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Results for “laparoscopy”

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PubMed2001

Transvaginal hydrolaparoscopy but not standard laparoscopy reveals subtle endometriotic adhesions of the ovary.

OBJECTIVE: To determine whether transvaginal hydrolaparoscopy is superior to standard laparoscopy for detection of subtle endometriotic adhesions of the ovary. DESIGN: Videotapes of standard laparoscopy and transvaginal hydrolaparoscopy were viewed by an independent observer in random order and in a blinded manner. SETTING: Tertiary referral centers for infertility. PATIENT(S): Patients with minimal or mild endometriosis (n = 11) and unexplained infertility (n = 10) on standard laparoscopy from a group of 43 patients with infertility who were undergoing both studies. INTERVENTION(S): Transvaginal hydrolaparoscopy followed by standard laparoscopy. MAIN OUTCOME MEASURE(S): Detection of unexplained ovarian adhesions. RESULT(S): Patients with minimal and mild endometriosis and unexplained infertility had significantly more ovarian adhesions on transvaginal hydrolaparoscopy than on standard laparoscopy. The subtle adhesions seen on transvaginal hydrolaparoscopy but not on standard laparoscopy were filmy, microvascularized, and nonconnecting. CONCLUSION(S): Unexplained ovarian adhesions are frequently detected on transvaginal hydrolaparoscopy but not on standard laparoscopy in infertile patients with minimal and mild endometriosis and unexplained infertility.

Endometriosis↗

PubMed1994

Utility of in vitro fertilization at diagnostic laparoscopy.

OBJECTIVE: To compare stimulation and outcome variables for IVF in stimulated cycles when ova are retrieved during diagnostic infertility laparoscopy versus transvaginal ultrasound (US) directed retrieval and to investigate the presence of unexpected failed fertilization in the diagnostic laparoscopy group, which allows an opportunity to diagnosis an etiology of infertility based on gamete interaction. DESIGN: Consecutive patients who needed infertility diagnostic laparoscopy and agreed to combination with IVF were compared with concurrent patients undergoing transvaginal US IVF. Male factor screening parameters (semen analysis, sperm penetrating assay) and resultant fertilization were analyzed for these patients. SETTING: The George Washington University Hospital, a tertiary referral center offering assisted reproductive technologies. Patients for diagnostic laparoscopy combined with IVF were enrolled in the Program of Oocyte Retrieval at Diagnostic Laparoscopy (PORDL). PARTICIPANTS: One hundred twenty-four women enrolled for diagnostic laparoscopy combined with IVF; 237 women were concurrently enrolled for transvaginal US IVF. RESULTS: Response variables (number of follicles, days of monitoring, ampules of hMG, maximum E2) between the two groups were similar. Outcome variables (ova retrieved, ova fertilized, ova cleaved, clinical pregnancy rate per embryo transferred) were similar despite a significantly higher number of embryos transferred for the transvaginal US group. The clinical pregnancy rate per cycle was similar, 26% versus 28% for the women in the transvaginal US versus those women in the PORDL group, as was the clinical pregnancy rate per ET, 31% versus 34%, respectively. The number of fertilized ova for each group was not significantly different: 5.5 +/- 0.3 for the transvaginal group versus 4.8 +/- 0.4 for the PORDL group. Patients in the PORDL group with a known male factor (group B) had a lower fertilization rate than those with no male factor (group A). Within the group A with no detectable male factor prospectively, 17.2% had unexpectedly poor fertilization (group A1), whereas the rest of the group A patients had higher fertilization rates as was expected (group A2). The clinical pregnancy rate per ET for group A1 was 0% compared with 43.4% for the group A2 patients. CONCLUSIONS: In vitro fertilization can be successfully performed during diagnostic laparoscopy yielding comparable results to transvaginal ultrasound IVF while gaining diagnostic information concerning sperm-ova interaction (i.e., fertilization).

Adult↗

PubMed1996

Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis.

