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At least 199 records · Page 11Linked to original sources

PubMed2000

Laparoscopy in infants and children: a prospective study on feasibility and the impact on routine surgery.

BACKGROUND/PURPOSE: The feasibility of laparoscopy in children and its impact on routine pediatric surgery are not well established. The purpose of this study was to determine the role of laparoscopy in a university department of pediatric surgery. METHODS: All children undergoing laparoscopy during the period of 1 year were included in a prospective trial. Data on patients, the operation, technical problems, intraoperative events, and the postoperative course were documented using standardized questionnaires. All patients underwent at least 1 follow-up assessment 2 weeks after the operation. All conventional abdominal operations performed during the same period were analyzed for comparison purposes. RESULTS: Of 244 abdominal operations performed during the study period, 147 (60.2%) were laparoscopies. One hundred twenty-three (83.7%) of these included a laparoscopic operation, and 24 (16.3%) were diagnostic procedures. Of 26 types of laparoscopic operations 3 were performed more than 15 times (fundoplication, appendectomy, pyloromyotomy), and 9 types were performed once. Problems with instruments and devices led to a mean time loss of 15.1 minutes in 15.6% of the procedures. The conversion rate was 10.1% mainly because of complicated appendicitis. Fifty-six children (38.1%) weighed less than 10 kg, and the conversion rate did not correlate with the body weight. There was 1 (0.07%) intraoperative event. A small bowel perforation was identified immediately and resolved with an uneventful course. Postoperative complications included an incisional hernia in 3 children and an incisional leakage of liquor in 1 child with a ventriculoperitoneal drain. There was a reprolaps after laparoscopic correction of an ileostomy in 1 child and fever in another. In 3 newborns the diagnosis was missed during laparoscopy and had to be established by laparotomy later with an uneventful course. Primary conventional operations were mainly restricted to bowel resection and anastomosis performed in 52 of 97 laparotomies. CONCLUSIONS: The authors showed that 60% of abdominal operations in children can be performed via laparoscopy. Most types of laparoscopic operations are not performed frequently, but the feasibility of the technique in routine use is excellent. However, the performance of instruments should be improved further, and laparoscopy for establishing the diagnosis in newborns remains difficult.

Abdomen↗

PubMed2002

Feasibility and diagnostic impact of fluorescence-based diagnostic laparoscopy in hepatocellular carcinoma: a case report.

Fluorescence-based diagnostic techniques are an evolving field in the staging of hepatologic and gastroenterologic malignancies. The method aims at improved accuracy in the detection of locoregional and distant metastases. In hepatocellular carcinoma, detection of metastases is of utmost importance, because advanced tumors preclude curative surgical therapy. We present here our first experience of fluorescence-based diagnostic laparoscopy in a patient with hepatocellular carcinoma. We performed diagnostic laparoscopy in a 76-year-old woman who presented with a tumor of the liver and increased serum levels of alpha-fetoprotein. For photosensitization, 5-aminolevulinic acid (20 mg/kg bodyweight, p.o.) was used 6 hours prior to laparoscopy, which was performed with a prograde 0 degree telescope suitable for fluorescence-based laparoscopy. The D-Light AF system was used as a light source. Laparoscopy was carried out according to common guidelines in the white-light as in the blue-light mode. The main tumor and the satellite metastases clearly showed intense fluorescence compared with unaffected liver parenchyma and other abdominal organs. Fluorescence-based laparoscopy identified several small metastases which had been missed during conventional white-light illumination. Hepatocellular carcinoma was confirmed by the histological examination of several biopsies drawn from suspicious areas. Fluorescence-based laparoscopy provided additional information in the staging of hepatocellular carcinoma. The technique can further improve diagnostic accuracy in the staging of hepatocellular carcinoma, particularly in patients potentially suitable for partial liver resection or transplantation.

Aged↗

PubMed2005

Diagnostic laparoscopy.

