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At least 217 records · Page 12Linked to original sources

PubMed1999

The new techniques of gynaecologic laparoscopy. Gasless, open Hasson, optic trocar.

BACKGROUND: New techniques of laparoscopy: gasless, open Hasson, optic trocars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alternative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery. METHODS DESIGN: Prospective evaluation. SETTING: University-affiliated county hospital. PATIENTS: Gasless laparoscopy surgery was performed on 49 patients between December 1995 and July 1996 with a retractor system without pneumoperitoneum consisting of an intrabdominal retractor using conventional surgical and laparoscopic instruments and to enable a simultaneous vaginal approach. RESULTS: Gasless laparoscopy was successful in 44 (90%) of cases. A simultaneous vaginal approach was used in one third of indications including vaginal myomectomy and laparoscopic assisted hysterectomy. Conversion to laparotomy was required in 5% of cases. Mean procedure duration was 90 minutes and mean hospitalisation time was 5.7 days. CONCLUSIONS: The introduction of new techniques of laparoscopy: gasless, open Hasson, optic trocars has broadened the application of operative laparoscopy. Gasless technique in lieu of conventional laparoscopy can be performed reliably and safely for most gynaecological indications. The most outstanding benefit of this method is that it can be combined with a vaginal approach which is not possible using a pneumoperitoneum due to gas leakage. The place of gasless laparoscopy will depend on continuing development by instrument manufacturers, in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.

Female↗

PubMed2000

The role of laparoscopy in the treatment of intra-abdominal malignancies.

The role of laparoscopy in the care of patients with cancer is currently evolving. Numerous experimental and clinical studies have attempted to elucidate the nature and cause of port-site metastases--particularly to discern whether they simply are a marker of advanced disease, or if they are a result of the laparoscopic intervention. Laparoscopy has a role in establishing the diagnosis of cancer in some situations by allowing biopsy of intraperitoneal and retroperitoneal masses, lymph nodes, and visceral lesions, as well as examination of abdominal contents under direct vision or with ultrasound probes. Laparoscopy is useful in the staging of established malignancies such as pancreatic cancer, hepatic lesions, lymphoma, and esophageal cancer. Laparoscopy also has a role in the surgical treatment of a variety of malignancies, including gastric carcinoma, pancreatic cancer, splenic malignancies, adrenal cancers, and colon cancer. The safety of laparoscopy for the definitive resection of colon cancer has not yet been proven, and until the results of a randomized prospective trial currently underway are known, should be performed only in the context of a clinical trial. Lastly, laparoscopy can play an important role in the palliative care of the cancer patient in performing procedures such as feeding-tube placement or intestinal stoma creation. It is imperative that using laparoscopy in the care of patients with malignancies be carefully and thoroughly evaluated since this technique can either benefit or adversely affect survival or quality of life.

Abdominal Neoplasms↗

PubMed1999

Prognostic significance of diagnostic laparoscopy for spontaneous fertility.

OBJECTIVE: To determine the prognostic significance of laparoscopy results for fertility outcome. STUDY DESIGN: Consecutive patients undergoing hysterosalpingography and laparoscopy for subfertility in our department between May 1985 and November 1987 were identified from medical records. The impact of tubal occlusion, hydrosalpinx and adhesions as detected at laparoscopy was studied. Kaplan-Meier curves for the occurrence of spontaneous intrauterine pregnancy were constructed for patients without tubal pathology, with mild tubal pathology (unilateral pathology or adhesions) and with severe tubal pathology (bilateral pathology). Fecundity rate ratios (FRR) were calculated to express the association between findings at laparoscopy and the occurrence of spontaneous intrauterine pregnancy. RESULTS: Of the 200 cases that could be analyzed, 129 (65%) showed no tubal occlusion on laparoscopy, 40 (20%) had unilateral tubal occlusion, and 31 (15%) had bilateral tubal occlusion. Unilateral hydrosalpinx was present in 13 (7%) patients, whereas 19 (10%) patients had bilateral hydrosalpinx. Adjusted FRRs were 0.65 and 0.20 for unilateral and bilateral tubal occlusion, and 0.46 and 0.32 for unilateral and bilateral hydrosalpinx. Peritubal adhesions were detected in 43% of patients and seemed to have no prognostic significance. CONCLUSION: Severe tubal pathology detected at laparoscopy affects fertility prospects strongly. However, since spontaneous intrauterine pregnancies occurred even in patients with bilateral tubal occlusion at laparoscopy, this technique should not be considered the gold standard in the diagnosis of tubal infertility.

