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At least 433 records · Page 24Linked to original sources

PubMed1998

Laparoscopy as a day-case procedure in patients with liver disease.

BACKGROUND AND STUDY AIMS: The present study was aimed at exploring the feasibility of diagnostic laparoscopy on a day-case basis in patients with liver disease. PATIENTS AND METHODS: Retrospective analysis was carried out of 85 consecutive day-case laparoscopies performed between January 1990 and January 1994. During this period, patients were observed in day-care facilities for a period of three hours. Patients' perception and acceptance of the procedure were assessed using a postal questionnaire. RESULTS: Laparoscopy was successful in 84 of the 85 patients; adequate liver biopsies were obtained in 83 patients. In three cases, the procedure was converted to a one-night hospital admission because of pain (1), persistent sedation (1) and collapse (1). Abdominal skin hematomas were reported by eight patients, and fever by two. Serious complications were not observed. The majority of patients experienced no complaints, or minor ones, after the procedure, and they expressed a preference for an outpatient procedure in case a renewed investigation might be indicated. Compared with in-hospital procedures, day-case laparoscopy was associated with a 33% reduction in cost. CONCLUSIONS: Diagnostic laparoscopy, with the hospital stay reduced to three hours, can be performed safely as a day-case procedure in selected patients.

Adult↗

PubMed1985

[Preoperative laparoscopy for determination of the surgical approach].

131 selected patients underwent preoperative laparoscopy directly before surgery and under the same anaesthesia during the period 1981-1984. In all 131 patients several findings were present in combined form that would have permitted abdominal surgery only, provided laparoscopy had not been performed. 49 patients were operated upon via the abdominal approach even though they had been subjected to laparoscopy. In 82 patients, the more favourable vaginal approach was rendered complicated by additional findings (in 22, antefixating preliminary operations on the uterus after Doléris or Baldy; in 29, cystic adnexal tumours; in 31, adhesions or unclear conditions of pain following known or unknown previous surgery). By preceding surgery by laparoscopy it became possible to treat these patients in such a manner that the subsequent vaginal operation was without risk and free from complications. Preoperative laparoscopy extends, enables and safeguards the indication for vaginal surgical approach if used with the necessary critical discrimination.

Aged↗

PubMed1993

Laparoscopy in adnexal pathology in the child: a study of 28 cases.

We report our experience with laparoscopy in adnexal pathology in the child. Twenty-eight children (mean age 13 years; range 8 to 16) underwent 30 laparoscopy procedures. Therapeutic laparoscopy was performed in 3 cases: transposition of an ovary before radiotherapy, bilateral gonadal excision for Turner's syndrome and ovarian fixation after contralateral torsion of normal adnexa (TNA). Diagnostic and potentially therapeutic laparoscopy was performed in 25 cases: 12 suspected torsion of adnexa (6 confirmed), 4 possible ovarian or appendicular pathology (1 appendicitis), 4 to confirm the histological nature of an ovarian tumor (2 functional cysts, 1 old TNA, 1 dermoid cyst), 3 suspected salpingitis (2 confirmed), and 2 chronic pelvic pain (1 endometriosis). No pathology was found in 2 cases, and in 1 case pelvic adhesions prevented confirmation of the diagnosis. Thirteen laparoscopically-guided surgical acts were performed: 2 detorsions of adnexa, 2 excisions of necrosed adnexa and 9 punctures with or without biopsy for functional cysts. Intralaparoscopic detorsion of TNA was complicated in one case by fibrinolysis requiring secondary laparotomy. Mean hospitalisation was 3 days (range 1 to 16). the preferential therapeutic indications for laparoscopy in the child are transposition of an ovary and ablation of the gonads in case of sexual ambiguity. It is used diagnostically in cases of sudden pelvic pain. In addition to this diagnostic role, it now allows most treatments to be carried out (detorsion with or without fixation, transparietal cystectomy), including those for associated lesions (appendicectomy). Its morbidity is quite low, which warrants increasing the number of indications in pediatric pathology.

Adolescent↗

PubMed1994

Laparoscopy and impalpable testis--a prospective multicentric study (232 cases). GECI. Groupe d'Etude en Coeliochirurgie Infantile.