Each diagnostic procedure needs to be viewed in the context of all the other available diagnostic tools, and therefore has to be reevaluated periodically. This is also true of diagnostic laparoscopy, whether performed by gastroenterologists in patients under sedoanalgesia or by surgeons in patients under general anesthesia. Publications during the previous year have shed light on many important issues. Despite its greater expense, fluorescence laparoscopy may have advantages over white-light laparoscopy in the diagnosis of small tumor seeding. The unchanged superiority of laparoscopy over other imaging modalities for detecting small superficial liver metastases and peritoneal seeding has been clearly demonstrated. Whether cytological investigation of peritoneal washing can add relevant information to laparoscopy remains a matter of debate. Diagnostic laparoscopy before surgery has proved to be effective in many fields, including traumatology. The use of diagnostic laparoscopy in certain clinical circumstances, such as the early postoperative period after major cardiac surgery using extracorporeal circulation, appears promising. A transgastric approach to the peritoneal cavity for diagnostic and therapeutic purposes, the feasibility of which has been demonstrated in a porcine model, is an exciting innovation with as yet unforeseeable implications.

Abdominal Pain↗

PubMed1998

The effect of laparotomy and laparoscopy on the establishment of spontaneous tumor metastases.

BACKGROUND: Surgical extirpation of solid tumors may be entirely possible, and the consequence of surgical excision is invariably the release of tumor cells into the systemic circulation. The aim of this study was to determine whether laparotomy affects the establishment of spontaneous pulmonary metastases after excision of the primary tumor in a murine flank tumor model and to determine possible underlying immune abnormalities. METHODS: An initial experiment was carried out to compare the development of gross spontaneous pulmonary metastases in the presence of a primary flank tumor and after excision of the tumor in C57/BL6 female mice. Another group of mice had flank tumors excised and were simultaneously randomized to undergo anesthetic only (control), laparoscopy, or laparotomy, after which the subsequent development of pulmonary metastases was determined. Finally, a third experiment entailed determination of natural killer cell (NK) cytotoxicity and the effect of splenic macrophages on NK cytotoxicity at days 1,7, and 14 after tumor excision. RESULTS: Excision of the primary tumor resulted in a significant increase in the number of pulmonary metastases in mice compared with mice that did not have tumors excised (P = .01). Both laparotomy and laparoscopy significantly increased the number of spontaneous pulmonary metastases after tumor excision compared with controls (P < or = .01), and there was also a significant difference between laparotomy and laparoscopy groups (P = .00). NK cytotoxicity was significantly suppressed at all time points after operation in the laparotomy group compared with both the laparoscopy group and the controls (P < or = .01). Suppression occurred after laparoscopy at 24 hours after the procedure compared with controls (P = .00); by day 7 this difference was not significant, but as day 14 there was again a significant suppression (P < or = .03). Splenic macrophages appeared to be a suppressor to natural killer cell cytotoxicity (NKCC) in the corresponding groups and at the corresponding time points. CONCLUSIONS: The differential establishment of spontaneous metastases after tumor excision and laparotomy and, to a lesser extent, laparoscopy results in lowered host antitumor surveillance and may be mediated at least in part by the generation of splenic suppressor cells in the early postoperative period, causing a more marked and prolonged effect after laparotomy than after laparoscopy.

Animals↗

PubMed2000

Laparoscopy and laparoscopic ultrasonography in staging carcinoma of the gastric cardia.

