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PubMed1995

Chronic pelvic pain in adolescent women. Diagnostic laparoscopy and ultrasonography.

OBJECTIVE: To evaluate the correlation of preoperative pelvic examination and ultrasonography with the laparoscopic findings in 45 adolescent women with chronic pelvic pain. STUDY DESIGN: Between January 1, 1989, and December 31, 1992, 45 adolescent women underwent diagnostic laparoscopy following a detailed clinical workup for evaluation of chronic pelvic pain. RESULTS: Thirty-five of 45 pelvic examination findings correlated with the laparoscopic findings. The predictive values of normal and abnormal findings at pelvic examination were 42.8% and 93.5%, respectively. Ultrasonography (US) correlated with laparoscopy in 39 of 45 cases. The predictive value of normal findings at US was 60%, and that of abnormal findings was 94.2%. When both pelvic examination and US were normal, 50% of cases were abnormal at laparoscopy. However, laparoscopy revealed abnormality in 100% of patients with abnormal pelvic examinations and abnormal US findings. CONCLUSION: Clinical evaluation of chronic pelvic pain, when combined with US, is highly predictive but needs confirmation, best provided by laparoscopy.

Adolescent↗

PubMed1995

The future of laparoscopy in urology.

Laparoscopy has not changed urological techniques as radically as could be supposed, as only 17% of urological techniques are performed by laparoscopy instead of the predicted 70%. However, this limited proportion corresponds to 30% of urological operating time. The author proposes a combination of open surgery and laparoscopy in certain cases. Laparoscopy is responsible for lower blood loss, less postoperative pain, a shorter hospital stay and a very small scar which account for its popularity among patients. A rational combination of laparoscopy, endoscopy and open surgery to treat urological diseases should be developed in the future.

Blood Loss, Surgical↗

PubMed1995

Diagnostic laparoscopy for suspected appendicitis.

One hundred consecutive patients who underwent diagnostic laparoscopy for suspected appendicitis were evaluated to assess the appropriate clinical setting for laparoscopic appendectomy. The usefulness of diagnostic laparoscopy in the setting of acute abdominal pain has been well documented. However, there is debate about the use of laparoscopy for definitive therapy. The purpose of this study is to evaluate the decision making process during diagnostic laparoscopy for suspected appendicitis. When pathology is identified other than in the appendix, the majority of patients can be treated without converting to an open procedure. In patients found to have no obvious pathology, incidental appendectomy can be performed laparoscopically. When appendicitis was identified, the majority of patients could be treated safely without converting to an open technique. However, there were certain clinical situations that necessitated conversion to an open operation. Involvement of the cecum or perforation at the base of the appendix puts the appendiceal stump at risk for leak and abscess formation. Evaluation of the cecum by palpation for a mass should also be performed in this situation. Another situation in which conversion to an open technique is warranted is an appendiceal abscess with adherent small bowel. The friability of bowel wall greatly increases the risk for bowel injury in this setting. Laparoscopy is a useful technique for the diagnosis and treatment of abdominal pain even if the appendix is normal on inspection. Conversion to an open operation should be employed when inflammation or perforation occurs at the base of the appendix and when bowel is found to be adherent to an appendiceal abscess.

Abdomen, Acute↗

PubMed1994

[Laparoscopy: obstacle or revolution in the development of surgery?].

Laparoscopy is a new fascinating technique. However, after the first wave of enthusiasm, laparoscopy currently raises different problems related with surgical training. A national survey concerning laparoscopy and its teaching was sent to every surgeon-in-chief, chief resident and resident of all Swiss teaching hospitals. Surgical training is nowadays an important problem in Switzerland. Our survey revealed that laparoscopy intensifies this problem: a specific training in laparoscopy is desired by all surgeons and has to take place in the Swiss Board of Surgery (FMH). A preliminary experience of conventional surgery is desirable. Then a laparoscopic training should start on experimental certified models and be applied progressively on patients in attendance with a trained surgeon.

Credentialing↗

PubMed1994

Open laparoscopy without special instruments or sutures. Comparison with a closed technique.

