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At least 37 records · Page 2Linked to original sources
PubMed1994

Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy.

Vasopressin may be associated with systemic hemodynamic changes, including severe myocardial ischemia, even in healthy patients. A 36-year-old woman underwent laparoscopy for the treatment of a uterine leiomyoma. After intravascular injection of vasopressin, she experienced life-threatening hypotension, and the procedure was subsequently aborted. After she recovered, she underwent successful laparoscopy without the use of vasopressin, and no complications occurred. As endogenous vasopressin levels sometimes rise during laparoscopy, patients may become susceptible to the drug's effects, and appropriate precautions must be taken.

Adult↗
PubMed1996

The role of laparoscopy in the evaluation of chronic pelvic pain: pitfalls with a negative laparoscopy.

Laparoscopic findings are negative in anywhere from 10% to 90% of women with chronic pelvic pain. When this occurs a woman is often told one or more of the following: (1) nothing is wrong; (2) the pain is in her head and she should see a psychiatrist; (3) she should have a neurolytic procedure, such as uterine nerve transection or presacral neurectomy; (4) the only thing that is left to do is a hysterectomy; or (5) nothing can be done and she must learn to live with the pain. Usually these statements are inappropriate, often stemming from the mistaken belief that laparoscopy represents the definitive diagnostic end point in the evaluation of a woman with chronic pelvic pain. It is important that gynecologists appreciate that laparoscopy is only one of many possible methods of evaluation and recognize its diagnostic limitations and pitfalls.

Chronic Disease↗
PubMed1991

Bradyarrhythmias and laparoscopy: a prospective study of heart rate changes with laparoscopy.

Cardiac arrhythmias are a common complication of laparoscopy. Brady-arrhythmias (including asystole) may be life-threatening. The recent introduction of new shorter-acting muscle relaxants (atracurium and vecuronium), with their lack of vagolytic activity, may exacerbate this situation. At the Royal Women's Hospital there have been several episodes of severe bradyarrhythmias and/or asystole associated with these relaxants. This study evaluated heart rate changes in 49 women during laparoscopy: 47% of patients had arrhythmias, 30% of these being bradyarrhythmias. Nearly all the episodes occurred during carbon dioxide insufflation or with traction on pelvic structures. The life-threatening nature of this phenomenon should be understood by all anaesthetists and gynaecologists engaged in laparoscopic procedures.

Adult↗
PubMed2006

Initial experiences with laparoscopy-assisted and total laparoscopy for anatomical liver resection: a preliminary study.

Although laparoscopic surgery has become more popular, its technical difficulties have limited the applications of this technique to liver surgery. We report here on our experience with liver resection with using the laparoscopy-assisted (Lap-Assist) and total laparoscopic (Total-Lap) methods. From April 2001 to June 2003, a total of 20 laparoscopic anatomical resections of the liver were retrospectively reviewed. These were comprised of 10 cases in which the Lap-Assist method was used (these were performed during the early study period), and 10 cases in which the Total-Lap was used (these were done in the later study period). In the Lap-Assist group, the following resections were performed: 7 cases of left lateral sectionectomy, a case of left hemihepatectomy, a case of right hemihepatectomy and a case of open conversion. In the Total-Lap group, 6 cases of left hemihepatectomy and 4 cases of left lateral sectionectomy were performed. The sizes of the incisions were 8.7 cm and 4.6 cm, respectively, (p=0.000). There were no differences in the operation times, the transfusion amounts, the starting days of the patients' diets, the complication rates or the durations of the hospital stay between the two groups. Both the laparoscopy-assisted method and the total laparoscopic method are feasible to use for performing anatomical liver resection.

Adult↗
PubMed1997

[Laparoscopy-assisted colonic polypectomy or how to be helped by laparoscopy to prevent colectomy in benign colonic polyps considered to be unresectable by colonoscopy].

The aim of this study was to prospectively evaluate the role of laparoscopic surgery in all patients presenting with colonic polyps. From April 1994 to April 1996, 16 consecutive patients were treated. The laparoscopy starts the procedure, then a colonoscopy easily and rapidly locates the colonic lesion. Under laparoscopic supervision a new snare polypectomy is often possible. If polypectomy remains impossible, a mini-laparotomy is performed above the polyp and allows polypectomy by extra-peritoneal colotomy. In one case, the polyp was not found on colonoscopy. Colonoscopic polypectomy was possible in 6 cases (40%), and 9 mini-laparotomies were necessary (60%). No colectomy was performed. The final histologic result showed two Dukes A carcinomas justifying secondary wide colectomy. Laparoscopy-assisted polypectomy is a safe and efficient procedure, allows complete excision of polyps and may avoid a colonic resection.

Aged↗
PubMed1976

[The risk of cardiac arrest during laparoscopy. A study of 50,000 laparoscopies and animal experimentation].