OBJECTIVE: To investigate the role of diagnostic laparoscopy and laparoscopic ultrasonography in the staging of carcinoma of the gastric cardia that is involving the distal oesophagus. DESIGN: Retrospective consecutive case series. SETTING: Tertiary care centre, The Netherlands. SUBJECTS: 48 patients (34 men and 14 women, median age 63 years, range 39-84) who presented with tumours of the gastric cardia that involved the distal oesophagus and in whom non-invasive staging had not shown unresectable locoregional disease or distant metastases. INTERVENTIONS: In addition to laparoscopy and laparoscopic ultrasonography, biopsy of all suspected lesions outside the area of potential resection. MAIN OUTCOME MEASURES: Number of patients in whom the findings obviated the need for exploratory laparotomy. RESULTS: There were no complications related to the laparoscopy. The investigation showed distant metastases (which were histologically verified) in 11 patients (23%, 95% confidence interval (CI) 16 to 30). These patients had non-operative palliation. Seven were identified by laparoscopy, and laparoscopic ultrasonography showed the other four. In three patients whose distant metastases had already been identified by laparoscopy, ultrasonography was omitted. Three additional patients had suspect lesions, but these were not confirmed histologically. However, these lesions were shown to be cancerous at laparotomy. One additional patient had an intra-abdominal metastasis which was missed by laparoscopy with ultrasonography. CONCLUSIONS: Laparoscopy with ultrasonography safely detected metastases that had not been shown by conventional staging investigations in 23% of 48 patients with carcinoma of the gastric cardia. The investigation should therefore be added to the standard staging procedures in patients with carcinoma of the gastric cardia that is involving the distal oesophagus.

Adult↗

PubMed2005

Laparoscopy and malignancy.

BACKGROUND: The advantages of pneumoperitoneum-based surgery are well documented. Laparoscopy is the gold standard of treatment in certain benign conditions such as cholelithiasis and gastroesophageal disease. This success has led to the application of laparoscopy in the management algorithm of malignant conditions. There is currently no universally accepted consensus of the role of pneumoperitoneum-based surgery in the treatment of cancer. This is due to the early reports of port site metastasis, initial lack of randomized controlled trials and the concern of performing oncologically adequate operations. The aim of this section is to review the current literature and attempt to obtain a consensus of the role of laparoscopy in the treatment of cancer. MATERIALS AND METHODS: A literature search was conducted through Pubmed with key words laparoscopy, pneumoperitoneum, carbon dioxide, malignancy, cancer, and port site metastasis. The obtained results were divided into various sections such as non-randomized reports, randomized reports, animal studies, human studies, etc. A comparison was made between laparoscopic and open resections when possible. RESULTS: There are several published reports of studies in animal models and in humans relating to pneumoperitoneum-based surgery in the setting of malignancy. There are also a few randomized controlled trials that compared open versus laparoscopic surgery for malignancies of various organ systems. In addition, the early reports of alarmingly high rate of port site metastasis have been scaled down to rates comparable to wound recurrences after open resections. SUMMARY: Laparoscopy has added another dimension to the management of patients with cancer. Advanced training, superior instrumentation, and a better understanding of the pathophysiology of carbon dioxide pneumoperitoneum has led to the successful application of laparoscopy. The improved results are obtained in centers with high volume of patients and with experience in both fields of oncology and minimally invasive surgery. Laparoscopy is now an integral tool in the management algorithm of malignancies of some organ systems and its role will be further expanded in the future.

Animals↗

PubMed1996

Laparoscopy for triage of penetrating trauma: the decision to explore.

The role of diagnostic laparoscopy in penetrating trauma continues to evolve. We reviewed our experience to determine the effect of laparoscopy on therapeutic laparotomy rates, length of hospital stay, and hospital charges. Laparoscopy was performed on 106 hemodynamically stable patients with penetrating abdominal injuries (66 had gunshot wounds, 40 had stab wounds). All patients with laparoscopically identified peritoneal penetration underwent open laparotomy. At laparoscopy, 41 (39%) had positive findings, whereas 65 (61%) had none. Two patients with retroperitoneal hematomas and one with ecchymosis of the peritoneum were not explored. Thus 68 (64%) did not require laparotomy. Among the 38 who underwent laparotomy, 29 (76%) had positive findings and 9 (24%) had a negative laparotomy. Nineteen patients (50%) had a therapeutic laparotomy. This compares with a therapeutic laparotomy rate of 18% had all 106 patients undergone mandatory laparotomy. Data for length of stay and hospital charges were analyzed. Due to the extended stay associated with tube thoracostomy (n = 21), a subgroup excluding patients with chest tubes was also analyzed. In this subgroup, there was a significant difference in hospital stay between those who had only a laparoscopy and those who underwent a negative laparotomy (2.6 +/- 1.7 vs. 4.7 +/- 1.6, p < 0.01). The average nonsurgical charge for patients who had a negative laparotomy was more than double that for those who had laparoscopy only ($8275 +/- 4692 vs. $3762 +/- 3786, p < 0.01). We conclude that the use of diagnostic laparoscopy to identify peritoneal penetration resulted in an improved therapeutic laparotomy rate as well as significant reduction in hospital stay and hospital charges.

