recent publications indicate that laparoscopic ultrasonography may be useful for detecting small liver metastases, lymph node metastases, small primary tumors of the pancreas and bile ducts, and for the assessment of the local extension of tumors of the pancreas and stomach. The ongoing improvements in US technology and the results of larger studies will in the near future determine the precise place of this new imaging modality for staging of abdominal tumors.

Abdominal Neoplasms↗
PubMed1998

Improvement in the management of bile duct injuries?

BACKGROUND: Previous studies have suggested that improvements in diagnostic workup and treatment of bile duct injuries (BDI) sustained during laparoscopic cholecystectomy can be expected as experience increases with the laparoscopic procedure. Many published articles reported that early diagnosis, proper classification, and optimal timing of treatment of BDI increase the likelihood of successful treatment. This study determined whether diagnosis and management of BDI have improved over the years. STUDY DESIGN: Between June 1990 and November 1996, 106 patients were diagnosed and treated in the Amsterdam Academic Medical Center for BDI sustained during laparoscopic cholecystectomy. Detailed information was obtained about peroperative findings, time interval from laparoscopic cholecystectomy to symptoms, and interval from symptoms to diagnosis. Bile duct injuries were classified into four types. Two patient groups were compared: BDI patients diagnosed from 1990 until 1994 ("learning phase") and patients diagnosed from 1995 until 1996. RESULTS: Bile duct injuries combined with bile leakage were diagnosed significantly earlier in the second period after the learning phase. The percentages of injuries diagnosed peroperatively, "blind laparotomies," and suboptimal timed hepaticojejunostomies were not different between the groups. CONCLUSIONS: Except for earlier diagnosis of BDI in the later period than in previous years, there appeared to be no significant improvement in diagnostic workup and management during the past 2 years.

Bile Ducts↗
PubMed1998

Cytology of peritoneal lavage performed during staging laparoscopy for gastrointestinal malignancies: is it useful?

OBJECTIVE: To evaluate the potential benefit of cytology of the peritoneal lavage obtained during diagnostic laparoscopy for staging gastrointestinal (GI) malignancies. SUMMARY BACKGROUND DATA: Peritoneal lavage is a simple procedure that can be performed during laparotomy for GI tumors. Tumor cells in the lavage fluid are thought to indicate intraperitoneal tumor seeding and to have a negative effect on survival. For this reason, peritoneal lavage is frequently added to diagnostic laparoscopy for staging GI malignancies. METHODS: Patients who underwent peritoneal lavage during laparoscopic staging for GI malignancies between June 1992 and September 1997 were included. Lavage fluids were stained using Giemsa and Papanicolaou methods. Cytology results were correlated with the presence of metastases and tumor ingrowth found during laparoscopy and with survival. RESULTS: Cytology of peritoneal lavage was performed in 449 patients. Tumor cells were found in 28 patients (6%): 8/87 with an esophageal tumor, 2/32 with liver metastases, 11/72 with a proximal bile duct tumor, 7/236 with a periampullary tumor, and none in 7 and 15 patients with a primary liver tumor or pancreatic body or tail tumor, respectively. In 19 of the 28 patients (68%) in whom tumor cells were found, metastatic disease was detected during laparoscopy, and 3 of the 28 patients had a false-positive (n = 1) or a misleading positive (n = 2) lavage result. Therefore, lavage was beneficial in only 6/449 patients (1.3%); in these patients, the lavage result changed the assessment of tumor stage and adequately predicted irresectable disease. Univariate analysis showed a significant survival difference between patients in whom lavage detected tumor cells and those in whom it did not, but multivariate analysis revealed that these survival differences were caused by metastatic or ingrowing disease. CONCLUSION: Cytology of peritoneal lavage with conventional staining should no longer be performed during laparoscopic staging of GI malignancies because it provides an additional benefit in only 1.3% of patients and has limited prognostic value for survival in this group of patients.

Gastrointestinal Neoplasms↗
PubMed1998

Laparoscopic cholecystectomy: day-care versus clinical observation.

