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PubMed2002

Conversion of laparoscopy to laparotomy due to adnexal malignancy.

PURPOSE: The purpose of the present report was to assess the conversion rate from laparoscopy to laparotomy due to adnexal malignancy and to identify factors that might assist in the selection of the appropriate operative approach in patients with suspicious adnexal masses. METHODS: A retrospective review of the medical records of women who underwent laparoscopy due to ultrasonically complex adnexal masses. Ninety-five consecutive patients fulfilling these criteria, were identified. A comparison of patients with benign tumors who had laparoscopy only to those with invasive malignancies in whom laparoscopy was converted to laparotomy was performed. RESULTS: Malignancy was diagnosed in 18 (18.9%) patients. In 13 patients with malignancy (two borderline and 11 invasive), comprising 72.2% of the malignancies and 13.7% of the total group with complex adnexal masses, the laparoscopy was converted to laparotomy. Age of more than 50 years and a serum CA125 level above 35 U/ml were significantly more common in the malignant than in the benign group (90.9% vs. 15.6% and 63.6% vs. 11.6%, respectively; p < 0.0001 and p < 0.003, respectively). When both factors were present, the sensitivity and specificity for malignancy were 73.3% and 93.2%, respectively, and the positive and negative predictive values 73.3% and 95.6%, respectively. CONCLUSION: When an ultrasonically complex adnexal mass is encountered, predictive factors for malignancy should be taken into account before the mode of intervention is chosen. The conversion from laparoscopy to laparotomy because of an invasive malignant tumor is acceptable, if it is performed immediately and a gynecologic oncologist is on stand-by.

Adnexal Diseases↗

PubMed1975

["Surgical" laparoscopy indications and value].

From 1971-1973, 1046 patients underwent laparoscopy in the gynecological department; 256 of the cases were surgical problems. In contrast to gastroenterological laparoscopy, surgical laparoscopy was performed in the operating room under general anaesthesia and everything prepared for immediate surgery. Major surgical interventions--if necessary--were performed immediately after laparoscopy. Indications for surgical laparoscopy were the following: preoperative evaluation of nature, extent and eventual metastases of tumors. Preoperative differentiation of acute and chronic appendicitis from other affections, particularly in younger female patients. Suspected intraabdominal hemorrhage of traumatic or non-traumatic origin. Evaluation of pathological palpatory findings in the abdominal cavity. Differential diagnosis of chronic relapsing intraabdominal complaints of unknown origin. Differential diagnosis of putrid, tuberculous or carcinomatous peritonitis with eventual biopsy. Preoperative evaluation of questions concerning surgery of liver, gallbladder or pancreas in connection with occlusive jaundice, hepatic cirrhosis or malignancy. The results of this study show, that by laparoscopy in over 50% of the patients, major surgical interventions could be avoided. Contraindications were primarily limited to pulmonal or cardiac insufficiency. The only complication (intestinal perforation), was adequately dealt with under the given operative conditions.

Abdomen, Acute↗

PubMed1978

Comparative evaluation of laparoscopy and hysterosalpingography in infertile patients.

A comparative study of hysterosalpingography (HSG) and laparoscopy in the investigation of infertility is presented. From 1973-1977, 352 cases were investigated with both HSG and laparoscopy. In 57.67% of the cases there was complete agreement between HSG and laparoscopy. The study included 168 cases of unexplained infertility and 184 cases with abnormal hysterosalpingographic findings. Pelvic adhesions were demonstrated in 151 cases by laparoscopy as compared to 76 cases in which its presence was only suspected by HSG. Laparoscopy revealed a 57.14% of associated pelvic pathology in cases of unexplained fertility. The present study concludes that laparoscopy as compared to HSG is not only more informative, but also more accurate and conclusive.

Adnexal Diseases↗

PubMedDate not supplied

Laparoscopy versus laparotomy for detorsion and sparing of twisted ischemic adnexa.