OBJECTIVE: To determine the outcome of laparoscopy compared with laparotomy in conservative surgical treatment for severe endometriosis. DESIGN: Comparison of nonrandomized historical surgical series. SETTING: Two teaching hospitals and referral centers specializing in reparative and reconstructive surgery. PATIENT(S): A total of 216 patients operated for severe endometriosis during a 5-year period. INTERVENTION(S): Conservative surgical treatment at laparoscopy (n = 67) or laparotomy (n = 149) with median follow-up of 24 months. MAIN OUTCOME MEASURE(S): Cumulative probability of pregnancy in previously infertile patients (22 in the laparoscopy group and 70 in the laparotomy group) and cumulative probability of pain recurrence in subjects with moderate or severe symptoms before surgery (47 in the laparoscopy group and 108 in the laparotomy group). RESULT(S): The 24-month cumulative probability of pregnancy according to the Kaplan-Meier method was 44.9% after laparoscopy and 62.7% after laparotomy. The 24-month cumulative probability of symptoms recurrence evaluated with a 0 to 3 point verbal rating scale was, respectively, 16.4% versus 20.3% for dysmenorrhea, 33.3% versus 15.4% for deep dyspareunia, and 25.0% versus 15.9% for nonmenstrual pain. The corresponding figures obtained with a 10-point linear analogue scale were 20.3% versus 24.7%, 28.6% versus 10.4%, and 17.5% versus 20.1%. No difference is statistically significant. CONCLUSION(S): Laparoscopy and laparotomy seem equally effective in the treatment of infertility and chronic pelvic pain associated with severe endometriosis. However, a trend was observed toward a higher pregnancy rate and lower dyspareunia recurrence rate after surgery for severe endometriosis performed at laparotomy compared with laparoscopy.

Adult↗

PubMedDate not supplied

Laparoscopy for pre-operative staging and assessment of operability in gastric carcinoma.

Laparoscopy was performed in 40 patients with gastric carcinoma, whose lesions were otherwise considered amenable to operation, in order to more accurately stage the disease and ascertain the prospect of resectability. Laparoscopy disclosed hitherto unrecognized distant metastases in 5 cases (12.5%) and locally advanced, unresectable neoplasia in 11 cases (27.5%). Thus, laparoscopy served as a basis for avoiding the burden of futile laparotomy in 16 patients (40%). Laparoscopy confirmed the feasibility of resection in 24 patients, and this finding was borne out in 20 of 23 patients surgically explored (87%). The overall diagnostic accuracy of laparoscopy was 91.6%. Laparoscopy was performed in these patients with no mortality or morbidity. We conclude that laparoscopy is an effective means of evaluating resectability of gastric carcinomas and can provide valuable help in planning surgical approach.

Humans↗

PubMed1996

The role of laparoscopy in the diagnosis of cirrhosis.

BACKGROUND: A definitive diagnosis of cirrhosis is important in the prognosis and management of patients with chronic liver disease. The diagnosis of cirrhosis is made either by histologic examination of a biopsy specimen or upon visualization of a diffusely nodular and firm surface of the liver at laparotomy or laparoscopy. A liver biopsy, however, may not demonstrate the histologic features of cirrhosis in some cirrhotic patients. Our goal in this study was to compare the accuracy of liver descriptions made during laparoscopy with liver histology found by laparoscopic biopsy in patients with chronic liver disease. METHODS: A retrospective review of paired laparoscopy and histology reports was performed on 434 consecutive patients who underwent laparoscopy between 1992 and 1994. (M:F ratio, 1.3:1; mean age, 48 +/- 14 years). ETIOLOGY: 52% hepatitis C, 8% hepatitis B, 8% fatty liver, 4% primary biliary cirrhosis, 3% autoimmune hepatitis, and 25% miscellaneous (cancer patients were excluded). RESULTS: One hundred sixty-nine patients had laparoscopic evidence of cirrhosis; 115 were confirmed by histology, representing a 32% sampling error. Two of 265 patients with histologic evidence of cirrhosis (0.8%) had no macroscopic evidence of cirrhosis at laparoscopy. CONCLUSIONS: (1) There was a 32% histologic sampling error among patients documented to have cirrhosis by laparoscopy. (2) Using laparoscopy as a gold standard, the sensitivity of liver biopsy was 68% and the specificity was 99%.

Adult↗

PubMed2003

Laparoscopy for nonpalpable testes.

