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At least 487 records · Page 27Linked to original sources

PubMed2001

Laparoscopy versus laparotomy management of tubal pregnancy.

OBJECTIVE: To compare laparoscopy versus laparotomy management of tubal pregnancy and the reproductive outcome. METHODS: A retrospective chart review of 81 patients admitted for management of tubal pregnancy was carried out at Riyadh Armed Forces Hospital from January 1998 until January 2000. The patients were divided according to surgical procedure performed into: Group I (33 patients) laparoscopy and group II (48 patients) laparotomy. We evaluated pre and postoperative serum b-human chorionic gonadotrophin levels, total operating time, total blood loss or blood transfusion or both, duration of hospital stay, recurrence rates of ectopic pregnancy and future fertility outcome for all patients. RESULTS: No differences were found between both groups in patient age, parity, size of adnexal mass, condition at the time of presentation, site of tubal pregnancy, previous history of ectopic, pre and postoperative serum b-human chorionic gonadotrophin and the total operating time. There were significant reductions of total blood loss, number of blood transfusion units, and duration of hospital stay, in the laparoscopic group compared to the laparotomy group. A total of 54 patients desired pregnancy, 23 patients in the laparoscopy and 31 patients in the laparotomy group. No significant differences were found in the fertility outcome between both groups. The rates of subsequent intrauterine pregnancy were 74% (17/23) in the laparoscopy group and 61%, (19/31) in the laparotomy group and the rates of subsequent ectopic pregnancy were 4% (1/23) in the laparoscopy group and 10% (3/31) in the laparotomy group. CONCLUSION: Laparoscopic treatment of ectopic pregnancy in hemodynamically stable patients offers major economic benefits superior to laparotomy in terms of less need for blood transfusion, shorter duration of hospital stay and convalescence.

Adolescent↗

PubMed2001

Complications of laparoscopic procedures after concentrated training in urological laparoscopy.

PURPOSE: To increase the safety and efficiency of laparoscopic surgery clinical training programs have been developed to increase the skill and efficiency of urological trainees. We evaluated the impact of dedicated laparoscopy training on the rate and type of complications after trainees entered clinical practice. MATERIALS AND METHODS: Data were obtained from 13 centers where laparoscopy was performed by a single surgeon with at least 12 months of training in urological laparoscopy before clinical practice. Data included training experience, laparoscopic procedures performed after commencing clinical practice and associated complications. Procedures were classified as easy, moderate and difficult. RESULTS: During training each surgeon participated in a mean of 71 cases. In clinical practice a total of 738 laparoscopic cases were performed with the group reporting an overall complication rate of 11.9%. The rate was unchanged when the initial 20, 30 and 40 cases per surgeon were compared with all subsequent cases (12%, 11.9% and 12% versus 11.8 to 12%, respectively). The re-intervention rate was 1.1%. The complication rate increased with case difficulty. Overall and early complication rates attributable to laparoscopic technique in the initial 20, 30 and 40 cases were identical. The most common complications were neuropathy in 13 patients, urine leakage/urinoma in 9, transfusion in 7 and ileus in 5. CONCLUSIONS: The complication rate of surgeons who completed at least 12 months of laparoscopy training did not differ according to initial versus subsequent surgical experience. Intensive training seems to decrease the impact of the learning curve for laparoscopy.

Humans↗

PubMedDate not supplied

Adhesions and adhesiolysis: the role of laparoscopy.

BACKGROUND: Adhesions commonly result from abdominal and pelvic surgical procedures and may result in intestinal obstruction, infertility, chronic pain, or complicate subsequent operations. Laparoscopy produces less peritoneal trauma than does conventional laparotomy and may result in decreased adhesion formation. We present a review of the available data on laparoscopy and adhesion formation, as well as laparoscopic adhesiolysis. We also review current adjuvant techniques that may be used by practicing laparoscopists to prevent adhesion formation. DATABASE: A Medline search using "adhesions," "adhesiolysis," and "laparoscopy" as key words was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. DISCUSSION: The majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy. However, laparoscopy by itself does not appear to eliminate adhesions completely. A variety of adjuvant materials are available to surgeons, and the most recent investigation has demonstrated significant potential for intraperitoneal barriers. Newer technologies continue to evolve and should result in clinically relevant reductions in adhesion formation.

Humans↗

PubMedDate not supplied

Pneumothorax after diagnostic laparoscopy.

