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At least 271 records · Page 15Linked to original sources

PubMed2003

Accuracy of diagnostic laparoscopy in the infertility work-up before intrauterine insemination.

OBJECTIVE: To evaluate the accuracy of diagnostic laparoscopy after normal hysterosalpingography (HSG) and before intrauterine insemination (IUI) with respect to laparoscopic findings leading to a change of treatment decisions in couples with male subfertility, cervical hostility, or idiopathic infertility. DESIGN: Retrospective chart review. SETTING: University medical centre. PATIENT(S): Infertility patients who had undergone diagnostic laparoscopy after a normal HSG and before IUI in a period of 5 years. INTERVENTION(S): Diagnostic laparoscopy in infertility work-up before IUI. MAIN OUTCOME MEASURE(S): Prevalence of laparoscopic findings leading to change in treatment decision. RESULT(S): Of 495 patients, 21 (4%) had severe abnormalities that resulted in a change of treatment to in vitro fertilization or open surgery. In 103 patients (21%) abnormalities, endometriosis (stages I and II), and adhesions were directly treated by laparoscopic intervention, followed by IUI treatment. If surgery to remove early stage endometriosis does not improve pregnancy rates, then the laparoscopic yield would be 40 out of 495 (8.1%). CONCLUSION(S): Diagnostic laparoscopy altered treatment decisions in an unexpectedly high number of patients before IUI. This suggests that laparoscopy may be of considerable value, provided the change in treatment is effective. Further prospective studies are required to assess whether the diagnostic use of laparoscopy is cost effective and whether interventions as result of laparoscopic findings are effective in improving pregnancy rates.

Cervix Uteri↗

PubMed1981

The corpus luteum in infertile patients found during laparoscopy.

A series of 407 infertile patients underwent luteal phase laparoscopy and endometrial biopsy as a part of their infertility workup. In 91% of the patients, a good correlation between the results of endometrial biopsy and those of laparoscopy was found. In 8% of the patients a secretory endometrium was found, but the laparoscopy did not show any luteal structures on the ovaries. Seventy-one percent of the patients had corpora lutea, but the stigma was only present in 17.5% of the series with secretory endometrium. Because of the stigma findings, only 326 patients with secretory endometrium were evaluated. The stigma was more frequently seen when laparoscopy was performed between day 17 and day 19 of the cycle. On the other hand, the stigma was also more frequently seen when laparoscopy was performed between 10 and 12 days before the actual onset of the next period. We conclude that the frequency of stigmata at the corpus luteum is a matter of the time in the cycle when laparoscopy is performed, and the particular cycle length of the patient should be considered.

Biopsy↗

PubMed1984

The nature of posttuboplasty pelvic adhesions as determined by early and late laparoscopy.

This study evaluates the gross and histologic difference between adhesions found in early laparoscopy (4 to 16 weeks afer surgery), compared with laparoscopy at approximately 18 months after the original tubal operation. Sixty-one patients who had undergone similar surgical procedures for infertility were evaluated. Forty-one patients underwent late laparoscopy, and 20 underwent early laparoscopy. Postoperatively, 60% of the early laparoscopy patients had filmy avascular adhesions, whereas 63% of the late laparoscopy patients had thicker, neovascular adhesions. This allows us to conclude that the adhesions immediately postoperatively are histologically different from those appearing a longer time after the original operation.

Fallopian Tubes↗

PubMedDate not supplied

Laparoscopy compared with ultrasonography in the diagnosis of hepatocellular carcinoma.

In recent years, various newer imaging procedures have superseded laparoscopy in the detection of many diseases. The role of laparoscopy in the diagnosis of hepatocellular carcinoma is still subject to debate. To assess the value of laparoscopy compared with that of ultrasonography, we compared data obtained from a series of 54 patients with hepatocellular carcinoma, all of whom had both procedures performed at nearly the same time. In our study, ultrasonography proved superior to laparoscopy in detecting the presence and extent of the hepatocellular carcinoma. Supplemental findings attributable to laparoscopy did not alter management, whereas additional information obtained by ultrasonography often did influence the choice of treatment. We conclude that ultrasonography is the primary diagnostic method of choice in the assessment of hepatocellular carcinoma and that laparoscopy should be reserved for only selected cases.