PURPOSE: Laparoscopy is now considered integral to the management of nonpalpable testes, although its benefits are not clearly documented. The authors prospectively determined the value of laparoscopy in patients with nonpalpable testes. METHODS: Between December 1997 and October 2001, 37 patients with 40 nonpalpable testes were scheduled for laparoscopy followed by definitive treatment. Laparoscopy was cancelled in 4 patients (5 testes) because their testes became palpable under anesthesia. In the remaining 33 patients (35 testes), it was determined at the time of surgery whether, as a consequence of laparoscopy: (1) retroperitoneal exploration was avoided (2) definitive treatment was facilitated. RESULTS: Laparoscopy did not alter the management of 27 testes (77%) that were treated through an inguinal incision with orchiopexy for 17 testes (6 intraabdominal and 9 at the deep ring) and removal of 10 atrophic nubbins. It was only useful in avoiding retroperitoneal dissection for 5 (14%) vanishing testes, and it may have been of benefit for 3 testes treated with a 2-stage Fowler-Stephens orchiopexy. CONCLUSIONS: The majority of our patients with nonpalpable testes could have been treated through an inguinal incision with laparoscopy being reserved for situations in which the testis was not identified on inguinal exploration.

Adolescent↗

PubMed1997

Benefits of laparoscopy and the Jones technique for the nonpalpable testis.

PURPOSE: We report on the role of diagnostic laparoscopy combined with the Jones suprainguinal approach to orchiopexy in the treatment of abdominal testes. MATERIALS AND METHODS: A retrospective review was done of 209 boys with 265 cryptorchid testes who underwent orchiopexy between January 1994 and March 1996. A subset of patients with nonpalpable testis underwent diagnostic laparoscopy and according to the laparoscopic findings either standard inguinal or suprainguinal extraperitoneal orchiopexy. RESULTS: Of 209 patients 47 had 63 impalpable testes. Laparoscopy was done on 31 patients (42 testes). Findings at laparoscopy revealed 29 (69%) abdominal, 7 (17%) intracanalicular and 6 (14%) vanishing testes. A satisfactory result with scrotal position of the testis and no atrophy was obtained in 18 of 19 patients operated via the Jones approach combined with diagnostic laparoscopy. The only patient with unsatisfactory result underwent ligation of the spermatic vessels at the time of operation. In contrast, satisfactory results were achieved for only 7 of 10 intra-abdominal testes after diagnostic laparoscopy and standard inguinal orchiopexy despite universal spermatic vessel ligation. Of these 10 testes 2 ended in an inguinal location and 1 atrophied. CONCLUSIONS: Laparoscopy was helpful in determining surgical approach in most cases. The suprainguinal approach allowed most abdominal testes to be placed in the scrotum without vascular ligation.

Adolescent↗

PubMed2002

The management of nonpalpable testis with combined groin exploration and subsequent transinguinal laparoscopy.

PURPOSE: About 20% of all cryptorchid testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of finding a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration for a nonpalpable testis. MATERIALS AND METHODS: While 30 patients each had a unilateral nonpalpable and a contralateral descended palpable testis, 3 had a unilateral nonpalpable and a contralateral undescended palpable testis. When we identified neither a normal testis nor a spermatic cord at exploration of the inguinal canal, we subsequently performed laparoscopic observation through the internal inguinal ring. RESULTS: Of the 30 patients with a unilateral nonpalpable and a contralateral descended testis 8 required transinguinal laparoscopy. However, the procedure was avoided in 22 patients because the testis, its remnant or testicular vessels and vas deferens were detected by inspecting the inguinal region. CONCLUSIONS: Further extended incision into a Pfannenstiel incision was unnecessary in cases of blind ending vas and vessels in the peritoneum with transinguinal laparoscopy. In addition, laparoscopy was avoided in 22 of the 30 children (73.3%) with a unilateral nonpalpable and a contralateral scrotal testis. Our strategy of initial inguinal exploration followed by transinguinal laparoscopy for nonpalpable testis may become a reasonable alternative.

Algorithms↗

PubMed2000

Cancer and laparoscopy, experimental studies: a review.