The value of laparoscopy in managing the impalpable testis remains controversial. Several reports have been published on this topic but series are usually short and rather heterogeneous in their presentation, so that critical analysis is not easy to perform. Therefore, the Groupe d'Etude en Coeliochirurgie Infantile started a multicentric prospective study in May 1991 with two objectives: what are the laparoscopic findings and what are the correlations between laparoscopy and surgery? In addition, this study tried to estimate the therapeutic implications. Two hundred and one boys underwent laparoscopy accounting for two hundred and thirty-two impalpable testis. Laparoscopic findings were mainly of three types: intra-abdominal testis (36%), abdominal blind ending cord structures (14%) and cord structures entering the deep inguinal ring (49%); rarely, there was absence of testis and cord structures (1%). Crossed testicular ectopia was not found in this series. One hundred and eighty-seven impalpable testis were operated on to control laparoscopic findings and correlations laparoscopy-surgery were excellent provided that laparoscopic exploration could be entirely performed in good conditions. Moreover, it could be evaluated that forty-seven per cent of impalpable testes could take advantage of laparoscopy.

Adolescent↗

PubMedDate not supplied

Laparoscopy in the management of impalpable testicle.

PURPOSE: In paediatric urology, one of the main applications of laparoscopy is the evaluation and treatment of impalpable testis. Herein we present our initial experience with laparoscopy in patients with impalpable testis. MATERIAL AND METHODS: Laparoscopy was performed under general anaesthesia on 13 patients. If the internal spermatic vessels and vas deferens made their way into the internal inguinal ring, the inguinal canal was dissected. Laparoscopic orchiopexy or orchiectomy was performed in cases with intra-abdominal testis. If the internal spermatic vessels found terminated intraperitoneally with a blind-end, the case was considered as a vanishing testis. RESULTS: Thirteen boys, aged from 18 months to 25 years (median 9.8 years) were identified with 21 impalpable testes. 14 of the 21 impalpable testes, the vas and the vessels were through the internal ring, and the inguinal region needed dissection. Orchiopexy was performed on 12 testes and orchiectomy was performed on two atrophic testes. Four of 21 testes were intra-abdominally localized. Laparoscopic orchiopexy was performed in two testes and laparoscopic orchiectomy was performed in two testes. Two boys were diagnosed as vanishing testes; the absence was unilateral on the left side in one case and bilateral in the other. CONCLUSION: Diagnostic laparoscopy is a very helpful, minimally invasive technique in the diagnosis of impalpable testes especially when ultrasonography and/or computed tomography are not informative enough. In addition, orchiectomy and orchiopexy can be done as laparoscopically in the patients with intra-abdominal testes. Therefore, the laparoscopy has an important role in the diagnosis and treatment of impalpable testes.

Adolescent↗

PubMed1997

Diverticulitis of the sigmoid colon. A comparison of CT, colonic enema and laparoscopy.

PURPOSE: To evaluate the use of laparoscopy, CT, colonic enema (CE), and laboratory tests (white blood cell count (WBC), sedimentation rate (SR), and C-reactive protein (CRP) in diagnosing diverticulitis of the sigmoid colon. MATERIAL AND METHODS: The diagnostic methods were prospectively evaluated in 88 patients, 30 of whom were referred for laparoscopy. RESULTS: Fifty-two patients were found to have sigmoid diverticulitis: 20 patients by laparoscopy, 21 by CT, and 11 by CE combined with one positive laboratory test. Laparoscopy proved to be superior to the other diagnostic methods in diagnosing diverticulitis of the sigmoid colon. CT had a high specificity (1.0; 95% CI: 0.92-1.0) but low sensitivity (0.69; 95% CI: 0.56-0.79) in detecting diverticulitis. CE had a higher sensitivity (0.82; 95% CI: 0.71-0.90) but a lower specificity (0.81; 95% CI: 0.67-0.91) than CT. CONCLUSION: CT was the best method for diagnosing abdominal pathology outside the colon. CT can be recommended as the first examination in seriously ill patients where abscesses and other causes of the symptoms than diverticulitis must first be ruled out. Laparoscopy is probably the most accurate method in diagnosing diverticulitis.