Adult↗

PubMed1996

Laparoscopy for diagnosis and treatment of recurrent abdominal pain in children.

Extensive radiographic evaluation of children with recurrent abdominal pain (RAP) is rarely diagnostic or cost-effective. The authors sought to define the role of laparoscopy in the evaluation of children with RAP. Fifteen children underwent laparoscopy for RAP in a 2-year period. Their mean age was 12 years (range, 6 to 16 years), 13 (87%) were female, and the mean duration of symptoms was 11 months (range, 2 to 60 months). Thirty-eight imaging studies (excluding plain films) had been obtained before laparoscopy, including 19 abdominal sonograms, 9 upper gastrointestinal series, four abdominal computed tomography scans, 3 barium enemas, 2 isotope scans, and 1 magnetic resonance examination of the head. Only two (5%) of these studies provided an accurate diagnosis. Eleven of the 15 children (73%) had positive findings diagnosed and treated laparoscopically. These included eight appendiceal abnormalities (in six patients), three Meckel's diverticula, one inguinal hernia, one urachal cyst, one para-fallopian tube cyst, and one adhesion to an appendectomy stump. Eight of 11 (73%) children with positive findings had immediate resolution of symptoms after laparoscopic treatment. Three children with pathological findings at the time of laparoscopy had persistent symptoms, which resolved completely within 4 months of the laparoscopy. Laparoscopy is an accurate technique for the evaluation and treatment of children with RAP. Its early application could provide economic benefit by eliminating many low-yield imaging studies and minimizing lost time from school.

Abdominal Pain↗

PubMed1999

Idiopathic intussusception: the role of laparoscopy.

BACKGROUND: The use of a barium enema affords both diagnostic confirmation and a chance for nonsurgical complete reduction of the intussusception, which must be proven by adequate reflux of barium into the distal ileum. If this does not occur, it is assumed that the intussusception has not been reduced, and the infant is taken straight to the operating room for laparotomy and surgical treatment. The aim of this study is to limit unnecessary surgical explorations by the diagnostic and the therapeutic policy of laparoscopy with assisted hydrostatic saline reduction under general anesthesia. METHODS: Over a period of 3 years, 90 patients with intussusception were treated. Twenty patients in whom hydrostatic reduction was contraindicated were treated initially by surgery. In the remaining 70 patients, hydrostatic reduction was successful in 50 (71%), and laparoscopy was performed in 20 patients before laparotomy. Hydrostatic saline reduction was used when there was failure of reduction seen by laparoscopy. RESULTS: In 20 patients, laparoscopy showed reduction of intussusception in eight patients (40%), and saline hydrostatic reduction was successful in six patients (30%), with failure of reduction in six patients (30%) necessitating laparotomy. CONCLUSION: The use of laparoscopy for diagnosis of failure of reduction of intussusception and the hydrostatic reduction by saline enema during laparoscopy saved 14 patients from unnecessary laparotomy.

Female↗

PubMed1998

A randomized, double-blinded trial of preemptive analgesia in laparoscopy.

OBJECTIVE: We tested the hypothesis that local anesthetic administered before skin incision, an example of preemptive analgesia, reduces postoperative pain for women undergoing laparoscopy, as compared with postincisional local anesthetic or placebo. METHODS: Patients undergoing diagnostic laparoscopy were randomized to one of three blinded treatment groups. Treatment group A patients received local infiltration of 0.5% bupivacaine at the surgical site before incision and a saline placebo infiltration before incision closure. Treatment group B received the saline placebo before skin incision and bupivacaine after laparoscopy but before closure of the skin incisions. For treatment group C patients, saline was infiltrated as a placebo before and after laparoscopy. All patients underwent a standardized general anesthetic induction and maintenance. Postoperative pain was evaluated using the modified McGill Present Pain Intensity scale. Pain and supplementary analgesic use was compared among the three treatment groups. RESULTS: A total of 57 patients completed the study for analysis. Age, weight, height, race, indication, and operating time did not vary significantly between the three groups. By 24 hours after surgery, patients in treatment group A reported significantly lower pain scores (McGill Present Pain Intensity Scale: 0.5+/-0.9) than either treatment group B (1.6+/-1.3) or C (1.3+/-1.2). Group A patients also could tolerate a significantly longer time delay to their first analgesic medication than patients who received postincisional bupivacaine or than control patients who received no bupivacaine. CONCLUSION: The preemptive administration of bupivacaine before laparoscopy results in decreased postoperative pain and should allow a more rapid return to normal activities. The popular practice of infiltrating bupivacaine at time of incision closure does not offer any benefit in the control of pain after laparoscopy.