An important advantage of open laparoscopy over closed techniques is the avoidance of placing a sharp trocar blindly into the peritoneal cavity. Although an open technique theoretically minimizes the risk of major retroperitoneal vessel injury and bowel injury, most laparoscopies are performed using a closed technique. In an effort to simplify open laparoscopy, a technique was developed that can be done without special equipment or sutures and nearly as quickly as a closed technique. To compare the effectiveness of this open laparoscopic technique to a closed technique, a prospective, observational, cohort study was carried out on 66 women undergoing laparoscopy for either infertility or pelvic pain. The open technique was performed on 35 consecutive patients and compared to a closed technique performed on 31 patients on a different service during the same period. Evaluation included total duration of the procedure, length of the incision, incidence of CO2 leakage and complications. The open technique took slightly longer, and the incision was slightly longer. CO2 leakage occurred in 5 of 35 of the open cases but in none of the 31 closed cases. Leakage was controlled effectively in every case by application of a towel clip to the skin incision. No complications occurred with either technique. This study suggested that an open technique that requires no special equipment or sutures may be a useful alternative approach for laparoscopy when insertion of a sharp trocar is undesirable.

Adult↗

PubMed1994

Repeated clinic laparoscopy for the treatment of pelvic adhesions: a pilot study.

OBJECTIVE: To evaluate the safety and feasibility of repeat outpatient laparoscopy following laparoscopic lysis of extensive pelvic adhesive disease in a standard operating room setting. METHODS: In a pilot study, eight patients with chronic pelvic pain associated with severe pelvic and abdominal adhesive disease underwent standard operative laparoscopic adhesiolysis. Tenckhoff catheters were placed in the abdominal wall during the procedure to allow repeat laparoscopy in an outpatient clinic setting with a 2-mm laparoscope. Successful adhesiolysis was documented in follow-up laparoscopy with the Optical Catheter System, performed 3 months later in four patients. RESULTS: Laparoscopy via the Tenckhoff catheters was accomplished in 26 of 32 attempts (81.3%). One patient had re-forming adhesions lysed with the Optical Catheter System. Simultaneous vaginal ultrasound enhanced visualization of the cul-de-sac. CONCLUSIONS: Outpatient clinic laparoscopy with a 2-mm laparoscope may prove practical for general diagnostic purposes. If validated in controlled trials with larger populations, the procedure may be an effective treatment of pelvic adhesive disease.

Adult↗

PubMed1995

A comparative study between pelvic ultrasonography and laparoscopy in the detection of pelvic pathology in the initial workup of subfertile women.

This study was conducted prospectively from June 1992 to September 1993, we evaluated 115 patients attending our infertility clinic for the first time to determine the correlation between abdominal ultrasound and laparoscopy in the detection of pelvic pathology in the initial workup of subfertile women, depicting laparoscopy as the gold standard. Normal ultrasound scans were reported in 80 women (69.56% of total) 58 of whom had also normal pelvic findings at laparoscopy. The remaining 22 patients with normal ultrasound scans had abnormal laparoscopic findings in the pelvis giving a false negative rate of 27.50 per cent. These were primarily related to; endometriosis with adhesions (10), filmy adnexal adhesions (5), omental and bowl adhesions (5), and hydrosalpinx (2). Thirty five women (30.44% of the total) had abnormal scans. Pelvic pathologies were confirmed in 30 at laparoscopy. The remaining five had a normal pelvis (three retroverted uteri, and two functional ovarian cyst had disappeared at time of laparoscopy) giving a false positive rate of 14.29 per cent for ultrasound scans. Statistical analysis revealed that abdominal ultrasound scan in the detection of pelvic pathology in the initial workup of subfertile women has a sensitivity of 57.69 per cent, specificity of 92.06 per cent, positive predictive value of 85.71 per cent with negative predictive value of 72.50 per cent and accuracy rate of 76.52 per cent. We conclude that the use of abdominal ultrasound in the detection of pelvic pathology in the initial workup of subfertile women is not an appropriate routine screening test as it has low efficiency in detecting the pelvic pathologies many of which are the causes of infertility.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

An overview of consumer-driven ambulatory surgery: operative laparoscopy.

