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At least 469 records · Page 26Linked to original sources

PubMed1995

Treatment of ectopic pregnancy by local injection of hypertonic glucose: a randomized trial comparing administration guided by transvaginal ultrasound or laparoscopy.

OBJECTIVE: To study local treatment of ectopic pregnancy by injection of hyperosmolar (50%) glucose, guided either by transvaginal ultrasound or by laparoscopy. METHODS: Eighty women were randomized, 39 into the sonography and 41 into the laparoscopy group. Criteria for inclusion were 1) ectopic pregnancy < or = 4 cm seen by transvaginal ultrasound, 2) hCG < or = 3000 IU/l, and 3) little or no intraabdominal bleeding. In the sonography group, patients were treated by one skilled ultrasound investigator, whereas injections by laparoscopy were performed by several colleagues. The former group were offered a second glucose injection if hCG levels were rising. Those successfully treated were offered hysterosalpingography (HSG) for evaluation of tubal patency. RESULTS: Twenty-nine (74.4%) women were successfully treated in the sonography group by one single injection, compared to 21 (51.2%) in the laparoscopy group. Eight women in the sonography group received a second glucose injection because of a rising hCG, increasing the success rate in this group to 82.1% (32 of 39 women). Six patients in the laparoscopy group were not injected due to technical difficulties during the operation, and the success rate for those injected were 60% (21 of 35 women). The overall success rate was 66.3%. Of the 28 women investigated by HSG, both tubes were normal in 19 (67.8%), and in 25 patients (89.3%) the treated tube was open. CONCLUSIONS: Local injection of hyperosmolar glucose guided by transvaginal ultrasound by one skilled investigator is an effective treatment for ectopic pregnancy. Most women preserve tubal patency after treatment.

Administration, Topical↗

PubMed1997

An economic evaluation of laparoscopy and open surgery in the treatment of tubal pregnancy.

BACKGROUND: Laparoscopy has generally replaced open surgery in the treatment of ectopic pregnancy. This study assesses the impact of the introduction of laparoscopy in the surgical treatment of tubal pregnancy on costs. METHODS: Consecutive patients undergoing primary surgery for tubal pregnancy between January 1992 and December 1995 were included in the study. Surgery was performed laparoscopically or by open surgery. Cost for each treatment was calculated by multiplying resources used with calculated resource unit prices. The analysis was stratified for radical and conservative surgery. RESULTS: Data of 255 patients were analysed. Tubal pregnancy was successfully treated in all patients. Costs per patient were US$ 3,490 for radical open surgery, US$ 1,872 for radical laparoscopic surgery, US$ 3420 for conservative open surgery and US$ 2,125 for conservative laparoscopic surgery. Differences in costs were caused by a decreased duration of hospital stay after laparoscopy, and, in case of conservative surgery, by an increased persistent trophoblast rate after laparoscopy. CONCLUSIONS: Laparoscopy is equally effective as open surgery in the treatment of tubal pregnancy, and considerably reduces costs.

Adult↗

PubMed1999

Laparoscopy-assisted urologic surgery through minilaparotomy.

Minimally invasive surgery has gained wide acceptance as a method of reducing postoperative pain and curtailing the convalescence period. We have devised a modified surgical technique of laparoscopy-assisted surgery through minilaparotomy. It is a hybridized form of conventional open and laparoscopic surgery and it combines the benefits of both techniques by reducing postoperative pain and scarring as in laparoscopy, but at the same time maintaining the safety of conventional open surgery. From January 1992 to September 1999, we performed laparoscopy-assisted surgery through minilaparotomy in 167 patients. The operative time for laparoscopy-assisted surgery through minilaparotomy ranged from 79 to 290 minutes (mean 125). There was no conversion to open surgery, no peri- or postoperative complications, and only 3 patients needed a blood transfusion at any stage. Pain was significant on the first day but resolved quickly. All patients resumed consistent oral intake on the second day. All patients commenced ambulation by the second postoperative day and were able to resume full ambulatory activity by the fourth postoperative day. The final would size did not exceed 10 cm in size and all patients expressed satisfaction with their wounds. In conclusion, we believe that laparoscopy-assisted minilaparotomy surgery is a truly minimally invasive technique maintaining the advantages of conventional surgery. Our method could become a first-line approach for simple nephrectomy, living donor nephrectomy and radical nephrectomy, as well as surgery for kidney and ureter stones.