BACKGROUND: Torsion of the ovary is an urgent event for fertile women. Until recent years, the common treatment for twisted ischemic ovaries was salpingo-oophorectomy. We have demonstrated in the past that the ovary can be salvaged provided detorsion is performed. We studied the outcome of women undergoing minimal surgery for ischemic ovaries versus the extended procedure including cystectomy in respect of ovarian function and fertility performance. METHODS: We retrospectively studied 102 women who underwent surgery for torsion of the ovary in which the macroscopic appearance of black-bluish ischemic adnexa was encountered during surgery. Detorsion without removal of the adnexa or the ovary was performed by laparoscopy in 67 patients and by laparotomy in 35 patients. Patients' files were reviewed for immediate and late outcomes. Patients were examined postoperatively with vaginal ultrasound for ovarian follicular function. Data concerning patients' further surgeries or in vitro fertilization were retrieved from the charts as well. RESULTS: Febrile morbidity was approximately 15% and 29% in the laparoscopy and laparotomy groups, respectively. Hospital stay was 2.1 +/- 1.2 and 7.4 +/- 1.5 days in the laparoscopy and laparotomy groups, respectively (P<0.001). Ultrasound follow-up was available in 60 of 67 patients who underwent laparoscopy and in 32 of 35 patients treated by laparotomy. Normal-sized ovaries with follicular development were encountered in the detorsed side in 93% and 91%, respectively. Normal macroscopic appearance of the adnexa at subsequent surgeries was reported in 9 of 9 patients in the laparoscopy group and in 4 of 5 patients in the laparotomy group. Four patients from the laparoscopy group and 2 from the laparotomy group underwent subsequent in vitro fertilization. In all 6 patients, oocytes retrieved from the previously detorsed ovary were fertilized. In both groups, none of the patients developed clinical signs of pelvic or systemic thromboembolism. CONCLUSIONS: Torsion of the ischemic adnexa should be treated laparoscopically by detorsion and adnexal sparing.

Adnexal Diseases↗

PubMed2003

[Comparison of assessing the patency of the Fallopian tubes during laparoscopy and during hysterosalpingography on television in infertile women with endometriosis].

OBJECTIVES: Sterility become nowadays not only medical, but as well socio-economic problem. One of its major causes is endometriosis. Recurrent adnexitis--one of the most common symptoms of endometriosis might be the cause of fallopian tubes occlusion. The hysterosalpingography (HSG) can be helpful to diagnose this tubal pathology. DESIGN: To compare the assessment of fallopian tubes patency during HSG with the results of laparoscopy in infertile women with endometriosis. MATERIAL AND METHODS: 331 women with endometriosis who were diagnosed during laparoscopy examination between 1998-2002 due to sterility. The presence of endometriosis was confirmed during laparoscopy. In each patient the control of the patency of both fallopian tubes was performed. These data were confirmed with those from HSG performed during follicular phase on the television path. The absence of the contrast passage through fallopian tubes as well as the only trace contrast passage into abdominal cavity were classified as tubal obstruction. RESULTS: In patients during the HSG physiological uterine shape and size in 91.3%, the bicornis uterus in 6.6%, and the unicornis uterus in 2.1% were observed. During laparoscopy we diagnosed the physiological uterine shape and size in 88.8%, the bicornis uterus in 8.2%, and the unicornis uterus in 3.0%. The diagnostic compatibility of these both examinations was 90.6%. In HSG the correct anatomical course of both fallopian tubes without occlusions in 51.7%, the only unilateral patency in 36.7%, and bilateral occlusions in 11.6% were found. During laparoscopy we diagnosed the anatomical course of both fallopian tubes without occlusions in 36.7%, the only unilateral patency in 33.3%, and bilateral occlusions in 30.0%. The diagnostic compatibility of these both examinations was 49.6% for both fallopian tubes, and 34.2% for the only one fallopian tube. In 16.2% both results were incompatible. CONCLUSIONS: The incorrect contrast passage through the fallopian tubes and its increased pressure during HSG in women with the characteristic history and clinical symptoms can suggest endometriosis. In these cases laparoscopy is necessary as the additional examination in the diagnostics of fallopian tubes patency, but the only objective method in diagnosis of endometriosis.

Adult↗

PubMed1978

Laparoscopy in the evaluation of gynecologic cancer.