Adult↗

PubMed2001

[Laparoscopy in differential internal medicine diagnosis].

Diagnostic laparoscopy has still important implications in the differential diagnosis of numerous diseases despite the impact of non invasive imaging procedures. One of the most important indication, besides chronic liver diseases, is staging of malignancies. Laparoscopy improves considerably the predictability whether a distal carcinoma of the esophagus, or a stomach cancer or a pancreatic carcinoma can be resected. Laparoscopy is unbeaten in diagnosing peritoneal metastases. Thus, laparoscopy prevents unnecessary explorative laparotomies. Regarding tumor staging, a comparison is mandatory between minilaparoscopy, conventional laparoscopy in analgosedation performed by the gastroenterologist and laparoscopy in intubation anesthesia performed by the surgeon immediately before planned laparotomy. The significance of minilaparoscopy especially regarding chronic liver diseases and correct diagnosis of liver cirrhosis and hepatocellular carcinoma in cirrhosis will certainly increase. Laparoscopy remains to be an important diagnostic tool in diseases of unknown causes, i.e. fever of unknown origin. Laparoscopic sonography is the most sensitive method to detect small liver tumors, such as metastases or multilocular hepatocellular carcinoma.

Anesthesia, General↗

PubMed2001

[Significance of laparoscopy for response assessment of chemotherapy in gastric cancer].

UNLABELLED: We performed laparoscopy before and after chemotherapy in two patients with relapsed and advanced gastric cancer, whose major metastatic sites had been diagnosed as being in the peritoneum. A change in tumor responses when assessed by laparoscopy was found. Case 1: A 63-year-old man presented with an umbilical metastasis and suspected peritoneal metastases after gastrectomy. Laparoscopy revealed peritoneal metastases before chemotherapy. After one course of chemotherapy the umbilical tumor disappeared (CR). Laparoscopy after two courses of chemotherapy revealed increasing peritoneal metastases (PD). The overall response was PD. Case 2: A 67-year-old woman was referred to our hospital with a diagnosis of type 4 gastric cancer. Staging laparoscopy revealed massive lymph node metastases and the patient was positive in peritoneal washing cytology. After four courses of chemotherapy, the primary tumor and the metastatic lymph nodes had decreased in size (PR). In contrast, laparoscopy revealed increasing peritoneal metastases (PD). The overall response was PD. CONCLUSION: In patients with peritoneal and other modes of metastasis, tumor response to chemotherapy may be misjudged by conventional imaging alone. Intraperitoneal examination by laparoscopy provides accurate information, including the tumor response to chemotherapy.

Aged↗

PubMed1975

Laparoscopy in endocrine and genetic disorders of the gonads.