OBJECTIVE: To determine the feasibility and desirability of laparoscopic cholecystectomy (LC) in day-care versus LC with clinical observation. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy has been performed regularly as outpatient surgery in patients with uncomplicated gallstone disease in the United States, but this has not been generally accepted in Europe. The main objections are the risk of early severe complications (bleeding) or other reasons for readmission, and the argument that patients might feel safer when observed for one night. Quality-of-life differences hitherto have not been investigated. METHODS: Eighty patients (American Society of Anesthesiology [ASA] I/II) with symptomatic gallstones were randomized to receive LC either in day-care or with clinical observation. Complications, (re)admissions, consultations of general practitioners or the day-care center within 4 days after surgery, use of pain medication, quality of life, convalescence period, time off from professional activities, and treatment preference were assessed. The respective costs of day-care and clinical observation were determined. RESULTS: Of the 37 patients assigned to the day-care group who underwent elective surgery, 92% were discharged successfully after an observation period of 5.7+/-0.2 hours. The remainder of the patients in this group were admitted to the hospital and clinically observed for 24 hours. For the 37 patients in the clinical observation group who underwent elective surgery, the observation time after surgery was 31+/-3 hours. Three patients in the day-care group and one patient in the clinical observation group had complications after surgery. None of the patients in either group consulted a general practitioner or the hospital during the first week after surgery. Use of pain medication was comparable in both groups over the first 48 hours after surgery. There were no differences in pain and other quality-of-life indicators between the groups during the 6 weeks of follow-up. Of the patients in the day-care group, 92% preferred day-care to clinical observation. The same percentage of patients in the clinical observation group preferred at least 24 hours of observation to day-care. Costs for the day-care patients were substantially lower (approximately $750/patient) than for the clinical observation patients. CONCLUSION: Effectiveness was equal in both patient groups, and both groups appeared to be satisfied with their treatment. Because no differences were found with respect to the other outcomes, day-care is the preferred treatment in most ASA I and II patients because it is less expensive.

Adult↗
PubMed1998

Laparoscopic ultrasonography of abdominal lymph nodes: correlation with pathologic findings.

The value of laparoscopic ultrasonographic criteria for distinguishing benign from malignant lymph nodes was assessed. The following criteria were evaluated in 41 lymph nodes: (1) long axis diameter, (2) short axis diameter, (3) long axis-short axis ratio, (4) nodal border delineation, (5) presence of hyperechoic hilar reflection, (6) echogenicity, and (7) inhomogeneity. Pathologic examination showed malignant infiltration in 11 lymph nodes and the absence of malignant infiltration in 30 lymph nodes. The presence of a hyperechoic center or a long axis-short axis ratio more than 2 suggested the absence of malignant infiltration, whereas inhomogeneity was suggestive of malignant infiltration. The other criteria did not seem useful in distinguishing benign from malignant lymph nodes.

Abdomen↗
PubMed1997

[Complications, hospital mortality and survival following partial pancreaticoduodenectomy].

OBJECTIVE: To analyse hospital mortality, complications and survival of patients after subtotal pancreaticoduodenectomy in the Academic Medical Centre, Amsterdam, the Netherlands, 1983-1996. DESIGN: Partly retrospective (1983-August 1987), partly prospective (September 1987-1996). METHOD: Patient characteristics, indication for surgery, postoperative complications, mortality and survival of patients who underwent subtotal pancreaticoduodenectomy were recorded in a computer database. Patients were subdivided into three groups (1983-September 1992; October 1992-1994; 1995-September 1996) to analyse the influence of change in surgical technique and the increase of experience. RESULTS: From 1983-to September 1996, 312 consecutive patients underwent a subtotal pancreaticoduodenectomy. Hospital mortality decreased from 4.9% to 1.4% in the last period (1995-1996). The complication rate decreased from 60% to 41%. The hospital stay decreased from median 24 days to 16 days. The actualized 5-year survival analysed for patients operated from 1983-to September 1992 was 31%. Patients with ampullary tumours had a 5-year survival of 50%. The 5-year survival of patients with bile duct and pancreatic carcinoma was 24% and 15% respectively. CONCLUSIONS: Subtotal pancreaticoduodenectomy can be performed safely with a low mortality (< 2%) in specialised centres. The morbidity is still substantial (40%). The survival is mainly dependent on type of tumour and patient selection and is approximately 50% for patients with ampullary tumours. The pylorus preserving procedure has become the standard operation.