Here we want to call laparoscopist's attention to pneumothorax after diagnostic laparoscopy. Diagnostic laparoscopy has less complications, compared with laparoscopic surgery. In our experience, only one case (0.04%) developed pneumothorax during routine diagnostic laparoscopic procedure. This complication is presented in a 50-year-old female. She complained of dyspnea just after the decrease of intraabdominal pressure and deflation of intraperitoneal gas. The chest roentgenogram showed a right pneumothorax, and a right chest tube was inserted with immediate relief of tension. Pneumothorax during diagnostic laparoscopy is relatively rare but a major complication; Medline literature research showed six reported cases of pneumothorax after diagnostic laparoscopy from 1983 to 1998 including our case. The etiology was idiopathy in 5 and diaphragmatic injury in 1. Hypotension, elevation of inspiratory pressure, dyspnea, a decrease in systemic oxygen saturation, and loss of breath sounds suggest tension pneumothorax. The clinical condition of the patients improved rapidly because of the easy diffusion of the gas used in laparoscopy. Diagnostic laparoscopists should be aware of this complication and treat ventilatory problems.

Biopsy↗

PubMedDate not supplied

Management of advanced pancreatic cancer: staging laparoscopy and immunochemotherapy--a new treatment strategy.

BACKGROUND/AIMS: Pancreatic cancer remains a challenging disease with a dismal prognosis. This study investigated the effect of two-route immunochemotherapy via artery (2-ICA) and usefulness of staging laparoscopy in the management of advanced cases. METHODOLOGY: Fifty-five patients admitted to our Department between April 1993 and April 2000 for resection of pancreatic cancer were the subjects of this study. Staging laparoscopy was performed in 16 of the patients, and 2-ICA was used to treat three of 16 because they were found to have small liver metastases during staging laparoscopy. RESULTS: According to the TNM staging system (UICC), 9 (56%) in the 16 patients who underwent staging laparoscopy were found to have Stage IVb disease, 4 (25%) to have Stage IVa disease and only 3 (19%) to have Stage III disease. The three patients with small liver metastases received 2-ICA therapy. The metastatic lesions in the liver had completely disappeared in one patient, and decreased to about half the size in the other two cases. CONCLUSIONS: Staging laparoscopy is useful for correctly diagnosing tumor stage in pancreatic cancer patients and selecting appropriate treatment. The 2-ICA therapy is a new and effective method of treatment for advanced cases.

Adult↗

PubMed1975

[Gynaecological laparoscopy (author's transl)].

The double puncture laparoscopy was abandoned in our department in favor of the single puncture technique. 187 diagnostic laparoscopies and 617 laparoscopic tubal ligations are reviewed. In 46% of the diagnostic laparoscopies, the findings were confirmed. In 40% of the diagnostic laparoscopies, normal findings were seen and in 11%, a different abnormal finding than suspected was found. In 3% of women, the findings could not be elucidated by laparoscopy. None of the 617 patients who underwent laparoscopic tubal sterilization have become pregnant. In 5% of the patients (0.6%) complications occurred. In 3 cases a laparotomy became necessary. In 2 cases there was bleeding from the fallopian tube or the greater omentum and in 1 case there was a trauma to the intestine. Laparoscopic tubal sterilization by the single puncture technique and coagulation without division of the tube only, is considered to be the lowest risk method of the laparoscopic tubal sterilizations.

Abdominal Injuries↗

PubMed2003

[Impalpable testis: complete inguinal exploration by laparoscopy].

OBJECTIVE: To prospectively evaluate an inguinal approach to surgery for impalpable testis possibly assisted by laparoscopy during the same operation. MATERIAL AND METHODS: From January 1996 to March 2002 each case of unilateral impalpable testis was operated via an inguinal incision and laparoscopy was performed during the same procedure whenever the inguinal canal was devoid of any testicular structures. Sixty boys were included in this study. Anatomical features were evaluated and testes were classified according to their trophicity and their site. We evaluated the number of laparoscopies and the factors justifying this procedure. Orchidopexy was performed via an inguinal approach with extensive retroperitoneal dissection to release spermatic vessels, when necessary. A one-stage Fowler-Stephens operation was performed when the vascular pedicle remained too short despite this dissection. The results of orchidopexy were evaluated by physical examination with a minimum follow-up of 4 months. RESULTS: In this series of 60 cases, we identified 19 viable testes. Fourteen were situated in the abdomen, 3 in the inguinal canal, and 2 in a perineal ectopic position. The other cases were considered to present testicular atrophy. Laparoscopy was performed in 23 boys (38%) in whom no viable or atrophic testis was demonstrated via the inguinal incision. Sixteen of the 19 viable testes were descended by preserving the spermatic vessels with a good result. Two Fowler-Stephens operations gave a good result. One testis was removed. CONCLUSION: An inguinal incision, possibly completed by laparoscopy, appears to be a simple and reliable method of evaluation and treatment of impalpable testis.