The guideline of this work is to examine the diagnostic value of laparoscopy in some endocrine and genetic syndromes connected with gonadal pathology or abnormal sexual development in relation to the various hormonal and cytogenetic techniques usually utilized by the endocrinologist. After a brief introduction, Chapter 1 stresses our purpose to examine the advantages and limits of laparoscopy by investigating the most significant cases that came to our observation. Attention is drawn in Chapter 2 to the application of laparoscopy in a particular form of amenorrhea (uterus absence), admittedly of great endocrinologic interest. In particular, the results obtained by the application of this technique are reported in cases of uterus agenesis and the testicular feminization syndrome. The clinical, cytogenetic and hormonologic study of one case of uterus agenesis is reported together with that of four cases of the testicular feminization syndrome with the view to discussing the differential diagnosis between these two syndromes and the particular diagnostic problems connected with the latter. Our conclusion is that laparoscopy, although usually having only a confirmatory value in these syndromes, may assume in certain cases major diagnostic importance (the post-puberal testicular feminization syndrome without palpable gonads, the pre-puberal testicular feminization syndrome, rare cases of the testicular feminization syndrome associated with chromosome aberrations). Chapter 3 discusses the application of laparoscopy in female gonadal dysgenesis on the basis of three cases of Turner's syndrome with different diagnostic problems and one of pure gonadal dysgenesis. It is stressed that, although in the majority of cases of Turner's syndrome the laparoscopic findings are quite characteristic (streak gonads), in some cases the gonads may also present the aspect of hypoplastic ovaries. This finding is observed in two cases of Turner's syndrome with XO/XX mosaicism, of which one case with spontaneous menarche. The diagnostic value of laparoscopy is discussed in the cases of pure gonadal dysgenesis and in variants of Turner's syndrome chromatin-positive with X chromosome partial monosomy and chromatin-negative with a Y chromosome. Our conclusion is that laparoscopy assumes particular diagnostic value in cases of pure gonadal dysgenesis without chromosome aberrations, because chromosome aberrations may be absent in this syndrome, as well as in chromatin-negative variants with a Y chromosome because the gonads and gonaducts differentiation may be variable.

Adolescent↗

PubMedDate not supplied

Abdominal tuberculosis: diagnosis by laparoscopy and colonoscopy.

BACKGROUND: Histopathological confirmation in abdominal tuberculosis is difficult due to suboptimal noninvasive access to the involved area. Peritoneoscopy and colonoscopy provide semi-invasive access to the peritoneum, large intestine and ileocecal area. Information on the diagnostic yield of these two investigation in abdominal tuberculosis is scarce. OBJECTIVE: To evaluate the role of laparoscopy and colonoscopy in the diagnosis of abdominal tuberculosis. PATIENTS AND METHODS: Between January 1998 and July 2001, 34 patients were diagnosed to have abdominal tuberculosis on the basis of laparoscopy or colonoscopy. The case records of these patients were retrospectively reviewed to assess the usefulness of laparoscopy and colonoscopy in the diagnosis of abdominal tuberculosis. RESULTS: Laparoscopy was performed in 23 patients. Peritoneal tuberculosis was diagnosed in 19 of them, characterized by presence of ascites, multiple whitish tubercles, fibrous bands and adhesions, hyperaemic edematous bowel loops or dense adhesions without ascites. Multiple jejunoileal hyperemic short segments with serosal neovascularization was noticed in three patients. One patient had cecal mass with pericecal inflammatory adhesions. In three patients, laparoscopy was converted to open laparotomy due to bowel injury, extensive adhesions, and difficulty in assessing lymph nodal mass in one patient each. Peritoneal biopsy confirmed the diagnosis in 10 of the 15 (67%) patients. In one patient pericecal tissue biopsy confirmed the diagnosis. The remaining patients received therapeutic trial with anti tuberculosis treatment. All patients showed good response. Thus laparoscopy provided positive diagnosis of tuberculosis in 20/23 (87%) and positive histology in 10 of the 15 (67%) patients with peritoneal lesions. Thirteen patients underwent colonoscopy. Mucosal lesions involving terminal ileum, cecum and colon was noted in 11 patients. Colonoscopic biopsy confirmed the diagnosis in six of the 11 patients (54%). Non of these patients had any complication related to colonoscopy. CONCLUSION: Laparoscopy was safe and helped in the diagnosis of peritoneal as well as intestinal tuberculosis in 87% of patients. Colonoscopy is useful for colonic and terminal ileal lesion with a positive diagnostic yield of 54%.

Adolescent↗

PubMed1992

Laser laparoscopy versus laparotomy in lysis of pelvic adhesions.