Adolescent↗

PubMed2003

Is laparoscopy an advantage in the diagnosis of cirrhosis in chronic hepatitis C virus infection?

AIM: To evaluate the potential of laparoscopy in the diagnosis of cirrhosis and outcome of interferon treatment in HCV-infected patients. METHODS: In this retrospective study, diagnostic laparoscopy with laparoscopic liver biopsy was performed in 72 consecutive patients with chronic HCV infection. The presence or absence of cirrhosis was analyzed macroscopically by laparoscopy and microscopically by liver biopsy specimens. Clinical and laboratory data and outcome of interferon-alfa treatment were compared between cirrhotic and noncirrhotic patients. RESULTS: Laparoscopically, cirrhosis was seen in 29.2 % (21/72) and non-cirrhosis in 70.8 % (51/72) of patients. Cirrhotic patients were significantly older with a significant longer duration of HCV infection than noncirrhotic patients. Laboratory parameters (AST, y-GT, y-globulin fraction) were measured significantly higher as well as significantly lower (prothrombin index, platelet count) in cirrhotic patients than in non-cirrhotic patients. Histologically, cirrhosis was confirmed in 11.1 % (8/72) and non cirrhosis in 88.9 % (64/72). Patients with macroscopically confirmed cirrhosis (n=21) showed histologically cirrhosis in 38.1 % (8/21) and histologically non-cirrhosis in 61.9 % (13/21). In contrast, patients with macroscopically non-cirrhosis (n=51) showed histologically non cirrhosis in all cases (51/51). Thirty-nine of 72 patients were treated with interferon-alfa, resulting in 35.9 % (14/39) patients with sustained response and 64.1 % (25/39) with non response. Non-responders showed significantly more macroscopically cirrhosis than sustained responders. In contrast, there were no significant histological differences between non-responders and sustained responders. CONCLUSION: Diagnostic laparoscopy is more accurate than liver biopsy in recognizing cirrhosis in patients with chronic HCV infection. Liver biopsy is the best way to assess inflammatory grade and fibrotic stage. The invasive marker for staging, prognosis and management, and treatment outcome of chronic HCV-infected patients need further research and clinical trials. Laparoscopy should be performed for recognition of cirrhosis if this parameter is found to be of prognostic and therapeutic relevance in patients with chronic HCV infection.

Adult↗

PubMed1992

Tuberculous peritonitis in Egypt: the value of laparoscopy in diagnosis.

Abdominal laparoscopy was performed on 200 patients with undiagnosed ascites. It was unsuccessful in one patient with tuberculous peritonitis because of extensive adhesions. A presumptive diagnosis of tuberculous peritonitis based on clinical findings and peritoneal tubercles or adhesions visualized during laparoscopy was made in 90 of these patients. The diagnosis was confirmed in 88 by histopathology, bacteriology, or therapeutic response. Two of the 109 remaining patients who had other presumptive diagnoses made during laparoscopy were eventually confirmed to be cases of tuberculous peritonitis. Of 91 patients with tuberculous peritonitis included in this series, 79% were females, with the majority (79%) of them being of child-bearing age. Half had been ill for longer than one month. The most frequent complaints were abdominal pain, fever, anorexia, night sweats, abdominal swelling, and weight loss. Ascites, fever, wasting, pallor, and abdominal tenderness were common findings. Ultrasonography demonstrated ascites in all patients who underwent this procedure; 21% also had adhesions. Pleural effusion was present in 15% and pulmonary tuberculosis was detected in only two patients. Biopsy samples taken during laparoscopy showed that 60% had noncaseous granulomas and 33% had caseous granulomas. Mycobacterium tuberculosis was detected in 77%, with guinea pig inoculation having the highest sensitivity, followed by culture, and lastly by acid-fast smear. Mycobacterium tuberculosis was isolated more easily from biopsy samples than from ascitic fluid. Nine of 20 M. tuberculosis isolates that were identified as to species were M. bovis. Tuberculous peritonitis, a frequent cause of febrile ascites in Egyptian women, was easily diagnosed by histopathologic and bacteriologic studies of biopsy samples taken at laparoscopy. All patients responded rapidly to antituberculosis therapy.