Adult↗
PubMed1997

[Experiences with outpatient laparoscopic cholecystectomy].

OBJECTIVE: To determine the feasibility and desirability of laparoscopic cholecystectomy in day care. DESIGN: Prospective, pilot study. SETTING: Academic Medical Centre, Amsterdam, the Netherlands. METHOD: Fifteen patients (ASA I/II according to the American Society of Anesthesiologists) with symptomatic gallstones underwent laparoscopic cholecystectomy with the intention to discharge them the same day. Data were collected about: pain (visual analogue scale); pain medication before and after discharge; (rc)admissions; consultations of general practitioner or day care centre; complications; satisfaction of the patients about this treatment modality. RESULTS: Fourteen patients could be discharged after 6.2 hour (standard deviation 1.2) of observation. The pain scores and medication use were low. Readmissions did not take place and there were no consultations of general practitioners or the day care centre. These patients had no complications. Thirteen of them preferred day care over admission in hospital. One patient was admitted because of colicky pains and a common bile duct stone was diagnosed, which was removed endoscopically. CONCLUSION: Laparoscopic cholecystectomy in day care appears feasible in patients with symptomatic gallstones and no functional incapacities if day care facilities are present.

Adult↗
PubMed1997

The efficacy of laparoscopic staging in patients with upper gastrointestinal tumors.

BACKGROUND: The major advantage of diagnostic laparoscopy for patients with a gastrointestinal tumor is the prevention of unnecessary explorative laparotomies. However, it is doubtful whether this procedure also prevents late laparotomies that are necessary for palliative treatment during follow-up. METHODS: From January 1992 to July 1995, 233 consecutive patients with gastrointestinal malignancies underwent laparoscopy and laparoscopic ultrasonography after routine diagnostic procedures had shown potential curative disease. RESULTS: After diagnostic laparoscopy, laparotomy was not performed in 21% of all patients (47 of 226) because of histologically proven, unresectable, mainly metastatic disease; 6% had esophageal tumors (4 of 64 patients), 43% had liver tumors (10 of 23), 43% had proximal bile duct tumors (9 of 21), 15% had periampullary tumors (17 of 111), and 43% had pancreatic body and tail tumors (3 of 7). Nonoperative palliation was successful in all patients. However, late laparotomies were necessary in 7 of these 47 patients (15%): 5 patients with periampullary tumors and 2 patients with proximal bile duct tumors. All 7 patients underwent a surgical bypass, most due to duodenal obstruction, 1 to 13 months after diagnostic laparoscopy. CONCLUSIONS: In this study, diagnostic laparoscopy may have prevented unnecessary laparotomies for exploration or palliation in 18% of all patients (40 of 226). The procedure is of doubtful benefit for patients with esophageal tumors because the current findings show that only 6% of explorative laparotomies could be prevented. In patients with periampullary tumors, the initial benefit was 15%, but the risk of a late laparotomy is relatively high (30%).

Bile Duct Neoplasms↗
PubMed1997

Local resection or pancreaticoduodenectomy for villous adenoma of the ampulla of Vater diagnosed before operation.