Adolescent↗

PubMed2003

Utility of laparoscopy in chronic abdominal pain.

BACKGROUND: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was undertaken to assess the utility of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 12 weeks. METHODS: All patients undergoing laparoscopy by the primary author were prospectively entered into a database for the 3-year period July 1, 1997 through June 30, 2000. The patients' demographic data, length of time with pain, number of diagnostic studies performed before surgery, intraoperative findings, interventions, pathology, and long-term follow-up were determined. RESULTS: A total of 70 patients (61 women and 9 men) with an average age of 42 years, underwent diagnostic laparoscopy only for the evaluation and treatment of chronic abdominal pain. The average length of time with pain was 74 weeks (range 12-260) and the average number of studies performed prior to surgical referral was 3.3. Fifty-three (76%) patients had their procedures performed as outpatients, with the remainder admitted for observation status. The average length of operative time was 70 minutes; no cases required conversion to an open procedure and no complications occurred. Findings included adhesions in 39, a hernia in 13, adhesions from the appendix to adjacent structures in 6, appendiceal pathology in 5, endometriosis in 3, and gallbladder pathology in 2. Ten patients had no obvious pathology. At the time of their initial postoperative visit, 90% reported their pain to be gone or improved. After an average follow-up of 129 weeks, 71.4% had long-term pain relief. All patients with recurrence of pain had it within the first 6 months. No patient experienced any long-term complications and all reported satisfaction with their procedure. CONCLUSIONS: Laparoscopy has a significant diagnostic and therapeutic role in patients with chronic pain. Therapeutic laparoscopy studies have to follow-up with patients at least 6 months. With aggressive indicated therapeutic laparoscopy, including adhesiolysis, appendectomy, cholecystectomy, or hernia repairs, more than 70% of patients can have improvement in their pain.

Abdominal Pain↗

PubMed1996

Laparoscopy in trauma.

Laparoscopy is a nearly century-old technique that has experienced a resurgence of interest from surgeons since the development of technology that has broadened its applications. Although laparoscopy has been used to evaluate patients with possible abdominal trauma, its use for this purpose is limited by the availability of other diagnostic procedures that may be more suitable for particular circumstances and are more accurate for certain injuries. Laparoscopy is contraindicated in patients who are hypovolemic or hemodynamically unstable and should not be performed in patients with clear indications for celiotomy. It may not be appropriate for patients with cardiac dysfunction, nor for those with significant head injuries who are at risk for intracranial hypertension. Its best applications may be in stable patients with stab wounds or those with tangential gunshot wounds of the abdomen. The likelihood of missing hollow visceral injuries depends upon the indications for conversion to celiotomy. If peritoneal violation or the presence of a small amount of blood in the peritoneal cavity is used as an indication for celiotomy, then the missed injury rate will be low but the unnecessary celiotomy rate will be diminished only slightly compared with a policy of mandatory celiotomy. Excessive enthusiasm for laparoscopy in trauma might result in its use when other diagnostic measures or simple observation are more appropriate. The desire to perform a procedure can be compelling, especially in circumstances in which the general surgeon would not operate upon a patient but simply provide postoperative care after other surgeons have operated. The use of laparoscopy for these purposes can only be condemned, as it increases the costs and risks of care without improving the outcome. The role of laparoscopy in trauma is evolving, and further research into its diagnostic role and therapeutic applications is clearly needed.

Abdomen↗

PubMed2003

Role of laparoscopy in patients with previous negative exploration for impalpable testis.

