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PubMed1984

[Laparoscopy in the diagnosis and treatment of adnexal torsion].

13 uterine adnexal torsions were diagnosed by means of laparoscopy between June 1978 and October 1982. Laparoscopy is an opportunity for the adnexae to be untwisted, and gives precision to estimate the severity of the damage of the adnexae and to elucidate the aetiology. In ten patients, the treatment was performed by means of laparoscopy Three patients underwent immediate laparotomy: two for necrosis of the adnexae, one for a mucinous cystadenoma. The post-operative course was always uneventful. A second look laparoscopy was performed to check the anatomical recovery of primary severe ischaemic lesions (4 cases). The usefulness of laparoscopy in diagnosing torsion of the uterine adnexae is now well established. We can also treat by means of laparoscopy. Contra-indications to this management are necrosis of the adnexae and organic tumours.

Adnexal Diseases↗

PubMed1981

Laparoscopy for second-look evaluation in ovarian cancer.

Although second-look laparotomy to ascertain primary therapeutic effect on ovarian cancer has been generally accepted, laparoscopy for this purpose has been controversial. Between 1974 and 1978, 119 consecutive laparoscopic examinations were performed on 57 patients with ovarian cancer to monitor the effect of chemotherapy or to determine disease status. Most procedures included intraperitoneal biopsy and cytologic evaluation of peritoneal washings. Seventy-three percent of the procedures were successful. Fourteen percent of the patients had major complications requiring laparotomy, most of which involved bowel perforation. Complications were significantly reduced when routine laparoscopy was preceded by needle laparoscopy. A negative laparoscopy including biopsy and cytologic evaluation was associated with a significant increase in survival when compared with the entire patient group. Repetitive laparoscopy permitted early detection of recurrence and identified patients whose risk of recurrence after 24 months was low. With each successive negative laparoscopy, the mean duration of remission was longer and the probability of recurrence lower.

Female↗

PubMed1994

The role of laparoscopy in the treatment of endometriosis.

The aim of the present study was to evaluate the role of laparoscopy not only in the diagnosis but also in the therapy of pelvic endometriosis. Ninety-four patients underwent laparoscopy between May 1991 and May 1993. The patients were divided into 2 groups, according to the indication for laparoscopy: group I (benign ovarian cysts n = 47); group II (chronic pelvic pain, n = 47). All laparoscopies were performed by 2 surgeons only. When present, endometriosis was scored according to the American Fertility Society revised classification 1985 (AFS 1985). Endometriosis was present in 37 (39.4%) of the 94 patients included in the study: 19 out of 47 (40.4%) in group I, 18 out of 47 (38.3%) in group II. In 29 patients with endometriosis (78.3%), the score was reduced surgically during the diagnostic procedure. In 24 cases (82.8%) by laparoscopy and in 5 cases (17.2%) only, by laparotomy. Therefore, the careful selection of cases, the use of appropriate instruments and the experience in endoscopic surgery, combined with a good knowledge of pelvic anatomy, may allow the treatment of endometriosis immediately after diagnosis by laparoscopy, resulting in shorter hospitalization, less physical trauma, and a lower number of post-operative adhesions.

Endometriosis↗

PubMed1996

The use of laparoscopy in the management of seat belt trauma in children.

Abdominal wall, hollow viscous, and spinal cord injuries are severe complications of two point seat belt restraints in children. Somatic abdominal wall pain can mask the presence of potentially life-threatening intraperitoneal injuries, false-positive peritoneal lavage can lead to unnecessary celiotomy, and CT scan can miss hollow viscous injury. All of these concerns point to the need for a more effective diagnostic modality. Laparoscopy may have a role in the diagnosis and management of lap belt-related hollow viscous and mesenteric injuries. The presence of either free peritoneal fluid or mesenteric thickening, seen on CT scan, associated with an seat belt-related abdominal wall contusion are criteria for diagnostic laparoscopy. Four patients, age 3 to 15, underwent laparoscopy. Diagnostic laparoscopy employed two additional laterally placed ports and extreme Trendelenburg and reverse Trendelenburg to facilitate the thorough examination of the small bowel. Injuries identified were a severely contused cecum, a contusion of the small bowel with associated mesenteric hematoma, transverse colon contusion and gastric perforation, and a small bowel contusion. No delayed reexplorations were required for missed injuries and there were no complications associated with laparoscopy. This experience suggests that laparoscopy may have a role in the diagnosis and management of seat belt trauma in children.