Laparoscopy was used to evaluate 60 patients with a variety of known or suspected gynecologic neoplasms. Diagnostic laparoscopy was performed on 18 patients to confirm benign or malignant pelvic masses or to confirm peritoneal carcinomatosis. Ten of these 18 patients (56%) were found to have unresectable carcinomatosis or benign disease which did not require further surgery. Staging laparoscopy was performed on 13 patients of which 3 had clinically unsuspected intraperitoneal spread of their disease. Surveillance laparoscopy was performed on 29 patients to determine the remission, regression, or progression of their disease following treatment; 8 (27%) had progressive or unresectable persistent disease. Despite the fact that the study comprised a high-risk group of previously operated on or irradiated patients, there was only one major complication. There was, however, a 10% incidence of laparoscopic failure from inadequate visualization. Twenty-one of the study patients (35%) were spared a laparotomy by the use of laparoscopy. The findings of this investigation help to identify those gynecologic oncology patients who should benefit most from the use of laparoscopy as an adjunct to the diagnosis, staging, or surveillance of intraabdominal malignant tumors.

Abdominal Neoplasms↗

PubMed2004

Stage I ovarian cancer: comparison of laparoscopy and laparotomy on staging and survival.

OBJECTIVE: The aim of this study was to compare staging accurateness as well as survival when managing early ovarian cancers by laparoscopy or laparotomy. MATERIAL AND METHODS: We have conducted a retrospective and multicentric study in France. Only Stage I ovarian epithelial cancers operated on from January 1, 1985 to December 31, 1999 were taken into account. Respondents had to fill in a form detailing in each case the surgical access; the surgical acts performed during the initial intervention as well as data on the patient's follow-up. Lack of follow-up or final Stage > I were considered as exclusion criteria. Data were recorded and analysed with SPSS 7.5 and STATA (Stata statistical sofware 7.0). (ANOVA, chi-square test or Fisher's exact test and log-rank test). RESULTS: 105 cases were included: 14 patients were exclusively operated on by laparoscopy (group 1), 13 other patients were subjected to a conversion from laparoscopy to laparotomy (group 2) and 78 patients exclusively underwent laparotomy (group 3). Patients in group 3 were significantly more frequently postmenopausal and had larger lesions. Cyst rupture was rare during laparoscopy (21%) and the use of an endobag was achieved in only 21% of the patients in group 1. Radical treatment was significantly more frequent in group 3 when compared to group 1 (67% vs 23%, p < 0.05). Laparoscopy was not adequate for staging since no lymphadenectomy was carried out by this approach. However, only 27% of patients subjected to an open approach underwent lymphadenectomy and omentectomy. The outcome in terms of survival was similar in the three groups with a mean follow-up period of 1,221 days (+/- 832) (p = 0.1). CONCLUSION: Laparoscopic management of early ovarian cancer is poorly efficient in staging although disease-free survival does not seem to be affected. Further evaluation of laparoscopy in this indication is needed.

Adult↗

PubMed2004

Is there a change in serum CA-125 levels after laparoscopy?

There is no adequate data in the medical literature defining serum CA-125 levels after laparoscopy. Therefore we designed this prospective study to evaluate the effects of laparoscopy on serum CA-125 levels. Eighty-two women (mean age 34.2 +/- 12.30 years) were included in the study between January, 2001 and April, 2003. Laparoscopies were performed in patients with chronic pelvic pain, dysmenorrhea, infertility, ovarian cysts and for tubal ligation. Mean serum CA-125 levels of the patients before and after the laparoscopic procedures were 13.96 +/- 4.86 U/ml and 14.02 +/- 4.96 U/ml, respectively. The change in serum CA-125 levels prior to laparoscopy was statistically insignificant when compared with the levels obtained at 24 hours after laparoscopic procedure (p > 0.05). We found that diagnostic laparoscopy or laparoscopic surgical procedures did not change the levels of CA-125 at the 24th hour after laparoscopy indicating either serum CA-125 levels are not correlated, at least within 24 hours, with peritoneal irritation or peritoneal irritation is minimal or absent in our operations.

Adult↗

PubMedDate not supplied

Laparoscopy versus laparotomy for pelvic and lumbar-aortic lymphadenectomy. A 11-year experience.