Abdominal Injuries↗

PubMed2003

Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?

Diagnostic laparoscopy is normally the standard procedure performed as the final test in the infertility work up before progressing to infertility treatment. Recently, there has been a growing tendency to bypass diagnostic laparoscopy after a normal hysterosalpingogram and instead to start direct infertility treatment [intrauterine insemination (IUI) or IVF] for indications such as unexplained infertility, male subfertility and cervical hostility. In our clinic, laparoscopy revealed abnormalities that resulted in changed treatment decisions in 25% of the patients who would normally have been scheduled for IUI if laparoscopy had not been performed. The changed treatments mainly concerned surgery for minimal/mild endometriosis and periadnexal adhesions, both performed during the diagnostic laparoscopy. Because the effect of such interventions on the success rate of IUI has never been described, it still remains unclear whether laparoscopy is usefully performed in these cases. Therefore, further prospective studies should be performed to assess whether delaying, or bypassing entirely, diagnostic laparoscopy is more cost effective and if laparoscopic interventions for intra-abdominal abnormalities are effective in terms of higher pregnancy rates after treatment with IUI.

Endometriosis↗

PubMed2002

Utility of staging laparoscopy in subsets of peripancreatic and biliary malignancies.

OBJECTIVE: To determine the relative benefit of staging laparoscopy in peripancreatic and biliary malignancies. SUMMARY BACKGROUND DATA: Staging laparoscopy has been used in a variety of peripancreatic and biliary malignancies. The utility of the technique in subsets of these types of cancer has not been systematically compared. METHODS: One hundred fifty-seven patients underwent laparoscopy after conventional tumor staging; 89 were also staged with laparoscopic ultrasonography. Diagnostic categories were cancer of the pancreatic head and uncinate process, cancer of the body and tail of pancreas, cancer of the extrahepatic bile duct, cancer of the gallbladder, and cancer of the ampulla of Vater/duodenum. RESULTS: In patients with cancer of the head of the pancreas, metastatic disease or vascular invasion was discovered frequently by laparoscopy (31%), whereas in ampullary/duodenal cancer it was never found. The laparoscopic findings in cancer of the head of the pancreas had an important influence on treatment decisions, whereas in cancer of the ampulla/duodenum, laparoscopy had no effect on clinical decisions. Laparoscopy also substantially influenced the treatment of gallbladder cancer; in other tumor types, results were intermediate. Laparoscopic ultrasonography was valuable in cancer of the head of the pancreas. CONCLUSIONS: The utility of staging laparoscopy depends on diagnosis. It is recommended for continued use in pancreatic head and gallbladder cancers but not in ampullary malignancies.

Adult↗

PubMed2005

Update on the role of laparoscopy in the treatment of gynaecological malignancy.

PURPOSE OF REVIEW: To update the available information and to report on how the recent literature has better defined the role of laparoscopy for the management of gynaecological malignancies. RECENT FINDINGS: When compared with laparotomy, laparoscopy provides a similar outcome with a shorter hospitalization, an earlier recovery, and an improved quality of life for the treatment of endometrial cancer. Recent reports in the literature on cervical cancer management now include follow-up data; however, only one study included a control group. These studies confirm the feasibility of radical hysterectomy by laparoscopy. The 2-year disease-free and overall survivals were similar in patients treated by laparoscopy and laparotomy in the study that included a control group. The role of laparoscopy for early ovarian cancer is limited by the absence of available data on upstaging. For advanced ovarian carcinoma, new applications of laparoscopy, such as laparoscopic fluorescence detection after intraperitoneal application of 5-aminolevulinic acid, have been reported but the real utility needs further investigation. One of the challenges for the development of laparoscopic surgery is the difficulty for physicians of acquiring advanced laparoscopic surgical skills. SUMMARY: The feasibility and safety of laparoscopy for most of the surgical procedures that are used for gynaecological malignancies are now established from cohort or case-control analytical studies. The absence of large phase III studies needs to be balanced by the relatively low incidence of cervical and ovarian cancer.