Abdominal Injuries↗

PubMed1997

[Diagnostic and therapeutic value of laparoscopy in acute abdomen].

The purpose of this work is to evaluate the degree of applicability of the diagnostic laparoscopy (DL) and therapeutic laparoscopy in the acute abdomen and trauma patients. The material of 109 cases of DL performed since 1983 has been evaluated retrospectively. 22 patients were operated by laparoscopy. The patients were assessed in the following groups: I-suspected acute appendicitis, II-acute abdomen of uncertain ethology, III-abdominal trauma. In the first group 60 patients were diagnosed, 13 of them were operated by laparoscopy, 28 by open access, 15 avoided the unnecessary laparotomy. In the second group 30 patients were diagnosed, 6 of them were operated by laparoscopy, 8 open interventions were noted, 16 avoided the non-therapeutic laparotomy. In the third group 19 patients were diagnosed, 13 underwent laparotomy, 6 avoided the unnecessary intervention. There has been one death, not associated with DL (acute bowel ischemia), morbidity was 1% (one case of bleeding from the mesenterial artery, treated by conversion to laparotomy), one DL was considered as falsely negative, one not sufficient to establish the diagnosis. Basing on our experience in DL as a diagnostic tool we can confirm the accuracy of the method in 99.08% with only 1% of morbidity. 20.1% of patients were operated by laparoscopy, without complications. In conclusions the authors consider the DL allows to establish a prompt and accurate diagnosis in the acute abdomen and trauma without a therapeutic delay and unnecessary hospital observation. The fault of the method and morbidity rate is acceptable. The treatment by the same laparoscopic access offers to these patients another benefit, the more the experience is increasing.

Abdomen, Acute↗

PubMed1998

Laparoscopy and lesser sac endoscopy in gastric carcinoma operability assessment.

The results of 502 laparoscopy and 200 lesser sac endoscopy applications in 502 patients with gastric carcinoma for operability assessment are studied. Laparoscopy demonstrated a 94.74 per cent sensitivity for diagnosis of peritoneal disseminations and liver metastases. However, laparoscopy failed to establish inoperability in any cases of carcinoma spread to areas not accessible to laparoscopic visualization. Of these latter cases, 95.74 per cent were caused by tumor spread to the lesser sac retroperitoneum. Thus, the resultant sensitivity of laparoscopy in gastric carcinoma inoperability diagnosis was only 42.35 per cent. Lesser sac endoscopy made it feasible to inspect all of the organs and tissues forming the lesser sac. Of 200 patients assessed by lesser sac endoscopy, invasion of gastric posterior wall serosa was found in 89, retroperitoneal tumor invasion in 97, and retroperitoneal metastases in 42. The sensitivity of gastric carcinoma inoperability diagnosis by lesser sac endoscopy was 93.44 per cent and in combination with laparoscopy, 96.7 per cent. Utilization of lesser sac endoscopy in patients with gastric carcinoma minimized the number of exploratory laparotomies 6.4 times in comparison with only laparoscopy use and was responsible for diminishing this number to 5 per cent of the total number of examined patients.

Adult↗

PubMed2002

Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates the need for laparoscopy.

