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Results for “laparoscopy”

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At least 235 records · Page 13Linked to original sources

PubMed1997

[The place of second-look laparoscopy in monitoring treatment of advanced malignant ovarian neoplasms].

The role of second-look laparotomy in management of advanced ovarian cancer is still controversial. One of the arguments against this method is the risk of this wide operation. Replacement of second-look laparotomy by laparoscopy maybe the way to minimize that risk. The aim of this report is the comparison of second-look laparotomy and laparoscopy. The prospectively gathered material consists of 56 women with ovarian cancer, 17 of them were qualified for second-look procedures. Laparoscopy was the first step in this procedure. In 5 patient the residual malignancy in abdominal cavity was found. In 11 there were no evidence of the disease, and in 1 case laparoscopic inspection was impossible. When the laparoscopy was negative or impossible the second-look laparotomy was performed. Only in one case after negative laparoscopy the evidence of malignancy during laparotomy was found. In our opinion: 1) Positive second-look laparoscopy is equivalent to laparotomy and permits to avoid it. 2) The negative second-look laparoscopy with its contemporary technique still requires the subsequent laparotomy.

Adult↗

PubMed1999

Laparoscopy in 533 patients with abdominal malignancy.

BACKGROUND: Laparoscopy in patients with intra-abdominal malignancy remains controversial. This study evaluates the incidence of tumor recurrence at the port site after laparoscopy in patients with intra-abdominal malignancy. METHODS: The medical records of all patients with nongynecologic malignancies who underwent laparoscopic procedures between May 1, 1990, and June 30, 1996, at the University of Texas M.D. Anderson Cancer Center were reviewed. Data on extent of tumor, histologic findings, primary location, procedures performed, and complications were recorded. RESULTS: During this time, 533 patients with known intra-abdominal malignancies underwent laparoscopy. Mean follow-up time was 13.2 +/- 0.5 months (range 1 to 71 months; median 10.6 months). Four recurrences at the port site were identified (0.8%). Three of these patients had advanced intra-abdominal disease at the time of laparoscopy; 1 patient without advanced disease at the time of laparoscopy had a recurrence at the port site as the only site of recurrent disease (0.19%). The incidence of port site recurrences among patients with advanced intra-abdominal disease at the time of laparoscopy (3/71) was significantly greater than the risk of development of a recurrence at the port site among patients without advanced intra-abdominal disease at the time of laparoscopy (1/462; P < .0003, by chi-square analysis). CONCLUSION: Recurrence at the port site is very rare. When implantation at the port site does occur, it is most commonly associated with advanced intra-abdominal disease.

Abdominal Neoplasms↗

PubMed1996

Scrotal-inguinal ultrasonography: a technique for identifying the nonpalpable inguinal testis without laparoscopy.

PURPOSE: Treatment of the patient with a nonpalpable testis is controversial, since a high percent will have an inguinal testis or testicular remnant at exploration. While laparoscopy is an effective modality for localizing the intra-abdominal testis, diagnostic laparoscopy is of limited value for patients with nonpalpable (normal or atrophic) inguinal testes. In an effort to identify preoperatively impalpable inguinal testes, we performed scrotal-inguinal ultrasound. MATERIALS AND METHODS: We evaluated 64 patients (74 nonpalpable testes) in the last 4 years, representing 20% of all those presenting with cryptorchidism. Average patient age was 4.5 years (range 6 months to 17 years). All patients underwent preoperative scrotal-inguinal ultrasound and surgical exploration. Diagnostic laparoscopy was reserved for patients with negative ultrasound and no palpable tissue in the scrotum or groin on a preoperative examination. RESULTS: Scrotal-inguinal ultrasound correctly identified 40 of the 42 inguinal testes (95% sensitivity), 7 of the 21 atrophic inguinal testes (33% sensitivity) and 1 of the 11 intra-abdominal testes (9% sensitivity). Therefore, scrotal-inguinal ultrasound correctly identified an inguinal testis or remnant for 47 of the 74 nonpalpable testes (64%), eliminating the need for diagnostic laparoscopy in those cases. For 26 of 74 nonpalpable testes with negative ultrasound 13 had an associated palpable inguinal or scrotal nubbin of tissue, and inguinal exploration only was performed, resulting in 9 orchiectomies, 2 inguinal orchiopexies and 2, 2-stage orchiopexies. Of the 13 nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound 8 were intra-abdominal and 5 were atrophic inguinal testes. CONCLUSIONS: Scrotal-inguinal ultrasound identifies patients with nonpalpable testes who will maximally benefit from diagnostic laparoscopy. When diagnostic laparoscopy was limited to nonpalpable testes without palpable nubbins and negative scrotal-inguinal ultrasound, only 13 of 74 (18%) required laparoscopy. Inguinal exploration without further diagnostic studies is appropriate for boys with nonpalpable testes and palpable nubbins.