In a French national enquiry into 50,000 laparoscopies it emerges that the number of cardiac arrests works out at 1 in 2,000. The percentage of reversible cardiac arrests was 1 in 2500 and of irreversible cardiac arrests 1.2 in 10,000. 25 cases were studied in great detail, both clinically and physiopathologically. This was thanks to a very full questionnaire most kindly filled up by those who had told us that this type of accident had happened in their practice. The physiopathogenesis of circulatory arrests during laparoscopy is complex. It appears however that among the different potentiating factors are changes in haemodynamics and biological changes that give rise to the greatest risks. Experimental work carried out with a long-tailed baboon was performed by the authors with the idea on the one hand of confirming that haemodynamic and biological troubles resulting from the pneumoperitoneum were important and on the other hand of analysing the changes in detail and of working out prophylactic principles for the anaesthetist and the laparoscopist.

Animals↗
PubMedDate not supplied

Making the transition from standard gynecologic laparoscopy to robotic laparoscopy.

OBJECTIVES: To determine the feasibility of using a simple procedure, a bilateral tubal ligation, as a transition procedure when adopting robotic laparoscopy for gynecologic surgery. METHOD: To obtain robotic credentialing and gain experience with the robotic system, the surgeons first went through robotic training, then 4 women desiring permanent sterilization had robotically assisted laparoscopic bilateral tubal ligations performed, using the Parkland method. RESULTS: Total operating room time varied from 1 hour 25 minutes to 2 hours 31 minutes. Improvement in operating time for each surgeon was noted with each successive case. Best times in robotic cases were similar to those of standard laparoscopy. CONCLUSION: Robotically assisted laparoscopic tubal ligation using the Parkland method is a satisfactory procedure to provide transition for gynecologic surgeons and operating room personnel to gynecologic robotic surgery.

Adult↗
PubMed1985

[Open laparoscopy. Contribution to safe gynecologic laparoscopy].

A modified form of "open" laparoscopy is proposed starting from the different estimation of the risk of "closed" laparoscopy, the differently manipulated technical procedure, the considerable possibilities of complications and their control especially at smaller gynaecologic departments. Safety and easy manipulation are underlined, first of all in extremely obese patients. Usage of this method is recommended even at smaller departments.

Female↗
PubMed1981

[Gynecological laparoscopy. A 5-year retrospective study on laparoscopy at the Technical University of Munich].

In a retrospective study we evaluated the results of 598 laparoscopies which had been carried out in the years 1973 through 1977 at the Women's hospital of the Technical University in Munich. A considerable increase in pelviscopic tube sterilizations could be observed. Severe complications resulting in a laparotomy occurred in 0,5% of the cases. For laparoscopic operations the medical indication was restricted, whereas it was generously applied for the differential diagnosis of an ectopic gravidity. The sterilization techniques most frequently used at the moment are the bi-polar high-frequency technique and--to a smaller extent--the light-current coagulation technique. The uni-polar high-frequency technique can be regarded as obsolete. As far as a restoration of fertility is concerned, the individual application of the various sterilization methods can be expected for the future.

Adult↗
PubMed1996

[Laparoscopy in suspected acute appendicitis. Experiences with the first 233 laparoscopies at a university hospital department].

In an initial stage of introducing laparoscopic appendicectomy, 233 patients with indication for surgical treatment were evaluated in an open prospective trial. Surgery was done by a total of 39 trainees on duty. The procedure was started as a diagnostic laparoscopy followed by laparoscopic appendicectomy if the appendix was macroscopically inflamed. If the appendix was normal, it was left in place. There were 51 patients with a macroscopically normal appendix. Subsequently, none of them suffered from appendicitis or any other disorder requiring surgery. In 182 patients with laparoscopically assessed inflamed appendix, laparoscopic appendicectomy was attempted. One hundred and forty-eight proved successful, whereas 34 were converted to an open operation, mainly because of limited experience with the laparoscopic technique. Wound infection occurred in two and intraperitoneal abscess in four patients (0.9% and 1.7%), respectively. There was only one complication (0.4%) directly related to the laparoscopic procedure, namely a coecal leak. In conclusion, in a teaching hospital, laparoscopic appendicectomy can be safely offered to patients where surgery is indicated due to suspicion of appendicitis.

Abdomen, Acute↗
PubMed1997

[Hepatic metastases disclosed by laparoscopy and echographic laparoscopy. Impact of ultrasound-guided biopsy].

UNLABELLED: The aim of this prospective study was to study the impact of biopsies of liver metastases guided by laparoscopic ultrasound (LUS) and to evaluate various biopsy techniques. MATERIAL AND METHODS: Laparoscopy with LUS was performed on 18 consecutive patients with liver metastases considered to be surgically curable. Any new liver lesion which could lead to a therapeutic modification was biopsied, with a forceps or guided by LUS using four different techniques. RESULTS: Of 17 patients successfully examined, a biopsy was indicated in 12 cases (71%), extension of the surgical procedure was decided in four cases (24%), and laparotomy was avoided in six cases (35%). The preoperative staging was correct in 15 stages (88%) and incorrect in two cases (12%). The positioning of the puncture needle in the axis of the scanning plane by "free hand" or in association with an abdominal transducer was effective, without complications. CONCLUSION: Any liver lesion discovered by LUS which could lead to a modification or abstention of surgery should be biopsied, with LUS-guidance in the case of deep lesions. However, an optimal and universal guiding system for LUS-probes, has not yet been developed.