OBJECTIVE: To determine whether sonohysterography can differentiate septate from bicornuate uterus. DESIGN: Prospective study. SETTING: Outpatient infertility clinic of a university hospital. PATIENT(S): Twenty patients with history of recurrent pregnancy loss and hysterosalpingographic diagnosis of septate or bicornuate uterus. INTERVENTION(S): Sonohysterography was done in all patients. Laparoscopy was performed to confirm diagnosis in 10 patients and was not done in 10 patients. All patients with septate uterus underwent hysteroscopic metroplasty; simultaneous laparoscopy was done in women who had diagnostic laparoscopy. Abdominal metroplasty was performed in patients with bicornuate uterus. MAIN OUTCOME MEASURE(S): Shape of the uterine cavity after surgery and pregnancy outcome. RESULT(S): The shape of the uterine cavity was normal in seven cases in each group and almost normal in six other patients after surgery. There were two pregnancy losses after metroplasty, one in a woman who had laparoscopy and one in a woman who did not have laparoscopy. One case of bicornuate uterus occurred in each group. CONCLUSION(S): Sonohysterography can differentiate septate and bicornuate uterus and may eliminate the need for laparoscopy to diagnose these uterine anomalies.

Abortion, Habitual↗

PubMed1998

A randomized blinded trial of preemptive local anesthesia in laparoscopy.

Objective: Laparoscopy, while routinely performed in the outpatient setting, is associated with considerable postoperative discomfort. Continuing pain experienced after surgery is due to post-traumatic functional changes in both the peripheral nervous system (hyperalgesia) and the central nervous system (hyperexcitability). Local anesthetic infiltrated at time of incision closure has limited effect because hypersensitivity and hyperexcitability have already developed. Preemptive analgesia refers to the blockage of afferent nerve fibers, before painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. 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 to postincisional local anesthetic or placebo.Materials and Methods: Seventy-five patients undergoing laparoscopy for pelvic pain, infertility, or sterilization were randomized to one of three treatment groups. Two 10 mL syringes, labeled "Pre" and "Post," were prepared at time of laparoscopy and contents blinded to anesthesiology, surgeons, and the patient. For treatment group A (preincisional), the presyringe contained 10 mL of 0.5% bupivacaine (50 mg) and the postsyringe contained 10 mL of 0.9% saline. For treatment group B (postincisional) patients, the presyringe contained 10 mL of 0.9% saline and the postsyringe contained 10 mL of 0.5% bupivacaine. For treatment group C (control) patients, both syringes contained 10 mL of 0.9% saline. All patients underwent a standardized general anesthetic induction and maintenance. After the patient was properly positioned and draped, 5 mL of the presyringe was infiltrated into the umbilical incision site. The remaining 5 mL was infiltrated in a similar fashion at the suprapubic trocar placement site. After laparoscopy and immediately prior to closure of the incisions, the postsyringe was infiltrated into both incisions above and below the fascia in a diamond-shaped pattern.For postoperative pain, oral ibuprofen was given, as needed, with 30 mg intramuscular ketorolac tromethamine given if the patient was unable to tolerate oral pain medication. All patients were discharged with 800 mg ibuprofen tablets and asked to take as needed for pain relief. The modified McGill Present Pain Intensity scale was evaluated by nurse interview at 30 minutes, 2 hours, 4 hours, and 24 hours after incision closure. Statistical analysis was accomplished using chi(2) tests for proportional data and ANOVA for pain scores and other parametric data.Results: Fifty-seven patients completed the study protocol. Age, weight, height, race, indication, and operating time did not vary significantly between the three groups. Patients in treatment group A (n = 20) could tolerate a significantly longer time delay to their first analgesic medication. (A: 486.7 +/- 435.3 minutes; B: 229.4 +/- 330.4; C: 143.1 +/- 156.7, P <.001). Their 24-hour pain scores were also significantly lower than either treatment group B (n = 19) or C (n = 18) (A: 0.50 +/- 0.9; B: 1.61 +/- 1.3; C: 1.2 +/- 1.2, P <.02). Although statistical significance was not reached, patients in treatment group A required less total doses of analgesic than either treatment group B or C (A: 2.4 +/- 1.6 doses; B: 3.1 +/- 1.5; C: 3.1 +/- 1.2, P =.07).Conclusions: Preemptive local anesthesia in patients undergoing laparoscopy results in a longer time before analgesic is required and significantly lower pain 24 hours after surgery.