Adolescent↗

PubMed1996

Use of laparoscopy in the management of malfunctioning peritoneal dialysis catheters.

The proper function of peritoneal dialysis (PD) catheters can be compromised by catheter malposition, fibrin clot, or omental wrapping. The purpose of this study was to determine the efficacy of laparoscopy in the treatment of malfunctioning PD catheters. All patients undergoing laparoscopy for catheter dysfunction at MetroHealth Medical Center in Cleveland, Ohio, from 1991 to 1995, were reviewed. Twenty-six laparoscopies were performed in 22 patients, for malfunction occurring an average of 3.9 months following insertion (range 0.5-18 months). Omental and/or small below wrapping as present in all but three cases. Lysis of adhesions was required in 19 of 26 cases, with repositioning only in seven. Eight patients had failed attempts at stiff wire manipulation prior to laparoscopy. Perioperative complications occurred in seven cases, consisting of temporary dialysate leakage (2), enterotomy (1), and early reocclusion (4). Repeat laparoscopy was successful in three of these four reocclusions. The overall success rate (catheter function > 30 days after laparoscopy) was 21/22 (96%). Laparoscopy is highly accurate and effective in the management of peritoneal dialysis catheter dysfunction and results in prolongation of catheter life.

Adult↗

PubMed1997

Outcome after exploratory laparoscopy for unexplained abdominal pain in childhood.

BACKGROUND: Abdominal pain in childhood is common yet frustrating when unexplained. OBJECTIVE: To describe the clinical features and outcome of 8 children (6 girls and 2 boys; mean[+/- SD] age, 13 +/- 2 years) with unexplained abdominal pain who underwent exploratory laparoscopy. SETTING: All 8 patients were examined at an academic pediatric gastroenterology center and referred for exploratory laparoscopy because of unexplained abdominal pain. Laparoscopy was offered after family agreement to pursue behavioral management if the pain and disability did not improve. RESULTS: In all 8 children, laparoscopy detected an anomaly at a site corresponding to that of the abdominal pain. Findings were adhesions in 7 children (3 colonic, 2 ileocecal, 1 gastric, and 1 appendiceal) and ovarian torsion in 1 child. At a mean follow-up of 12.6 months, the abdominal pain had completely resolved in 6 children, notably improved in 1 child, and continued unchanged in 1 child. Disability completely resolved in 2 of 3 children. CONCLUSIONS: In children with unexplained abdominal pain that is acute in onset, well described, and suggestive of peritoneal involvement, exploratory laparoscopy (1) successfully ends the cycle of abdominal pain in most cases; and (2) commonly identifies abnormalities, usually adhesions. However, whether laparoscopy, the placebo effect, or both promote the healing process is unclear. Further study is needed to develop criteria for referral for laparoscopic evaluation of unexplained abdominal pain.

Abdominal Pain↗

PubMed2000

Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy.