Female↗

PubMed1997

Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience.

BACKGROUND: Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited. METHODS: Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy. RESULTS: Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor. CONCLUSIONS: Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.

Abdominal Injuries↗

PubMed2002

Impact of increased use of laparoscopy on negative laparotomy rates after penetrating trauma.

BACKGROUND: Our institution was one of the first to report the use of laparoscopy in the management of penetrating abdominal trauma (PAT) in 1977. Despite early interest, laparoscopy was rarely used. Changes in 1995 resulted in an increase in interest and use of laparoscopy. We present our recent experience with laparoscopy. METHODS: Our trauma registry and operative log were used to identify patients with blunt and penetrating injuries to the abdomen, back, and flank who underwent laparotomy or laparoscopy during the past 5 years. Patient demographics, operative findings, complications, and length of stay were reviewed. The number of laparoscopic explorations, therapeutic, nontherapeutic, and negative laparotomies were trended. RESULTS: There were 429 abdominal explorations for trauma. The rate of laparoscopy after penetrating injury increased from 8.7% to 16%, and after stab wounds from 19.4% to 27%. There was an associated decrease in the negative laparotomy rate. Laparoscopy prevented unnecessary laparotomy in 25 patients with PAT. Four patients with diaphragm injuries underwent repair laparoscopically. CONCLUSION: An aggressive laparoscopic program can improve patient management after PAT.

Abdominal Injuries↗

PubMed2005

Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy.

Laparoscopy-assisted distal gastrectomy has been applied to the treatment of early gastric cancer in Japan. So far, several studies about comparison between laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy were reported. However, there are few reports on the laparoscopy-assisted total gastrectomy, mainly because this procedure is performed relatively infrequently, and the procedure is more difficult than laparoscopy-assisted distal gastrectomy. This was a case-control study comparing between laparoscopy-assisted total gastrectomy group and open total gastrectomy group. From June 2001 to August 2004, laparoscopy-assisted total gastrectomy was performed in 20 patients. Reconstruction was performed by Roux-en-Y method or Roux-en-Y with jejunal pouch method through the mini-laparotomy. These cases were compared with 19 cases of open total gastrectomy, regarding operating time, blood loss, leukocyte count, C-reactive protein, time to the first passage of gas, time to initiate oral intake, and postoperative hospital stay.Laparoscopy-assisted total gastrectomy was successful in 20 patients. The mean operating time was 280 minutes and blood loss was 227.5 mL. Leukocyte counts on days 1, 3, and 7 were significantly lower in laparoscopic surgery group than in open surgery group. The time to first flatus, time to initiate oral intake, and postoperative hospital stay was significantly shorter (P < 0.05) in the laparoscopic surgery group than in the open surgery group. This study demonstrated that laparoscopy-assisted total gastrectomy is suitable and feasible for early gastric cancer and has the advantage of a shorter recovery time compared with open total gastrectomy.

Adenocarcinoma↗

PubMed2003

Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study.