Journal Article↗

PubMed1996

Laparoscopy versus Laparotomy for Radical Hysterectomy

From July 1993 to March 1996 we performed 62 radical hysterectomies, 15 (24.2%) by laparoscopy and 47 (75.8%) by laparotomy. All patients had cervical carcinoma FIGO stages Ia2 and Ib1. We compared the duration of surgery, blood loss, number of pelvic nodes obtained, surgical margins, and complications. The average duration of laparoscopic surgery was 4.5 hours versus 3 hours for laparotomy. Blood loss at laparoscopy was 250 ml, and 600 ml at laparotomy. The number of pelvic nodes obtained by laparotomy was 24.74 and by laparoscopy an average of 25. In all cases the surgical margins were free of tumors. Two complications in the laparoscopy group were a vaginal hematoma and a ureteral injury. At laparotomy one ureteral fistula occurred. No difference between approaches in pathology specimens were seen. Blood loss was lower at laparoscopy but the duration of surgery was longer. Radical hysterectomy by laparoscopy seems safe and effective.

Journal Article↗

PubMed2004

[What is the potential for acute laparoscopy in penetrating abdominal injuries?].

AIM: The aim of this work was to show current opinions on performing acute laparoscopic exploration in penetrating injuries of the abdomen and to assess the authors' own experience in performing the above operation in conditions of the regional hospital. METHODOLOGY: The authors present 17 patients treated between the years 1997-2002 for penetrating injuries of the abdomen or suspected for a penetrating injury. Acute laparotomy was performed in 11 cases, acute laparoscopy in 6 patients. The authors specify certain indications which lead to the acute laparoscopy, the method performed and its diagnostic value. RESULTS AND CONCLUSION: In the group observed, an intraabdominal injury was diagnosed in 41% of the patients, in 59% of cases findings were negative. When the intraabdominal injuries were assessed, the group of the acute laparotomies had 54% of negative findings, the group of the acute laparoscopies had 66.6% of negative findings. Laparoscopy decreased the total number of all negative laparotomies from 59% down to 35%. Diagnostic laparotomy fits to complement a spectrum of examination methods. Especially in equivocal cases, when a penetrating injury is suspected, it decreases the number of so called "necessary" non-therapeutic laparotomies to a minimum. It is most efficient, compared to other diagnostic methods, in verifying injuries of the peritoneum and diaphragm. However, acute laparoscopy should be always performed by an experienced surgeon. A therapeutic potential of the acute laparoscopy depend on proficiency of the operating surgeon and on the technical potential of each hospital. However, they, mostly, still remain restricted to caring for minor, isolated intraabdominal injuries.

Abdominal Injuries↗

PubMed1979

[The evolution of the indications for laparoscopy between 1973 and 1977. 1,758 cases (author's transl)].

In order to avoid the misuse of laparoscopy by an unnecessary increase in the indications for the procedure the authors have reviewed the evolution of these indications in the five years between 1973 and 1977. Certain indications have stayed stable, such as chronic pain in the pelvis, masses found in the pelvis, symptoms suggestive of upper genital tract infection or of ectopic pregnancy and tubal or unexplained sterility. Stability in these indications is correct because laparoscopy and laparoscopy alone can give a precise diagnosis of the lesion and complete the clinical findings and the other methods of investigation. There are two indications which have become less frequent and these are: ovarian sterility and amenorrhoea. This is logical since more reliance has come to be placed on biological methods. Laparoscopy should be reserved in these conditions for cases where are contradictions between biological findings or where there are therapeutic failures. An increase in the indications which is very justified is in those laparoscopies which are carried out as a control of the results of tubal surgery, because there a prognosis can be given and therapy can be carried out (such as division of adhesions) and in cases of malignant tumours of the ovary which, although the procedure will give less precise information than laparotomy, has the advantage that it can be repeated from time to time.