Adult↗

PubMed2002

Abdominal emergencies: diagnostic and therapeutic laparoscopy.

BACKGROUND: Laparoscopy has been practiced in the management of emergencies resulting from inflammatory conditions, lumenal obstruction, perforation, vascular occlusion, and trauma. This article identifies and discusses controversial areas in the field, in particular surrounding the efficacy, cost effectiveness, and perceived advantages of laparoscopy in the evaluation and treatment of patients with acute abdominal conditions. MATERIALS AND METHODS: Review and commentary on pertinent articles in the English language literature are presented. RESULTS: Prospective randomized trials have been reported in the treatment of some disorders, but a lack of recommendations that are evidence-based has hindered more widespread usage of laparoscopy in an emergency setting. In addition, concerns have been raised that the creation of capnoperitoneum in the patient with established peritonitis may be detrimental with respect to potentiation of bacteremia and severe sepsis, and experimental studies have yielded conflicting data in this regard. CONCLUSION: As such issues are resolved, utilization of laparoscopy is likely to increase substantially as expertise is acquired. A minimal-access approach carries less morbidity and may offer other practical advantages in terms of surgical technique and application. When surgical intervention is appropriate, laparoscopy is now preferred for acute biliary disease. Female patients of reproductive age with acute appendicitis may benefit, particularly if there is preoperative diagnostic uncertainty. Selected cases of intestinal obstruction and visceral perforation presenting soon after symptom onset and in whom shock is absent may also be amenable to laparoscopic repair. Its use in the treatment of most trauma patients and patients with generalized peritonitis or hemodynamic instability is not recommended at present.

Abdomen↗

PubMed1991

Double laparoscopy: an alternative two-stage procedure to minimize bowel and blood vessel surgery.

We present double laparoscopy as an alternative technique especially useful with the scarred abdomen postlaparotomy or when open laparoscopy has failed. This is a two-stage abdominal endoscopic procedure. Stage 1. This is the establishment of a pneumoperitoneum with insertion of a Verres needle through the left upper quadrant of the abdominal wall lateral to the rectus muscle, two fingers beneath the inferior costal margin. A sharp 5 mm trocar and sleeve is inserted through a small skin incision at the needle puncture site, and a small endoscope is then inserted. The hysteroscope or a 5 mm OD diagnostic laparoscope is an excellent instrument for upper abdominal laparoscopy in the adult and for general laparoscopy in infants and children. The abdominal cavity is surveyed, especially viewing the periumbilical area. Stage 2. When an adhesion-free and bowel-free area is identified, a standard 10 mm sharp trocar and sleeve is inserted under direct vision, and a standard laparoscope is introduced. We present a small sampling (24 cases) of our combined experience of 5000 laparoscopies, where this technique proved useful. Although we have used this technique over the years without any complications, the procedure has never been published.

Blood Vessels↗

PubMed1994

Pain after laparoscopy: an observational study and a randomized trial of local anesthetic.

Our objective was to determine if local anesthesia reduces pain after a laparoscopy. Eighty women were assigned randomly 10 ml of 0.5% bupivacaine or 0.9% saline flushed over the peritoneal folds and into the abdominal wall after laparoscopy under general anesthesia. Pain scores from the deep abdomen, skin, shoulder, and back were collected 30 min, 2 h, 4 h, and the day following laparoscopy. Pain scores also were correlated with patients' height, weight, operative findings, surgical technique and procedure, and volume of gas insufflated into the abdomen. Bupivacaine has a small effect on abdominal and skin pain 2 h after surgery (p = 0.01) but has no effect on shoulder or back discomfort. Women who have been sterilized, have not had previous abdominal surgery, or have evidence of old pelvic inflammation report more postoperative backache and deep abdominal pain but no greater skin or shoulder discomfort. Weight, height, whether the abdominal wall was picked up, and the volume of gas used to insufflate the abdomen are independent of all postoperative pain scores. Local anaesthetic instilled down the laparoscopy trocar reduces skin discomfort 2 h after surgery, but this beneficial effect is small compared with other factors influencing pain after laparoscopy.