Atrophy↗

PubMedDate not supplied

Ischemic preconditioning decreases laparoscopy-induced oxidative stress in small intestine.

BACKGROUND/AIMS: Laparoscopy is advantageous but its adverse effects have not yet been completely elucidated. Pneumoperitoneum performed to facilitate laparoscopy causes the organ perfusion decrease such as in the intestine. Oxidative stress reflects the tissue injury related to ischemia and reperfusion. We previously showed that laparoscopy causes oxidative stress in intestinal tissues. To assess whether the preconditioning phenomenon could be taken advantage of during laparoscopy we designed this randomized, controlled, experimental study with blind outcome assessment. We evaluated the effect of preconditioning, including sequential periods of pneumoperitoneum and desufflation on laparoscopy-induced tissue injury of small bowel with the help of two important markers of oxidative stress, thiobarbituric acid reactive substances and reduced glutathione. METHODOLOGY: Forty Sprague-Dawley male rats were used. After anesthesia, an intraperitoneal catheter was inserted. Pneumoperitoneum was created in all except controls, by CO2 insufflation under a pressure of 15 mmHg. The rats were randomized into the groups below: Group P was subjected to 60 minutes of pneumoperitoneum; Group P/D was subjected to 60 minutes of pneumoperitoneum followed by 45 minutes of desufflation; Group IP + P was subjected to 10 minutes of pneumoperitoneum, 10 minutes of desufflation and 60 minutes of pneumoperitoneum; Group IP + P/D was subjected to 10 minutes of pneumoperitoneum, 10 minutes of desufflation, 60 minutes of pneumoperitoneum and 45 minutes of desufflation; Group C (Control) was subjected to a sham operation, without pneumoperitoneum. Small bowel tissue malondialdehyde and reduced glutathione activities were measured, as applicable, by investigators blinded to the study design. The results were decoded and statistically analyzed with Kruskal-Wallis test. Mann-Whitney U test was used to compare the paired groups. p < 0.05 was considered significant. RESULTS: Small bowel tissue malondialdehyde levels were increased, whereas glutathione values were decreased in Groups P and P/D, as compared to Groups PRE/P and PRE/P/D; the latter two groups had results similar to the Control Group. CONCLUSIONS: Laparoscopic preconditioning may reduce the oxidative injury in intestine following laparoscopic procedures.

Animals↗

PubMed1992

[Use of laparoscopy in gynecology].

Paper concerns 1822 performed laparoscopies. The most frequent indications to laparoscopy were: sterility, adnexal mass, tubal pregnancy and pelvic pain syndrome. In 80% cases of sterility we found pathologic findings, which could be the cause of sterility. adnexal mass, tubal pregnancy and pelvic pain syndrome. In 80% cases of sterility we found pathologic findings, which could be the cause of sterility. In 75% of cases we confirmed adnexal mass, which were operated by laparoscopy or by laparotomy. In 17 cases we confirmed unruptured tubal pregnancy, which were conservatively operated by laparoscopy or by laparotomy. Laparoscopy is useful method in gynecology, especially in diagnostically difficult cases of gynecologic disease.

Adolescent↗

PubMed1992

[Diagnostic laparoscopy. Its current indications].

Operative laparoscopy and laparoscopic surgery are quite topical today, but not so much diagnostic laparoscopy. In fact, the wide distribution and great accuracy of new noninvasive exploratory techniques has revolutionized strategy for the diagnosis of abdominal diseases. It has been said that these techniques have now superseded laparoscopy, which should be abandoned. The reply should be that, indeed, laparoscopy has lost many of its classic indications, but that it still retains other important ones. The results obtained with a very close integration of laparoscopy and ultrasonography should particularly be emphasized, as they provide a decrease in risks and an improvement of diagnoses.

Abdominal Neoplasms↗

PubMed1977

Needle laparoscopy in patients with suspected bowel adhesions.