Amenorrhea↗

PubMed1998

Effects of carbon dioxide pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy on body weight and tumor growth.

BACKGROUND: The oncologic consequences of intraperitoneal carbon dioxide (CO2) insufflation during the laparoscopic resection of cancer are under debate. The effect of other insufflating gases or gasless laparoscopy on cancer requires study. OBJECTIVE: To study body weight and tumor growth in rats after CO2 pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy. METHODS: On day 1, an 8-mg bolus of ROS-1 tumor was placed under the renal capsule of both kidneys in rats. In experiment A, rats had either CO2 insufflation (n=10) or a gasless laparoscopic bowel resection (n=10) on day 3 and were humanely killed after 7 days. In experiment B, rats had either a laparoscopic bowel resection with CO2 insufflation (n=11) or insufflation with air (n=11) on day 3 and were killed after 7 days. In both experiments, postoperative weight loss and tumor growth were measured, and the differences were tested with an analysis of covariance. RESULTS: Renal subcapsular tumor growth in the group having gasless laparoscopy was less than that in the group having CO2 pneumoperitoneum (P=.04). Postoperative weight loss in these groups showed no differences (P=.55). No differences in tumor growth or weight loss were found between rats having insufflation with CO2 and those having insufflation with air (P=.61 and P=.68, respectively). CONCLUSIONS: The restoration of body weight after a laparoscopic surgical procedure was similar with CO2, air, or gasless laparoscopy. Gasless laparoscopy was associated with less renal subcapsular tumor growth than was insufflation with CO2. Therefore, the application of gasless techniques in laparoscopic oncologic surgical treatment demands further study.

Air↗

PubMed2000

The impact of laparoscopy and laparoscopic ultrasonography on the management of pancreatic cancer.

HYPOTHESIS: Laparoscopy and laparoscopic ultrasonographic (LAPUS) examinations combined with a biopsy of the pancreatic lesion contribute significantly in the determination of resectability of pancreatic cancer. DESIGN: A prospective evaluation of the impact of laparoscopy and LAPUS on surgical decision making in patients with pancreatic cancer. SETTING: A general community hospital; the department of surgery serves as referral for pancreatic surgery. PATIENTS: During a 36-month period, 94 patients with pancreatic lesions were prospectively examined. Twenty-seven patients were found to have advanced disease. The remaining 67 patients were examined by laparoscopy and LAPUS to determine the resectability of the pancreatic tumor. RESULTS: Laparoscopy and LAPUS contributed new, additional data in 40 patients (60%). Advanced disease was found in 30 patients, precluding curative resection. The study indicated potentially resectable tumors in 37 patients (55%), including 3 defined by conventional imaging studies as probably unresectable, and these patients were operated on with the intention of curative resection. Thirty-three patients underwent resection, and 4 (6%) were found to have nonresectable disease and form the false-positive group of the study. A summary of the results shows that the study resulted in a change of the decision regarding surgical intervention in 24 patients (36%) and avoided unnecessary laparotomies in 21 (31%). The study had a sensitivity of 100%, a specificity of 88%, and a false-positive rate of 6%. The positive predictive value of the study is 89%, and the negative predictive value is 100%. CONCLUSIONS: Although rather invasive procedures that require general anesthesia and hospitalization, laparoscopy and LAPUS significantly contribute to the staging of patients with potentially resectable pancreatic cancer, avoiding unnecessary explorative laparotomies. These procedures should be performed in all patients with potentially resectable pancreatic cancer before explorative laparotomy.

Female↗

PubMed1992

The utility of diagnostic laparoscopy for abdominal disorders. Audit of 120 patients.