UNLABELLED: This study is a retrospective comparison of laparoscopy and laparotomy lymphadenectomy (pelvic and lumbar-aortic) in cervical cancer stage IA1 and more, in a gynaecological service in Lyon, France. MATERIAL AND METHODS: During 11 years, there were 126 cases of cervical cancer patients in which lymphadenectomy was performed, either by laparoscopy or laparotomy. We analysed if there were significant differences regarding the 2 accesses in terms of stage, tumour size, surgical interventions associated, number of lymph nodes extracted, and outcome. RESULTS: Regarding the stage of our cases, 3 of them were IB1, IB2 and IIB; the more advanced the stage, the fewer lymphadenectomies were performed by laparoscopy. As for the tumour size, the smaller tumour was statistical significantly associated with pelvic laparoscopic lymphadenectomy (p = 0.01) while the tumours larger than 4 cm mean lumbar-aortic lymphadenectomy by laparotomy (p = 0.006). Regarding the associated surgical interventions, the laparoscopic lymphadenectomies were associated to low-stage operations: conisation/trachelectomy, vaginal or abdominal simple hysterectomy, or extra-fascial hysterectomy (type 1 or 2). There was no significant difference between laparoscopy and laparotomy ways regarding the number of lymph nodes extracted (median 13.5 vs 11, p = 0.45 for pelvic nodes, and 8 vs 4 for lomb-aortic nodes, p = 0.43, for laparoscopy vs laparotomy). CONCLUSION: Laparoscopic lymphadenectomy is as effective as the laparotomy procedures, and the training of young gynaecologic oncologists should not ignore laparoscopy as an alternative technique for nodes sampling.

Aorta↗

PubMedDate not supplied

Comparison between laparotomy and operative laparoscopy in the treatment of moderate and severe stages of endometriosis.

A retrospective study was designed to compare the results of treatment of moderate and severe stages of endometriosis by laparotomy and by laparoscopy. Patients were divided into three groups: the first consisted of 42 patients treated by laparotomy followed immediately with danazol treatment for 6-9 months; the second, 44 patients treated by operative laparoscopy followed immediately with danazol treatment for 4-6 months; and the third, 62 patients treated by operative laparoscopy followed immediately with danazol treatment for 6-10 weeks. The cumulative pregnancy rate in the laparoscopy groups was better than that of the laparotomy group. Most patients who failed to conceive underwent a second-look laparoscopy for reevaluation. Residual endometriosis and associated adhesions were noticed least in the third group. It is concluded that operative laparoscopy could be efficiently used for the treatment of moderate or even severe endometriosis.

Adult↗

PubMed1990

[Usefulness of laparoscopy as a second-look method in neoplasms of the ovary].

The usefulness of second-look laparoscopy in the follow-up of ovarian cancer is evaluated. This procedure has been included in the protocol for the treatment of these tumors. During the period 1980-1987 a total of 3038 laparoscopies were performed; 205 (7%) were for ovarian cancer. We present the results of 72 explorations in 52 patients; after surgery and chemotherapy all of them were in complete remission. 44 explorations were second-look laparoscopy and 28 third-look laparoscopy. All the examinations were done under local anesthesia. There were two failures due to the presence of adhesions secondary to the previous surgery which prevented the pneumoperitoneum. In 35 (48.6%) explorations a neoplasia was found and a laparotomy was avoided. There were 31% (4/13) false negative in second-look laparotomy post-laparoscopy. The correlation between gross and microscopic findings was excellent. There were no complications in spite of the previous abdominal surgery. We recommend second-look laparoscopy in patients under treatment of ovarian cancer which in our experience avoided laparotomy almost in half of the cases; no complications were observed and the procedure was well-tolerated.

Adult↗

PubMed1989

Diagnostic laparoscopy: a prospective review of 100 cases.

The perceived role of laparoscopy in the management of liver disease has changed because of the widespread use of image-guided biopsy. Laparoscopy, however, permits direct inspection of the liver surface and the abdominal cavity, as well as tissue sampling. In order to assess the utility of laparoscopy, and specifically, the diagnostic value of direct visualization of the liver surface, we prospectively collected information on 100 consecutive patients undergoing laparoscopy. The contribution of the laparoscopic findings to patient management and the predictive value of the laparoscopic diagnosis compared to histology were assessed. Laparoscopy had a 95% diagnostic yield. Liver surface characteristic consistent with malignancy, cirrhosis, or fibrosis were sensitive and specific predictors of histologic findings. We conclude that laparoscopy continues to be a valuable diagnostic procedure, especially in cases where accurate assessment of the liver architecture is required.

Adolescent↗

PubMedDate not supplied

Hysterosalpingography, pre- and postoperative laparoscopy in operative treatment of infertility.