Suspected bowel adhesions are generally considered to be a contraindication to laparoscopy. Among 32 patients who were refused laparoscopy for that reason, only 1 patient was found to have adhesions at laparotomy. To attempt preoperative diagnosis of intraabdominal adhesions, needle laparoscopy was performed in 21 patients using a 1.7-mm endoscope. In 20 of the patients it was possible to establish the presence or absence of adhesions and to determine the feasibility of laparoscopic sterilization. This preliminary evaluation suggests that needle laparoscopy may avert bowel perforation in some instances and may permit laparoscopic tubal sterilization to be performed in some women who would otherwise, because of multiple previous operations, be denied laparoscopy.

Female↗

PubMed1992

Laparoscopy using a simplified open technique. A review of 585 cases.

Laparoscopy was carried out using a simplified open method on 585 patients. In the group, 173 (29.5%) had undergone a previous laparoscopy or laparotomy, 28 (4.8%) suffered from gross obesity and 1 patient had a large umbilical hernia. Laparoscopy was diagnostic in 216 (37%) patients and operative in 369 (63%). In this series there were no technical failures or major complications; the incidence of minor complications was 2.7%. The above results seem to suggest that open laparoscopy compared to the closed method may offer the advantage of a lack of contraindications secondary to previous surgery, no risk of failure with unintended laparotomy and, possibly, decreased postoperative discomfort. A larger, randomized series to settle the controversy between closed and open laparoscopy regarding the safety differences between the two approaches may result in more widespread use of the open technique.

Female↗

PubMedDate not supplied

The role of laparoscopy in the localization and management of adult impalpable testes.

BACKGROUND: Very few studies are available that describe the role of laparoscopy in adults with impalpable testes. This study compares laparoscopy with ultrasonography in this subset of patients. METHODS: Fourteen adults, having a mean age of 21 years, with 19 undescended testes were evaluated. None of the testes was palpable, preoperative ultrasound localized 7 testes (36.8%), but a change in findings was observed in 3 of these cases (42.8%) on subsequent laparoscopy. On laparoscopy, 18 (94.7%) of the testes were localized as intraabdominal. The remaining patient had a case of true anorchia. Seven patients with unilateral undescended testes underwent laparoscopic orchiectomy, and 2 patients with unilateral undescended testes and all the patients with bilateral undescended testes underwent laparoscopic-assisted orchiopexy. No complication was noted in any of the cases. Hernia, present in 4 patients, was simultaneously repaired laparoscopically. CONCLUSION: Laparoscopy is a safe and effective modality in the localization and management of adult undescended testes. In adults, orchiectomy with the subsequent reduction in the risk of malignancy is the major issue of concern. Also, the repair of concomitant hernias is desirable. Both of these procedures can be done laparoscopically in the same sitting without the need for inguinal exploration.

Adult↗

PubMed2004

[Clinical analysis of radical hysterectomy plus pelvic lymphadenectomy for patients with malignant uterine tumors: laparoscopy versus laparotomy].

OBJECTIVE: To compare clinical efficacy of laparoscopy with laparotomy in radical hysterectomy plus pelvic lymphadenectomy for patients with malignant uterine tumors. METHODS: This retrospective study population included two groups: (1) 26 patients underwent laparoscopy-assisted radical hysterectomy plus pelvic lymphadenectomy (group laparoscopy) and (2) 27 patients were treated with radical hysterectomy plus pelvic lymphadenectomy through laparotomy (group laparotomy). The tumor stage in these two groups of patients was matched. Multiple clinical parameters were observed and analyzed statistically. RESULTS: Compared to the patients in group laparotomy, the patients in group laparoscopy had a longer operative time (310 vs 238 min), more pelvic lymph nodes removed (22 vs 16), lower volume of blood loss (756 vs 1129 ml), and transfusion (321 vs 746 ml), a shorter postoperative gastrointestinal function recovery time (37 vs 62 h), a quicker return to normal temperature (5 vs 8 d), and a shorter period to use antibiotics (6 vs 8 d) (P < 0.01) However, there were no significant differences in the volume of pelvic drainage (321 vs 216 ml), urination recovery time (13 vs 10 d), number of WBC found (11 x 10(9)/L vs 10 x 10(9)/L), hospital stay (26 vs 28 d) and cost (25 986 vs 22 672 Yuan) between the two groups (P > 0.05). CONCLUSION: The clinical efficacy of radical hysterectomy plus pelvic lymphadenectomy by laparoscopy for patients with malignant uterine tumor is equal to that through laparotomy.