Adolescent↗

PubMed2001

[Laparoscopy-assisted total nephroureterectomy for renal pelvic and/or lower ureteral cancer].

PURPOSE: The usefulness of laparoscopy-assisted total nephroureterectomy for patients with renal pelvic and lower ureteral cancer is evaluated. MATERIAL: Seven patients with renal pelvic cancer and four with lower ureteral cancer performed laparoscopy-assisted total nephroureterectomy from May 1997 to December 2000 (Ten males and one female, mean age 68.5 year-old). METHOD: Of the 11 patients, the initial one received preoperative embolization of the renal artery. Under general anesthesia laparoscopy-assisted total nephroureterectomy underwent via transperitoneal approach in three patients and retroperitoneal approach in eight. After the kidney was completely dissected under laparoscopic procedure, it was delivered en bloc with ureter from the skin incision in the lower abdomen. RESULT: Two patients needed conversion to open surgery. The mean operating time of nine patients except for conversion cases was 272 minutes and the mean blood loss was 313 ml. There was no major complication associated with laparoscopic procedure. There was no significant difference in both complication and recurrence rate between laparoscopy-assisted total nephroureterectomy and open surgery. CONCLUSION: Laparoscopy-assisted total nephroureterectomy is an useful procedure for the treatment of patients with renal pelvic and lower ureteral cancer because it enables us to remove out the kidney and ureter from one small lower abdominal incision.

Aged↗

PubMed1999

Laparoscopy in gynecologic surgery.

Laparoscopy has been utilized in gynecologic surgery for over 20 years. With the introduction of video monitoring and the development of new endoscopic instruments, the role of laparoscopy has greatly expanded. Laparoscopy is an invaluable tool in the management of the cancer patient. Current use focuses primarily on the diagnosis and staging of intraabdominal and pelvic malignancies. However laparoscopy is also utilized as an adjunct to therapeutic resection and palliation. The following is a brief discussion of the role of laparoscopy in the management of gynecologic cancer.

Adult↗

PubMed1999

[Clinical evaluation of patients submitted to open vs conventional gynecologic laparoscopy].

The objective was to comparate the clinical evolution and rates of complications for open and conventional gynecological laparoscopy. Were studied the cases of 253 patients divided in two groups: Group 1 (n = 106) patients treated with open laparoscopy, and group 2 (n = 147) patients managed with conventional surgery. The major indication for performing laparoscopy was infertility management. There were not early or I ate complications of trocar insertion or operative laparoscopy in the group 1. However, in group 2 there were four complications (P < 0.05), two related with needle or trocar insertion. As conclusion, in the studied group open laparoscopy can to eliminate the risks of blind insufflation and trocar insertion observed in the classifical technique, is a safe and efficacious method to treat several gynecological pathologies.

Adult↗

PubMed1999

Improved tumor staging by diagnostic laparoscopy.

This study was performed to assess the role of additional diagnostic laparoscopy in the preoperative staging of patients with adenocarcinoma of the esophagus, gastric cancer and pancreatic cancer prior to intended curative surgery. 89 patients with primary solid abdominal tumors were eligible for evaluation; of those 49 patients had a gastric cancer, 33 a pancreatic cancer and seven an adenocarcinoma of the esophagus. Patients without histologically proven metastases proceeded to laparotomy. Metastases were detectable laparoscopically in nine of 49 patients (18.4%) with gastric cancer (peritoneum n = 5, omentum n = 2, liver n = 2). Intraoperatively metastases were evident in further five cases (liver n = 3, peritoneum n = 2). In eleven of 33 patients (33%) with pancreatic cancer metastases were detected by laparoscopy (liver n = 6, peritoneum n = 2, liver and peritoneum n = 3) and in further four patients intraoperatively (liver n = 2, peritoneum n = 2). One of seven patients with an adenocarcinoma of the esophagus had liver metastases detected by laparoscopy. Intraoperatively no metastases were evident in those patients. Laparotomies were avoidable in 21 of the 89 patients (23.6%) who had a diagnostic laparoscopy prior to intended curative resection. Preoperative staging by additional diagnostic laparoscopy proved effective in patients with gastric and pancreatic cancer.