BACKGROUND: The optimal strategy for identifying patients with abdominal stab wounds requiring surgical repair has not been defined. The potential benefits of diagnostic laparoscopy by incorporating it into the routine diagnostic workup of patients with anterior abdominal stab wounds was evaluated in a two-layer, randomized study. METHODS: From May 1997 through January 2002, stable patients without peritonitis but with demonstrated peritoneal violation were randomized (A) to exploratory laparotomy (AEL) (n = 23) or diagnostic laparoscopy (ADL) (n = 20). Simultaneously, patients with equivocal peritoneal violation on local wound exploration were randomized (B) to diagnostic laparoscopy (BDL) (n = 28) or expectant nonoperative management (BNOM) (n = 31). Hospital morbidity, length of stay, and costs were primary endpoints, with postdischarge disability being a secondary endpoint. RESULTS: In patients with peritoneal penetration (AEL vs. ADL), there were minimal differences in the therapeutic operation rate (8 of 23 [AEL] vs. 8 of 20 [ADL], p = 0.761), mortality (none), morbidity (3 of 23 vs. 2 of 20, p = 0.999), hospital stay (mean +/- SD) (5.7 +/- 2.5 vs. 5.1 +/- 4.0 days, p = 0.049), hospital costs (4.6 +/- 1.3 vs. 4.8 +/- 1.9 x 1,000 EUR, p = 0.576), and length of sick leave (34 +/- 12 vs. 29 +/- 11 days, p = 0.305). In patients with equivocal peritoneal penetration (BDL vs. BNOM), laparoscopy found more mostly minor organ injuries (7 of 28 [BDL] vs. 1 of 31 [BNOM], p = 0.022) with no significant difference in therapeutic operations (3 of 28 vs. 1 of 31, p = 0.337) or morbidity (3 of 28 vs. 0 of 31, p = 0.101), but was associated with increased length of stay (2.6 +/- 2.1 vs. 1.9 +/- 1.8 days, p = 0.022), hospital costs (4.2 +/- 1.3 vs. 1.5 +/- 1.1 x 1,000 EUR, p = 0.000), and sick leave requirements (18 of 23 vs. 8 of 28 of eligible patients, p = 0.001). CONCLUSION: In patients with demonstrated peritoneal violation, laparoscopy offers little benefit over exploratory laparotomy. In patients with equivocal peritoneal penetration on local wound exploration, laparoscopy detects more mostly minor organ injuries than expectant nonoperative management but is associated with increased hospital stay, costs, and sick leave requirements. Overall, diagnostic laparoscopy cannot be recommended as a routine diagnostic tool in anterolateral abdominal and thoracoabdominal stab wounds.

Abdominal Injuries↗

PubMed1975

Laparoscopy and laparotomy combined with bone marrow biopsy in staging Hodgkin's disease.

The relative merits of laparoscopy with liver and spleen biopsy and staging laparotomy were studied in 91 unselected patients with Hodgkin's disease. Laparoscopy with liver and spleen biopsy were combined with needle biopsy of the bone marrow and laparotomy was combined with open bone marrow biopsy. In 65 untreated patients six out of seven with liver or marrow disease, or both, were shown to have extranodal lymphomas in these sites by laparoscopy plus needle marrow biopsy. Among 26 patients who had been treated this finding occurred in six out of 10 patients. Spleen biopsies during laparoscopy detected infiltration by lymphoma in 14 out of 37 (38%) patients with diseases spleens. Morbidity was higher after laparotomy than after laparoscopy. Laparoscopy produced abdominal bleeding secondary to splenic biopsy in two patients. All patients with Hodgkin's disease should be subjected to laparoscopy plus needle marrow biopsy before undergoing laparotomy.

Adolescent↗

PubMed2004

Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy.

BACKGROUND: The interest of laparoscopy in the preoperative staging of pancreatic head adenocarcinoma before curative pancreaticoduodenectomy is a matter of controversy and depends on the accuracy of preoperative imaging techniques. AIM: To assess the potential value of laparoscopy when a standardised and optimal preoperative staging is performed, including spiral computed tomography (CT) and endoscopic ultrasonography (EUS). METHODS: All consecutive patients operated on with a view to curative pancreaticoduodenectomy for pancreatic head or ampullary adenocarcinoma in our centre from January 1998 to August 2000 were retrospectively studied. All of them had preoperative spiral CT and EUS. Tumour resectability was considered as highly probable (HP) or uncertain (U) according to well-defined criteria. Operative records of patients were reviewed to indirectly assess the effective resectability rate and the criteria responsible for unresectability and which of them would have been identified by laparoscopy if initially performed. RESULTS: 69 consecutive patients were studied. Resectability was HP (n = 56) or U (n = 13) after preoperative staging. Curative pancreatoduodenectomy was performed in 53 patients (77%) (48 HP, 5 U). Positive predictive value of preoperative imaging for highly probable resectability was 86% (48/56). Among the 16 unresectable tumours (8 HP, 8 U), the cause of non-resection would have been found at laparoscopy in 9 patients (56%) (6 HP, 3 U). Finally, if initially performed, laparoscopy would have avoided laparotomy in 9/69 patients (13%) (6/56 HP (11%); 3/13 U (23%)). CONCLUSIONS: With accurate preoperative staging using spiral CT and EUS, laparoscopy would detect tumours which were unresectable in 13% of patients with pancreatic head cancer. Laparoscopy remains useful in selected patients, such as those with preoperative uncertain resectability, in whom it can prevent unnecessary laparotomy in one fourth of patients.