OBJECTIVE: To review the experimental studies on laparoscopy and cancer and to propose guidelines for the clinical management of gynecologic cancer. METHODS: The literature in MEDLINE was searched from January 1992 to December 1998 using the terms 'cancer', 'laparoscopy' and 'experimental or animal study'. Cross-referencing identified additional publications. Abstracts and letters to the editor were excluded. All the relevant papers were reviewed. RESULTS: Depending on the model used, controversial results have been reported on the incidence of trocar site metastasis when comparing CO(2) laparoscopy and laparotomy. In contrast, the following conclusions can be proposed: (i) tumour growth after laparotomy is greater than after endoscopy; (ii) tumour dissemination is worse after CO(2) laparoscopy than after laparotomy; (iii) some of the disadvantages of CO(2) laparoscopy may be treated using local or intravenous treatments or avoided using other endoscopic exposure methods, such as gasless laparoscopy. CONCLUSIONS: The laparoscopic treatment of gynecologic cancer has potential advantages and disadvantages, and may only be performed in prospective clinical trials. The risk of dissemination appears high when a large number of malignant cells are present. Adnexal tumours with external vegetations, and bulky lymph nodes should be considered as contra-indications to CO(2) laparoscopy.

Animals↗

PubMed2002

Role of laparoscopy in the evaluation of biliary tract cancer.

Patients with malignancies of the biliary tract have a dismal prognosis. As in most abdominal cancers, resection is the only effective treatment with potential for cure. Preoperative staging is not completely accurate, however, and a significant number of patients with biliary carcinoma undergo unnecessary laparotomy. As imaging technology improves, more patients with unresectable disease will be identified, avoiding the need for a laparotomy. Laparoscopy is a major addition, but its usefulness in staging of abdominal malignancies continues to evolve. The importance of laparoscopy to better predict the resectability in liver malignancies increasingly has been recognized. Conversely, the use of staging laparoscopy for other cancers has shown little benefit. For hilar cholangiocarcinoma and gallbladder cancer, the authors' analysis of 100 patients supports the use of staging laparoscopy for assessing these tumors. In this series, staging laparoscopy correctly identified unresectable disease and prevented unnecessary laparotomy in one third of patients. Patients with unresectable disease that was not detected at laparoscopy most often had locally advanced tumors. LUS did not contribute to the assessment of resectability in these patients. The yield of laparoscopy was lower for hilar cholangiocarcinoma, but could be improved by targeting patients who are at higher risk for occult unresectable disease, such as patients with T2 or T3 lesions. These patients and patients with primary gallbladder carcinoma have a high incidence of metastatic disease and should undergo laparoscopic staging before attempting at resection.

Bile Duct Neoplasms↗

PubMed2003

Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy.

STUDY OBJECTIVE: To quantify and compare neuroendocrine stress responses during and immediately after surgery by laparoscopy, minilaparotomy, and laparotomy for benign ovarian cysts. DESIGN: Prospective study (Canadian Task Force classification II-1). SETTING: Tertiary care university hospital. PATIENTS: Thirty healthy women with no major diseases and without endocrine disorders. INTERVENTIONS: Surgery for benign ovarian cysts performed by laparoscopy (10), minilaparotomy (10), or laparotomy (10). MEASUREMENTS AND MAIN RESULTS: Venous blood samples were collected at fixed times as follows: at 8 A.M. in the ward before transferring the patient to the operating room (time 0), 30 minutes after the beginning of surgery (time 1), at the end of surgery after extubation with the patient awake (time 2), and 2 and 4 hours after the end of surgery (times 3 and 4). We evaluated intraoperative and postoperative variations of the following stress-related markers: norepinephrine (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), human growth hormone (hGH), prolactin (PRL), and cortisol, and postoperative pain. No differences were present in demographic characteristics and operating times in the three groups. No anesthesiologic or surgical complications occurred. Postoperative pain was similar in the laparoscopy and minilaparotomy group but significantly higher in the laparotomy group (p <0.001). Serum levels of markers were not significantly different among the groups at baseline. In the laparoscopy group the increase of hGH was limited to intraoperative time (p <0.05); increases in NE, E, ACTH, and PRL were limited to intraoperative and early postoperative time after extubation (p <0.01), with only PRL persisting with significantly higher levels after the end of surgery (p <0.05). In the minilaparotomy group no increase was detected for hGH, a significant intraoperative increase in cortisol was present (p <0.05), and NE, E, ACTH, and PRL were significantly higher even after the end of surgery (p <0.01). In this group levels of NE, E, and hGH were significantly higher than in the laparoscopy group 2 and 4 hours after the end of surgery (p <0.05). In the laparotomy group significant intraoperative increases were present for all stress markers and persisted until after extubation for ACTH (p <0.01) and to the postoperative period for NE (p <0.01), E (p <0.01), cortisol (p <0.01), PRL (p <0.05), and hGH (p <0.01). In this group levels of NE, E, ACTH, and hGH were significantly higher than those in the laparoscopy group from the beginning (NE p <0.05, E p <0.01, ACTH p <0.05, hGH p <0.01) until after the end of surgery. Comparison of laparotomy and minilaparotomy groups showed the former to have significantly higher plasma levels of E, cortisol, and hGH in intraoperative and postoperative times (p <0.001); significantly higher NE at sampling times 1 and 2 (p <0.001) and time 4 (p <0.01), and no difference at sampling time 3; and ACTH significantly higher only during surgery (p <0.01). CONCLUSION: Laparoscopic surgery causes minimal activation of stress hormones, which in some instances is confined to the intraoperative period. Minilaparotomy may be a valid alternative to laparoscopy in high-risk patients who cannot tolerate abdominal distention.