Adult↗

PubMedDate not supplied

Gasless laparoscopy-assisted colon surgery utilizing mini-laparotomy and a subcutaneous abdominal wall lift system.

BACKGROUND/AIMS: This study was performed to investigate the technical aspects and perioperative results of using a subcutaneous abdominal wall lift system for laparoscopy-assisted colectomy. METHODOLOGY: We attempted a laparoscopy-assisted colectomy for 19 patients and completed 16 cases using mini-laparotomy and a subcutaneous abdominal wall lift system, observing monitor images via laparoscopy or direct views through mini-laparotomy. All 5 surgeons had no experience of laparoscopy-assisted colectomy but considerable experience of laparoscopic cholecystectomy. RESULTS: The operating time ranged from 120 to 360 minutes with an average of 188. Intraoperative blood loss ranged from 20 to 300 mL with an average of 116 mL. No postoperative major complications occurred, but 5 cases suffered wound infection. CONCLUSIONS: Laparoscopy-assisted colon surgery utilizing a subcutaneous abdominal wall system and mini-laparotomy was feasible as minimally invasive surgery for colorectal diseases, even for surgeons with little previous experience.

Abdominal Wall↗

PubMed2005

Laparoscopy in chronic abdominal pain: a prospective nonrandomized long-term follow-up study.

GOAL: Our aim was to assess the long-term efficacy of diagnostic laparoscopy and adhesiolysis on the treatment of intractable chronic abdominal pain. STUDY: This was a prospective nonrandomized study of 72 patients (60 women and 12 men). One surgeon performed a total of 79 diagnostic laparoscopies including 61 adhesiolysis. The patients' demographic data, operative findings, and long-term postoperative course were carefully recorded. A quality-of-life questionnaire was mailed after the mean follow-up of 3.7 years to find out the late course of any chronic abdominal symptoms after the surgery. RESULTS: Intra-abdominal adhesions were found in 61 patients (85%) in the laparoscopy, gynecologic disorders in 4, chronic appendicitis in 1, and no abnormality in 6 patients. The abdominal wall pain was a likely reason for pain in 12 patients (17%). The complication rate was minimal, including only four bleedings (one major), one perforation of urinary bladder, and three wound infections. At 1-month control, 38% of the patients were completely free of pain. In the long-term follow-up, chronic abdominal pain was totally healed in 33%, diminished in 46%, and unchanged in 21% of the patients. A total of 65 patients (90%) reported that the surgery had been beneficial for their intractable pain. CONCLUSIONS: By careful selection, for patients with chronic abdominal pain, laparoscopy alleviates the symptoms in more than 70% of the patients, and it should be considered if other diagnostics tests are negative. A placebo-controlled study is needed, in which the patients are randomized into laparoscopy and conservatively treated groups with a quality-of-life measurement.

Abdominal Pain↗

PubMed2004

[Total mesorectal excision by laparoscopy for rectal cancer].

The treatment of rectal cancer has improved mostly because of the emergence of total mesorectal excision (TME), first described by Heald, and the adjunct of adjuvant therapy in the form of radiotherapy and chemotherapy. Laparoscopy has now been performed for more than a decade with results showing faster return to activity and decreased postoperative pain for intra-abdominal surgery. Laparoscopy is now widely used and is well accepted for the treatment of most intra-abdominal benign pathologies. Furthermore, several authors now report excellent short and medium-term results for the treatment of colorectal cancer. These study tends to show that laparoscopy can be safely applied to digestive malignancies, when oncological principles specific to laparoscopy are respected. The laparoscopic approach is in our opinion a perfect approach for the performance of TME, because of the magnification of structures that it provides, and allows the surgeon to see important structures that need to be identified for the performance of the best oncological and functional procedure possible. This paper describes in a through manner our standardized technique. We also review our own experience with laparoscopic TME, the multimodal treatment of rectal cancer, and provide an analysis of the literature about TME when performed by laparotomy and laparoscopy.

Clinical Trials as Topic↗

PubMed1979

[The value of laparoscopy in gynecology].

There is a definite place for laparoscopy in gynaecology as a diagnostic tool and for limited operative procedures. Nevertheless, the indication for laparoscopy should be subjected to the same strict criteria as any other operative procedure. The use of laparoscopy and its various indications are discussed. So-called major operative laparoscopy or pelviscopy is rejected. Greatest restraint should be employed to use laparoscopy for obtaining biopsy material from ovarian tumours for diagnostic purposes.

Female↗