Anesthesia, General↗

PubMed1995

A comparison of laparotomy and laparoscopy in the management of ovarian masses.

To compare the results of laparoscopy with laparotomy in the management of ovarian masses not suspected of being malignant, a retrospective review was made of 115 patients with ovarian masses operated on, 50 by laparotomy and 65 by laparoscopy, in the Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong, from November 1, 1992, to October 31, 1993. In the laparoscopy group, the average size of the ovarian masses was smaller, and there was a significant reduction in the intraoperative blood loss, postoperative analgesic requirement, morbidity (particularly febrile morbidity and urinary retention), length of hospital stay, and recuperation period. The incidence of rupture of the ovarian mass was not related to the operative approach but to the underlying pathology. Two patients in the laparoscopy group were converted to laparotomy, and 1 in the laparotomy group required a second laparotomy. The operating time was longer in the laparoscopic approach, but this could be reduced with experience and improved technique in specimen removal. Laparoscopy appears to be a better approach than laparotomy in the management of ovarian masses where malignancy is not suspected and a competent surgeon is available.

Adult↗

PubMed1997

Postoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures.

In this prospective study, we have compared women undergoing laparoscopic cholecystectomy, laparoscopic gynaecological surgery and laparoscopic minor gynaecological procedures (diagnostic, tubal, ligation) (n = 10 in each group) to determine if lower abdominal laparoscopy results in less postoperative pulmonary dysfunction than upper abdominal laparoscopy. Pulmonary testing was performed before operation, and 3 and 6 h after operation, on the first and second days after surgery. After operation, a significant reduction in forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate occurred after laparoscopic cholecystectomy at each time. There were no significant changes after minor gynaecologic laparoscopy, whereas laparoscopic gynaecological surgery resulted in minor pulmonary dysfunction on the day of surgery only. We conclude that postoperative pulmonary function was less impaired after gynaecological laparoscopy than after laparoscopic cholecystectomy. This study suggests that the site of surgery is an important determinant of lung dysfunction after laparoscopy.

Abdomen↗

PubMed2002

Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?

Traditionally, a diagnosis of unexplained infertility is established only when all standard clinical investigations yield normal results. When tubal patency has been established by hysterosalpingography (HSG), laparoscopy has been suggested as a mandatory step to preclude the existence of peritubal adhesions and endometriosis as causes of infertility. In women without a previous history suggestive of tubal disease and who have a normal HSG, it was demonstrated that the probability of clinically relevant tubal disease or endometriosis is very low and that laparoscopy does not seem justified or cost effective. In the minority of these cases, laparoscopy might reveal minimal or mild endometriosis or peritubal adhesions. In these cases, either surgery or medical treatment has not been proven to improve fecundity. With the current success rates of assisted reproductive technologies (ART) and the relatively low contribution of diagnostic laparoscopy to the decision-making process of treating patients with a normal HSG, we suggest that laparoscopy should be omitted in couples suspected of having unexplained infertility. These patients should be treated by 3-6 cycles of combined gonadotrophins and intrauterine insemination, and if unsuccessful switched to ART.

Endometriosis↗

PubMed2006

Routine use of hysterosalpingography prior to laparoscopy in the fertility workup: a multicentre randomized controlled trial.

BACKGROUND: A multicentre randomized controlled trial with or without hysterosalpingography (HSG) was conducted to assess the usefulness of HSG as a routine investigation in the fertility workup prior to laparoscopy and dye. METHODS: From 1 April 1997 to 1 April 2002, subfertile women were allocated by a computer-based 1 : 1 ratio randomization procedure, either for an HSG followed by laparoscopy and dye (the intervention group) of for laparoscopy and dye only (the control group) as a part of their fertility workup. Cumulative pregnancy rate (CPR) within 18 months after randomization was the primary outcome of interest. RESULTS: 344 women were randomized to the intervention group (n = 169) and the control group (n = 175). There was no significant difference in CPR at 18 months in the intervention group (49.1%) [95% confidence interval (CI) 41.6 to 56.6] and the control group (50.3%) (95% CI 42.8 to 57.8), a difference of -1.2% (95% CI -11.8% to 9.5%). CONCLUSION: The routine use of HSG at an early stage in the fertility workup prior to laparoscopy and dye does not influence CPR, compared with the routine use of laparoscopy and dye without HSG.