Adult↗

PubMed2001

Major complications of operative and diagnostic laparoscopy for gynecologic disease.

STUDY OBJECTIVE: To compare complication rates of diagnostic and operative laparoscopy. Design. Retrospective study (Canadian Task Force classification II-2). SETTING: One medical center and three teaching hospitals. PATIENTS: Six thousand four hundred fifty-one women with various indications for laparoscopic diagnosis and/or laparoscopic surgery from January 1994 through June 1999. INTERVENTION: Diagnostic and operative laparoscopies. MEASUREMENTS AND MAIN RESULTS: Forty-two major complications occurred that directly resulted in one death. One patient had stomach injury, 3 had major vessel injuries, 5 had ureter injuries, 10 had intestinal injuries, and 23 had bladder injuries. The overall complication rate for all laparoscopies was 0.65% (42/6451); however, it rose to 0.80% (39/4865) for operative laparoscopy compared with 0.19% for diagnostic laparoscopy (3/1586; p <0.001, Fisher's exact test). CONCLUSION: Laparoscopic surgery is appropriate for managing various gynecologic diseases and has an acceptable complication rate. However, operative laparoscopy should be performed carefully because its rate of complications is significantly higher than that of diagnostic laparoscopy, especially for laparoscopic-assisted vaginal hysterectomy. (J Am Assoc Gynecol Laparosc 8(1):68-73, 2001)

Catheterization↗

PubMed1999

Complications and long-term outcomes after adnexal surgery by laparotomy and laparoscopy.

STUDY OBJECTIVE: To assess complications and subjective outcomes after adnexal surgery by laparotomy and laparoscopy. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Two-hundred twenty-eight women requiring adnexal surgery for benign indications. INTERVENTIONS: The 114 patients who underwent laparotomy and 114 having laparoscopy were followed prospectively for 1 year. Two questionnaire-based evaluations were undertaken to determine subjective outcomes. To evaluate possible later surgical procedures, hospital records were reviewed 4 years after operation. MEASUREMENTS AND MAIN RESULTS: No major complications occurred in the laparotomy group. The two (1.8%) in the laparoscopy group were intestinal injury and aortal injury, both in women who had previously undergone laparotomy. Rates of minor complications were 11.4% for laparotomy and 7.0% for laparoscopy. Two patients in both groups were readmitted. No difference was found between groups in need for additional adnexal procedures up to 4 years after operation. After 1 year, frequencies of subjective complaints and satisfaction with surgical procedure did not differ significantly. Mean hospital cost per patient was less for laparoscopy than for laparotomy. CONCLUSION: No statistically significant differences were seen after adnexal surgery by laparoscopy and laparotomy with regard to frequency of complications and subjective outcomes. Laparoscopy in women who have previously undergone laparotomy may be associated with a slightly greater risk of major complications than another laparotomy.

Adnexa Uteri↗

PubMed2002

A comparison of MRI and laparoscopy in detecting pelvic structures in cases of vaginal agenesis.