The benefit of routine hysterosalpingography (HSG) and pre- and postoperative laparoscopy in diagnosing and treating anatomical infertility was investigated in 115 women. The findings at HSG and laparoscopy were compared with the diagnoses obtained by laparotomy. Laparoscopy was significantly better than HSG in detecting adhesions. Both procedures were of equal value in assessing tubal pathology. Although HSG revealed additional findings in 5 per cent of cases, none of these needed operative correction. Postoperative laparoscopy, which was performed in 70 patients, did not affect the incidence of either intra- or extra-uterine pregnancy. It is concluded that all patients should be offered diagnostic laparoscopy. HSG and second-look laparoscopy should not be used routinely.

Adult↗

PubMed1985

Laparoscopy in patients admitted for acute abdominal pain.

In 81 patients with acute abdominal pain, laparoscopy was performed because of diagnostic doubt. Diagnosis by clinical methods proved to be correct in 42 of the patients and laparoscopy gave correct diagnosis in 70. Appendectomy revealed acute appendicitis in 19 patients and normal appendix in five. Failure to establish a diagnosis by laparoscopy was due to incomplete visualization of appendix in nine patients, pelvic adhesions in one patient, and failure to enter the peritoneal cavity in another. A clinical diagnosis of acute appendicitis could be invalidated by laparoscopy in 17 of 40 patients. Negative laparotomy is potentially avoidable by use of laparoscopy when a diagnosis of appendicitis is questionable. Laparoscopy may therefore be warrantable in such cases.

Abdomen, Acute↗

PubMed1984

Clinical selection of infertile patients for laparoscopy.

For a period of time routine hysterosalpingography and laparoscopy were carried out in every patient complaining of more than 2 years of primary infertility. The records of 433 such patients were retrospectively evaluated according to their clinical aspects. Complete agreement between the two diagnostic methods was found in 70.9% of this unselected population. Almost 50% of the population had some abnormalities in either hysterosalpingography or laparoscopy. According to the patient's past history, pelvic examination, and the duration of infertility, the unselected infertile population was classified into a) high risk infertility and b) low risk infertility. High risk infertility patients had (P less than 0.01) greater abnormal findings at both hysterosalpingography and laparoscopy. In this high risk group we recommend early laparoscopy and the postponement of hysterosalpingographic investigation for patients with suspected cornual occlusion or destruction of ampullary rugae (valuable in assessing tubal damage). Low risk infertility patients had (P less than 0.01) low abnormal findings at both hysterosalpingography and laparoscopy, and in these patients hysterosalpingography does not discriminate the group of higher abnormal laparoscopic findings. Hysterosalpingography can be initially indicated as a less invasive investigation in the low risk group. We conclude that clinical data are very valuable in the selection of infertile patients for early or late laparoscopy.

Fallopian Tube Patency Tests↗

PubMed1984

Clinical selection of infertile patients for laparoscopy.

Female↗

PubMed1984

Laparoscopy in post partum sows with special emphasis on the effects of uterine manipulation on the release of prostaglandin F2 alpha.

One hundred laparoscopies were performed on 30 primiparous post partum sows and complications during and after examinations recorded. Nineteen of these animals were separated into two groups and subjected to different treatments: group 1 (10 sows), with conventional laparoscopy; group 2 (nine sows) with two minutes extra manipulation of the uterus after laparoscopy. Blood was sampled before and after the operations. The plasma was analysed for its content of 15-keto-13,14-dihydroprostaglandin F2 alpha by radioimmunoassay. The results indicate that laparoscopies were successful and can be used in post partum sows during lactation and after weaning without any severe complications. In some sows laparoscopy alone or laparoscopy followed by manipulation of the uterus for two minutes caused a peak of the prostaglandin metabolite. However the height and duration of this peak were not sufficient to influence reproductive performance in pigs.

Animals↗

PubMed1984

Laparoscopy in the diagnosis and management of ovarian cancer.

Ninety-two laparoscopies were performed for diagnosis and follow-up on 83 patients with clinical diagnoses of ovarian cancer from May 1979 to May 1981. With laparoscopy about 10% of the cases were disproven; of suspicious cases only 53% were confirmed. Laparoscopy was very helpful in clarifying the clinical diagnosis of ovarian carcinoma. Laparoscopy for follow-up evaluation of treatment was done on 44 patients. Very early recurrence, which is very difficult to detect on clinical examination, was found with second-look laparoscopy. If few adhesions are present, laparoscopy can replace second-look exploration in the majority of cases of complete remission.

Diagnosis, Differential↗