BACKGROUND: Although several studies compare surgical results of laparoscopic and open colonic resections, there is no study of laparoscopic gastrectomy compared with open gastrectomy. HYPOTHESIS: When compared with conventional open gastrectomy, laparoscopy-assisted Billroth I gastrectomy is less invasive in patients with early-stage gastric cancer. DESIGN: Retrospective review of operative data, blood analyses, and postoperative clinical course after Billroth I gastrectomy. SETTING: University hospital in Japan. PATIENTS: The study included 102 patients who were treated with Billroth I gastrectomy for early-stage gastric cancer from January 1993 to July 1999: 49 with laparoscopy-assisted gastrectomy and 53 with conventional open gastrectomy. MAIN OUTCOME MEASURES: Demographic features examined were operation time; blood loss; blood cell counts of leukocytes, granulocytes, and lymphocytes; serum levels of C-reactive protein, interleukin 6, total protein, and albumin; body temperature; weight loss; analgesic requirements; time to first flatus; time to liquid diet; length of postoperative hospital stay; complications; proximal margin of the resected stomach; and number of harvested lymph nodes. RESULTS: Significant differences (P<.05) were present between laparoscopy-assisted and conventional open gastrectomy when the following features were compared: blood loss (158 vs 302 mL), leukocyte count on day 1 (9.42 vs 11.14 x 10(9)/L) and day 3 (6.99 vs 8.22 x 10(9)/L), granulocyte count on day 1 (7.28 vs 8.90 x 10(9)/L), C-reactive protein level on day 7 (2.91 vs 5.19 mg/dL), interleukin 6 level on day 3 (4.2 vs 26.0 U/mL), serum albumin level on day 7 (35.6 vs 33.9 g/L), number of times analgesics given (3.3 vs 6.2), time to first flatus (3.9 vs 4.5 days), time to liquid diet (5.0 vs 5.7 days), postoperative hospital stay (17.6 vs 22.5 days), and weight loss on day 14 (5.5% vs 7.1%). There was no significant difference between laparoscopy-assisted and conventional open gastrectomy with regard to operation time (246 vs 228 minutes), proximal margin (6.2 vs 6.0 cm), number of harvested lymph nodes (18.4 vs 22.1), and complication rate (8% vs 21%). CONCLUSIONS: Laparoscopy-assisted Billroth I gastrectomy, when compared with conventional open gastrectomy, has several advantages, including less surgical trauma, less impaired nutrition, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no decrease in operative curability. When performed by a skilled surgeon, laparoscopy-assisted Billroth I gastrectomy is a safe and useful technique for patients with early-stage gastric cancer.

Adenocarcinoma↗

PubMed1997

Gasless laparoscopy may reduce the risk of port-site metastases following laparascopic tumor surgery.

OBJECTIVE: To compare the incidence of port-site metastases in an experimental tumor model following tumor manipulation during laparoscopy aided by conventional insufflation with laparoscopy using a gasless technique. SETTING: An experimental model applied in a research laboratory. PARTICIPANTS AND INTERVENTIONS: Malignant tumors were implanted in the abdominal wall of 24 rats. Twelve rats underwent tumor laceration at laparoscopy with carbon dioxide insufflation, and 12 rats underwent the same procedure during gasless laparoscopy achieved by abdominal wall suspension. Rats were killed 1 week later and were examined for evidence of tumor metastases. The surgical wounds were examined microscopically by a histopathologist who was unaware of the operative technique used and the site of origin of the specimens. MAIN OUTCOME MEASURE: Histologically confirmed tumor metastasis to laparoscopic port wounds. RESULTS: Growth of the primary tumor was equal in both groups. Wound metastases were less likely in the gasless laparoscopy group (3 of 12 vs 10 of 12; P = .01, Fisher exact test). CONCLUSION: The use of laparoscopy without gas insufflation may reduce the risk of wound metastasis following laparoscopic surgery for cancer.

Animals↗

PubMed1997

Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junction.