OBJECTIVES: To evaluate the impact of laparoscopy in the treatment of patients with previous negative inguinal exploration for impalpable undescended testes. METHODS: A retrospective review was performed of patients who underwent laparoscopy after prior incomplete or "questionable" negative inguinal explorations for nonpalpable undescended testes. RESULTS: Twenty-seven males aged 1 to 22 years old, with 30 impalpable testes, underwent laparoscopy after prior negative open exploration. The operative notes were available for all patients. In 9 patients (33%), blind-ending spermatic vessels, vas deferens, and a closed ring were found. However, in the remaining 18 patients (67%), viable intra-abdominal or inguinal gonads (9 patients) and intra-abdominal remnants (9 patients) were identified. In 1 patient, seminoma of an intra-abdominal testis was present. CONCLUSIONS: When a patient is referred with an inconclusive previous open exploration for an impalpable gonad, laparoscopy has an important role in establishing or refuting the diagnosis of an absent testis. Moreover, therapeutic laparoscopy provides definitive options to standard open techniques when a viable testis or remnant is encountered. In this study, laparoscopy proved more accurate than open exploration with operative notes available defining the nature of the exploration.

Adolescent↗

PubMed1975

Preoperative laparoscopy in diagnosis of acute abdominal pain.

During 1973, 56 patients on one of three general surgical services at the Peter Bent Brigham Hospital, Boston, Massachusetts, who were judged to require hospital admission for acute abdominal pain were dividied into two groups. This division was determined by whether or not the physician responsible thought a definite diagnosis could be established on clinical grounds. 27 patients were thought to have a definite diagnosis and underwent laparotomy without preoperative laparoscopy; at laparotomy, 6 of these patients (22%) had no operable lesion. An additional 29 patients had severe abdominal pain and required observation in hospital. An exact diagnosis could not be clinically established in these patients, and many would in the past have required exploratory laparotomy. These 29 patients underwent laparoscopy resulting in all but 1 (4%) having the presence or absence of intra-abdominal disease requiring operative intervention definitely established. At laparoscopy, diagnosis was made in 18 patients who did not require laparotomy while 11 had disease requiring laparotomy after laparoscopy. No complications resulted from laparoscopy. The difference in the median length of stay and hospital charges resulted in a saving of one and a half days in hospital and $87 when laparoscopy rather than explatory laparotomy determined that acute abdominal pain was caused by a condition not requiring surgical intervention.

Abdomen, Acute↗

PubMed2003

Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma: a review of 43 cases.

BACKGROUND: Recently, laparoscopy and laparoscopy-assisted surgery have been used increasingly as less-invasive alternatives to conventional open surgery. But the use of this approach in gastric carcinoma has received little attention, possibly from the low incidence of early-stage disease in the West and the relative complexity of the surgical procedure. STUDY DESIGN: A prospective feasibility study of laparoscopy-assisted distal gastrectomy was performed in patients with histologically confirmed gastric carcinoma located in the lower or middle third of the stomach. Patients whose preoperative evaluations, including endoscopic ultrasonography and computerized tomography, led to a diagnosis of T1 N0 stage disease, and who had no advanced disease discovered during laparoscopy, were eligible. Intraoperative blood loss, time of operation, mortality, and morbidity were assessed, along with the number of lymph nodes retrieved and shortterm survival. RESULTS: Between 1998 and 1999, 43 patients were enrolled. Laparoscopy-assisted distal gastrectomy was converted to an open procedure in one patient. There were no operative or in-hospital deaths, but the incidence of anastomotic leakage was 14% (6 of 43). The mean blood loss was 239 mL, the time of operation was 225 minutes, and lymph node retrieval was 20.2 nodes. These results are comparable with a series of conventional open operations. One patient died of recurrent disease, and all other patients remain disease-free to date. Port-site recurrence was not observed. CONCLUSIONS: Although laparoscopy-assisted distal gastrectomy was equivalent to open surgery in several clinical parameters, the relatively high morbidity was a drawback. Its appropriateness to gastric cancer surgery must be verified by further studies.

Adenocarcinoma↗

PubMed1998

The role of diagnostic laparoscopy in pancreatic and periampullary malignancies.