Adult↗

PubMed1996

Laparoscopic myomectomy of large symptomatic leiomyoma using airlift gasless laparoscopy: a preliminary report.

Despite the expanding role of laparoscopic surgery in many gynaecological fields, some discrepancies still exist regarding the efficacy of laparoscopic myomectomy in treating patients with large symptomatic leiomyoma. In this report, a better operative procedure and the results of treatment are evaluated. Patients (n = 14) presenting with infertility, menorrhagia, pressure symptoms or pelvic mass associated with a large leiomyoma were managed with laparoscopic myomectomy using airlift gasless laparoscopy. Uterine size ranged from 14 to 24 weeks gestational age and the weight of the myoma ranged from 246 to 669 g (mean 454); operative time ranged from 78 to 165 min (mean 104) and blood loss from 90 to 580 ml (mean 201). No major complication occurred during the operation or follow-up. All except one patient were discharged within 72 h of the operation and resumed normal activity within 1 week. When myomectomy is indicated, the airlift gasless laparoscopic approach appears to offer a better alternative to abdominal or pneumoperitoneum laparoscopic surgery in selected cases. Airlift gasless laparoscopy has several advantages: (i) small abdominal incisions and minimal endoscopic equipment are required; (ii) the excised leiomyomata mass can be easily cut into strips and removed through the small abdominal incision; (iii) the uterine defect can be more efficiently repaired using easily performed suture techniques; (iv) high-pressure irrigation and large-volume suction devices can be used without fear of decompressing the pneumoperitoneum; and (v) the potential risk of metabolic and haemodynamic derangements during pneumoperitoneum laparoscopy are obviated. Gasless laparoscopy also has some disadvantages. The exposure obtained with gasless laparoscopy is not as good, under some circumstances, as that achieved by pneumoperitoneum. For patients who are thin, and even those with moderate obesity, the exposure obtained with airlift mechanical suspension is adequate; however, morbidly obese patients with previous abdominal surgery with suspected pelvic adhesions can incur some problems during the operation because of a poor operative field.

Adult↗

PubMed1994

Salpingectomy by operative laparoscopy and subsequent reproductive performance.

Between January 1984 and August 1991, 511 cases of extrauterine pregnancies were diagnosed by laparoscopy in our department. In 374 cases salpingectomy was performed: 184 by explorative laparotomy, and 190 by operative laparoscopy. Patients were scheduled for salpingectomy if one or more of the following criteria were fulfilled: (i) a ruptured tube which was surgically unsuitable for conservation; (ii) no interest in future fertility; (iii) tubes with ectopic gestation previously operated on; (iv) a previous tubal pregnancy on the same side, which was treated expectantly. Salpingectomy was performed via operative laparoscopy with bipolar diathermy forceps and laparoscopic scissors. Pregnancy rates, i.e. intra-uterine and repeat extra-uterine, were evaluated. The reproductive performance following salpingectomy did not differ significantly, whether by laparotomy or laparoscopy: the intra-uterine pregnancy rate was 78 and 64%, respectively and the repeat ectopic pregnancy rate was 12 and 6%, respectively. Salpingectomy via laparoscopy can be performed safely with a low incidence of complications, with subsequent reproductive performance comparable to laparotomy.

Adult↗

PubMed1997

Diagnostic laparoscopy by physicians: we should do it.

Only a few centres in the UK practise diagnostic laparoscopy and liver biopsy; in comparison, laparoscopy is widely practised by physicians in Europe, the Far East and in the US. We consider the role of diagnostic laparoscopy in the assessment of liver disease in the 1990s, and describe the technique of laparoscopy, including how it may be performed safely in the endoscopy suite, under local anesthesia with mild sedation and analgesia, enabling direct visualization of the liver. We examine potential complications and contraindications. Complication rate and mortality are similar to that for percutaneous liver biopsy. Finally, the invaluable role of laparoscopy in diagnosing and staging chronic hepatitis, cirrhosis, liver tumours, hepatic infiltration, infection and structural abnormalities is considered.