BACKGROUND AND OBJECTIVES: Adequate preoperative staging of patients with esophageal and cardia carcinoma offers the potential for a rational choice of the therapy. The aim of this study was to assess the diagnostic value of laparoscopy compared to ultrasonography (US) and computed tomography (CT) in detecting intra-abdominal metastatic spread. METHODS: Between November 1995 and December 1996, 36 patients with adenocarcinoma of the cardia and 14 patients with squamous cell carcinoma of the lower third of the esophagus were studied with CT scan and US, followed by laparoscopy performed at the same session of planned surgical resection. Mean operative time of laparoscopy was 20 minutes (range 15-55 min). There was no mortality nor morbidity related to the laparoscopic procedure. RESULTS: Laparoscopy lead to a change of the therapeutic approach in five patients (10%): three patients with peritoneal carcinosis undetected at the imaging examinations, and one patient with advanced liver cirrhosis with signs of portal hypertension did not undergo resection; conversely, one patient with a liver hemangioma simulating a metastatic mass at CT/US underwent esophagogastric resection. Laparoscopy showed a higher sensitivity than US and CT in detecting peritoneal metastases (71% vs. 14% vs. 14%, respectively), macroscopic nodal metastases (78% vs. 11% vs. 55%), and liver metastases (86% vs. 71%). CONCLUSIONS: Laparoscopy represents a safe and effective diagnostic procedure in the preoperative staging of esophageal and cardia carcinoma; it provides the potential to avoid unnecessary exploratory laparotomies and to select the most appropriate treatment.

Adenocarcinoma↗

PubMed1995

Laparoscopy in the management of patients with cancer of the gastric cardia and oesophagus.

The role of laparoscopy in determining suitability for resection was prospectively evaluated in 244 patients with cancer of the gastric cardia and oesophagus. Laparoscopy enabled detection of inoperable disease in 92 patients (38 per cent), several of whom had more than one contraindication to surgery. Hepatic metastases (n = 75, 31 per cent), extensive peritoneal (n = 25, 10 per cent) or lymph node involvement (n = 5, 2 per cent) and direct invasion of the liver or colon (n = 5, 2 per cent) were considered contraindications to surgery. Laparoscopy was poorly tolerated in a further 11 (5 per cent) patients, who were not considered suitable for resection. Extra-abdominal metastatic disease was detected in 17 patients who appeared normal at laparoscopy, and a further six patients refused surgery. The remaining 118 patients underwent laparotomy with a view to resection which was successful in 85 (72 per cent). Laparoscopy thus prevented ill-advised laparotomy in 103 patients (42 per cent), either because of extensive intra-abdominal disease or poor tolerance to anaesthesia. Laparoscopy may be a valuable investigation when used to assess the feasibility of resection.

Adenocarcinoma↗

PubMed2004

Bowel injury as a complication of laparoscopy.

BACKGROUND: Bowel injury is a rare but serious complication of laparoscopic surgery. This review examines the incidence, location, time of diagnosis, causative instruments, management and mortality of laparoscopy-induced bowel injury. METHODS: The review was carried out using the MeSH browser within PubMed. The keywords used were 'laparoscopy/adverse effects' and 'bowel perforation'. Additional articles were sourced from references within the studies found in the PubMed search. RESULTS: The incidence of laparoscopy-induced gastrointestinal injury was 0.13 per cent (430 of 329 935) and of bowel perforation 0.22 per cent (66 of 29 532). The small intestine was most frequently injured (55.8 per cent), followed by the large intestine (38.6 per cent). In at least 66.8 per cent of bowel injuries the diagnosis was made during the laparoscopy or within 24 h thereafter. A trocar or Veress needle caused the most bowel injuries (41.8 per cent), followed by a coagulator or laser (25.6 per cent). In 68.9 per cent of instances of bowel injury, adhesions or a previous laparotomy were noted. Management was mainly by laparotomy (78.6 per cent). The mortality rate associated with laparoscopy-induced bowel injury was 3.6 per cent. CONCLUSION: At 0.13 per cent, the incidence of laparoscopy-induced bowel injury is small and such injury is usually discovered during the operation. Nevertheless, laparoscopy-induced bowel injury is associated with a high mortality rate of 3.6 per cent.