Laparoscopy is considered one of the first truly consumer-driven medical advances. It is estimated that 30% to 70% of all gynecologic surgery currently performed via laparotomy incision could be completed by using the laparoscope. The emerging trend in recent years is the change from using the laparoscope in gynecology for diagnosis and tubal sterilization to treating ectopic pregnancy and ovarian neoplasm. The 1991 and 1992 Gynecologic and Obstetrical Society's review and recommendations of this surgical specialty reflect a 1.5-fold increase in the number of laparoscopic procedures reported in 1988. Pelvic pain is the most frequent indication for operative laparoscopy. There is a need for further evaluation of laparoscopy, including an evaluation of cost-savings claims and an evaluation of necessary recovery time in comparison with laparotomy. Primary care providers can effectively monitor patients' potential surgical needs and appropriately counsel patients when armed with knowledge of the benefits and risks of operative laparoscopy. This article provides a review of the history, purpose, benefits, risks, and patient surgical outcomes of operative laparoscopy.

Ambulatory Surgical Procedures↗

PubMed1996

[Comparative study on assessment of tubal patency among tubal insufflation, hydrotubation, hysterosalpingography and chromotubation under laparoscopy].

OBJECTIVES: To compare the diagnostic value of tubal insufflation, hydrotubation, hysterosalpingography (HSG) and chromotubation under laparoscopy for tubal patency assessment. METHODS: Among 258 women who underwent chromofubation during laparoscopy procedures for infertility assessment in our hospital, tubal insufflation were performed in 42 cases, hydrotubation in 70, HSG in 63, both insufflation and hydrotubation in 20, insufflation and HSG in 11, and hydrotubation and HSG in 22. The accuracy of each method was compared with that of chromotubation under laparoscopy. RESULTS: The accuracy rates of hydrotubation (87.1%) and HSG (73.0%) were significantly higher than that of insufflation (50.0%) (P < 0.01, P < 0.05 respectively). Similar results were shown when 2 different procedures in the same patient were compared with laparoscopy. CONCLUSIONS: Tubal insufflation has no longer its place in tubal patency assessment due to its grossly inaccuracy; Both hydrotubation and HSG can be used as screening methods. Laparoscopy is the most accurate procedure in assessing tubal patency, as well as in searching pelvic abnormalities.

Adult↗

PubMedDate not supplied

Staging of abdominal cancer by local anesthesia outpatient laparoscopy.

BACKGROUND/AIMS: Our aim was to review the results of one trocar staging laparoscopies performed under local anesthesia in out patients with intra-abdominal cancer. MATERIALS AND METHODS: Two hundred fifteen patients with intra-abdominal cancer (predominantly esophagogastric and pancreatohepatobiliary) underwent one trocar staging laparoscopy on lidocain infiltration anesthesia under conscious sedation. In 43 patients computed tomography (CT) or ultrasonography (US) had raised a suspicion of hepatic metastases, but percutaneous needle biopsy had failed to confirm it; 172 patients had negative CT or US. Peritoneum and liver were examined and biopsies were taken under direct laparoscopic control. RESULTS: Fourteen patients (7%) received narcotics during the 2-6 hour observation. Mortality was zero. Complications occurred in 5 patients (2%): 1 small bowel perforation (operated), 1 bleeding from the abdominal wall, 1 acute atrial fibrillation, and 2 wound infections. In 79 patients histology demonstrated hepatic or peritoneal metastases. Out of 136 patients 123 were operated in whom laparoscopy did not demonstrate metastases. Thirty-eight of these were unresectable at laparotomy: Five patients (4%) had peritoneal or liver metastases and 33 (27%) proved locally inoperable. The sensitivity of laparoscopy to ascertain peritoneal or liver metastases was 94%. CONCLUSIONS: We conclude that one trocar local anesthesia outpatient laparoscopy is a fairly safe and effective method to detect peritoneal and liver metastases in abdominal cancer.

Abdominal Neoplasms↗

PubMed1997

Staging laparoscopy with laparoscopic ultrasonography: optimizing resectability in hepatobiliary and pancreatic malignancy.