Anesthesia, Local↗

PubMed1996

Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases.

OBJECTIVE: A tumor model in the rat was used to study peritoneal tumor growth and abdominal wall metastases after carbon dioxide (CO2) pneumoperitoneum, gasless laparoscopy, and laparotomy. SUMMARY BACKGROUND DATA: The role of laparoscopic resection of cancer is under debate. Insufflation of the peritoneal cavity with CO2 is believed to be a causative factor in the development of abdominal wall metastases after laparoscopic resection of malignant tumors. METHODS: In the solid tumor model, a lump of 350-mg CC-531 tumor cells was placed intraperitoneally in rats having CO2 pneumoperitoneum (n = 8), gasless laparoscopy (n = 8), or conventional laparotomy (n = 8). After 20 minutes, the solid tumor was removed through a laparoscopic port or through the laparotomy. In the cell seeding model, 5 x 10(5) CC-531 cells were injected intraperitoneally before CO2 pneumoperitoneum (n = 12), gasless laparoscopy (n = 12), or laparotomy (n = 12). All operative procedures lasted 20 minutes. After 6 weeks, in the solid tumor model and after 4 weeks in the cell seeding model, tumor growth was scored semiquantitatively. All results were analyzed using the analysis of variance. RESULTS: In the solid tumor model, peritoneal tumor growth in the laparotomy group was greater than in the CO2 pneumoperitoneum group (p < 0.01). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p < 0.01). The size of abdominal wall metastases was greater at the port site of extraction of the tumor than at the other port sites (p < 0.001). In the cell seeding model, peritoneal tumor growth was greater after laparotomy in comparison to CO2 pneumoperitoneum (p < 0.02). Peritoneal tumor growth in the CO2 group was greater than in the gasless group (p < 0.01). The port site metastases in the CO2 group were greater than in the gasless group (p < 0.01). CONCLUSIONS: The following conclusions can be made: 1) that direct contact between solid tumor and the port site enhances local tumor growth, 2) that laparoscopy is associated with less intraperitoneal tumor growth than laparotomy, and 3) that insufflation of CO2 promotes tumor growth at the peritoneum and is associated with greater abdominal wall metastases than gasless laparoscopy.

Abdominal Neoplasms↗

PubMed1993

A critical evaluation of laparoscopy in penetrating abdominal trauma.

One hundred hemodynamically stable patients with penetrating abdominal trauma (65, stab wounds, 35, gunshot wounds) were evaluated with laparoscopy. Sixty percent of the patients had wounds in the thoracoabdominal area or the upper abdominal quadrants and 25% had injuries located in the lower abdomen and flanks. Fifteen percent had epigastric wounds. Twenty-two stabs and 21 gunshots had not penetrated the peritoneum (negative laparoscopic results). Fifty-seven patients had peritoneal penetration and were noted to have hemoperitoneum only (n = 14), hemoperitoneum and solid organ injuries (n = 23), diaphragmatic lacerations (n = 17), and hollow viscus injuries (n = 2) on laparoscopic examination. Three of the 57 patients, one with omental herniation only and two with low grade nonbleeding lacerations of the liver, were managed uneventfully without laparotomy. The remaining 54 patients underwent laparotomy with confirmation of the laparoscopic findings. Seven patients (three with stab wounds and four with gunshots) had additional GI tract injuries seen at laparotomy. The diagnostic accuracy of laparoscopy was excellent for hemoperitoneum, solid organ injuries, diaphragmatic lacerations, and retroperitoneal hematomas. For GI injuries, laparoscopy was found to have a 100% specificity but only a 18% sensitivity. The majority of these discordant findings occurred in epigastric SWs and flank and lower quadrant GSWs, all in patients with undetected hollow viscus injuries. The major role of laparoscopy in penetrating abdominal trauma is in avoiding unnecessary laparotomy in tangential SWs and GSWs. It is excellent for evaluating the diaphragm in thoracoabdominal wounds. Caution is urged in excluding hollow viscus injuries based on laparoscopy.

Abdominal Injuries↗