We audited our recent experience with diagnostic laparoscopy performed over a 30-month period on 131 consecutive patients. Laparoscopy was 100% accurate in the diagnosis or exclusion of intra-abdominal malignant neoplasms, and future care decisions were affected by this information. Laparoscopy in the evaluation of chronic abdominal pain yielded positive findings in 47% of cases. The majority of referrals (73%) for the investigation of chronic abdominal pain came from the medical services, whereas the majority of referrals (72%) for the investigation of cancer originated from surgeons. Laparoscopy in the setting of acute abdominal pain yielded useful information that affected patient outcomes in 71% of cases. There were no serious complications in this series. Laparoscopy is a safe and useful diagnostic tool, especially for the diagnosis, staging, or exclusion of cancer.

Abdominal Neoplasms↗

PubMed1980

The value of laparoscopy under local anaesthesia in 250 medical and surgical patients.

This study reports our experience of laparoscopy under local anaesthesia in 250 patients; the procedure was safe, quick and easy to perform with minimal inconvenience to the patient. We advocate the early use of laparoscopy in patients with ascites and when there is difficulty in the diagnosis of patients with jaundice and hepatomegaly, an accurate histological diagnosis being obtained in the majority. In patients with intra-abdominal malignancy, in whom surgery is planned, laparoscopy can detect disseminated disease and so avoid an unnecessary laparotomy. Laparoscopy may also provide a diagnosis in patients presenting with a variety of vague symptoms such as abdominal pain, weight loss, lethargy etc. We have found laparoscopy an excellent investigation if positive but, as if only allows the surface inspection of viscera, when negative, we recommend caution in its interpretation.

Abdominal Neoplasms↗

PubMed1989

Laparoscopy, ultrasound and computed tomography in cancer of the oesophagus and gastric cardia: a prospective comparison for detecting intra-abdominal metastases.

We have evaluated the sensitivity, specificity and accuracy of laparoscopy under general anaesthesia, ultrasound and computed tomography (CT) in detecting intra-abdominal metastases in 90 consecutive patients with carcinoma of the oesophagus or cardia. Metastases were histologically confirmed as hepatic in 25 patients, nodal in 35 and peritoneal in nine. All investigations had high specificity (86-100 per cent) for each type of metastasis. Laparoscopy was found to be significantly more sensitive (P less than 0.01; P less than 0.02) and more accurate (P less than 0.01; P less than 0.01) than either ultrasound or CT, respectively, with regard to hepatic status. Although laparoscopy performed best with regard to nodal metastases, this reached statistical significance only when sensitivity of ultrasound was compared (P less than 0.01). Neither ultrasound nor CT detected any peritoneal metastases, although laparoscopy detected eight out of nine, giving a sensitivity of 89 per cent and an accuracy of 98 per cent. There was no morbidity or mortality associated with laparoscopy, which offers a safe, reliable method of determining intra-abdominal status and may obviate the need for surgery in some patients with malignant dysphagia.

Abdominal Neoplasms↗

PubMed1994

Triage by laparoscopy in patients with penetrating abdominal trauma.

Laparoscopy was performed on 33 patients with penetrating abdominal injuries to identify those with peritoneal penetration. Diagnostic or therapeutic manoeuvres were not attempted; evidence of peritoneal penetration mandated exploratory laparotomy. Twenty-two patients had gunshot wounds and 11 stab wounds. Ten patients had multiple penetrating injuries. Intraperitoneal injury was not evident by clinical assessment in any patient and all were haemodynamically stable. Twenty-three patients underwent negative laparoscopy and no intraperitoneal injury was subsequently detected. Laparoscopy demonstrated peritoneal penetration in ten patients and subsequent laparotomy detected intraperitoneal injuries in nine. No complications of laparoscopy occurred. In stable patients with penetrating trauma and no clinical evidence of intraperitoneal injury, laparoscopy effectively and safely detects those with peritoneal penetration.

Abdominal Injuries↗

PubMedDate not supplied

A comparative study of the tubal ring applied via minilaparotomy and laparoscopy in postabortion cases.

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectiveness of the two surgical methods. One hundred and forty-nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.

Abortion, Induced↗