Humans↗

PubMed1998

Results of selective use of operative laparoscopy in gynecologic oncology.

OBJECTIVE: To evaluate the impact of integration of operative laparoscopy on length of stay (LOS) and complication rates on an academic gynecologic oncology service. METHODS: Retrospective analysis of all admissions to our gynecologic oncology service was performed for the academic years 1990/1991 and 1993/1994. Primary endpoints were frequency of complications and LOS. RESULTS: In 1990/1991, there were 785 total admissions, of which 287 were surgical and 3% were approached laparoscopically. In 1993/1994, there were 973 admissions of which 436 were surgical and 23% were approached laparoscopically. Operative laparoscopy was applied equally regardless of age and reproductive status; the utilization of laparoscopy was increased by 14-fold for patients with cancer, 4. 5-fold for patients with benign disease, and 12-fold for patients with adnexal masses. No change in the mean LOS of nonsurgical admissions was noted, yet overall LOS for all patients decreased from 6.3 to 4.8 days (P < 0.0001). Mean LOS in surgical patients decreased from 9.4 to 6.0 days (P < 0.0001). After correction for complications, decreases in LOS only occurred in procedures for which laparoscopy was significantly integrated. No reductions in LOS were noted with like surgical approaches; i.e., there was no change in the LOS of patients undergoing laparotomy in both years. Surgical complications were not increased by laparoscopy. CONCLUSIONS: Aggressive utilization of operative laparoscopy, even only for selected patients, into the surgical practice of a gynecologic oncology service demonstrates significant improvements in LOS without adversely affecting surgical complication rates.

Adult↗

PubMed1999

Potential decreased morbidity of interstitial brachytherapy for gynecologic malignancies using laparoscopy: A pilot study.

OBJECTIVES: This pilot study was designed to prospectively assess whether the addition of laparoscopy at the time of interstitial brachytherapy is safe, provides verification and/or guidance of needle placement, and results in a reduction of treatment-related morbidity. METHODS: Between 7/93 and 2/97 15 consecutive eligible patients were entered into this study. All patients received external pelvic radiation to a dose range between 45 and 61.20 Gy using 1.8-Gy fractions. In each patient the minimum prescribed dose for the brachytherapy portion was 20 Gy. Minimum cumulative doses to sites of gross disease ranged from 71.8 to 115.3 Gy. A Syed-Neblett afterloading perineal template was used in all the procedures. Laparoscopy using established guidelines was performed during placement of interstitial needles. During template placement, verification of interstitial needles on laparoscopy and any subsequent changes or needle rearrangement were noted. RESULTS: No acute radiation toxicity greater than Grade 2 was noted during the external beam portion of treatment, and no perioperative complications were encountered. These needles were withdrawn under laparoscopic guidance to just below the peritoneal reflection, avoiding proximity to the bowel and improving tumor coverage. Median follow-up time was 26 months. No late radiation morbidity greater than Grade 2 nor any laparoscopic-related complications were noted. To date, one patient has died of disease; six are alive with disease; and eight are alive free of disease with a mean disease-free survival of 17.3 months. CONCLUSION: Laparoscopy at the time of interstitial brachytherapy appears to be safe. No radiation toxicity greater than Grade 2 has developed. No perioperative complications were seen with the addition of laparoscopy. The addition of laparoscopy to the placement of transperineal interstitial implants impacted needle arrangement and/or loading of sources in 50% of patients.

Adult↗

PubMed1995

Pretherapeutic assessment of resectability in patients with upper gastrointestinal tract cancer by using a combination of endoscopic ultrasonography (EUS) and laparoscopy.