Severe adhesions were induced at laparotomy by laser ablation of the surface of one uterine horn and 1 cm2 of pelvic sidewall in 20 rabbits. Three weeks later the rabbits were selected at random for laparoscopy or laparotomy. Adhesions at the horn, sidewall and incidental sites were scored and lysed with laser at similar power densities. Three weeks later animals were killed and adhesions were blindly scored. We found a significant and similar reduction in severe adhesions at uterine horns after either laser laparoscopy or laser laparotomy, better lysis of sidewall and incidental adhesions by laser laparoscopy and formation of de novo adhesions at nonoperative sites after laparotomy but not after laparoscopy. We conclude that (1) de novo adhesions are common after laparotomy; (2) severe uterine horn adhesions can be reduced equally well by both laparoscopy and laparotomy but laparoscopy is superior to laparotomy with less severe peripheral adhesions; (3) outcome of adhesiolysis depends on several variables, including adhesion density and location and approach (laparotomy or laparoscopy), even when the tool (laser) is constant.

Animals↗

PubMed1992

Comparison of CO2 laser laparoscopy with laparotomy for treatment of endometriomata.

OBJECTIVE: To assess the effectiveness of laparoscopy versus laparotomy in the treatment of endometriomata. DESIGN: Controlled study using data prospectively tabulated. SETTING: Treatment performed by senior author in a referral reproductive endocrinology and surgery private practice. PATIENTS: One hundred infertile women were diagnosed with endometriomata. INTERVENTION: Forty-eight women were treated with CO2 laser laparoscopy (laparoscopy group) and 52 women were treated with CO2 laser or nonlaser laparotomy (laparotomy group). MAIN OUTCOME MEASURE: The hypothesis that laparoscopy group pregnancy rates (PRs) would be equal to or greater than laparotomy group was formulated before data analysis but after data tabulation. RESULTS: The 1 and 3-year life table estimated cumulative PRs +/- SE were 0.30 +/- 0.07 and 0.52 +/- 0.09 for laparoscopy group and 0.23 +/- 0.06 and 0.46 +/- 0.09 for laparotomy group (Breslow P = 0.48). Monthly fecundity over 3 years was 2.4% for laparoscopy group and 2.0% for laparotomy group. CONCLUSIONS: Laparoscopy with CO2 laser can be a safe and effective modality for treating endometriomata.

Adult↗

PubMed1979

[Ten years experience with laparoscopy in the state women's clinic of Nurenberg].

During the period from 1968--1977 2400 laparoscopies were performed. Of these 10.7% were for diagnostic purposes only, in 3.6% of the cases laparoscopy was combined with biopsie and in 85.7% with tubal sterilization. Deaths or serious bleedings did not occur, laparotomies were not necessary. Total insignificant complications amounted to 1.6% (1.3% small bleedings which did not necessitate an operation and in 0.3% clinical signs of peritonitis, these disappeared after 3 to 15 days). In 0.7% laparoscopy was interrupted because of poor vision. Nine of 2055 women became pregnant after sterilization (4.5 pregnancies/1000 sterilizations). In 2 cases the ligamentum rotundum was coagulated, in 7 cases recanalization was histologically confirmed. Until Oct. 1975 coagulation was unipolar, afterwords bipolar. In 45.3% the patients had undergone an operation before, like Ceasarian section, gallbladder operation, appendectomy or umbilical hernia operation. Patients with longitudinal incision, with preceding peritonitis or ileus were excluded from laparoscopy. Laparoscopy was performed by all assistents during their last year of clinical instruction. Their first 30 laparoscopies were done under control, every assistent performed about 100 laparoscopies.

Female↗

PubMed2005

[Laparoscopy in chronic pelvic pain--a prospective clinical study].