Adult↗
PubMed1998

[Has laparoscopy changed the surgical approach in gastroesophageal reflux? Apropos of an experience with 63 cases of gastroesophageal reflux treated by laparoscopy].

INTRODUCTION: Indications for surgery in gastrooesophageal reflux disease (GERD) have decreased significantly since the introduction of proton pump inhibitors. At the same time there has been renewed surgical interest in this disease triggered by the development of laparoscopy. We present our results with laparoscopic treatment of GERD and the change in our surgical approach to the condition during the past few years. METHODS: All patients admitted to the surgical department underwent prior evaluation by a gastroenterologist. Indications for surgery were resistance to medical therapy in 30 cases, recurrence of GERD after cessation of treatment in 25 cases and personal preference of the patient when maintenance therapy was necessary in 6 cases. The data were reviewed and the patients contacted during the first trimester of 1998 to evaluate long-term results. RESULTS: 63 patients were operated on between 1991 and July 1997. Rossetti-Nissen fundoplication was performed routinely until March 1995. Thereafter, the type of antireflux surgery has been chosen according to the preoperative evaluation of the patients, including endoscopy, oesophageal manometry and gastric emptying studies. There was no mortality and, except for one case, only minor morbidity. Four patients required reoperation, two for severe gas bloat syndrome and two for recurrence of GERD. Overall, the long-term follow-up shows that 93 patients are satisfied or very satisfied with their outcome (Visick 1 or 2). 5% of the patients need daily medication for heartburn, 5% complain of occasionally disturbing dysphagia, and 12% of sometimes distressing gas bloat. More patients have gas bloat after the Rossetti-Nissen procedure than after the Nissen or Toupet fundoplications. CONCLUSIONS: The enthusiasm of surgeons for the laparoscopic approach to GERD has prompted renewed interest in the pathophysiology of the disease. Consequently, indications for surgery are better defined, surgical technique is chosen according to the individual patient based on objective preoperative studies and follow-up has improved. In this setting, laparoscopic fundoplication represents an effective treatment for GERD. It is associated with lower postoperative morbidity than open surgery and represents the first choice when surgery is indicated.

Adult↗
PubMed2001

Equi-lasting doses of rocuronium, compared to mivacurium, result in improved neuromuscular blockade in patients undergoing gynecological laparoscopy : [Des doses de durée équivalente de rocuronium, comparé au mivacurium, améliorent la curarisation chez des patientes qui subissent une laparoscopie gynécologique].

PURPOSE: To compare equi-lasting doses of a short-acting (mivacurium) to an intermediate-acting (rocuronium) neuromuscular relaxant, with regard to intubating conditions, efficacy, number of maintenance doses, hemodynamic alterations, adverse events and costs, in patients undergoing laparoscopic gynecological surgery. METHODS: Sixty patients were randomly allocated to receive either 0.2 mg*kg(-1) (3 x ED(95)) mivacurium or 0.5 mg*kg(-1) (1.7 x ED(95)) rocuronium, under propofol/fentanyl anesthesia. T1, first twitch of the train-of-four (TOF) and TOF ratio (T4:T1) were used to evaluate neuromuscular block using the Relaxometer(R) mechanomyograph. The trachea was intubated when T1 was maximally suppressed. Neuromuscular block was maintained at 25% T1 with equi-lasting doses of 0.075 mg*kg(-1) mivacurium or 0.15 mg*kg(-1) rocuronium. RESULTS: Mean (min) +/- SD mivacurium onset time (1.9 +/- 0.4) was longer than that of rocuronium (1.3 +/- 0.3). This did not yield a statistical difference in intubating conditions between the two groups. Interval 25-75% T1 recovery and time to 0.8 TOF recovery were prolonged following rocuronium (11.9 +/- 3.9, 52.6 +/- 15.5 respectively) compared to mivacurium (6.7 +/- 2.3, 39.2 +/- 8.1 respectively). More patients, 22/30, required mivacurium maintenance doses compared to 14/30 patients in the rocuronium group. Arterial blood pressure declined and 13/30 patients manifested erythema following mivacurium administration. The acquisition costs of rocuronium (6.93 Euro/patient) were 23% lower compared to mivacurium (8.96 Euro/patient). CONCLUSION: Equi-lasting doses of rocuronium resulted in favourable intubating conditions more rapidly, improved hemodynamic stability, required less frequent administration of maintenance doses and were not associated with erythema, compared to mivacurium.

Adolescent↗