An accurate pretherapeutic assessment of resectability in patients with upper gastrointestinal malignancies (UGIM) is mandatory in order to choose the optimal treatment strategy. Endoscopic ultrasonography (EUS) has significantly reduced the need for exploratory laparotomy in patients with UGIM, but the pretherapeutic evaluation in about 10% of the patients is incomplete due to certain limitations of the EUS. We prospectively evaluated the use and results of diagnostic laparoscopy in patients with UGIM selected for this procedure by EUS. In six patients with incomplete EUS, laparoscopy demonstrated nonresectability in five patients and a resectable tumor in one patient, and laparoscopy thus filled the informational gap in all cases. In addition, laparoscopy confirmed nonresectability in ten patients in whom EUS had suggested nonresectability. By employing the combinated use of EUS and laparoscopy it seems possible to avoid a great number of futile laparoscopies, and it should also reduce the need for explorative laparotomies. Larger prospective studies have been initiated and might be able to confirm this.

Aged↗

PubMedDate not supplied

Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy.

Evaluation of a potential acute abdomen in patients who require intensive care for concurrent medical/surgical problems is often difficult due to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent diagnostic laparoscopy to evaluate a suspected acute intraabdominal process. Thirteen laparoscopies were negative, and 12 were positive. The overall accuracy for laparoscopy was 96% as confirmed by subsequent laparotomy, autopsy, or clinical course. Laparoscopic findings led to a change in management in nine patients (36%), leading to earlier exploration in four patients, and avoidance of laparotomy in five. No significant hemodynamic effects were noted during laparoscopy, and the procedure-related morbidity was low (8.0%). Diagnostic laparoscopy is a safe and accurate guide for managing the ICU patient with a suspected acute surgical abdomen. The use of laparoscopy can help avoid nontherapeutic laparotomy or confirm the need for operative intervention in these complex cases.

Abdomen, Acute↗

PubMedDate not supplied

Fluorescein-assisted laparoscopy in the identification of arterial mesenteric ischemia.

Accurate identification of acute mesenteric ischemia remains a challenge. It was hypothesized that fluorescein-assisted laparoscopy (FAL) may have a role in the identification of acute arterial mesenteric ischemia. Arterial ischemic small-bowel segments were prepared in 11 dogs. Following 2.5 h of ischemia, laparoscopy was performed with a standard light source followed by FAL with an argon laser. These two techniques were immediately compared with open inspection. Standard laparoscopy correctly identified 10 ischemic segments. FAL correctly identified 9 ischemic segments and the combination of the 2 techniques allowed laparoscopy to correctly identify all 11 ischemic segments. Standard laparotomy with and without fluorescein correctly identified 10 ischemic segments. The difference between laparoscopy and laparotomy was not significant (P > 0.6, Fisher's exact test). The combination of laparoscopic evaluation with and without fluorescein allowed identification of small-bowel ischemia in all subjects in this canine model. Further studies are warranted to delineate the accuracy of laparoscopy in other patterns of mesenteric insufficiency before clinical application.

Animals↗

PubMed1997

[Comparison of local and systemic inflammation after laparotomy or laparoscopy in the rat sepsis model].

BACKGROUND: Laparoscopic techniques are frequently used in patients with peritonitis or intra-abdominal inflammatory diseases although increased intraperitoneal pressure may cause sepsis by promoting bacteraemia and systemic inflammatory response. METHODS: This experimental study investigates the influence of laparotomy and laparoscopy on bacteraemia, tumour necrosis factor (TNF)-alpha and endotoxin plasma levels. Standardized foecal inoculum was injected intraperitoneally and rats underwent either laparotomy (n = 20), laparoscopy (n = 20), or no further manipulation in the control group (n = 20). RESULTS: One hour after intervention, bacteraemia was significantly higher in both the laparotomy or laparoscopy groups than in the control group (P = 0.01). Foecal inoculum caused a significant increase in TNF-alpha and endotoxin plasma levels 1 h after intervention with the significantly highest levels after laparotomy (P < 0.05). In addition, the mean number of intraperitoneal abscesses were also significantly higher (P < 0.05) after laparatomy (n = 10) than after laparoscopy (n = 8) or in the control group (n = 5). CONCLUSIONS: Laparotomy and laparoscopy increased the incidence of bacteraemia and systemic inflammation compared to control group. However, inflammatory response and intraperitoneal abscess formation were significantly higher in the laparotomy group than in the laparoscopy group.