BACKGROUND: Open laparotomy has traditionally been required to stage hepatobiliary and pancreatic (HBP) cancers accurately. For unresectable patients, costs and morbidity have been high. Today, laparoscopy alone or combined with laparoscopic ultrasonography (LUS) is being examined for its value in defining the extent of malignancy. STUDY DESIGN: We have analyzed the effect of routine implementation of this new staging technique in our HBP center. Staging laparoscopy (SL) with LUS was performed in 50 consecutive patients with HBP malignancies. All patients were considered to have resectable tumors as determined by traditional preoperative staging modalities. Primary tumors were located in the liver (n = 7), biliary tract (n = 11), or pancreas (n = 32). An average of 2.7 preoperative studies per patient were performed prior to SL-LUS. RESULTS: Staging laparoscopy with laparoscopic ultrasonography predicted resectable tumors in 28 patients (56%). At laparotomy, 26 of 28 were actually resectable: the false-negative rate was 4%. Staging laparoscopy with laparoscopic ultrasonography indicated unresectability in 22 patients (44%). Staging laparoscopy alone demonstrated previously unrecognized occult metastases in 11 patients (22%). In 11 other patients (22%) in whom SL alone was negative, LUS established unresectability from vascular invasion (n = 5), lymph node metastases (n = 5), or intraparenchymal hepatic tumor (n = 1). All cases of unresectability due to vascular invasion were validated by laparotomy. Five of six lymph node or hepatic metastases were proved histologically by LUS-guided needle biopsy rather than laparotomy. CONCLUSIONS: Unnecessary laparotomy can be safely avoided by SL-LUS in many patients with HPB malignancies, reducing costs and morbidity.

Adult↗

PubMed1997

[The differential diagnostic importance of laparoscopy in pathology of the lesser pelvis].

It is known that presently the diagnostic process is enriched by the application of endoscopic methods like laparoscopy and hysteroscopy. The aim of our work is to point out the importance of laparoscopy in differential diagnostical processes. 358 laparoscopies were carried out for the period 1988-92. After laparoscopy the authors correct clinical diagnoses of the different patients' groups. The results of our experience in application of laparoscopy to cases of pathologic changes in the pelvis enable us to recommend this additional method, having in mind ist considerable value for the differential diagnosis in the gynaecological practice.

Diagnosis, Differential↗

PubMed1997

Adolescent laparoscopy.

Laparoscopy is a useful and safe diagnostic procedure that provides excellent visualization of the pelvic structures and often permits the diagnosis of gynecologic disorders and pelvic surgery without laparotomy. During the period 1994-1996 40 laparoscopies were performed as a diagnostic procedure on adolescents aged between 14-19 years. In 21 cases of primary amenorrhea the laparoscopy showed 12 cases of Rokitanski-Kuster-Hauser syndrome (57.2%), hematocolpos-hematometra 4 (19.0%), polycystic ovarian disease 2 (9.5%), late onset of puberty 2 (9.5%) and gonadal dysgenesis 1 (4.8%). Laparoscopy which was performed in 12 cases of pelvic pain showed 6 with normal genitalia (50%), endometriosis in 2 (16.7%, infection in 2 (16.7%), fibroma in 1 (8.3%) and torsion in 1 (8.3%). Four laparoscopies were performed for ovarian mass; three cystic masses and one case of endometriosis were detected.

Adolescent↗

PubMed1997

[Contribution of laparoscopy in the management of abdominal stab wounds].

Laparotomy is useless in 5 to 39% of patients suffering from penetrating abdominal trauma. The objective of this study is to try to determine the value of laparoscopy in the management of such patients. Thirteen patients underwent laparoscopy for abdominal wound. 11 of these patients had a penetrating abdominal trauma and only 4 of them suffered from lesions requiring surgical treatment (2 intestinal wounds, 1 gastric wound and 1 coeliac artery disruption). No treatment was required in 30 cases (1 wound of intestinal serosa and 2 superficial hepatic wounds). In the last 6 cases no intra-abdominal wound was found. There was no mortality or morbidity. No lesions were missed at laparoscopy. Laparoscopy avoided useless laparotomy in 9 out of 13 patients. This suggests that laparoscopy is a reliable method in the management of patients suffering from abdominal wounds, allowing a very sensitive and specific diagnosis of penetration and visceral injuries. In some cases, is allows laparoscopic treatment of the visceral injury.

Abdominal Injuries↗

PubMed1998

[Colonic polyps considered unresectable by endoscopy. Removal by combinations of laparoscopy and endoscopy in 65 patients].