BACKGROUND: The role of diagnostic laparoscopy before laparotomy in patients with pancreatic or periampullary malignancies remains controversial. We analyzed the value of using diagnostic laparoscopy to avoid laparotomy in these patients. STUDY DESIGN: Between November 1993 and December 1996, 254 patients with pancreatic or periampullary malignancies were treated. In 74 patients, multiple distant metastases precluded further surgical treatment. In all, 180 patients underwent laparotomy for pancreatic cancer (119 patients) or periampullary cancer (61 patients). Preoperatively, all patients underwent computed tomography for staging and to assess resectability of the tumor. Based on the results of the imaging procedure, the patients were scheduled for either tumor resection or a palliative operation. RESULTS: Twenty-one of 180 patients (12%) with pancreatic or periampullary malignancies were scheduled preoperatively for nonresectional operations because of distant metastasis or retroperitoneal tumor infiltration. In none of these patients was the operative strategy changed. In 159 of 180 patients (88%), a pancreatic resection was planned preoperatively; 119 patients underwent pancreatic resection. In the remaining 40 patients preoperatively scheduled for tumor resection, removal of the tumor was not possible. In 24, this resulted from tumor infiltration into the retropancreatic vessels, and in 16 it resulted from liver or peritoneal metastasis detected for the first time intraoperatively. These 16 patients (10%) could have benefited from diagnostic laparoscopy. Similar results were found in the subgroup of 119 patients with pancreatic cancer, of whom 102 were planned for tumor resection and 17 for palliative operation. Of the 102 patients planned preoperatively for tumor resection, 71 patients (70%) underwent pancreatic resection. In the remaining 31 patients scheduled for tumor resection, removal of the tumor was not possible: in 17 because of tumor infiltration into the retropancreatic vessels and in 14 because of liver or peritoneal metastasis detected for the first time intraoperatively. These 14 patients (14%) also would have benefited from laparoscopy. CONCLUSIONS: Preoperative computed tomography is a reliable technique to detect tumor metastasis in patients with pancreatic or periampullary cancer. Unlike other investigators, we found that only 10% of patients with periampullary or pancreatic cancer and 14% of patients with pancreatic cancer might profit from laparoscopy. Because of this low number, laparoscopy cannot generally be recommended for patients with pancreatic or periampullary cancer before laparotomy.

Adult↗

PubMed2002

Cost analysis of tubal anastomosis by laparoscopy and by laparotomy.

STUDY OBJECTIVE: To compare the costs of tubal anastomosis performed by laparoscopy and by laparotomy. DESIGN: Cost analysis study using the hospital administrative database (Canadian Task Force classification II-2). SETTING: University teaching hospital. PATIENTS: Eighty-nine women. Intervention. Tubal anastomosis by laparoscopy (43) and by laparotomy (46). MEASUREMENTS AND MAIN RESULTS: Tubal anastomosis took longer when performed by laparoscopy than by laparotomy; however, the total time patients spent in the operating room was similar. Women treated by laparoscopy spent more time in the recovery room. Labor costs for nurses in the operating room and recovery room costs were significantly higher in the laparoscopy group. Costs for operating room supplies were similar. Pharmacy costs and expenses in the ward were lower in the laparoscopy group. The mean total cost for laparoscopic tubal anastomosis was $861 +/- 137 and for laparotomy was $1348 +/- 188 (p <0.001). CONCLUSION: Laparoscopic tubal anastomosis costs less than tubal anastomosis by laparotomy.

Anastomosis, Surgical↗

PubMed2003

Bowel injury in gynecologic laparoscopy.

STUDY OBJECTIVE: To review surveys of the last decade on bowel injuries to evaluate the prevalence, causes, management, and outcomes of these events occurring during or as a result of laparoscopy. DESIGN: Retrospective evaluation (Canadian Task Force classification II-2). SETTING: Surveys and databases. PATIENTS: None. INTERVENTION: Data analysis. MEASUREMENTS AND MAIN RESULTS: Combined data show that diagnostic and minor operative laparoscopy are associated with a 0.08% risk of bowel injury, and in major operative laparoscopy the risk increases to 0.33%. Injuries occurring during access and operative procedure decrease significantly with experience, but even in experienced hands injury during access cannot be avoided. Delayed diagnosis remains a major problem. Up to 15% of these injuries are not diagnosed during laparoscopy, and one of five cases of delayed diagnosis results in death. Perioperative diagnosis and immediate repair by laparoscopy or laparotomy reduce the likelihood of severe complications and consequently medicolegal actions. CONCLUSIONS: Several surveys on complications of gynecologic laparoscopy tend to underestimate the risk of bowel injury. Prevention starts by awareness that such injury is an inherent risk of the technique, even in hands of experienced surgeons.

Belgium↗

PubMed2000

Stress responses during laparoscopy with CO2 insufflation and with mechanical elevation of the abdominal wall.