Adenocarcinoma↗

PubMedDate not supplied

Laparoscopy in the management of children with chronic recurrent abdominal pain.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate the results of diagnostic laparoscopy in children with chronic recurrent abdominal pain. PATIENTS AND METHODS: Thirteen children with chronic recurrent abdominal pain were subjected to diagnostic laparoscopy. Ages varied from 10 to 17 years. There were six males and seven females. Abdominal pain was present from 3 weeks to 12 months (mean, 2 months). Extensive laboratory and imaging studies did not contribute to the diagnosis. In all patients, the pain was disabling and severe enough to warrant repeated visits to the pediatrician, emergency room visits, or hospital admissions, as well as absence from school. RESULTS: All children recovered uneventfully. Laparoscopic findings that identified the cause of abdominal pain were obtained in 12 of 13 patients. Laparoscopic appendectomy was done in all patients. There were no operative complications. One child presented three months later with incomplete small bowel obstruction, which resolved with conservative management. There were no other postoperative complications. Follow-up varied from six months to three years. Abdominal pain resolved in ten patients. One patient presented eight months later with biliary dyskinesia. She improved following laparoscopic cholecystectomy and later on sphincterotomy, but her pain has not yet completely resolved. One patient presented six months later with abdominal pain secondary to intestinal adhesions. Her pain completely resolved after laparoscopic lysis of adhesions. A third patient who developed lower abdominal pain six months after laparoscopy improved with conservative management and antibiotics for pelvic inflammatory disease. CONCLUSIONS: Diagnostic laparoscopy is a valuable procedure in the management of children with chronic recurrent abdominal pain. In the present study, laparoscopic examination revealed the cause of abdominal pain in most patients, and this pain resolved in most cases. Based on our experience, we recommend diagnostic laparoscopy early in the course of debilitating chronic recurrent abdominal pain in children. Appendectomy should be done when no other significant cause of abdominal pain has been identified, even if the appendix looks normal.

Abdominal Pain↗

PubMed1999

[Sanative postoperative laparoscopy using rapid bacteriological methods in comprehensive treatment of patients with diffuse peritonitis].

In treatment of patients with diffuse peritonitis the authors have been using postoperative sanative laparoscopy which proved to provide a means not only for rapid evaluating the dynamics of peritonitis course, but also for carrying out a series of therapeutic manipulations aimed at proper management of infections and inflammatory complications. Sanative laparoscopy was accompanied by taking samples of peritoneal exudate to study sensitivity of microflora to antibiotics and antiseptic substances, ensuring rational antibacterial treatment of peritonitis. This therapeutic method was used in 38 patients who underwent 60 examinations. Sanative laparoscopy was of a planned character in 30 patients, and in 8 cases it was carried out for emergency indications. All the studies were performed within 12-23 hours. A single examination was carried on in 11 subjects, the rest of the patients demanding from 2 to 3 examinations. No complications related to sanative laparoscopy were observed. Positive outcome was noted in the majority of the patients, re-laparoscopy being indicated but for 3 patients. Two patients died due to causes not related to the pathology involved.

Anti-Bacterial Agents↗

PubMed1999

[Laparoscopy in abdominal trauma].

Laparoscopy is very useful in penetrating abdominal trauma, in particular to exclude intraabdominal lesions in stab wounds. In blunt abdominal trauma laparoscopy is not the first choice of diagnostic means though it warrants comparable good results to CTscan and ultrasound. Invasiveness, high costs, and time consuming procedure require a critical and specific application making it suitable especially in unclear clinical situations and equivocal diagnostic findings. Without doubt laparoscopy is only useful in hemodynamically stable patients and is of secondary value in polytraumatized patients. In the future it has to be thought about laparoscopy in local anesthesia and in bedside procedure e.g. on the intensive care unit. Laparoscopy should be regarded as an integral part of diagnostic spectrum in blunt abdominal trauma.