OBJECTIVE: To determine to what extent segmental colectomy could be avoided in patients with polyps though to be endoscopically unresectable by using combination laparoscopy and endoscopy. METHODS: Sixty-five patients referred for colonic polyps though to be unresectably by conventional endoscopy were studied. After analysis of the endoscopic findings, endoscopy was performed in a medicosurgical unit when possible, otherwise a surgical procedure was performed consisting of laparoscopy followed by colonoscopy. Therapeutic strategy depended on laparoscopic and endoscopic findings. RESULTS: Segmental colectomy was avoided in 44 patients (67.7%). Among them, 20 were treated by simple endoscopic polyp removal, 12 by laparoscopy-assisted colonoscopic polypectomy, 9 by laparoscopic wedge colonic resection and 3 by colotomy after colonic exteriorization and polyp resection. Laparoscopic or laparoscopy-assisted segmental colectomy was performed in 16. Segmental colectomy by laparotomy was necessary in 5. No complication occurred. CONCLUSION: Segmental colectomy for unresectable colonic polyps could be avoided in more than half of the patients using laparoscopy and colonoscopy combinations.

Adult↗

PubMed1998

[Clinical evaluation of patients treated with open gynecologic laparoscopy].

The objective was to evaluate the clinical evolution and rates of complications for open gynecological laparoscopy. Were studied the records of ninety two patients treated with open laparoscopy for gynecological pathology. The major indication for performing laparoscopy was infertility management. There were not early or late complications of trocar insertion or operative laparoscopy. As conclusion, in the studied group open laparoscopy can to eliminate the risks of blind insufflation and trocar insertion observed in the classical technique, is a safe and efficacious method to treat several gynecological pathologies.

Adult↗

PubMedDate not supplied

Laparoscopy during pregnancy: a literature review.

OBJECTIVE: To review the literature regarding the role of laparoscopy during pregnancy, particularly adnexal mass and non-obstetric surgery, incorporating the results of a series of 9 cases of laparoscopy during pregnancy at our centers. MATERIALS AND METHODS: A Medline search was performed to review the literature, and the reference lists provided by those articles were further explored for citations regarding laparoscopic adnexal surgery, appendectomy, and cholecystectomy. Our series of 9 patients consisted of pregnant patients with adnexal mass or acute abdomen who would otherwise have undergone exploratory laparotomy. Follow-up data for these 9 cases were collected by office visits, inquiry to the primary referring physicians, and telephone calls to the patient. RESULTS: The literature search yielded 42 additional cases of operative pelvic laparoscopy and 51 cases of abdominal operative laparoscopy (cholecystectomy and appendectomy). The publications, particularly regarding cholecystectomy, were supportive of the laparoscopic approach during pregnancy. All of the patients in our series had favorable outcomes. CONCLUSIONS: Advanced operative laparoscopy has been successfully performed for certain indications during pregnancy.

Adnexal Diseases↗

PubMedDate not supplied

Laparoscopy in pediatric abdominal trauma.

BACKGROUND: The use and indications for laparoscopy have been increasing. As part of this trend, a new algorithm may emerge for pediatric trauma in which laparoscopic techniques are used in hemodynamically stable patients with suspected hollow viscus perforation. CASE REPORT: We present a case in which laparoscopy was successfully used in a pediatric trauma patient as a diagnostic and therapeutic modality. A 4-year-old boy was a back-seat passenger in a head-on collision motor vehicle accident. He was restrained by a lap seat belt. He sustained a concussion, a large forehead laceration and a seat belt abdominal injury. On admission, he complained of abdominal pain. Physical examination revealed a soft, non-distended abdomen with moderate diffuse tenderness. He was hemodynamically stable. Computerized tomography of the abdomen revealed free fluid in the pelvis. No abnormalities were detected in the liver or spleen. Because of clinical deterioration and suspected intestinal perforation, diagnostic laparoscopy was utilized instead of proceeding directly to celiotomy. At laparoscopy a jejunal perforation was found and successfully repaired laparoscopically. Large hematomas were seen in the mesentery, as well as an unsuspected splenic laceration. No active bleeding was found. The patient recovered uneventfully and was discharged 5 days following the surgical procedure. CONCLUSION: This case illustrates the efficacy of using early laparoscopy in children with abdominal trauma when diagnosis is difficult and hollow viscus injury is suspected.

Abdominal Injuries↗