STUDY OBJECTIVE: To compare the intensity of stress responses caused by laparoscopy combined with CO2 insufflation (CI) with those caused by mechanical elevation of the abdominal wall (MEA). DESIGN: Prospective study (Canadian Task Force classification I). SETTING: Tertiary care university hospital. PATIENTS: Thirty-one women. Intervention. Laparoscopy, 16 with CI and 15 with MEA. MEASUREMENTS AND MAIN RESULTS: Circulating levels of norepinephrine, epinephrine, cortisol, and interleukin (IL)-6 were compared in the two groups. Arterial partial pressure of CO2 (PaCO2) did not increase during laparoscopy by either method. Plasma norepinephrine and epinephrine levels increased after extubation in the MEA group but not in the CI group. Circulating cortisol levels in both groups increased during laparoscopy; mean intraoperative levels were higher in the CI group. Serum IL-6 levels increased after extubation in the MEA but not the CI group. Mean heart rate increased during laparoscopy in both groups, whereas blood pressure increased only in the CI group. More patients in the MEA group required postoperative analgesia. CONCLUSION: Laparoscopy with MEA caused more pronounced adrenosympathetic and cytokine responses than that with CI when PaCO2 was maintained within the range of normocapnia.

Carbon Dioxide↗

PubMed2001

Accuracy of the preoperative diagnosis in 100 emergency laparoscopies performed due to acute abdomen in nonpregnant women.

STUDY OBJECTIVE: To assess the validity of preoperative diagnosis in the emergency room in relation to the surgical diagnosis at laparoscopy. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred consecutive nonpregnant women who underwent emergency laparoscopy for acute abdomen between 1997 and 1999. Intervention. Emergency diagnostic laparoscopy. MEASUREMENTS AND MAIN RESULTS: The preoperative diagnosis was confirmed by laparoscopy in 29 (44%) of 66 cases of ovarian torsion, 9 (82%) of 11 cases of ovarian cyst, and 12 (80%) of 15 cases of bleeding corpus luteum. Unsuspected diagnoses among nonconfirmed cases were ovarian cysts (24), adhesions (5), bleeding corpus luteum (3), degenerative myomas (3), pelvic inflammatory disease (2), and appendicitis (1). The preoperative diagnosis was confirmed by emergency laparoscopy in 56% of all patients. Diagnoses most likely to be predicted accurately were ovarian cysts and bleeding corpora lutea. Ovarian torsion was most difficult to diagnose preoperatively, as it was not confirmed during laparoscopy in over half patients. Ovarian cysts and adhesions were the most common unsuspected findings. CONCLUSION: Patients and surgeons alike should be aware of difficulty making accurate preoperative diagnoses of acute gynecologic pathologies in the emergency room. (J Am Assoc Gynecol Laparosc 8(1):92-94, 2001)

Abdomen, Acute↗

PubMed1998

Laparoscopy and laparoscopic ultrasonography in staging of oesophageal and cardial carcinoma.

BACKGROUND: The ideal method for staging tumours of the oesophagus and gastric cardia is not known. This paper was designed to assess the value of laparoscopy and laparoscopic ultrasonography in the staging of oesophageal and cardial carcinoma. METHODS: From October 1993 to January 1996, 60 patients in whom no metastases were seen on gastroscopy, ultrasonography of the abdomen and supraclavicular region, helical computed tomography of the chest and abdomen or endosonography were scheduled for laparoscopy and laparoscopic ultrasonography. RESULTS: Some 40 patients had carcinoma of the oesophagus, in one of whom liver metastases were found at laparoscopy and proven histologically. On laparoscopic ultrasonography metastases were found in four patients but were impossible to biopsy. These lymph node metastases were confirmed at exploratory laparotomy. Twenty patients had carcinoma of the gastric cardia; distant metastases were found in four at laparoscopy. On laparoscopic ultrasonography metastases were present in four further patients, all proven by biopsy. CONCLUSION: In this study laparoscopy was not an effective staging technique for oesophageal carcinoma. The inclusion of laparoscopic ultrasonography was of little benefit. A problem that was encountered was biopsy under laparoscopic guidance. In carcinoma of the gastric cardia, laparoscopy was more effective; adding laparoscopic ultrasonography doubled the number of patients seen to have metastatic disease.

Adenocarcinoma↗