OBJECTIVE: To determine whether laparoscopy improves detection of uterine structures over MRI in cases of vaginal agenesis. DESIGN: Prospective case series. SETTING: Ambulatory pediatric gynecology clinic in a tertiary care children's hospital. PARTICIPANTS: Subjects with vaginal agenesis who had an MRI to detect uterine structures. MAIN OUTCOME MEASURES: A chart review identified subjects with vaginal agenesis who had an MRI to assess müllerian structures. The MRI findings were correlated with physical exam, presenting symptoms, and operative findings. We assessed degree of agreement between laparoscopy and MRI in patients both with and without pelvic pain to determine sensitivity and specificity of MRI in predicting uterine structures confirmed on laparoscopy. RESULTS: Twenty-two subjects with vaginal agenesis were identified and 14 had both an MRI and laparoscopic evaluation. MRI successfully predicted uterine anomalies in six cases (43%) and lack of uterine structures in one case (8%). MRI diagnosis did not correlate with laparoscopic findings in the remaining seven cases (50%). Among subjects presenting with no complaints of pelvic pain (n = 6), three had negative MR imaging but positive laparoscopy. Using laparoscopy as a gold standard, MRI had a sensitivity of 53% for accurately detecting uterine anomalies confirmed on laparoscopy. CONCLUSION: Laparoscopy improves detection of uterine structures over MRI alone in women with vaginal agenesis.

Adolescent↗

PubMedDate not supplied

A prospective analysis of staging laparoscopy in patients with primary and secondary hepatobiliary malignancies.

Laparoscopy and laparoscopic ultrasound are used widely in cancer staging and are perceived to prevent unnecessary open exploration in many patients. The aim of this study was to analyze the impact of staging laparoscopy in improving resectability in patients with primary and secondary hepatobiliary malignancies. Over a 10-month period (November 1, 1997 to August 31, 1998), 186 patients with primary and secondary hepatobiliary cancers were submitted to operation for potentially curative resection. One hundred four patients staged laparoscopically (LAP) before laparotomy were compared prospectively to 82 patients undergoing exploration without laparoscopy (NO LAP). Assignment to each group was not random but was based on surgeon practice. Demographic data, diagnoses, the extent of preoperative evaluation, and the percentage of patients resected were similar in the two groups. Laparoscopy identified 26 (67%) of 39 patients with unresectable disease. In the NO LAP group, 28 patients (34%) had unresectable disease discovered at laparotomy. In patients with unresectable disease and submitted to biopsy only, the operating times were similar in the two groups (LAP 83 +/- 22 minutes vs. NO LAP 91 +/- 33 minutes; P = 0.4). However, laparoscopic staging significantly reduced the length of hospital stay (LAP 2.2 +/- 2 days vs. NO LAP 8.5 +/- 8.6 days; P = 0.006). Likewise, total hospital charges, normalized to 100 in the NO LAP patients, were significantly lower in the LAP group (LAP 54 +/- 42 vs. NO LAP 100 +/- 84; P = 0.02). Staging laparoscopy identified the majority of patients with unresectable hepatobiliary malignancies, significantly improved resectability, and reduced the number of days in the hospital and the total charges. The yield of laparoscopy was greatest for detecting peritoneal metastases (9 of 10), additional hepatic tumors (10 of 12), and unsuspected advanced cirrhosis (5 of 5) but often failed to identify nonresectability because of lymph node metastases, vascular involvement, or extensive biliary involvement. Eighty-three percent of patients subjected to laparotomy after laparoscopy underwent a potentially curative resection compared to 66% of those who were not staged laparoscopically.

Biliary Tract Neoplasms↗

PubMedDate not supplied

The value of laparoscopy in the management of ampullary, duodenal, and distal bile duct tumors.