Abdominal Injuries↗

PubMed1999

Two-millimeter minisite mini-laparoscopy for rescue of dysfunctional continuous ambulatory peritoneal dialysis catheters.

In addition to peritonitis, mechanical outflow obstruction is the most common complication of continuous ambulatory peritoneal dialysis. If conservative methods are unsuccessful, the insufficient catheter must be placed in the right position or freed surgically. Currently, laparoscopy appears to be the method of choice in these cases. "Standard" laparoscopy using 10- and 5-mm ports can lead to dialysate wound leakage. Two-mm mini-laparoscopy was employed in three cases with good results. In two patients, catheters are still patent (after 19 and 23 months), and in one patient, the catheter had to be replaced after 5 weeks. No postoperative complications occurred. In some cases of catheter dislodgement or wrapping, mini-laparoscopy using a 2-mm MiniSite device can replace open surgery and even "standard" laparoscopy.

Catheters, Indwelling↗

PubMed2000

[Diagnostic possibilities of laparoscopy in acute surgical diseases of the abdominal organs].

The diagnostic combined laparoscopy was performed in 3.3% of patients, hospitalized with conjectural diagnosis of an acute disease of the abdominal cavity organs. In 655 of the total of 16,233 patients operated on in emergency, an acute disease was not revealed. In 37.3% of patients an urgent laparoscopy was performed for the abdominal trauma. Diagnosis, established before the laparoscopy performance, was confirmed in 36.6% of patients. Basing on the urgent laparoscopy data, performed for abdominal trauma, in 133 (49%) of patients the laparotomy conduction have been avoided. Conjectural diagnosis of an acute appendicitis according to the laparoscopy data was confirmed in 25.6% of observations, perforative ulcer--in 28.6%, an acute cholecystitis--in 54.3%, an acute pancreatitis--in 45.6%.

Abdomen↗

PubMed2000

Input and output for surgical simulation: devices to measure tissue properties in vivo and a haptic interface for laparoscopy simulators.

Current efforts in surgical simulation very often focus on creating realistic graphical feedback, but neglect some or all tactile and force (haptic) feedback that a surgeon would normally receive. Simulations that do include haptic feedback do not typically use real tissue compliance properties, favoring estimates and user feedback to determine realism. When tissue compliance data are used, there are virtually no in vivo property measurements to draw upon. Together with the Center for Innovative Minimally Invasive Therapy at the Massachusetts General Hospital, the Haptics Group is developing tools to introduce more comprehensive haptic feedback in laparoscopy simulators and to provide biological tissue material property data for our software simulation. The platform for providing haptic feedback is a PHANToM Haptic Interface, produced by SensAble Technologies, Inc. Our devices supplement the PHANToM to provide for grasping and optionally, for the roll axis of the tool. Together with feedback from the PHANToM, which provides the pitch, yaw and thrust axes of a typical laparoscopy tool, we can recreate all of the haptic sensations experienced during laparoscopy. The devices integrate real laparoscopy toolhandles and a compliant torso model to complete the set of visual and tactile sensations. Biological tissues are known to exhibit non-linear mechanical properties, and change their properties dramatically when removed from a living organism. To measure the properties in vivo, two devices are being developed. The first is a small displacement, 1-D indenter. It will measure the linear tissue compliance (stiffness and damping) over a wide range of frequencies. These data will be used as inputs to a finite element or other model. The second device will be able to deflect tissues in 3-D over a larger range, so that the non-linearities due to changes in the tissue geometry will be measured. This will allow us to validate the performance of the model on large tissue deformations. Both devices are designed to pass through standard 12 mm laparoscopy trocars, and will be suitable for use during open or minimally invasive procedures. We plan to acquire data from pigs used by surgeons for training purposes, but conceivably, the tools could be refined for use on humans undergoing surgery. Our work will provide the necessary data input for surgical simulations to accurately model the force interactions that a surgeon would have with tissue, and will provide the force output to create a truly realistic simulation of minimally invasive surgery.

Computer Simulation↗

PubMed2001

[Diagnostic laparoscopy--a useful tool in abdominal lymphoma].