OBJECTIVE: The aim of this study was to analyze the incidence, causes and management in women with chronic pelvic pain and to evaluate the role of laparoscopy. DESIGN: A prospective non-randomized clinical trial on 86 women with chronic pelvic pain. SETTING: Clinic of Gynecology and Obstetrics, JMF CU Martin, Slovak Republic. METHODS: A prospective clinical trial was performed on 86 patients with chronic pelvic pain, who have undergone laparoscopy from March 2003 to March 2004. Only patients with a pain history of at least 6 month were enrolled into this trial. Specific patient's history characteristics, laparoscopic and cytologic findings were reviewed and analyzed (pain interval, organic findings, preoperative ultrasound examination, previous surgical intervention, oral contraceptive usage, patient's medical history, menstrual cycle regularity, age, presence of dysmenorrhea). In all women, laparoscopy was performed under general anesthesia. RESULTS: During the study we have performed 309 diagnostic laparoscopic examinations, from which 86 (27.8%) were done due to chronic pelvic pain. The mean patient's age was 35.8 years (19-56). The mean parity was 1.6, ranging from 0-5. Pelvic organ pathology was present in 88.4% of the patients. The most frequent finding was endometriosis (31.4%). According to revised criteria of the American Fertility Society the presence of first, second, third and fourth stage of endometriosis was 55.6, 25.9, 11.1 and 7.4%, respectively. The most frequent occurrence of endometriotic lesions were on ligamenta sacrouterina (21.4%) and plica vesicouterina (19.0%). Pelvic adhesions, myomas, pelvic varicosities and chronic inflammatory process were present in 25.6, 15.1, 9.3 and 3.5% of the cases, respectively. No somatic origin of pain was identified at laparoscopy in 11.6% of patients. Preoperative ultrasonic examination with pelvic pathology findings were performed in 36 patients, and laparoscopy correlated with ultrasonographic findings in 31 (86.1%) cases. The average pain duration was 11.5 months (6-28) with the majority among women with history of previous surgical intervention (48.8%) and parturated women. Presence of pain was most common among women after 31 years of age. Predominantly, cytology examination of biological materials (peritoneal fluid, cyst fluid) revealed an increased histiocytic reaction in coincidence with chronic inflammation process in 31.6%. CONCLUSION: Invasive laparoscopy in chronic pelvic pain pertains to one of the most important examination procedures for its high specificity and sensitivity. Laparoscopy can reveal organic causes of pelvic pathology in 60% of cases with the possibility of following treatment. Our combined effort should stop the progression of such pathology leading to possible morphologic, functional and psychological alteration, especially among young women in fertile age. Today, endometriosis still remains the main cause of chronic pelvic pain in high percentage rate.

Adult↗

PubMedDate not supplied

Robotic-assisted laparoscopy in gynecological surgery.

BACKGROUND: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries. METHODS: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated. RESULTS: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky. CONCLUSION: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly and the bulkiness of the equipment.

Colposcopy↗

PubMed1989

Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy.

This study was designed to compare prospectively the parameters of morbidity, cost, length of hospital stay, and fertility outcome after linear salpingostomy by laparoscopy versus laparotomy. Entry criteria included stable vital signs, hematocrit greater than 30%, age over 18 years, and desire for future fertility. All patients underwent diagnostic laparoscopy. Sixty patients with unruptured ectopic gestations of 5 cm or smaller were randomized to either laparoscopy (N = 30) or laparotomy (N = 30). Postoperative follow-up included serial measurements of serum beta-hCG titers at 3-day intervals and hysterosalpingography at 12 weeks. The laparoscopy and laparotomy groups were similar in age, height, weight, gravidity, gestational age, hematocrit, ectopic pregnancy size, and preoperative beta-hCG levels. The estimated blood loss was significantly (P less than .001) lower in patients undergoing laparoscopy, and was not affected by vasopressin injection. Two patients in the laparoscopy group required laparotomy for hemostasis, and two patients undergoing laparotomy had wound infection. One patient in each group had persistent trophoblastic activity. Baseline serum beta-hCG levels and the rate and magnitude of postoperative beta-hCG decline were similar in both groups. The length of hospital stay was significantly (P less than .001) shorter after laparoscopic salpingostomy (1.4 +/- 0.1 days) than after laparotomy (3.3 +/- 0.2 days). Postoperative hysterosalpingography showed patency of the involved tube in 16 of 20 (80%) and 17 of 19 (89%) of patients in the laparoscopy and laparotomy groups, respectively. Pregnancy rates were ten of 18 (56%) and 11 of 19 (58%) in these groups, respectively, and all pregnancies were conceived within 6 months of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

[Analysis of 35,013 gynecologic laparoscopies (East German survey). 1].