Laparoscopy identifies radiologically occult advanced disease in patients with pancreatic adenocarcinoma. The value of laparoscopy in the management of peri-ampullary tumors was determined. One hundred forty-four patients with radiologically resectable nonpancreatic adenocarcinoma, periampullary tumors were identified from a prospective database between August 1993 and December 2000. Criteria for laparoscopic unresectability included histologically proved peritoneal or hepatic metastases, distant nodal involvement, arterial involvement, and local extension outside the resection field. Median age at operation was 70 years (range 31 to 87 years) and 56% of the patients were men. An adequate laparoscopy was performed in 134 cases (93%). Laparoscopy identified 13 patients (10%) with unresectable disease. Of 121 patients with laparoscopic resectable disease, 111 (92%) went on to subsequent resection; CT correctly predicted resectability in 82%. Laparoscopy spared 36% of unresectable patients a nontherapeutic laparotomy. Patients with resectable disease were treated by pancreaticoduodenectomy (n = 91, 76%), ampullectomy (n = 12, 10%), duodenal resection (n = 10, 9%), or bile duct excision (n = 6, 5%). The addition of diagnostic laparoscopy to dynamic CT scanning in this selected patient population identifies an additional 10% of patients with unresectable disease. We believe that laparoscopy should be used in a selective manner for preoperative staging of patients suspected of having nonpancreatic periampullary tumors.

Adult↗

PubMedDate not supplied

Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction.

Tumor staging in patients with a malignant obstruction of the proximal bile duct is focused on selecting patients who could benefit from a resection. Diagnostic laparoscopy, which has proved its value in several gastrointestinal malignancies, has been used routinely at our hospital since 1993 in patients with a malignant obstruction of the proximal bile duct, although data in the literature with regard to its additional value are conflicting. Therefore the diagnostic accuracy of diagnostic laparoscopy in patients with malignant proximal bile duct obstruction was evaluated. From January 1993 to May 2000, diagnostic laparoscopy was performed in 110 patients (61 males and 49 females), with a mean age of 60 years (range 30 to 80 years), who had a suspected malignant proximal bile duct tumor and in whom "potential resectability" was demonstrated by means of conventional radiologic staging methods (i.e., ultrasound combined with Doppler imaging, CT, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography). Laparoscopy revealed histologically proved incurable disease in 44 (41%) of the 110 patients (31 with metastases and 13 with extensive tumor ingrowth). Laparoscopic ultrasound imaging, however, revealed histologically proved incurable disease in one patient (1%), thereby preventing exploratory laparotomy in 46 because these patients had already been treated by palliative endoscopic stent placement. The remaining 65 patients were staged as having a resectable tumor and underwent surgical exploration. Thirty patients had an unresectable tumor (distant metastases in five; tumor ingrowth in surrounding tissues in 24) or benign disease (one patient). Sensitivity and negative predictive value of diagnostic laparoscopy for detecting unresectable disease were 60% and 52%, respectively. Diagnostic laparoscopy avoided unnecessary laparotomy in 41% of patients with a malignant proximal bile duct obstruction considered resectable according to conventional imaging studies. The additional value of laparoscopic ultrasound was limited. Therefore diagnostic laparoscopy should be performed routinely in the workup of patients with a potentially resectable proximal bile duct tumor.

Adult↗

PubMed2001

A normal appendix found during diagnostic laparoscopy should not be removed.

BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for suspected appendicitis. While the normal appendix used to be removed routinely, laparoscopy allows us to leave a normal looking appendix in place. This latter strategy is, however, not generally accepted. The long-term results of not removing a normal looking appendix were evaluated. METHODS: This was a prospective evaluation of 109 diagnostic laparoscopies for suspected appendicitis in which a normal looking appendix was left in place. After a median follow-up of 4.4 years a telephone questionnaire was performed. RESULTS: There were no false-negative laparoscopies. In 65 patients (60 per cent) another diagnosis was obtained (group 1). In 44 patients (40 per cent) no diagnosis was obtained (group 2). After a median interval of 8 months, 15 patients presented to the emergency department for symptoms possibly involving the appendix, during the median follow-up of 4.4 years. This resulted in readmission of nine patients, of whom eight were reoperated. In only one patient (1 per cent) was a histologically proven appendicitis found and the appendix removed. Some 105 patients were eligible for follow-up. Of the 100 patients interviewed (95 per cent), nine patients (9 per cent) (six in group 1 and three in group 2) still had recurrent pain in the right lower abdominal quadrant. There were no differences between patients with or without another diagnosis obtained during preceding laparoscopy. CONCLUSION: It is safe to leave a normal looking appendix in place when a diagnostic laparoscopy for suspected appendicitis is performed, even if another diagnosis cannot be found at laparoscopy.

Adult↗