BACKGROUND: Treatment of ampullary adenoma is complicated by difficult preoperative staging, malignant potential and a high recurrence rate. This study was designed to assess the accuracy of diagnosis and staging by endoscopic biopsy and endosonography, and to compare the results of local resection and pancreaticoduodenectomy (Whipple procedure). METHODS: All 23 patients, diagnosed by endoscopic biopsy and surgically treated by local resection (n = 12) or pancreaticoduodenectomy (n = 11) between 1984 and 1994, were analysed retrospectively. RESULTS: Pancreaticoduodenectomy was associated with more complications (seven of 11 patients versus three of 12) and a longer hospital stay (36 versus 18 days) than local resection. After local resection tumour excision was incomplete in half of the patients. One patient died after a Whipple procedure. Endoscopic biopsy did not identify infiltrating carcinoma in seven of the 23 patients. Endoscopic ultrasonography had a 44 per cent accuracy rate for tumour invasion and was false positive for lymph node metastases in five of 16 patients. After local resection one recurrence was observed during follow-up and one possibly died from tumour recurrence. CONCLUSION: Diagnosis and staging of ampullary adenomas by endoscopic biopsy and endosonography was unreliable. Local resection seems a viable alternative for patients whose general condition does not allow a Whipple procedure.

Adenoma, Villous↗
PubMed1997

Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy.

BACKGROUND: A comparative study was performed between patients with exocrine pancreatic insufficiency after conventional pancreatoduodenectomy (Whipple's procedure) and pylorus-preserving pancreatoduodenectomy (PPPD). In these patients the pharmacodynamics of 2-mm enteric-coated pancreatin microspheres (ECPMs) and their gastric transit time in relation to that of a solid meal were investigated. The efficacy of ECPM preparations may differ after Whipple's procedure compared with PPPD, because the latter procedure does not include gastrectomy. METHODS: Gastric transit was assessed by double-isotope scintigraphy. A pancake meal was labelled with 99mTc. ECPMs were cold-labelled with 170Er and neutron activated shortly before ingestion to enable imaging with a gamma camera. Intraluminal pancreatic enzyme activity was assessed during a 6-h period with two indirect tests: the cholesteryl [14C]octanoate breath test and the N-benzoyl-L-tyrosyl-p-aminobenzoic acid-p-aminosalicylic acid (NBT-PABA-PAS) test. RESULTS: In patients who had Whipple's procedure, the gastric transit time of ECPMs and of the pancake meal was not significantly different. The outcome of the indirect pancreatic function tests during enzyme supplementation was comparable, and not significantly different, from that in healthy volunteers. In patients who had PPPD, however, the gastric transit time of microspheres was greatly delayed compared with that of the pancake meal (P < 0.05). Improvement in the outcome of the indirect pancreatic function tests during enzyme supplementation was much less and remained well below that of healthy volunteers (P < 0.05). CONCLUSION: In cases of exocrine pancreatic insufficiency after Whipple's procedure, 2-mm ECPM treatment adequately restores pancreatic enzyme activity. Following PPPD, however, ECPM treatment is often ineffective because the microspheres are retained in the stomach. In these patients, use of conventional powdered pancreatin enzyme preparations may improve the efficacy of treatment.

4-Aminobenzoic Acid↗
PubMed1997

Laparoscopic cholecystectomy using abdominal wall retraction. Hemodynamics and gas exchange, a comparison with conventional pneumoperitoneum.

BACKGROUND: Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed to facilitate laparoscopic surgery without conventional pneumoperitoneum (15 mmHg CO2). We investigated the effects of the AWR on hemodynamics and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot study revealed that cholecystectomy without low-pressure pneumoperitoneum was technically impossible. METHODS: A prospective randomized controlled trial: Twenty patients undergoing laparoscopic cholecystectomy were randomly allocated into group 1: AWR with low-pressure pneumoperitoneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg). RESULTS: Surgery using the AWR lasted longer, 72 +/- 16 min (mean +/- SD) vs 50 +/- 18 min compared with standard laparoscopic cholecystectomy. There were no differences between the groups with respect to hemodynamic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 +/- 0.7 to 3. 2 +/- 1.1 l/min) and an increase during AWR (from 4.2 +/- 0.9 to 5.2 +/- 1.5 l/min). Peak inspiratory pressures were significantly higher during conventional pneumoperitoneum compared to AWR. A slight decrease in pH accompanied by an increase in CO2 developed during pneumoperitoneum and during the use of the AWR. In both groups arterial PO2 decreased. CONCLUSIONS: The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming. Possible advantages of this devices' effects on hemodynamics and ventilatory parameters could not be confirmed in this study.

Abdominal Muscles↗