Statistic from 81 women hospitals in which a total of 35,013 laparoscopies had been made figures were collected by means of questionnaires (inquiry forms). The largest increase of laparoscopies (56.2%) could be found since 1980. Results showed that in 48 hospitals (59.3%) less than 50 laparoscopies were made per year. In all hospitals laparoscopy was performed under clinical conditions by the gynaecologist, mainly using endotracheal anesthesia (96.3%). 20 hospitals (24.7%) are able to perform laparoscopies in the day-time only. More than 90% of the questioned ones regarded thoracic roentgenogram, electrocardiogram as well as urine examination and hemoglobin determination as sufficient pre-examinations. 70.4% of the questioned hospitals demand a written confirmation that before the operation was carried out appropriate instructions had been given. The technical performance of laparoscopy corresponds to today's usual practice. For the pneumoperitoneum, for which 51.8% of the hospitals use an automatic system, CO2 (6.7%) is preferred. Patients are dismissed from hospital on 1st (19.8%), 2nd (50.6%) or 3rd day after the operation and later in 29.5% of the cases. Women are unable to work for an average of eight days following laparoscopy.

Diagnostic Tests, Routine↗

PubMed1986

Comparative trial of tubal insufflation, hysterosalpingography, and laparoscopy with dye hydrotubation for assessment of tubal patency. World Health Organization.

A World Health Organization-sponsored multicentered trial comparing the efficacy of gaseous tubal insufflation with hysterosalpingography (HSG) and/or laparoscopy plus dye hydrotubation in the assessment of tubal patency was undertaken. Three hundred ninety-three women in eight centers were involved (365 insufflations, 289 HSG, 189 laparoscopy). Patency was proven positive in 56% of insufflation, 45% of salpingography, and 52% of laparoscopy cases. Laparoscopy showed some women to have fibroids and a number of others to have ovarian abnormalities, endometriosis, pelvic adhesions, and/or congenital uterine malformation. Comparison of insufflation and HSG showed a false-positive rate of 42% and false-negative rate 24% in 363 cases. The false-positive rate of insufflation versus laparoscopy was 35% and the false-negative rate 38% of 180 cases. Only 55% of 125 women undergoing both HSG and laparoscopy had similar findings. The results suggest that gaseous tubal insufflation should not be employed as a method of investigating tubal patency. Diagnostic reliability of HSG is poor, but it is useful as a primary screening procedure, particularly when complimented with laparoscopy plus dye hydrotubation, which is the optimum method not only for assessing tubal patency but for discovering other hitherto unsuspected disease.

Clinical Trials as Topic↗

PubMed1995

The physiological effect of CO2 pneumoperitoneum in pediatric laparoscopy.

BACKGROUND: The physiological effect of CO2 pneumoperitoneum during laparoscopy is a great concern of the anesthesiologists. Its effect in pediatric laparoscopy has not been previously reported. The purpose of this study was to examine the physiological alteration of pediatric patients during CO2 pneumoperitoneum. METHODS: One hundred and twenty six children aged from 11 mon to 13 yr undergoing laparoscopic inguinal exploration were divided into three groups based on age orientation: group I comprising 40 children with age from 11 mon to 2 yr; group II 46 children with age between 2 to 5 yr; and group III 40 children aged from 5 to 13 yr. All patients received endotracheal anesthesia with halothane-N2O in 50% O2 and atracurium for muscle relaxation. Respiration was controlled by an Ohmeda 7000 ventilator with constant minute ventilation to maintain baseline end-tidal CO2 tension (PETCO2) between 32-33 mmHg. After anesthesia, CO2 was insufflated into the peritoneal cavity via the opened hernia sac. The intraabdominal pressure exerted by CO2 was 10 mmHg and the duration of pneumoperitoneum and laparoscopy was 15 min. We recorded airway pressure, PETCO2, body temperature, blood pressure, heart rate, heart rhythm, and oxygen saturation simultaneously at 1 min interval before, during, and after laparoscopy. RESULTS: The airway pressure and PETCO2 showed significant increases during laparoscopy (15-18% and 18-20% respectively) in all cases, but the percentage of increases were not significantly different among groups. However, the PETCO2 change in terms of time lag were different between groups: (1) the time lag from CO2 insufflation to the emergence of PETCO2 change (latent period) was respectively 0.7 +/- 0.1 (mean +/- SD) min in group I, 0.9 +/- 0.2 min in group II and 1.5 +/- 0.2 min in group III (p < 0.05); (2) the PETCO2 change from baseline to a plateau (ascending period) was respectively 4.2 +/- 0.6 min in group I, 6.3 +/- 1.0 min in group II and 9.1 +/- 1.1 min in group III (p < 0.05); (3) the PETCO2 decline from plateau to baseline after CO2 deflation (descending period) was respectively 6.2 +/- 0.5 min in group I, 8.3 +/- 0.8 min in group II and 12.0 +/- 1.3 min in group III (p < 0.05). The body temperature and hemodynamics including blood pressure, heart rate, heart rhythm, oxygen saturation were not significantly changed during laparoscopy in all groups. CONCLUSIONS: The changes of PETCO2 during laparoscopy did not influence the hemodynamic stability in our study. The younger children give a faster reaction time of PETCO2 change after CO2 insufflation than do the older children which may be related to the variation of physiological exhibition at different state of development.