Abdominal Abscess↗

PubMed1998

[Diagnosis of non-palpable testis in childhood: laparoscopy or magnetic resonance tomography?].

Laparoscopy and magnetic resonance imaging (MRI) are competetive tools in the diagnostic of non-palpable testis. Advantages and disadvantages of this methods will be demonstrate. 29 boys investigated for this indication with MRI. In case MRI failed to locate the testis laparoscopy was performed with a new miniaturized set of pediatric instruments (1.9 mm optic). The aim of laparoscopy was the identification of the spermatic duct and vessels and their topographic relation to the internal inguinal ring. All findings were verified by open surgical procedures. MRI revealed 10 inguinal and 7 abdominal testis. There was no false positive finding. In 12 boys MRI showed no testis. 4 cases were correct negative, 8 cases were false negative (32%). In these 8 MRI-negative patients laparoscopy revealed 7 inguinal and 1 abdominal testis. The optical quality of the mini-telescope was sufficient for a 100% correct diagnosis. Laparoscopy related complications did not occur. Laparoscopy proved to be a powerful low risk diagnostic method in non-palpable testis with high sensitivity and specifity (100% correct positive, 0% false negative). Therefore lapraroscopy is recommended as primary diagnostic access for this indication. In the same anesthesia a optimal therapy is possible. Nevertheless a positive MRI-finding locates the testis reliably, whereas a negative finding always needs further exploration because testis might have been missed.

Adolescent↗

PubMed2003

Accuracy of laparoscopy in the diagnosis and staging of lymphoproliferative diseases.

Laparoscopy seems to be playing an emerging role in the management of lymphoproliferative diseases. The aim of this study was to prospectively analyze personal experience evaluating the role and limits of laparoscopy in the management of lymphomas. From July 1993 to December 2000, 131 consecutive patients were referred to our institution for primary diagnosis (group A, n = 70), suspected relapse (reassessment) (group B, n = 54), or staging/restaging of lymphoproliferative diseases (group C, n = 7). Diagnostic and/or operative laparoscopy was performed in all patients. To assess the accuracy of laparoscopy, the results were analyzed according to the indications for surgery. In all, 128 procedures were completed laparoscopically (95.5%). Conversion was required in 7 cases (5.1%). Causes of the conversions were severe obesity (body mass index 62.5), uncontrolled intraoperative bleeding (HIV+), nondiagnostic tissue sampling (2 cases), perisplenic inflammation and perisplenic abscesses (3 cases). The results of this study highlight the safety of diagnostic and staging laparoscopy and laparoscopic splenectomy in patients with lymphoproliferative diseases (major complications 2.9%, perioperative mortality 0%). In all, 96.4% of patients from group A and 100% of patients from group B were treated on the basis of laparoscopic findings. No false negative diagnosis occurred. Laparoscopy may become the "gold standard" in the management of lymphoproliferative disease in the following settings: for the differential diagnosis of hepatic and/or splenic focal lesions; when percutaneous needle biopsy fails and/or genetic analysis is needed for therapeutic decision; for the primary diagnosis and abdominal staging of patients with diffuse retroperitoneal lymphadenopathy in the absence of peripheral lymphadenopathy; for cases of abdominal restaging after concurrent chemoradiotherapy and in cases of suspected relapse when percutaneous biopsy is not technically possible; and for patients with lymphoproliferative disease when splenectomy is required. Marked splenomegaly with perisplenic inflammatory reaction and lymphadenopathy in HIV+ patients should be considered possible causes of failure of the laparoscopic approach.

Adult↗