Imaging-guided (CT/US) percutaneous biopsy has significantly improved diagnosis of intra-abdominal lymphoma. However, in many cases the tissue retrieved may be inadequate for specialized studies such as immunophenotyping or cytogenetic analysis that may be required for a complete analysis of lymphoma or determination of therapy. The success of diagnostic laparoscopy in the diagnosis and staging of gastrointestinal malignancies suggests that it could be used for intra-abdominal lymphomas as well. We describe our experience in 15 patients with suspected lymphoma who underwent diagnostic laparoscopy during 1995-98. Preoperative investigation performed in all included percutaneous FNA in 9 without conclusive diagnosis. Laparoscopy was diagnostic for lymphoma in 14 (93%) while in 1 there was a false negative result due to sampling error and the lymphoma was only diagnosed at a second laparoscopy. There was no mortality nor any major complication. Average hospital stay was 2 days and patients were then referred for further oncological treatment. Our experience shows that diagnostic laparoscopy is a safe and efficient tool and without major complications in diagnosing abdominal lymphoma.

Abdominal Neoplasms↗

PubMedDate not supplied

The success of laser laparoscopy in the treatment of endometriosis: a two-step analysis.

BACKGROUND AND OBJECTIVES: The most advantageous treatment for nonextensive endometriosis has long been the subject of debate. In recent years, the ability to detect atypical presentations has allowed the gynecological surgeon to treat this disease more readily. The treatment in the past has only been concerned with the singular treatment being applied at the time, not on the effects that previous treatments have had. The purpose of the current study was to see whether previous unsuccessful treatment modalities affected subsequent laser laparoscopy treatment of endometriosis. METHODS: Patients who were previously treated for their endometriosis (minimal and mild) underwent treatment of their disease by laser laparoscopy and the results were analyzed by chi2 (chi-square) analysis. RESULTS: Those patients previously treated with laser laparoscopy and laparotomy demonstrated poorer results than those previously treated with expectant, medical, or cautery. The sum of the original treatments plus the second treatment of laser laparoscopy was equal in all groups. CONCLUSIONS: If endometriosis is diagnosed at the time of laparoscopy and is easily amenable to treatment, it behooves the physician to treat it at the time of surgery.

Adult↗

PubMed2001

[Laparoscopy as part of the evaluation and management of ovarian and cervix neoplasms].

INTRODUCTION: Surgery is the treatment of choice in most early stages of cervical cancer and advanced stages of ovarian cancer. Failing to preoperatively diagnose para-aortic and parametrial metastases in cervical cancer or a non-resectable, ovarian cancer, may results in a superfluous laparotomy. AIM: To evaluate the advantage of using laparoscopy in cervical and ovarian cancer. PATIENTS AND METHODS: Study population includes patients with ovarian or cervical cancer referred between 1997-1999. A CT scan and a trans-vaginal sonography were used to detect involvement of pelvic and para-aortic lymph nodes, parametrium and other metastases. In patients with cervical cancer, para-aortic lymph node dissection was laparoscopically performed. When para-aortic nodes were negative and parametrium was clear, radical hysterectomy and pelvic lymph nodes dissection was conducted through laparotomy. When para-aortic lymph nodes or parametrium were positive, patients were referred for radiation therapy. In ovarian cancer patients, the upper abdomen and the pelvis were examined laparoscopically to evaluate the possibility of optimal debulking surgery. Staging was done for patients who were not candidates for optimal debulking surgery and second debulking surgery was considered. RESULTS: Nine patients with stage 1b-11a cervical cancer were included. Preoperatively, 2 of them were suspected for lymph node involvement. Following laparoscopy one was confirmed to have para-aortic lymph node involvement and the other did not. In the remaining 8 patients, one was found to have parametrial involvement and laparotomy was avoided, while the rest were treated surgically. Eighteen ovarian cancer patients were included in this study. Laparoscopy revealed an extensive disease in 7 patients and therefore staging laparoscopy was completed. In the remaining 11 patients, laparotomy was performed, operable disease was found and complete debulking surgery was conducted. In only one patient of the 11 complete debulking surgeries was not possible. CONCLUSIONS: In accordance with the experience and skills of the surgical team, we propose utilizing laparoscopy in cases where laparotomy may be avoided.

Female↗