Adenocarcinoma↗

PubMed1986

[Open laparoscopy, a report of 12 cases in gynecology--with special reference to the diagnosis and treatment of infertility].

Open laparoscopies were performed on patients with eleven infertilities and one ectopic pregnancy in our gynecology clinic. Eight cases of endometriosis were revealed in eleven severe infertile patients. There were three cases of different findings between preoperative hysterosalpingograms and chromotubations under laparoscopies. One case of ectopic pregnancy was cured by salpingectomy after diagnostic laparoscopy. All 12 patients had N2O gas pneumoperitoneum under endo-tracheal intubated anesthesia. One case with both halothane and N2O anesthesia became temporarily hypothermic during open laparoscopy. Indications of gynecologic laparoscopy, characteristics of open laparoscopy and its comparison with closed laparoscopy are discussed.

Adult↗

PubMed1999

Major complications of laparoscopy: a follow-up Finnish study.

OBJECTIVE: To examine recent figures on major laparoscopic complications in Finland. METHODS: This was a nationwide record-linkage study from January 1995 through December 1996 including all Finnish hospitals performing gynecologic laparoscopies. Data files of the National Patient Insurance Association and the Finnish Hospital Discharge Register were used. Data were compared with previous results from 1990 to 1994. RESULTS: Among 32,205 gynecologic laparoscopies, 130 major complications were noted. The total complication rate was 4.0 per 1000 procedures: 0.6 per 1000 in diagnostic laparoscopies, 0.5 per 1000 in sterilization, and 12.6 per 1000 in operative laparoscopies. Intestinal injuries were reported in 0.7 per 1000, incisional hernias in 0.3 per 1000, urinary tract injuries in 2.5 per 1000, major vascular injuries in 0.1 per 1000, and other injuries in 0.5 per 1000 gynecologic laparoscopic procedures. Seventy-five percent (88 of 118) of the major complications in operative laparoscopies occurred during hysterectomies. The total major complication rate decreased from 4.9% in 1993 to 2.3% in 1996 (chi2 = 8.55, P = .003), but the incidence of ureteral injuries remained stable, at about 1% of laparoscopic hysterectomies. Ureteral injuries were most common in local hospitals (2.6%), followed by central (1.1%) and university hospitals (0.9%). From 1990 through 1996, the relative risk for ureteral injury in laparoscopic hysterectomies, compared with other operative laparoscopies was 29.0 (95% confidence interval [CI] 13.3, 63.0), for bladder injury 13.0 (95% CI 6.0, 28.2), for intestinal injury 1.3 (95% CI 0.6, 2.5), and for major vascular injury 0.4 (95% CI 0.1, 3.6). Compared with the figures for 1990-1994, all major complications in operative laparoscopies increased, from 0 per 1000 in 1990 to 14.0 per 1000 in 1996 (chi2 = 20.28, P<.001), but part of this increase was due to the increased proportion of laparoscopic hysterectomies. CONCLUSION: Laparoscopic hysterectomies are still associated with a stable 1% risk of ureteral injury, whereas other major complications were decreasing until 1996. Complications in other laparoscopic procedures generally are rare.

Female↗