Adolescent↗

PubMedDate not supplied

Treatment of ectopic pregnancy by systemic methotrexate, transvaginal methotrexate, and operative laparoscopy.

OBJECTIVE: To evaluate the efficacy of treatment of ectopic pregnancy by local administration of methotrexate, systemic methotrexate, and laparoscopy. METHODS: This study was a retrospective analysis from the department of Obstetrics and Gynecology of two university-affiliated hospitals. Medical records of 40 patients who were treated by methotrexate from January 1991 to October 1994 and 66 patients who were treated surgically by laparoscopy from April 1986 to June 1994 were reviewed. Among the methotrexate group, 19 patients were treated by ultrasound-guided injection and 31 others were treated by intramuscular administration. Success rate of the primary treatment and the duration of hospitalization were examined for each group. The cases of methotrexate failure were characterized and compared with the primary laparoscopic group. RESULTS: The success rate was similar between the local (79.8%) and the systemic (66.7%) methotrexate groups. The primary laparoscopy group had a significantly higher success rate (95.5%) than the methotrexate group (72.5%); P < .01. When patients who had laparoscopy as their primary treatment (n = 66) were compared with those who underwent surgery after failed methotrexate treatment (n = 11), the primary laparoscopic group were seen to have shorter hospitalization time, smaller tubal diameter at surgery, and higher pre-operative hemoglobin level (P < .05). More patients in the methotrexate failure group (45.5%) had hemoperitoneum of > 500 mL than those in the primary laparoscopy group (1.5%; P < .001). CONCLUSIONS: There is no difference in efficacy between local and systemic methotrexate administration. Laparoscopic treatment of ectopic pregnancy is associated with a higher success rate than methotrexate treatment. Patients treated by laparoscopy after methotrexate failure were sicker than those who were treated by laparoscopy as their primary treatment.

Adult↗

PubMed1997

[Laparoscopy in the non-palpable testicles. Is it always necessary?].

In order to know the role of diagnostic laparoscopy with non palpable testicles (NPT), 15 children with 16 NPT were studied. Middle age was 7 years (R: 2-12). The surgical procedure was: laparoscopy initially and open inguinal surgery (OIS) after that. Six NPT were discovered with laparoscopy (37.5%). With OIS inguinal hernia was present in 4 cases, with testicle into the inguinal sac in 3 cases; 12 cases had not inguinal hernia, and 6 of them showed spermatic vessel and vas deferent without testicle. Orquidopexy of the 6 located testicles and testicular prothesis implantation in the other 10 cases, were performed. Finding of laparoscopy and OIS were perfectly correlated. Laparoscopy made the diagnosis in 7 cases, which the OIS would have been unable to do it (43.7%). In the other 9 cases, the OIS would have been diagnostic enough (56.2%) without laparoscopy. For those results, the authors prefer to begin the surgical procedure with OIS and if the spermatic vessels are no located, then the laparoscopy is done under the same anesthesia.

Child↗